South Carolina Claimed Some Unallowable Room-and-Board Costs Under the Intellectual and Related Disabilities Waiver

The South Carolina Department of Health & Human Services (State agency) operates a waiver program that provides long-term care and support for individuals with intellectual or related disabilities. The State agency contracts with the South Carolina Department of Disabilities and Special Needs (the Department) to provide waiver services. The Department provides these services through contractual arrangements with a network of 39 local Disabilities and Special Needs (DSN) Boards.

We found that the State agency claimed Medicaid reimbursement of $6.7 million ($4.8 million Federal share) for unallowable room-and-board costs under the waiver program that the Department operated. The State agency claimed unallowable room-and-board costs because neither the State agency nor the Department had adequate controls to (1) ensure that the Department followed applicable Federal law and guidance or its own guidance or (2) detect errors or misstatements on the local DSN boards' cost reports. Additionally, the Department did not prescribe a uniform format for the local DSN boards to follow when preparing the cost reports. Rather, each local board prepared its cost reports in its own format, making it difficult to identify when unallowable costs were claimed.

We recommended that the State agency (1) refund to the Federal Government $4.8 million, representing the Federal share of the room-and-board costs that the Department improperly claimed on its waiver cost reports; (2) instruct the Department to follow Federal law and its own guidance and remove room-and-board related administrative and general costs from future waiver program cost reports; (3) instruct the Department to develop a uniform cost reporting process and require each local board to follow this process; (4) instruct the Department to strengthen its cost report review procedures to ensure that it will detect errors or misstatements on the local DSN boards' cost reports; and (5) strengthen its own procedures for reviewing the waiver cost reports submitted by the Department. The State agency concurred with all of our recommendations and said that it would work with CMS to negotiate repayment of the improperly claimed room-and-board costs.