Ohio’s Medicaid State Plan allows for the provision of Community Alternative Funding System (CAFS) services through the rehabilitation option (3.1-A, Item 13 in the state plan). These rehabilitative services are provided by certified habilitation centers through the CAFS program. The number of CAFS providers has grown significantly over the years, from slightly under 50 in 1990 to approximately 450 CAFS providers when the program ended June 30, 2005. Many of these CAFS providers are also reimbursed for Case Management and Service Coordination using the CAFS reimbursement methodology for services provided under the Targeted Case Management authority in the state plan.
Through June 30, 2005, the CAFS program was a cost reimbursed system administered by the Ohio Department of Developmental Disabilities (DODD) through an interagency agreement with the Ohio Department of Job and Family Services (ODJFS). Because providers of CAFS and Targeted Case Management services were cost reimbursed, audits of these providers were required. The audit function was transferred from the ODJFS to the DODD starting cost reporting year 2001.
For the 2001, 2002, 2003 and 2004 through December 31, 2003 (if applicable) cost reporting periods, DODD plans to perform 15 audits of providers on cost report year 2002. These audits will be used to settle cost report year 2002. The providers and cost report years on which audits will not be performed, DODD plans to use the provider interim settlement as the final settlement.
For the 2004 and 2005 through June 30, 2005 (if applicable) cost reporting periods, DODD plans to settle cost report using the provider interim settlement as the final settlement.
Providers will be asked to agree to adjudicate these years as final settlements but may raise additional issues for consideration. Issues raised will be resolved based on documentation presented by the providers. Any provider who chooses to accept the proposed adjudication will be final settled. Providers will be given 30 days to bring forward additional clarifying information, which will be considered by DODD in adjusting their final settlement. DODD, however, retains the right to verify any information in any manner it deems necessary.
DODD believes that this mass settlement approach is a viable method to resolve these audits in the most cost effective and efficient manner. CMS is also requiring that DODD review provider matching documentation to verify that Medicaid match complies with the provisions of 42 CFR 433.54 regarding bona fide donations. In addition, CMS is requiring that DODD review transportation transactions relating to school aged children to validate that such transaction are consistent with the May 21, 1999 State Medicaid Director letter.
For more information about this topic, contact Greg Mason, Deputy Director of Internal Audits, at Greg.Mason@dmr.state.oh.us.
MASS Audit Settlement for 2004 and 2005 through 6/30/05