Department of Health
Controlling Changes to Medicaid Provider Payment Rates (Follow-Up Review) Hospitals, clinics, nursing homes, home health care agencies, and managed care plans receive rate-based Medicaid reimbursements. Such reimbursement rates are based on providers' operating expenses and are used by the Medicaid Management Information System to pay about 90 percent of all Medicaid claims. In our prior audit report 97-S-45, we found that DOH did not have adequate policies and procedures in place to ensure that the Medicaid program uses only accurate and authorized rates to reimburse providers. DOH needed to take the necessary steps to ensure that providers are reimbursed with the proper rates. In our follow-up review, we found that DOH officials have made substantial progress in implementing our five recommendations.
For a complete copy of Report 99-F-54 click here.
For a copy of the 90-day response click here.