Missouri IDD Case Management Medicaid Rate Miscalculation Results In $11.5 Million Pay Back

An improper methodology in Missouri Medicaid’s 2011 calculations to rebase payment rates for targeted case management (TCM) for individuals with developmental disabilities resulted in unallowable payments of $11.5 million during 2012 and 2013. When the Missouri Department of Social Services, HealthNet Division rebased the payment rate in 2011 it failed to include cost reports from all TCM provider organizations in 2010, and calculated the rate at $7.78 per unit. A recent federal review of the methodology recalculated the rate at $6.88 using costs reported by all TCM provider organizations as required by the state plan. HealthNet . . .