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

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Date Issued

Tuesday, March 8, 2022

Submitting OIG

Department of Health & Human Services OIG

Other Participating OIGs

Department of Health & Human Services OIG

Agencies Reviewed/Investigated

Department of Health & Human Services

Components

Centers for Medicare and Medicaid Services

Report Number

A-02-20-01012

Report Type

Audit

Location

NJ,
United States

Number of Recommendations

Questioned Costs

Funds for Better Use

External Entity

CMS

Open Recommendations

This report has 6 open recommendations.

Recommendation Number	Significant Recommendation	Recommended Questioned Costs	Recommended Funds for Better Use
22-A-02-044.01	No	$0	$0
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	No	$0	$0
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	No	$0	$0
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	No	$0	$0
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	No	$0	$0
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	No	$0	$0
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).