RD30 - Evaluation of Effectiveness and Appropriateness of Review Methodology for Home and Community Based Services - November 1, 2011


Executive Summary:
Item 297 AAAAA of the 2011 Appropriations Act directed DMAS to consult with representatives of providers of Home and Community Based Services (HCBS) concerning audits of such providers, evaluate the effectiveness and appropriateness of the audit methodology and report to the Governor and Chairman of the House Appropriations Committee and Senate finance Committee by November 1, 2011 (Attachment I). As directed by the Act, DMAS held a series of stakeholder meetings in order to obtain input from HCBS providers on the DMAS audit methodology. In addition, DMAS conducted a survey of other state Medicaid programs, in order to determine common audit practices, and DMAS considered and addressed issues raised in previous versions of Appropriations Act language. This report: 1) describes the stakeholder process; 2) describes DMAS audit programs; 3) describes HCBS services; 4) provides a summary of DMAS audit activities and recent audit results; 5) reports on the survey of state Medicaid audit practices with comparisons to DMAS practices; and 6) discusses stakeholder issues and provides recommendations.