New York Followed Its Approved Methodology for Claiming Enhanced Medicaid Reimbursement Under the Community First Choice Option
Why OIG Did This Audit
In October 2015, the Centers for Medicare & Medicaid Services (CMS) approved New York's Community First Choice option (CFCO). The approval permitted New York to receive an additional 6 percent of Federal Medical Assistance Percentage (FMAP), referred to as "enhanced FMAP," for eligible home and community-based services and supports provided to individuals that are otherwise required an institutional level of care.
Our objective was to determine whether New York followed its CMS-approved methodology for claiming enhanced FMAP on payments made for CFCO services.
How OIG Did This Audit
Our audit covered $310 million in fee-for-service payments and $4.5 billion in managed care payments for beneficiaries determined eligible by New York. New York claimed enhanced FMAP of $287.6 million related to these payments on its Form CMS-64s for CY 2016. We reviewed New York's CFCO eligibility determinations for 60 beneficiaries for whom New York claimed the enhanced FMAP.
What OIG Found
End of Translation
New York followed its CMS-approved methodology for claiming enhanced FMAP on Medicaid fee-for-service and managed care payments made for CFCO services provided to beneficiaries that New York determined eligible in CY 2016.
What OIG Recommends
This report contains no recommendations.
Filed under: Centers for Medicare and Medicaid Services