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New Jersey’s Medicaid School-Based Cost Settlement Process Could Result in Claims That Do Not Meet Federal Requirements

Submitting OIG: 
Department of Health & Human Services OIG
Date Issued: 
Tuesday, March 8, 2022
Agency Reviewed / Investigated: 
Department of Health & Human Services
Submitting OIG-Specific Report Number: 
A-02-20-01012
Component, if applicable: 
Centers for Medicare & Medicaid Services
Centers for Medicare and Medicaid Services
External entity, if applicable: 
CMS
Location(s): 
NJ,
United States
Type of Report: 
Audit
Questioned Costs: 
$0
Funds for Better Use: 
$0
Number of Recommendations: 
6
View Document: 
AttachmentSize
PDF icon 22001012.pdf1.73 MB

Related Open Recommendations

Recommendation Number Recommendation Status Significant Recommendation Additional Details
22-A-02-044.01 Open No
To ensure that the State agency complies with Federal requirements and does not claim unallowable costs, we recommend that the Centers for Medicare & Medicaid Services direct the State agency to revise the Process Guide to include days worked during September in RMTSs.
22-A-02-044.02 Open No
To ensure that the State agency complies with Federal requirements and does not claim unallowable costs, we recommend that the Centers for Medicare & Medicaid Services direct the State agency to revise the Process Guide to obtain RMTS responses within 3 days after the date of the sampled moment.
22-A-02-044.03 Open No
To ensure that the State agency complies with Federal requirements and does not claim unallowable costs, we recommend that the Centers for Medicare & Medicaid Services direct the State agency to revise the Process Guide to prohibit the substitution of sampled personnel.
22-A-02-044.04 Open No
To ensure that the State agency complies with Federal requirements and does not claim unallowable costs, we recommend that the Centers for Medicare & Medicaid Services direct the State agency to revise the Process Guide to revise the definition of the RMTS code described in the report to include only activities necessary for the proper and efficient administration of the Medicaid State plan.
22-A-02-044.05 Open No
To ensure that the State agency complies with Federal requirements and does not claim unallowable costs, we recommend that the Centers for Medicare & Medicaid Services direct the State agency to revise the Process Guide to require the collection of information (e.g., student names or case numbers) to support whether an RMTS respondent’s time was part of a health care service or a Medicaid administrative activity.
22-A-02-044.06 Open No
To ensure that the State agency complies with Federal requirements and does not claim unallowable costs, we recommend that the Centers for Medicare & Medicaid Services direct the State agency to revise the Process Guide to develop a method for allocating health care services costs to Medicaid that does not require it to rely on IEP and MP ratios (e.g., require a school district to determine whether an RMTS moment is for a health care service or administrative activity performed for a student enrolled in Medicaid).
Displaying 6 of 6 Recommendations