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HRD-77-56 1 (1977-03-01)

handle is hein.gao/gaobaabxa0001 and id is 1 raw text is: / STATUS OF TMPLE'4ENTATION OF MEDICAID -B l-I INSTITUTIONAL UTILIZATION CONTROL 3/_22 REQUIREMENTS/try . / . i HRD-77-56 R E S T R I CT E LM100516 Pursuant to a request from Chairman, Subcommittee on Oversight and Investigations, House Committee on Interstate and Foreign Commerce, we reviewed HEW and States compliance with section 1903(g) of the Social Security Act. Section 1903(g)(1) requires each State to submit a quarterly showing (certification) that it has an effective program of utilization control over long-term institution care. HEW must validate States' certifications by at least conducting on-site sample surveys at medical facilities with Medicaid recipients. We have-det-ermi-ned- that: -All States except Delaware have submitted all required certifications of compliance for the quarters starting April I and July 1, 1976. As a result, Delaware's grant award for long-term care in mental hospitals were reduced for the quarter starting April 1, 1976. -HEW has sent disallowance letters to three States indicating a total amount of $122,371 to be reduced from the States' grant awards for not submitting the required certifications for the fiscal year 1975 validation survey. -HEW should request more information from States as evidence of having an effective program of utilization control. -The HEW validation survey for fiscal year 1975 was very limited in scope.

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