1. FINANCIAL ACCOUNTABILITY – FISCAL AUDIT A. INTRODUCTION The United States Department of Health and Human Services (HHS),Centers for Medicare and Medicaid Services (CMS) requires the state operating agency of the I/DD Waiver to conduct fiscal audits on all I/DD Waiver service providers annually to strengthen the fiscal integrity and financial accountability of the Medicaid program. Under Section 1915(c) of the Social Security Act, Financial accountability is one (1) of the mandatory I/DD Waiver assurances that the STATE is required to demonstrate compliance with. (Section 1915 [42 U.S.C. 1396n]) Demonstration of compliance is achieved through an annual fiscal audit of post payment reviews. The fiscal audit of post payment reviews is conducted to ensure that the services are authorized; approved services are rendered as identified on the participant’s person-centered service plan; and claims are coded correctly and billed appropriately. The STATE is required to conduct an annual fiscal audit on all I/DD Waiver service providers and report annually to CMS to ensure that services are rendered, and claims are coded correctly and billed appropriately. The STATE currently conducts fiscal audits of post payment reviews on approximately fifty (50) I/DD Waiver service providers on average annually, averaging four (4) to five (5) fiscal audits per month and reviews an average of two thousand three hundred (2,300) claims for three hundred fifty (350) participants annually.
