Administration of Medicaid Payments to Nursing Facilities for Long-Term Care
Learn how the AI-generated research projects were createdOverall Conclusion
Moderately effective.
Source Document
Audit Scope
Examination of MDHHS's Medicaid long-term care rate setting, LTC audit, and cost settlement processes, covering October 1, 2015 through May 17, 2018 (with fieldwork through June 30, 2018).
Key Findings Summary
Timeliness of audit process needs improvement.
Improvements needed to the cost settlement process.
Consideration of alternative reimbursement methodologies.
View the Findings tab to see all 5 findings
AI-Assisted
AI Scope Summary
The audit examined the effectiveness of MDHHS's administration of its long-term care Medicaid rate setting, LTC audits, and cost settlements, covering an extended period (2015–2018) and resulting in five findings and recommendations. The overall conclusion was moderately effective, with scope highlighting the need to consider alternative reimbursement methodologies, improve report acceptance, auditing, and settlement timeliness. The summary suggests that future audits could focus on the transition to case-mix models, automation, and stronger controls to reduce delays and ensure accuracy.
AI-Generated Insight
This performance audit evaluates MDHHS's administration of the Medicaid LTC rate setting, LTC audit, and cost settlement processes in Michigan. It identifies a series of weaknesses across rate setting, cost reporting, and settlement activities, including complexity and inefficiency of the cost-based reimbursement methodology, incomplete cost report acceptance, unidentifiable unallowable costs in audits, and significant audit backlogs and delays in settlements. The report notes MDHHS's ongoing reforms, including exploring case-mix methodologies, implementation of automated tools (TeamMate), policy updates (MSA 19-28), and training efforts to improve consistency and timeliness.
Audit Objectives
To assess the effectiveness of MDHHS's efforts to administer its LTC rate setting process.
To assess the effectiveness of MDHHS's efforts to administer its LTC audit process.
To assess the effectiveness of MDHHS's efforts to administer its LTC cost settlement process.
Audit Findings (5)
Timeliness of audit process needs improvement.
Improvements needed to the cost settlement process.
Consideration of alternative reimbursement methodologies.
Improvements needed to the cost report acceptance process.
Cost report audit process needs improvement.
Recommendations (5)
We recommend that MDHHS reevaluate its Medicaid LTC cost reimbursement methodology.
We recommend that MDHHS enhance its cost report submission and initial review processes.
We recommend that MDHHS improve its audit procedures to help identify unallowable costs and more consistently disallow unallowable costs.
We recommend that MDHHS improve the timeliness of its audit process and perform on-site audits at least once every four years.
We recommend that MDHHS improve the timeliness and accuracy of its cost settlement process.