New York’s Department of Health claimed Medicaid reimbursement on behalf of 1,688 beneficiaries at developmental centers totaling more than $2.26 billion ($1.13 billion federal share) in its fiscal year 2009. The state’s actual costs for the developmental centers totaled $577.7 million, according to the report.
Specifically, the report found the state’s rate-setting methodology for developmental services may not have met federal requirements for “efficiency and economy.”
According to the report, the daily Medicaid reimbursement rate for the developmental centers significantly outpaced those of both state-operated and privately operated intermediate care facilities — from $195 per day in SFY 1985 to $4,116 per day in SFY 2009, which is the equivalent of $1.5 million per year for one Medicaid beneficiary. The report stated that this rate is more than nine times the average rate for all other ICFs for the same period.
The report recommended the state work with CMS to ensure its reimbursement rates for developmental centers “be consistent with efficiency and economy.”
To view the full report, click here.
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