Audit of Oregon's Medicaid Management Information System Expenditures for the Period October 1, 2007, Through September 30, 2009.

摘要

A Medicaid Management Information System (MMIS) is a system of software and hardware used to process Medicaid claims and manage information about Medicaid beneficiaries and services. An MMIS may be operated by a State agency and/or a fiscal agent, which is a private contractor hired by the State. Section 1903(a)(3)(A)(i) of the Social Security Act (the Act) authorizes Federal reimbursement at an enhanced rate of 90 percent (90-percent rate) for the design, development, or installation of an MMIS. Section 1903(a)(3)(B) of the Act authorizes Federal reimbursement at an enhanced rate of 75 percent (75-percent rate) for the operation of an MMIS. Section 1903(a)(7) of the Act authorizes Federal reimbursement at a standard rate of 50 percent (50-percent rate) for Medicaid administrative expenditures. The Centers for Medicare & Medicaid Services (CMS) State Medicaid Manual (the Manual), part 11, identifies the specific types of MMIS expenditures that are allowable for Federal reimbursement and the reimbursement rates that apply. In Oregon, the Department of Human Services (State agency) administers the Medicaid program. During our audit period (October 1, 2007, through September 30, 2009), the State agency used contractors to assist with the administration of the Medicaid program, operate and maintain its MMIS, and develop a replacement MMIS. The State agency began using the replacement MMIS in December 2008. For the audit period, the State agency claimed at enhanced Federal reimbursement rates expenditures totaling $44,209,420 ($37,971,070 Federal share) for the design, development, installation, and operation of its MMIS. Of this amount, we reviewed $30,956,274 ($27,103,971 Federal share). Our objective was to determine whether the State agency claimed enhanced Federal Medicaid reimbursement for MMIS expenditures in compliance with Federal requirements.