Review of Medicaid Personal Care Service Claims Submitted by Clarity Care, Inc., and Claimed by Wisconsin from July 1, 2006, Through June 30, 2008

摘要

Pursuant to Title XIX of the Social Security Act (the Act), the Medicaid program provides medical assistance to low-income individuals with disabilities. The Federal and State Governments jointly fund and administer the Medicaid program. At the Federal level, the Centers for Medicare & Medicaid Services (CMS) administers the Medicaid program. Each State administers its Medicaid program in accordance with a CMS-approved State plan. Although the State has considerable flexibility in designing and operating its Medicaid program, it must comply with applicable Federal requirements. In Wisconsin, the Department of Health Services (DHS) is the State agency responsible for operating the Medicaid program. Within DHS, the Division of Health Care Access and Accountability administers the Medicaid program. DHS contracts with a private vendor to process and pay Medicaid claims through its Medicaid Management Information System (MMIS), including personal care services claims. During the period July 1, 2006, through June 30, 2008, the Federal medical assistance percentage varied from 57.47 to 57.65 percent.