Review of Disproportionate Share Hospital Costs Claimed by the State of Missouri for Fiscal Year Ended June 30, 1999

EXECUTIVE SUMMARY:

This final audit report points out that the State of Missouri overstated its disproportionate share hospital (DSH) claims by $36.2 million (federal share) for State Fiscal Year 1999. Contrary to the Omnibus Budget Reconciliation Act of 1993 (OBRA), the State included nonhospital (community mental health center) costs in the DSH calculations. We recommended a financial adjustment for the $36.2 million. We also recommended that the State identify and refund similar excessive claims from subsequent years, and implement procedures and controls to prevent similar types of DSH claims in future periods. The State did not concur, contending that the nonhospital costs were allowable.