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How does a state comply with this assurance?

States must describe what agency (or agencies) are going to conduct financial audits, how often, and the methods they will use.

States must document that audits have been conducted and report the results of the audits to CMS. When a state validates the bills submitted by providers, it must make sure that:

  • The participant was enrolled on the HCBS waiver when the service was rendered.
  • The service was authorized in the participant’s service plan.
  • The services were actually provided.
  • The provider met qualifying standards to render the service.

 

 

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