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Follow-up Audit of New Jersey's Medicaid Adult Partial Care Program

Announced on  | Last Modified on  | Project Number: A-02-22-01007
Status
Completed
Agency
Centers for Medicare and Medicaid Services

OBJECTIVE

Prior audit work identified a State agency's Medicaid adult partial care program as at high risk for improper payments. The purpose of the adult partial care program is to provide Medicaid beneficiaries with serious mental illnesses individualized outpatient clinic services to reduce unnecessary hospitalizations. Our prior audit made a financial recommendation and procedural recommendations to the State agency to improve its guidance and monitoring. This audit work will determine whether the State agency adequately implemented our prior recommendations. We will also review claims for compliance with Federal and State requirements, including the State agency's implementation of telehealth services due to the COVID-19 pandemic.

TIMELINE

REPORT PUBLISHED

New Jersey Significantly Improved Its Oversight of Medicaid Adult Partial Care Services Except for Those Provided Using Telehealth During the COVID-19 Public Health Emergency (A-02-22-01007)

24-A-02-054.01 to CMS - Closed Implemented
Closed on 10/17/2024
New Jersey Department of Human Services should work with CMS to refund the recommended disallowance of $94,830,718 from a prior audit.

24-A-02-054.02 to CMS - Open Unimplemented
Update expected on 04/24/2026
New Jersey Department of Human Services should refund $18,826,714 associated with deficiencies identified in the current audit.

24-A-02-054.03 to CMS - Closed Implemented
Closed on 10/17/2024
New Jersey Department of Human Services should provide training or guidance to providers to address noncompliance issues it identifies during site visits or audits to ensure Medicaid enrollees receive required services with the necessary amount of care.

View in Recommendation Tracker
Work Plan Type
Office of Audit Services
HHS Agencies
Centers for Medicare and Medicaid Services
Issue Areas
COVID-19 Mental Health
Target Groups
-
Financial Groups
Medicaid