Supports waiver services. Expenditures are certified annually utilizing cost report data. from the Public Provider Reimbursement Unit at the University of Massachusetts Medical School (UMMS) Center for Health Care Financing review cost reports and allowable and disallowable costs (such as room and board). ayments to providers . These providers retain 100% of the payment. Certified Public Expenditures (CPE) of Local Government Agencies. Specify: (a) the local government agencies that incur certified public expenditures for waiver services; (b) how it is assured that the CPE is based on total computable costs for waiver services; and, (c) how the State verifies that the certified public expenditures are eligible for Federal financial participation in accordance with 42 CFR §433.51(b). (Indicate source of revenue for CPEs in Item I-4-b.) d. Billing Validation Process. Describe the process for validating provider billings to produce the claim for federal financial participation, including the mechanism(s) to assure that all claims for payment are made only: (a) when the individual was eligible for Medicaid waiver payment on the date of service; (b) when the service was included in the approved service plan; and, (c) participant’s the services were provided: The Massachusetts Medicaid Management Information System (MMIS) maintains date specific eligibility information on Medicaid waiver participants. Only service claims for participants whose MassHealth waiver eligibility is verified are submitted for payment processing. The participant’s case manager validates that the service was in fact provided and is included in the participant's approved Plan of Care. e. Billing and Claims Record Maintenance Requirement. Records documenting the audit trail of adjudicated claims (including supporting documentation) are maintained by the Medicaid agency, the operating agency (if applicable), and providers of waiver services for a minimum period of 3 years as required in 45 CFR § 92.42.
Supports waiver services. Expenditures are certified annually utilizing cost report data. from the Public Provider Reimbursement Unit at the University of Massachusetts Medical School (UMMS) Center for Health Care Financing review cost reports and allowable and disallowable costs (such as room and board). ayments to providers . These providers retain 100% of the payment. Certified Public Expenditures (CPE) of Local Government Agencies. Specify: (a) the local government agencies that incur certified public expenditures for waiver services; (b) how it is assured that the CPE is based on total computable costs for waiver services; and, (c) how the State verifies that the certified public expenditures are eligible for Federal financial participation in accordance with 42 CFR §433.51(b). (Indicate source of revenue for CPEs in Item I-4-b.) d. Billing Validation Process. Describe the process for validating provider billings to produce the claim for federal financial participation, including the mechanism(s) to assure that all claims for payment are made only: (a) when the individual was eligible for Medicaid waiver payment on the date of service; (b) when the service was included in the participant’s approved service plan; and, (c) the services were provided: The Massachusetts Medicaid Management Information System (MMIS) maintains date specific eligibility information on Medicaid waiver participants. Only service claims for participants whose MassHealth waiver eligibility is verified are submitted for payment processing. The participant’s case manager validates that the service was in fact provided and is included in the participant's approved Plan of Care. e. Billing and Claims Record Maintenance Requirement. Records documenting the audit trail of adjudicated claims (including supporting documentation) are maintained by the Medicaid agency, the operating agency (if applicable), and providers of waiver services for a minimum period of 3 years as required in 45 CFR § 92.42.
ABI-RH%20Renewal%20Application-Redlined%20draft-October%202017.docx