Review of Medicaid Residential Rehabilitation Services for Children in Maryland

We could not determine whether residential rehabilitative services claimed by Maryland complied with Federal and State requirements. The State plan is unclear about the precise definition of a residential rehabilitative service and the requirements for documentation of claims for residential rehabilitative services. Therefore, we were unable to determine whether the documentation that the State submitted as support for the 2,652 claims in our 100 sampled beneficiary-months was sufficient to demonstrate that a service had been provided.

We recommended that the State work with CMS to amend its State plan to define the services provided under the residential rehabilitation program, define the necessary documentation requirements for each service, and adjust its reimbursement methodology if needed to reflect costs for services provided.

The State did not concur with our draft report findings and recommendation. We considered the State's comments and revised the report and recommendations to reflect that the State plan is unclear about the precise definition of a residential rehabilitative service. The type of claimed service actually provided and the documentation necessary to demonstrate that a service was provided were also unclear.