Department of Health
Enhanced Medicaid Payments to Selected Nursing Service Agencies That Provide Care for Medically Fragile Children In 2007, New York increased its Medicaid reimbursement rates for the nursing services provided to medically fragile children (i.e., children who are at risk of hospitalization or institutionalization because of their complex medical needs, but who can be cared for at home if provided with the appropriate nursing services). In the two years covered by our audit, New York’s Medicaid program paid nursing agencies $129 million for these services. The Department of Health is responsible for ensuring that nursing agencies pass on the funding increases to the nurses serving the children. The Department may audit the agencies to determine whether they are doing so and may recover any funds that were not used as intended.
We visited three nursing agencies that were paid a total of $20 million by Medicaid for services provided to medically fragile children during our two-year audit period. We examined the agencies’ records to determine whether they were passing on the funding increases to the nurses serving the children, as intended. We found indications all three agencies were not passing on the funding increases to the extent intended by the law. We recommended that the Department investigate the agencies and recover any funds that were not used as intended. We also recommended that the Department increase its oversight of nursing agencies to better ensure that they were using their enhanced Medicaid reimbursements as intended.
For a complete copy of Report 2008-S-127 click here.