Medicaid School-Based Services in Utah ' Review of Payment Rates

The State agency's claims for Medicaid reimbursement for school-based services generally were not in accordance with Federal requirements or the State plan.  We were unable to determine what portion of $36.8 million of the $37.9 million claimed was allowable as final payments.  The State agency did not perform a cost settlement reconciling interim payments to actual costs to determine final payments, as required by the State plan, because it considered payments made to school districts to be final payments.  The State agency's claims for the remaining $1.1 million, which were for nursing services that were paid based on the Medicaid fee-for-service schedule, were allowable.

We recommended that the State agency (1) work with the Centers for Medicare and Medicaid Services to determine what portion of the $36.8 million claimed based on interim payments is allowable and (2) perform cost settlements to ensure that future final payments for school-based services are based on actual costs. The State agency concurred with the recommendations.