Massachusetts Medicaid Payments to Calvin Coolidge Nursing and Rehabilitation Center for Northhampton Did Not Always Comply with Federal and State Requirements.

摘要

The Massachusetts Executive Office of Health and Human Services, Office of Medicaid (State agency), is responsible for administering MassHealth, the Massachusetts Medicaid program, in compliance with Federal and State statutes and administrative policies. The State agency reimburses nursing homes based on an established per diem rate for services provided to Medicaid beneficiaries. Pursuant to Medicaid requirements, the State agency must use certain additional resources that a beneficiary has, including Social Security payments, to reduce its Medicaid payments to nursing homes. The State agency determines the amount of a beneficiary's contribution during the financial eligibility process and enters this amount into its computer system. The beneficiarys contribution is remitted to the nursing home each month. When the State agency reimburses the nursing home and does not reduce the Medicaid per diem payment by the amount of the beneficiary's contribution, the nursing home could receive overpayments. Pursuant to Medicaid requirements, the nursing home must return any overpayments to the State Medicaid program, which in turn is required to refund the Federal share to the Centers for Medicare & Medicaid Services (CMS) on its Form CMS-64, Quarterly Statement of Expenditures for the Medical Assistance Program. Calvin Coolidge Nursing and Rehabilitation Center for Northampton (Calvin Coolidge), located in Northampton, Massachusetts, is a Medicare and Medicaid certified facility.