Title XXI Federal Financial Participation Claimed for Rehabilitative Treatment Services State Children's Health Insurance Program (SCHIP)

EXECUTIVE SUMMARY:

The objective of this review was to determine whether the amounts claimed by the Iowa Department of Human Services (the State) for Rehabilitative Treatment Services met title XXI reimbursement requirements for Federal financial participation (FFP).  We identified errors in 68 of 100 sample claims and 28 of those contained multiple errors.  Staff that lacked the qualifications to develop treatment goals or provide therapy and behavioral management services performed many of the services.  We identified services not considered rehabilitative treatment of the client, which included general age-appropriate training and services provided to family members.  In addition, services were not directed at the effective treatment of the client.  Some providers did not properly support the billed services and allowed non-family members to be present during treatment services.  Furthermore, we found services provided in conjunction with day treatment programs, services provided with insufficient staff-to-client ratios and billed services that did not meet the minimum requirements for core services.  As a result, we recommended a refund of $303,276 in Medicaid FFP claimed for FFY 2001.