MM Curator summary
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[MM Curator Summary]: The state IG says the Medicaid agency owes CMS a lot of cash because of poor oversight of personal care services payments. The Medicaid agency disagrees, and now its up to CMS to decide.
ST. LOUIS — A federal agency is pushing Missouri to refund more than $34 million in Medicaid payments, after an audit raised issue with some of the state’s policies for programs that help patients with day-to-day tasks.
In the audit, the Health and Human Services Office of Inspector General looked at claims filed for personal care assistance, which offers help with daily tasks like meal preparation, shopping, grooming and bathing.
The audit found that in some cases, time sheets couldn’t be provided or lacked detail. In other cases, documentation was missing for the attendants who provided the care.
It also looked at what emergency preparedness policies the state had during that period. Because the audit looked at the 2018 and 2019 fiscal years, it looked at plans in place prior to the COVID-19 pandemic.
When HHS looked for “backup plans,” meant to ensure that patients are safe in the event that they can’t be reached in an emergency, in some cases it found little or no information or instructions.
The state objected to many of the audit’s findings. It said the federal agency looked at just a small sampling of claims. It argued that some of the documents it cited had all the information that is legally required. And it noted that the state health department established a Quality Assurance Unit in late 2020.
Still, HHS issued recommendations for repayments and policy changes this month, including a recommendation that the state refund at least $34.2 million to the federal government.
The Missouri Department of Social Services and the Department of Health and Senior Services reiterated Tuesday that they disagreed with the recommendations. The agencies do not believe “that any of these funds should be disallowed,” DHSS spokesperson Lisa Cox said in an email.
The suggestions by HHS will be reviewed by the U.S. Centers for Medicare and Medicaid Services, or CMS, which will make the final decision about what actions the state must take and whether it must make any refunds. If the state disagrees with CMS’ determination, it will have the option to appeal.
HHS called the state out for similar issues a decade earlier, also with personal care services. In a 2012 audit, the agency found problems like missing care plans and unsigned time sheets.