Upon request of a House Appropriations subcommittee, PEER reviewed the Medicaid nursing home audit and reimbursement system, assessed overall Medicaid program cost-containment efforts, and tested for reductions in direct care provided during late evening and early morning shifts in nursing homes.
Medicaid relies on unverified cost reports to establish nursing home reimbursement rates. Audits are inadequate in number, frequency, and depth to ensure that only reasonable and necessary costs are reimbursed. However, the Director of the Division of Medicaid contends that current procedures are adequate and cost-effective based upon apparent stability and reasonableness of reimbursement rates.
Short-term cost-control measures have been implemented when essential to sustain operations during periods of fund shortages. In an attempt to encourage long-term cost-containment efforts, PEER made six recommendations for consideration by the Medicaid Division and Legislature.
Unannounced inspections revealed no uniform pattern of direct care degradation during late evening and early morning shifts.
For a paper copy of this report, contact PEER by telephone at 601-359-1226 or by e-mail at reports@peer.ms.gov.