Waiver Auditing Services

The vendor is required to provide waiver auditing services.
- The fiscal audit of post payment reviews is conducted to ensure that the services are authorized; approved services are rendered as identified on the participant’s person-centered service plan; and claims are coded correctly and billed appropriately.
- The state currently conducts fiscal audits of post payment reviews on approximately fifty (50) disabilities waiver service providers on average annually, averaging four (4) to five (5) fiscal audits per month and reviews an average of two thousand three hundred (2,300) claims for three hundred fifty (350) participants annually.
- The state requests proposals that will ensure accountability and compliance with the requirements of operating the agency by developing and implementing robust systems to prevent fraud, abuse, and waste by conducting post-payment reviews, auditing electronic visit verification (EVV) data, assisting disabilities waiver service providers in implementing billing practices and safeguards, and ensuring adequate service rates for disabilities waiver service providers to operate sustainably.
- Participate in introductory meetings with the state to review the current fiscal audit process.
- Prepare for and testify at the administrative hearing, provide analysis and opinions, review documents provided by the disabilities waiver service provider, identify issues, and provide recommendations to the state to determine the best course of action.
- Assist the state in meeting federal and state compliance by developing, improving, and implementing policies and procedures.
- Crisis mobile outreach (CMO) services include the initial call requesting outreach and the immediate, face-to-face, onsite crisis support to individuals with Disabilities and families experiencing an active crisis which is impacting the individual’s ability to function within their family, living situation, and/or community environments.
- Contract Period/Term: 1 year
- Questions/Inquires Deadline: July 7, 2025