type: other

jurisdiction: US

text: b' DEPARTMENT OF HEALTH & HUMAN SERVICES Office of Inspector General\n\n Washington, D.C. 20201\n\n\n\n\nApril 16, 2010\n\nTO: Charlene Frizzera\n Acting Administrator\n Centers for Medicare & Medicaid Services\n\n\nFROM: /Joseph E. Vengrin/\n Deputy Inspector General for Audit Services\n\n\nSUBJECT: Review of New Jersey\xe2\x80\x99s Medicaid School-Based Health Claims Submitted by\n Maximus, Inc. (A-02-07-01051)\n\n\nAttached is an advance copy of our final report on New Jersey\xe2\x80\x99s Medicaid school-based health\nclaims submitted by Maximus, Inc. We will issue this report to the New Jersey Department of\nHuman Services within 5 business days.\n\nIf you have any questions or comments about this report, please do not hesitate to call me, or\nyour staff may contact George M. Reeb, Assistant Inspector General for the Centers for\nMedicare & Medicaid Audits, at (410) 786-7104 or through email at George.Reeb@oig.hhs.gov\nor James P. Edert, Regional Inspector General for Audit Services, Region II, at (212) 264-4620\nor through email at James.Edert@oig.hhs.gov. Please refer to report number A-02-07-01051.\n\n\nAttachment\n\x0c DEPARTMENT OF HEALTH & HUMAN SERVICES Office of Inspector General\n\n\n Office of Audit Services\n Jacob K. Javits Federal Building\n 26 Federal Plaza, Room 3900\n New York, NY 10278\n\nApril 23, 2010\n\nReport Number: A-02-07-01051\n\nMs. Jennifer Velez, Esq.\nCommissioner\nNew Jersey Department of Human Services\n222 South Warren Street\nP.O. Box 700\nTrenton, NJ 08625-0700\n\nDear Ms. Velez:\n\nEnclosed is the U.S. Department of Health & Human Services (HHS), Office of Inspector\nGeneral (OIG), final report entitled Review of New Jersey\xe2\x80\x99s Medicaid School-Based Health\nClaims Submitted by Maximus, Inc. We will forward a copy of this report to the HHS action\nofficial noted on the following page for review and any action deemed necessary.\n\nThe HHS action official will make final determination as to actions taken on all matters reported.\nWe request that you respond to this official within 30 days from the date of this letter. Your\nresponse should present any comments or additional information that you believe may have a\nbearing on the final determination.\n\nSection 8L of the Inspector General Act, 5 U.S.C. App., requires that OIG post its publicly\navailable reports on the OIG Web site. Accordingly, this report will be posted at\nhttp://oig.hhs.gov.\n\nIf you have any questions or comments about this report, please do not hesitate to call me, or\ncontact Richard Schlitt, Audit Manager, at (212) 264-4817 or through email at\nRichard.Schlitt@oig.hhs.gov. Please refer to report number A-02-07-01051 in all\ncorrespondence.\n\n Sincerely,\n\n\n\n /James P. Edert/\n Regional Inspector General\n for Audit Services\n\n\nEnclosure\n\x0cPage 2 \xe2\x80\x93 Ms. Jennifer Velez, Esq.\n\n\nDirect Reply to HHS Action Official:\n\nMs. Jackie Garner\nConsortium Administrator\nConsortium for Medicaid and Children\xe2\x80\x99s Health Operations\nCenters for Medicare & Medicaid Services\n233 North Michigan Avenue, Suite 600\nChicago, IL 60601\n\x0c Department of Health & Human Services\n OFFICE OF\n INSPECTOR GENERAL\n\n\n\n\nREVIEW OF NEW JERSEY\xe2\x80\x99S MEDICAID\n SCHOOL-BASED HEALTH CLAIMS\n SUBMITTED BY MAXIMUS, INC.\n\n\n\n\n Daniel R. Levinson\n Inspector General\n\n April 2010\n A-02-07-01051\n\x0c Office of Inspector General\n http://oig.hhs.gov\n\n\n\nThe mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452, as amended, is\nto protect the integrity of the Department of Health & Human Services (HHS) programs, as well as the\nhealth and welfare of beneficiaries served by those programs. This statutory mission is carried out\nthrough a nationwide network of audits, investigations, and inspections conducted by the following\noperating components:\n\nOffice of Audit Services\n\nThe Office of Audit Services (OAS) provides auditing services for HHS, either by conducting audits with\nits own audit resources or by overseeing audit work done by others. Audits examine the performance of\nHHS programs and/or its grantees and contractors in carrying out their respective responsibilities and are\nintended to provide independent assessments of HHS programs and operations. These assessments help\nreduce waste, abuse, and mismanagement and promote economy and efficiency throughout HHS.\n\nOffice of Evaluation and Inspections\nThe Office of Evaluation and Inspections (OEI) conducts national evaluations to provide HHS, Congress,\nand the public with timely, useful, and reliable information on significant issues. These evaluations focus\non preventing fraud, waste, or abuse and promoting economy, efficiency, and effectiveness of\ndepartmental programs. To promote impact, OEI reports also present practical recommendations for\nimproving program operations.\n\nOffice of Investigations\nThe Office of Investigations (OI) conducts criminal, civil, and administrative investigations of fraud and\nmisconduct related to HHS programs, operations, and beneficiaries. With investigators working in all 50\nStates and the District of Columbia, OI utilizes its resources by actively coordinating with the Department\nof Justice and other Federal, State, and local law enforcement authorities. The investigative efforts of OI\noften lead to criminal convictions, administrative sanctions, and/or civil monetary penalties.\n\nOffice of Counsel to the Inspector General\nThe Office of Counsel to the Inspector General (OCIG) provides general legal services to OIG, rendering\nadvice and opinions on HHS programs and operations and providing all legal support for OIG\xe2\x80\x99s internal\noperations. OCIG represents OIG in all civil and administrative fraud and abuse cases involving HHS\nprograms, including False Claims Act, program exclusion, and civil monetary penalty cases. In\nconnection with these cases, OCIG also negotiates and monitors corporate integrity agreements. OCIG\nrenders advisory opinions, issues compliance program guidance, publishes fraud alerts, and provides\nother guidance to the health care industry concerning the anti-kickback statute and other OIG enforcement\nauthorities.\n\x0c Notices\n\n\n THIS REPORT IS AVAILABLE TO THE PUBLIC\n at http://oig.hhs.gov\n\n Section 8L of the Inspector General Act, 5 U.S.C. App., requires\n that OIG post its publicly available reports on the OIG Web site.\n\nOFFICE OF AUDIT SERVICES FINDINGS AND OPINIONS\n\n The designation of financial or management practices as\n questionable, a recommendation for the disallowance of costs\n incurred or claimed, and any other conclusions and\n recommendations in this report represent the findings and\n opinions of OAS. Authorized officials of the HHS operating\n divisions will make final determination on these matters.\n\x0c EXECUTIVE SUMMARY\n\nBACKGROUND\n\nPursuant to Title XIX of the Social Security Act (the Act), the Medicaid program provides\nmedical assistance to certain low-income individuals and individuals with disabilities. The\nFederal and State Governments jointly fund and administer the Medicaid program. At the\nFederal level, the Centers for Medicare & Medicaid Services (CMS) administers the program.\nEach State administers its Medicaid program in accordance with a CMS-approved State plan.\nAlthough the State has considerable flexibility in designing and operating its Medicaid program,\nit must comply with applicable Federal requirements. In New Jersey, the Department of Human\nServices is responsible for operating the Medicaid program.\n\nSection 411(k)(13) of the Medicare Catastrophic Coverage Act of 1988 (P.L. No. 100-360)\namended section 1903(c) of the Act to permit Medicaid payment for medical services provided\nto children under the Individuals with Disabilities Education Act through a child\xe2\x80\x99s individualized\neducation plan. Pursuant to Federal and State requirements, such services require a referral or\nprescription from a properly credentialed physician or licensed practitioner. These services must\nbe provided by an individual who meets Federal qualification requirements and be fully\ndocumented. In addition, pursuant to New Jersey\xe2\x80\x99s State Medicaid plan requirements, these\nservices must be documented in a treatment plan.\n\nFor the period July 27, 2003, through October 4, 2006, New Jersey received more than\n$32.2 million in Federal Medicaid reimbursement for school-based health claims submitted by\nits billing agent, Maximus, Inc. (Maximus).\n\nOBJECTIVE\n\nOur objective was to determine whether New Jersey\xe2\x80\x99s Medicaid school-based health claims\nsubmitted by its billing agent, Maximus, complied with Federal and State requirements.\n\nSUMMARY OF FINDINGS\n\nNew Jersey\xe2\x80\x99s claims for reimbursement of Medicaid school-based health services submitted by\nMaximus did not fully comply with Federal and State requirements. Of the 100 school-based\nhealth claims in our sample, 49 complied with Federal and State requirements. However, the\nremaining 51 did not.\n\nOf the 51 noncompliant claims, 19 claims contained more than one deficiency:\n\n \xef\x82\xb7 Thirty-two claims contained services that were not provided or supported.\n\n \xef\x82\xb7 Twenty-four claims lacked a referral or prescription.\n\n\n\n\n i\n\x0c \xef\x82\xb7 Fourteen claims did not meet Federal provider qualification requirements.\n\n \xef\x82\xb7 Eight claims contained services not documented in the child\xe2\x80\x99s plan.\n\nThese deficiencies occurred because: (1) New Jersey provided improper guidance concerning\nFederal Medicaid requirements to school-based health providers, (2) school-based health\nproviders did not comply with guidance related to Federal requirements, and (3) New Jersey did\nnot adequately monitor school-based health claims for compliance with Federal and State\nrequirements.\n\nBased on our sample results, we estimate that New Jersey was improperly reimbursed\n$8,079,312 in Federal Medicaid funds during our July 27, 2003, through October 4, 2006, audit\nperiod.\n\nRECOMMENDATIONS\n\nWe recommend that New Jersey:\n\n \xef\x82\xb7 refund $8,079,312 to the Federal Government,\n\n \xef\x82\xb7 provide proper and timely guidance on Federal Medicaid criteria to its school-based\n health providers, and\n\n \xef\x82\xb7 improve its monitoring of school-based health providers\xe2\x80\x99 claims to ensure compliance\n with Federal and State requirements.\n\nNEW JERSEY COMMENTS\n\nIn its comments on our draft report, New Jersey disagreed with our recommended refund. In\naddition, New Jersey questioned our sampling methodology and disagreed with what we\naccepted as valid referrals. However, New Jersey also described corrective actions that it\nplanned to take in response to the remaining recommendations. New Jersey also provided\nadditional documentation for 5 of the 53 claims questioned in our draft report.\n\nOFFICE OF INSPECTOR GENERAL RESPONSE\n\nOur statistical sampling methodology used to determine the estimated overpayment was valid.\nAfter reviewing the additional documentation provided by New Jersey, we determined that some\nservices for the five claims complied with Federal and State requirements and revised our\nfindings and recommended refund accordingly.\n\n\n\n\n ii\n\x0c TABLE OF CONTENTS\n Page\n\nINTRODUCTION.....................................................................................................................1\n\n BACKGROUND .................................................................................................................1\n Medicaid Program ........................................................................................................1\n Medicaid Coverage of School-Based Health Services.................................................1\n New Jersey\xe2\x80\x99s Medicaid Program..................................................................................1\n Prior Office of Inspector General Audit Reports .........................................................3\n\n OBJECTIVE, SCOPE, AND METHODOLOGY...............................................................3\n Objective.......................................................................................................................3\n Scope ............................................................................................................................3\n Methodology.................................................................................................................4\n\nFINDINGS AND RECOMMENDATIONS ...........................................................................5\n\n SERVICES NOT PROVIDED OR NOT SUPPORTED ....................................................5\n\n REFERRAL OR PRESCRIPTION REQUIREMENTS NOT MET...................................6\n\n FEDERAL PROVIDER REQUIREMENTS NOT MET....................................................7\n Speech Therapy Provider Requirements Not Met........................................................7\n Occupational Therapy Provider Requirements Not Met ..............................................8\n\n SERVICES NOT DOCUMENTED IN CHILD\xe2\x80\x99S PLAN...................................................8\n\n CAUSES OF THE IMPROPER CLAIMS ..........................................................................8\n New Jersey Issued Improper Guidance Regarding Provider Requirements ................9\n Providers Did Not Comply With Federal Requirements..............................................9\n New Jersey Did Not Adequately Monitor School-Based Health Claims.....................9\n\n RECOMMENDATIONS.....................................................................................................9\n\n NEW JERSEY COMMENTS AND OFFICE OF\n INSPECTOR GENERAL RESPONSE...............................................................................9\n Sampling Methodology ..............................................................................................10\n Referrals .....................................................................................................................10\n Additional Documentation .........................................................................................11\n Attendance..................................................................................................................11\n\n\n\n\n iii\n\x0cAPPENDIXES\n\n A \xe2\x80\x93 SAMPLE DESIGN AND METHODOLOGY\n\n B \xe2\x80\x93 SAMPLE RESULTS AND ESTIMATES\n\n C \xe2\x80\x93 SUMMARY OF DEFICIENCIES FOR EACH SAMPLED CLAIM\n\n D \xe2\x80\x93 NEW JERSEY COMMENTS\n\n\n\n\n iv\n\x0c INTRODUCTION\n\nBACKGROUND\n\nMedicaid Program\n\nPursuant to Title XIX of the Social Security Act (the Act), the Medicaid program provides\nmedical assistance to certain low-income individuals and individuals with disabilities. The\nFederal and State Governments jointly fund and administer the Medicaid program. At the\nFederal level, the Centers for Medicare & Medicaid Services (CMS) administers the program.\nEach State administers its Medicaid program in accordance with a CMS-approved State plan.\nAlthough the State has considerable flexibility in designing and operating its Medicaid program,\nit must comply with applicable Federal requirements.\n\nMedicaid Coverage of School-Based Health Services\n\nSection 411(k)(13) of the Medicare Catastrophic Coverage Act of 1988 (P.L. No. 100-360)\namended section 1903(c) of the Act to permit Medicaid payment for medical services provided\nto children under the Individuals with Disabilities Education Act (IDEA) (originally enacted as\nP.L. No. 91-230 in 1970) through a child\xe2\x80\x99s individualized education plan.\n\nFederal and State rules require that school-based health services be (1) referred or prescribed by\na physician or another appropriate professional, (2) provided by an individual who meets Federal\nqualification requirements, (3) fully documented, (4) actually furnished in order to be billed, and\n(5) documented in the child\xe2\x80\x99s plan.\n\nIn August 1997, CMS issued a guide entitled Medicaid and School Health: A Technical\nAssistance Guide (technical guide). According to the technical guide, school-based health\nservices included in a child\xe2\x80\x99s plan may be covered if all relevant statutory and regulatory\nrequirements are met. In addition, the technical guide provides that a State may cover services\nincluded in a child\xe2\x80\x99s plan as long as: (1) the services are listed in section 1905(a) of the Act and\nare medically necessary; (2) all Federal and State regulations are followed, including those\nspecifying provider qualifications; and (3) the services are included in the State plan or available\nunder the Early and Periodic Screening, Diagnostic and Treatment Medicaid benefit. Covered\nservices may include, but are not limited to, physical therapy, occupational therapy, speech\npathology/therapy services, psychological counseling, nursing, and transportation services.\n\nNew Jersey\xe2\x80\x99s Medicaid Program\n\nIn New Jersey, the Department of Human Services is responsible for operating the Medicaid\nprogram. Within the New Jersey Department of Human Services, the Division of Medical\nAssistance and Health Services administers the Medicaid program. The administrative\nresponsibility for operating New Jersey\xe2\x80\x99s school-based health services program, known as the\nSpecial Education Medicaid Initiative (SEMI), is shared among three State departments: Human\nServices, Education, and Treasury. The State also contracted with a billing agent, Maximus, Inc.\n\n\n\n\n 1\n\x0c(Maximus), to help administer its Medicaid school-based health services program. The\nresponsibilities of each are as follows:\n\n 1. The Department of Human Services oversees school-based health provider enrollment,\n provides technical assistance to school-based health providers, and processes providers\xe2\x80\x99\n claims through New Jersey\xe2\x80\x99s Medicaid Management Information System fiscal\n intermediary.\n\n 2. The Department of Education (DOE) certifies school-based health providers and provides\n policy guidance.\n\n 3. The Department of Treasury serves as the contract manager for the SEMI billing agent.\n\n 4. The billing agent was responsible for processing billing agreements and pupil registration\n information from school-based health providers, providing technical assistance (including\n monitoring) on school-based health program issues, and conducting Medicaid eligibility\n verification for registered pupils. Maximus was the contracted billing agent for New\n Jersey during our audit period. 1\n\nThe primary State guidance for administering and operating the school-based health program is\nthe SEMI Provider Handbook (State handbook). New Jersey and the billing agent developed the\nhandbook using both education and Medicaid requirements. The State handbook is issued to all\nschool-based health providers and contains detailed instructions on their responsibilities under\nthe school-based health program.\n\nPursuant to New Jersey\xe2\x80\x99s Medicaid State plan, the school-based health program comprises\nrehabilitative services, 2 evaluation services, 3 and transportation services. 4 School-based health\nproviders submitted monthly \xe2\x80\x9cturnaround documents\xe2\x80\x9d to Maximus that showed the daily school-\nbased services provided during the month to each student. Maximus then prepared claims based\n\n\n\n1\n Maximus oversaw the SEMI program from November 1998 to January 2005 under a contingency-fee-based\narrangement. New Jersey received Federal Medicaid reimbursement for claims submitted by Maximus through\nOctober 2006. Although Maximus was not paid directly with Federal Medicaid funds, it was paid a percentage of\nthe Federal Medicaid reimbursements made for New Jersey\xe2\x80\x99s SEMI program. We selected this program for review\nas part of a nationwide contingency-fee review.\n2\n Often referred to as related school health services, rehabilitative services include occupational, physical, and\nspeech-language therapies; audiology services; psychological counseling and psychotherapy; and nursing.\n3\n Evaluation services identify the need for specific services and prescribe the range and frequency of services that\nthe student requires. Evaluation services may include reevaluation or review of the current services specified in the\nchild\xe2\x80\x99s plan.\n4\n Transportation services are allowable when provided on the same day as a related service and when transportation\nis included in the child\xe2\x80\x99s plan. Pursuant to a May 21, 1999, letter from the Director of CMS\xe2\x80\x99s Center for Medicaid\nand State Operations to all State Medicaid directors, only specialized transportation can be billed to Medicaid.\nAccording to CMS, \xe2\x80\x9cspecialized transportation\xe2\x80\x9d means that a child requires transportation in a vehicle adapted to\nserve the needs of the disabled, including a specially adapted school bus.\n\n\n 2\n\x0con the documents received. A school-based claim consisted of a bill for related school-based\nhealth services, evaluation services, or transportation services.\n\nThe Federal Government\xe2\x80\x99s share of costs for school-based health claims is known as the Federal\nmedical assistance percentage (FMAP). From July 27, 2003, through June 30, 2004, the FMAP\nwas 52.95 percent in New Jersey; from July 1, 2004, through October 4, 2006, the FMAP was\n50 percent. For the period July 27, 2003, through October 4, 2006, the State received more than\n$32.2 million of Federal Medicaid reimbursement for 86,533 claims.\n\nPrior Office of Inspector General Audit Reports\n\nOn May 19, 2006, the Office of Inspector General issued a report (A-02-03-01003) on the State\xe2\x80\x99s\nSEMI program for the period July 1, 1998, through June 30, 2001. The objective of the audit\nwas to determine whether Federal Medicaid payments for school-based health services claimed\nby school-based health providers in New Jersey were in compliance with Federal and State\nrequirements. Among other recommendations, the report recommended that New Jersey refund\n$51,262,909 to the Federal Government and work with CMS to resolve $1,046,786 in set-aside\nclaims. 5\n\nOn February 8, 2008, the Office of Inspector General issued a report (A-02-04-01017) on the\nrates used by New Jersey for claiming Federal Medicaid reimbursement for the SEMI and\nMedicaid Administrative Claiming programs. The objective of the audit was to determine\nwhether the rates used by New Jersey were reasonable and complied with Federal requirements\nand the Medicaid State plan. The report recommended that New Jersey work with CMS to\ndetermine overpayment amounts for the period July 1, 1998, through June 30, 2001, and ensure\nthat rates used to claim Federal Medicaid reimbursement for school-based health services are\nproperly developed and documented.\n\nOBJECTIVE, SCOPE, AND METHODOLOGY\n\nObjective\n\nOur objective was to determine whether New Jersey\xe2\x80\x99s Medicaid school-based health claims\nsubmitted by its billing agent, Maximus, complied with Federal and State requirements.\n\nScope\n\nOur review covered 86,533 claims totaling $62,563,888 ($32,223,604 Federal share) for the\nperiod July 27, 2003, through October 4, 2006. During our audit, we did not review the overall\ninternal control structure of Maximus, New Jersey, or the Medicaid program. Rather, we limited\nour internal control review to those controls that were significant to the objective of our audit.\n\nWe conducted fieldwork at the Department of Human Service\xe2\x80\x99s offices in Mercerville and\nTrenton, New Jersey, as well as at 49 selected schools throughout the State.\n\n\n5\n CMS sustained the recommendations with minor adjustments.\n\n\n 3\n\x0cMethodology\n\nTo accomplish our objective, we:\n\n \xef\x82\xb7 reviewed applicable Federal and State laws, regulations, and guidelines;\n\n \xef\x82\xb7 held discussions with New Jersey and billing agent officials to gain an understanding of\n New Jersey\xe2\x80\x99s school-based health services program;\n\n \xef\x82\xb7 obtained an understanding of computer edits and administrative controls regarding\n claiming Medicaid reimbursement for school-based health services;\n\n \xef\x82\xb7 obtained a computer-generated file identifying all Medicaid school-based health claims\n submitted by New Jersey for the period July 27, 2003, through June 27, 2007;\n\n \xef\x82\xb7 separated the file into two segments based on billing agent: claims submitted by\n Maximus and claims submitted by Public Consulting Group, Inc. (PCG), 6 and the\n Maximus sampling frame consisted of 86,533 student-months (all services provided to an\n individual student for a month during our audit period) with a total Medicaid paid amount\n of $62,563,888 ($32,223,604 Federal share);\n\n \xef\x82\xb7 used stratified random sampling techniques to select a sample of 100 claims from the\n sampling frame of 86,533 claims; 7\n\n \xef\x82\xb7 visited the school associated with each sample claim to review documentation supporting\n the claim; 8\n\n \xef\x82\xb7 determined if the service provider or speech pathologist associated with the sample claim\n was certified by the American Speech-Language-Hearing Association (ASHA) and/or\n licensed by the New Jersey Division of Consumer Affairs, the State licensing agency; and\n\n \xef\x82\xb7 estimated the dollar impact of the improper Federal reimbursement claimed in the total\n population of 86,533 school-based claims.\n\nAppendix A contains the details of our sample design and methodology. Appendix B contains\nour sample results and estimates.\n\n\n\n6\n We will be conducting a separate review (A-02-07-01052) of claims submitted by New Jersey for the period\nApril 6, 2005, through June 27, 2007, when PCG was the State\xe2\x80\x99s school-based health services billing agent.\n7\n The 100 sample claims included 163 services: 46 claims for speech services, 37 for evaluation services, 26 for\noccupational therapy services, 19 for physical therapy services, 15 for transportation services, 12 for nursing\nservices, and 8 for psychological counseling services.\n8\n If documentation was not readily available, we accepted faxed copies at later dates.\n\n\n 4\n\x0cWe conducted this performance audit in accordance with generally accepted government\nauditing standards. Those standards require that we plan and perform the audit to obtain\nsufficient, appropriate evidence to provide a reasonable basis for our findings and conclusions\nbased on our audit objectives. We believe that the evidence obtained provides a reasonable basis\nfor our findings and conclusions based on our audit objective.\n\n FINDINGS AND RECOMMENDATIONS\n\nNew Jersey\xe2\x80\x99s claims for reimbursement of Medicaid school-based health services submitted by\nMaximus did not fully comply with Federal and State requirements. Of the 100 school-based\nhealth claims in our sample, 49 complied with Federal and State requirements. However, the\nremaining 51 did not. Table 1 summarizes the deficiencies noted and the number of claims that\ncontained each type of deficiency. Appendix C contains a summary of deficiencies, if any,\nidentified for each sampled claim.\n\n Table 1: Summary of Deficiencies in Sampled Claims\n\n Type of Deficiency Number of Deficient Claims 9\n Services not provided or not supported 32\n Referral or prescription requirements not met 24\n Federal provider requirements not met 14\n Services not documented in child\xe2\x80\x99s plan 8\n\nThese deficiencies occurred because: (1) the State provided improper or untimely guidance\nconcerning Federal Medicaid requirements to school-based health providers, (2) school-based\nhealth providers did not comply with State guidance related to Federal requirements, and (3) the\nState did not adequately monitor school-based health claims from providers for compliance with\nFederal and State requirements.\n\nBased on our sample results, we estimate that New Jersey was improperly reimbursed\n$8,079,312 in Federal Medicaid funds during our July 27, 2003, through October 4, 2006, audit\nperiod.\n\nSERVICES NOT PROVIDED OR NOT SUPPORTED\n\nPursuant to section 1902(a)(27) of the Act, States claiming Federal Medicaid funding must\ndocument services provided. This requirement is reiterated in CMS\xe2\x80\x99s technical guide and the\nState handbook, which both state that school-based health providers must maintain records\ndocumenting that a related service or evaluation service was provided. The technical guide\nstates that relevant documentation includes the date and location of the service, the identity of the\nprovider, and the length of time required for the service.\n\n\n9\n The total exceeds 51 because 19 claims contained more than 1 deficiency.\n\n\n\n 5\n\x0cIn addition, pursuant to 42 CFR \xc2\xa7 455.1(a)(2), States are required to have a method for verifying\nwhether services reimbursed by Medicaid were actually furnished. Further, pursuant to 42 CFR\n\xc2\xa7 455.18, New Jersey\xe2\x80\x99s Medicaid provider agreements require providers to certify that the\ninformation on their Medicaid claims is true, accurate, and complete. 10 Providers and billing\nagents also certify that they agree to keep records necessary to fully disclose the extent of\nservices provided, as required by section 1902(a)(27) of the Act.\n\nFor 32 of the 100 claims in our sample, school-based health providers received Medicaid\npayments for services that were not provided or not supported. 11 Specifically:\n\n \xef\x82\xb7 For 18 claims, documentation indicated that the related service(s) billed were not\n provided. Specifically:\n\n o For 10 claims, documentation for the associated student did not support the\n number of services billed.\n\n o For six claims, the associated student\xe2\x80\x99s attendance record indicated that the\n student was absent from school on at least 1 day that the school-based health\n provider claimed services.\n\n o For two claims, the school-based health provider submitted duplicate claims for\n the same service.\n\n \xef\x82\xb7 For 10 claims containing specialized transportation services, school-based health\n providers did not have documentation to support the number of transportation services\n billed.\n\n \xef\x82\xb7 For six claims, school-based health providers could not provide any documentation to\n support the related service.\n\nREFERRAL OR PRESCRIPTION REQUIREMENTS NOT MET\n\nPursuant to 42 CFR \xc2\xa7 440.110 (a)(b)(c), a referral or prescription from a physician or another\nlicensed practitioner of the healing arts is required for physical therapy; occupational therapy;\nand services for individuals with speech, hearing, and language disorders provided by or under\nthe direction of a qualified practitioner to be eligible for Medicaid reimbursement. For nursing\nservices, the New Jersey Board of Nursing Statute 45:11-23 allows nurses to execute medical\nregimens as prescribed by a licensed (or otherwise legally authorized) physician or dentist.\n\n\n10\n The regulation requires State Medicaid claim forms to include a certification by providers that the information on\nthe claims is true, accurate, and complete or States may print similar wording above the claimant\xe2\x80\x99s endorsement on\nchecks payable to providers. In New Jersey, both the Provider Electronic Billing Agreement for Providers With\nBilling Agents and the Medicaid Health Insurance Portability and Accountability Act Electronic Data Interchange\nAgreement include such certifications.\n11\n The total exceeds 32 because 2 claims contain more than 1 deficiency.\n\n\n\n 6\n\x0cFor 24 of the 100 claims in our sample, the school-based health provider could not provide\nreferrals or prescriptions to support the related service. Specifically, 21 speech therapy services,\n6 occupational therapy services, and 1 physical therapy service did not meet Federal referral and\nprescription requirements; 3 nursing services did not meet State prescription requirements. 12\n\nFEDERAL PROVIDER REQUIREMENTS NOT MET\n\nFederal regulations (42 CFR \xc2\xa7 440.110) set forth provider credential requirements for physical,\noccupational, and speech therapy services. For 14 of the 100 claims in our sample, the speech\ntherapy or occupational therapy practitioner associated with the claim did not meet these\nregulations.\n\nSpeech Therapy Provider Requirements Not Met\n\nPursuant to 42 CFR \xc2\xa7 440.110(c)(2), for a speech therapy claim to be eligible for Medicaid\nreimbursement, it must be provided by or under the direction of a speech pathologist who: (1) is\ncertified by ASHA or (2) has completed the equivalent educational requirements and work\nexperience necessary to be eligible for ASHA\xe2\x80\x99s certificate of clinical competence or (3) has\ncompleted the academic program and is in the process of acquiring the necessary work\nexperience to qualify for the certificate.\n\nIn a December 28, 1993, letter, CMS asked New Jersey officials to provide assurance that speech\ntherapy providers would meet the qualifications detailed in 42 CFR \xc2\xa7 440.110(c)(2). In an\nAugust 1, 1995, letter, New Jersey assured CMS that it would bill Medicaid for only those\nservices provided by or under the direction of qualified speech-language practitioners.\n\nHowever, for 13 of the 100 claims in our sample, the practitioner who provided the speech\ntherapy service was not ASHA-certified or did not have the equivalent educational requirements\nand work experience necessary to be eligible for ASHA certification.\n\nASHA requires all applicants for certification in speech language pathology to possess a master\xe2\x80\x99s\nor doctoral degree granted by a regionally accredited institution of higher education and have\ncompleted a minimum of 75 semester credit hours in a course of study addressing the knowledge\nand skills pertinent to the field of speech-language pathology. Additionally, applicants must\ncomplete a 350-hour clinical practicum under the supervision of an individual who holds a\ncertificate of clinical competence and a 36-week, full-time fellowship.\n\nNone of the practitioners associated with the 13 claims in our sample met these requirements.\nThe practitioners that provided the services were authorized by the New Jersey DOE to serve in\npublic schools as either a speech correctionist or a speech language specialist. The DOE does\nnot require specific coursework towards a master\xe2\x80\x99s degree, a 350-hour clinical practicum, or a\nclinical fellowship.\n\n\n12\n The total exceeds 24 because multiple related school-based health services were provided and billed on the same\nmonthly claim.\n\n\n\n 7\n\x0cFinally, for the 13 sample claims in question, the school-based providers did not furnish any\ndocumentation showing that the services provided met the \xe2\x80\x9cunder the direction of\xe2\x80\x9d requirements.\nPursuant to 42 CFR \xc2\xa7 440.110(c) and Medicaid State Operations Letter 95-12, issued on\nFebruary 9, 1995, \xe2\x80\x9cunder the direction of a speech pathologist\xe2\x80\x9d means that the speech pathologist\nis individually involved with the patient under his or her direction and accepts ultimate\nresponsibility for the actions of the personnel that he or she agrees to direct.\n\nOccupational Therapy Provider Requirements Not Met\n\nPursuant to 42 CFR \xc2\xa7 440.110(b)(2), for an occupational therapy claim to be eligible for\nMedicaid reimbursement, the occupational therapist providing the service must be registered by\nthe American Occupational Therapy Association (AOTA) or be a graduate of a program in\noccupational therapy approved by the Committee on Allied Health Education and Accreditation\nof the American Medical Association and engaged in the supplemental clinical experience\nrequired before registration by AOTA. For 1 of the 100 claims in our sample, the individual who\nprovided the occupational therapy service did not meet these provider requirements. The school-\nbased health services were provided by an occupational therapist assistant and the provider did\nnot provide any documentation showing that the services were \xe2\x80\x9cunder the direction of\xe2\x80\x9d a licensed\noccupational therapist.\n\nSERVICES NOT DOCUMENTED IN CHILD\xe2\x80\x99S PLAN\n\nSection 1903(c) of the Act permits Medicaid payment for medical services provided to children\nunder IDEA if the services are included in a child\xe2\x80\x99s plan. Pursuant to Part B of IDEA, school\ndistricts must prepare a child\xe2\x80\x99s plan for each child that specifies all special education and related\nservices that the child needs. New Jersey\xe2\x80\x99s State Medicaid plan provides that a child\xe2\x80\x99s plan must\nstate which related services are to be provided. For 8 of the 100 claims in our sample, the related\nschool-based health or transportation service was not documented in the child\xe2\x80\x99s plan.\nSpecifically, for five claims, the associated school could not produce the child\xe2\x80\x99s plan, and for\nthree claims, the child\xe2\x80\x99s plan did not document the services billed.13\n\nCAUSES OF THE IMPROPER CLAIMS\n\nAlthough the frequency at which New Jersey improperly claimed school-based health services\nfor Medicaid reimbursement decreased from our prior audit (A-02-03-01003), our review found\ndeficiencies similar to those previously reported. 14 We found three main causes of the\nunallowable claims.\n\n\n\n\n13\n School officials indicated that the child\xe2\x80\x99s plan associated with each of the five sampled claims may have followed\nthe child to another school. The school officials contacted schools where each child\xe2\x80\x99s plan may have been sent but\nwere unable to produce the child\xe2\x80\x99s plan associated with each of these claims.\n14\n The number of claims in error decreased from 109 out of 150 sampled claims to 51 out of 100 sampled claims.\n\n\n\n 8\n\x0cNew Jersey Issued Improper Guidance Regarding Provider Requirements\n\nSome of the improper claims occurred because New Jersey issued guidance to school-based\nhealth providers that did not adequately explain Federal provider requirements. For example,\nNew Jersey\xe2\x80\x99s guidance did not indicate that, per Federal regulations, speech and occupational\ntherapy services require referrals.\n\nProviders Did Not Comply With Federal Requirements\n\nSome of the improper claims occurred because school-based health providers did not comply\nwith Federal requirements. The State handbook specifies that school-based health providers\nmust maintain records per Federal requirements that document a related service or an evaluation\nservice was provided on a specific date. However, some providers did not maintain this\ndocumentation. As a result, we were unable to verify that services billed were actually provided.\n\nNew Jersey Did Not Adequately Monitor School-Based Health Claims\n\nBased on our review, we determined that monitoring by Maximus was not effective and that\nNew Jersey did not adequately monitor school-based health claims to ensure compliance with\nprogram requirements by providers and Maximus. From January 2003 through the end of its\ncontract with New Jersey, Maximus conducted 40 monitoring visits. We reviewed\ndocumentation from these monitoring visits and detected deficiencies similar to those that we\nfound in our audit.\n\nRECOMMENDATIONS\n\nWe recommend that New Jersey:\n\n \xef\x82\xb7 refund $8,079,312 to the Federal Government,\n\n \xef\x82\xb7 provide proper and timely guidance on Federal Medicaid criteria to its school-based\n health providers, and\n\n \xef\x82\xb7 improve its monitoring of school-based health providers\xe2\x80\x99 claims to ensure compliance\n with Federal and State requirements.\n\nNEW JERSEY COMMENTS AND OFFICE OF INSPECTOR GENERAL RESPONSE\n\nIn its comments on our draft report, New Jersey disagreed with our recommended refund. In\naddition, New Jersey questioned our sampling methodology and disagreed with what we\naccepted as valid referrals. However, New Jersey also described corrective actions that it\nplanned to take in response to the remaining recommendations.\n\nNew Jersey also provided additional documentation for five claims we questioned in our draft\nreport. After reviewing this documentation, we determined that some services for the five claims\ncomplied with Federal and State requirements and revised our findings and recommended refund\n\n\n 9\n\x0caccordingly. We have summarized New Jersey\xe2\x80\x99s comments, along with our response, below,\nand we have included those comments in their entirety as Appendix D.\n\nSampling Methodology\n\nNew Jersey Comments\n\nNew Jersey questioned our sampling methodology used to determine the estimate for the\noverpayment associated with unallowable claims for school-based health services and said that it\nresulted in inaccurate findings and recommendations. New Jersey stated that our sample size did\nnot appear large enough for an accurate estimate of overpayments. New Jersey also said that our\nsample should have been stratified based on the type of service and the beneficiary\xe2\x80\x99s medical\ncondition (i.e., type of disability).\n\nOffice of Inspector General Response\n\nWe followed our longstanding statistical sampling policies with regard to both sample size and\nstratification. The Departmental Appeals Board (Board) has supported the Office of Inspector\nGeneral\xe2\x80\x99s (OIG) use of statistical sampling to calculate disallowances in accordance with these\npolicies. Specifically, in one case involving the OIG\xe2\x80\x99s use of statistical sampling, the Board\nstated that \xe2\x80\x9cSince the individual case determinations were voluminous, the auditors used\nstatistical sampling techniques in lieu of examining all records to establish the amount of the\ndisallowance, an approach upheld in principle by courts and this Board before.\xe2\x80\x9d 15\n\nReferrals\n\nNew Jersey Comments\n\nNew Jersey stated that it did \xe2\x80\x9cnot concur with the auditor\xe2\x80\x99s interpretation of acceptable referral\ndocumentation\xe2\x80\x9d for two sample claims (S1-4 and S1-10) and provided documentation related to\nthe claims. New Jersey said that there is no \xe2\x80\x9cdefinitive guidance\xe2\x80\x9d as to how long a referral is\nvalid to support services. In addition, New Jersey stated that, for three sample claims (S1-28,\nS2-15, and S2-29), the individual who referred the speech therapy services was certified by\nASHA but was not licensed by the State\xe2\x80\x99s licensing body. New Jersey stated that, because\nASHA-certified individuals can provide speech therapy services, referrals for speech therapy\nservices by ASHA-certified individuals should be allowed.\n\nOffice of Inspector General Response\n\nWe agree that there is no guidance regarding how long a referral is valid to separate services.\nTherefore, we accepted claims that we questioned in our draft report related to this issue and\nhave revised our findings, recommended refund, and Appendix C accordingly. However, we\n\n15\n California Department of Social Services, DAB No. 816 (1986); see also Maine Dept. of Health and Human\nServices, DAB No. 2292 (2009); New York State Office of Children and Family Services, DAB No. 1984 (2005);\nCalifornia Department of Social Services, DAB No. 524 (1984); Ohio Department of Public Welfare, DAB No. 226\n(1981); and precedents cited therein.\n\n\n 10\n\x0cdisagree with New Jersey\xe2\x80\x99s statement that an unlicensed individual can refer services. Pursuant\nto 42 CFR \xc2\xa7 440.110 (a)(b)(c), a referral or prescription from a physician or another licensed\npractitioner of the healing arts is required for physical therapy; occupational therapy; and\nservices for individuals with speech, hearing, and language disorders.\n\nAdditional Documentation\n\nNew Jersey Comments\n\nNew Jersey provided additional documentation for 3 of the 53 claims (S1-27, S2-32, and S2-45)\nquestioned in our draft report.\n\nOffice of Inspector General Response\n\nWe reviewed the documentation that New Jersey provided for the three claims and accepted\nsome services based on the documentation. Specifically, we accepted some services that we\npreviously questioned because of referral issues; however, we continue to question services\nrelated to these claims that still did not meet referral, provider, or documentation requirements.\nWe have revised our findings, recommended refund, and Appendix C accordingly.\n\nAttendance\n\nNew Jersey Comments\n\nNew Jersey stated that, for one sample claim (S2-39), there was service documentation in place\nalthough attendance data for the corresponding student did not match. New Jersey indicated that\nthere are multiple reasons that attendance may be in error and that \xe2\x80\x9cvalid service documentation\ndata\xe2\x80\x9d should be accepted as proof of service delivery.\n\nOffice of Inspector General Response\n\nStudents must be in attendance on a given day to receive school-based health services on that\nday. To determine if a student was in attendance on the date of a sampled service, we reviewed\nthe school register to determine if school was in session and the student was marked present. We\nthen compared the school\xe2\x80\x99s attendance record to the SEMI service record. For sample claim\nS2-39, the school register indicated that the student was absent from school. Therefore, we did\nnot accept the billed SEMI service for this claim.\n\n\n\n\n 11\n\x0cAPPENDIXES\n\x0c Page 1 of 2\n\n\n APPENDIX A: SAMPLE DESIGN AND METHODOLOGY\n\nPOPULATION\n\nThe population was Medicaid claims for school-based services provided by school-based health\nproviders in New Jersey that were submitted for Federal Medicaid reimbursement by Maximus,\nInc. (Maximus). The claims were for service dates from July 1, 1998, through January 31, 2005,\nwith payment dates from July 27, 2003, through October 4, 2006 (our audit period).\n\nSAMPLING FRAME\n\nThe sampling frame was a computer file containing 86,533 student-months representing all\nclaims for school-based services provided by school-based health providers in New Jersey with\npayment dates from July 27, 2003, through October 4, 2006. The total Medicaid paid amount for\nthe 86,533 student-months was $62,563,888 ($32,223,604 Federal share). State officials\nextracted the database from the paid claims files maintained at the Medicaid Management\nInformation System fiscal agent.\n\nSAMPLE UNIT\n\nThe sample unit was an individual student-month. Each sampling unit represents all services\nprovided to an individual student for a month during our audit period that were billed for Federal\nMedicaid reimbursement by Maximus.\n\nSAMPLE DESIGN\n\nWe used stratified random sampling to evaluate the population of Medicaid school-based claims.\nTo accomplish this, we separated the sampling frame into two strata:\n\n - Stratum 1\xe2\x80\x94less than $1,400.00: 70,445 student-months\n\n - Stratum 2\xe2\x80\x94equal to or greater than $1,400.00: 16,088 student-months\n\nSAMPLE SIZE\n\nWe selected a sample of 100 student-month claims with 50 items from each stratum.\n\nSOURCE OF THE RANDOM NUMBERS\n\nWe used the Office of Inspector General, Office of Audit Services\xe2\x80\x99 statistical software, RAT-\nSTATS, to generate the random numbers.\n\x0c Page 2 of 2\n\n\nMETHOD OF SELECTING SAMPLE ITEMS\n\nWe sequentially numbered the student-months in each stratum. After generating 50 random\nnumbers for each stratum, we selected the corresponding frame items. We then created a list of\nthe 100 sample items.\n\nESTIMATION METHODOLOGY\n\nWe used RAT-STATS to calculate our estimates. We used the lower limit of the 90-percent\nconfidence interval to estimate the overpayment associated with the unallowable claims.\n\x0c APPENDIX B: SAMPLE RESULTS AND ESTIMATES\n\n Sample Details and Results\n Value of Value of Value of\n Frame Sample Unallowable\nStratum Claims in (Federal Sample (Federal Unallowable Claims\nNumber Frame Share) Size Share) Claims (Federal Share)\n 1 70,445 $16,332,459 50 $11,202 26 $4,577\n 2 16,088 $15,891,145 50 $50,881 25 $12,966\n\n Total 86,533 $32,223,604 100 $62,083 51 $17,542 1\n\n\n\n Estimated Overpayment Associated with the Unallowable Claims\n (Limits Calculated for a 90-Percent Confidence Interval)\n\n Point Estimate $10,619,719\n Lower Limit $8,079,312\n Upper Limit $13,160,126\n\n\n\n\n 1\n The dollar amounts do not add due to rounding.\n\x0c Page 1 of 3\n\n\n APPENDIX C: SUMMARY OF DEFICIENCIES FOR EACH SAMPLED CLAIM\n\n Legend\n1 Referral or prescription requirements not met\n2 Federal provider requirements not met\n3 Services not provided or not supported\n4 Services not documented in child\xe2\x80\x99s plan\n\n Office of Inspector General Review Determinations on the 100 Sampled Claims\n\n Deficiency Deficiency Deficiency Deficiency No. of\n Claim No. 1 2 3 4 Deficiencies\n S1-1 0\n S1-2 X 1\n S1-3 X 1\n S1-4 0\n S1-5 X 1\n S1-6 X X 2\n S1-7 0\n S1-8 X 1\n S1-9 0\n S1-10 0\n S1-11 0\n S1-12 0\n S1-13 0\n S1-14 0\n S1-15 X 1\n S1-16 X X 2\n S1-17 X X 2\n S1-18 0\n S1-19 0\n S1-20 0\n S1-21 0\n S1-22 X X 2\n S1-23 X 1\n S1-24 X 1\n S1-25 X 1\n S1-26 X X X 3\n S1-27 X X 2\n S1-28 X 1\n S1-29 X X 2\n S1-30 0\n S1-31 X X 2\n S1-32 0\n S1-33 X 1\n\x0c Page 2 of 3\n\n Deficiency Deficiency Deficiency Deficiency No. of\nClaim No. 1 2 3 4 Deficiencies\n S1-34 0\n S1-35 X 1\n S1-36 0\n S1-37 0\n S1-38 0\n S1-39 X X 2\n S1-40 X X 2\n S1-41 0\n S1-42 X X X 3\n S1-43 0\n S1-44 0\n S1-45 X 1\n S1-46 X X 2\n S1-47 0\n S1-48 0\n S1-49 X X X 3\n S1-50 X 1\n S2-1 0\n S2-2 0\n S2-3 0\n S2-4 X 1\n S2-5 0\n S2-6 X 1\n S2-7 X 1\n S2-8 X 1\n S2-9 X 1\n S2-10 X 1\n S2-11 0\n S2-12 0\n S2-13 0\n S2-14 X 1\n S2-15 X 1\n S2-16 0\n S2-17 0\n S2-18 X X X 3\n S2-19 X X X 3\n S2-20 0\n S2-21 0\n S2-22 0\n S2-23 0\n S2-24 0\n S2-25 0\n\x0c Page 3 of 3\n\n Deficiency Deficiency Deficiency Deficiency No. of\nClaim No. 1 2 3 4 Deficiencies\n S2-26 0\n S2-27 0\n S2-28 0\n S2-29 X 1\n S2-30 0\n S2-31 0\n S2-32 X 1\n S2-33 0\n S2-34 X 1\n S2-35 X 1\n S2-36 X 1\n S2-37 X 1\n S2-38 X 1\n S2-39 X X X 3\n S2-40 X X X 3\n S2-41 X 1\n S2-42 0\n S2-43 X 1\n S2-44 0\n S2-45 X X 2\n S2-46 X X X 3\n S2-47 0\n S2-48 0\n S2-49 X 1\n S2-50 X 1\nCategory\n Totals 24 14 32 8 78\n51 claims in error\n\x0c Page l of6\n\n\n APPENDIX D: NEW JERSEY COMMENTS \n\n\n\n\n\n II1aU of PI"" ,Jns,g\n D EPAJnM&IT OF H UMAN SEltVICES\n D IVISION OF MEDICAL AssiSTANCE AND HEAL11i SERVICES \n\n PO Box 712 \n\n T..EN\'ltlJf HI 08625-07 12 \n\n TEtB\'HONi! 1-800-356-1561 \n\n August 27, 2009\n\n\nJames P. Edert\nRegional Inspector General for Audit Services\nDepartment of Health and Human Services\nOffICe of Inspector Genet\'al\nOffICe of Audit Services Region II\nJacob K. Javits Federal Building - Room 3900\nNew Yorl!;, NY 10278\n\nReport Number A-02-07-01051\n\nDear Mr. Edert:\n\nT hiS Is in response to your tetter dated May 14, 2009 concerning the Department of Health and Human\nServices, OffICe of the Inspector General\'s (OIG) draft report entitled \xc2\xb7Review of New Jersey\'s Medicaid\nSchool-Based Health Claims Submitted By Maxlmus, Inc." Your letter provides the opportunity to\ncomment on this draft report.\n\nThe objective of this review was to determine whether New Jersey\'s Medicaid school-based health claims\nsubmitted by its billing agent, Maximus, complied with Federal and Stale requirements. The review\nperiod was July 27, 2003 through October 4, 2006.\n\nThe draft audit report concJuded thai New Jersey\'s dalms for reimbursement of Medicaid schoc)I.based\nhealth seMceS submitted by Maximus did nol fully oomply with Federal and Slate requirements. WhHe 47\nof the 100 school-based health claims in !he sample fully complied with an Federal and State\nrequirements, the remaining 53 did not meet one or more of the applicable requirements , The report\nindicates that the non-compliance Issues were manifested in four types of deficiencies: services wel\'e not\nprovided or not suppol1ed; referral or prescription requirements were not met: federal provider\nrequirements were not met; and services were not documented in child\'s plan. The report states tha t the\ndefICiencies occurred because: the State provided iTlproper or untimely guidance concerning Federal\nMedicaid requirements to school-based health providers; school-based health providers did not comply\nwith State gYidance related to Federal requirements: and the Stale did not adequately monitor schooI\xc2\xad\nbased health claims from providers fOf compliance ....i th Federal and State requirements. Based on the\nsample results, t!\'le auditOf estimated that New JefSey was improperly reimbursed $8,849,949 In Federal\nMedicaid funds during the July 27, 2003, through October 4. 2006, audit period.\n\nFollowing are lhe auditors\' recommendations and the DivIsion of Medical AsSistance and Health SeMces\n(OHMAS) responses:\n\nI. RECOMMENDATION:\n\nNew Jersey should refund $8,849,949 to the Federal Government\n\x0c Page 20f6\n\n\n\n\nJames P Edetl\nAugust 27, 2009\nPage 2\n\n\n\n RESPONSE:\n\nThe State does not concur with this recommendation. Based on the analysis outlined below performed\nwith the assistance of.a statisllc!an, it appears the sampling methodology used by the audllOf provided\nInaccurate findings and recommendations.\n\n\n ::\';~~~;W\'!;\'i\'!~~~Ii\'," in order 10 accurately estimate some characteristic of the\nt~~~~;~~5:~; necessary to I population.\' This definition of a population fOf a particular\n~ sampling frame. Individual elements and units within the sampling frame are selected\n various kinds of sampling proce<iUfes.\n\nThe selection of random samples is the preferred method for studies in which population characteristics\nare esUmated based on sample because random sampling leads to extremely accurate estimates when\nthe sampling procedures are appropriate fOf what we know (or can assume) about the characteristics of\nthe total populaUon. Random samples can be selected by simple random sampling or by stratified random\nsampling. Simple random sampling leads to accurate results if we know Of can assume thaI the\npopulation Is relatively homogenous with respect to the questions of interest. For instance, a sample of\nstudent-months representing the rate of non-eompliance of all Medicaid school-based health dalms\nsubmitted for one type of service fOf individuals within one type of disability cat8gOl"y selected by simple\nrandom sampling may be extremely accurate for estlmating the overall rate of non-compliance.\n\nIf known or assumed, however, that the population Is heterogeneous with respect to the questions of\ninlerest so that the findings are likely to differ substantially within subgroups of the population, the validity\nof the estimates of population characteristics is greatly improved by stratified random sampling. Stratified\nrandom sampling ensures that the proportion of Individual units w;thin each subgroup of the sample\nmatches the proportion of individual units within each subgroup of the total population and thus the\ncombined estimates derived from subgroups within the sample represent the characteristics of the total\npopulation accurately.\n\nMedicaid daims for school-based services in New Jersey include a broad array of different types of\nservices. The services for which school-based health claims are submitted indude:\n\n1. Rel"labililative services-occupatlonal, physical, and speech-language therapies; psychological\ncounseling and psychotherapy; and nursing;\n2. Evaluation services Identifying the need for SpecifIC services and presCfiDing the range and frequency\nof services that the student requires which may include reevaluation Of review of the current services\nspecifl8d In the chHd\'s plan; and\n3. Specialized transportation s9fVices In a vehicle adapted to S9fVe the needs of the disabled, inciudif"IQ\nspecially adapted school buses, when provided on the same day as a related service and when\ntransportation is included in the child\'s plan.\n\nEach subgroup of services is quite likely to differ substantially in ways that may impact overall estimates\nof noncompliant claims fOf the entire population of school-based health daims. In addiUon to the cost of\nservices, the proportion of daims submitted varies by type of service. The proportion of daims submitted\nas well as the extent to which multiple claims are submrtled for services provided across all three majO!"\ntypes of services differs substantially by disability group as well with some lower-Incidence disability\ngroups accounting for a relatlvely high proportion of claims. Since H Is likely that types of noncompliance-\xc2\xad\nservices not provided or supported, services lacking a referral Of prescription, sel"Vices meeting Federal\nprovider qualification requirements, and services not documented in the child\'s plan- afe also correlated\nwith the type of services provided, any estimation procedure based on a sampling frame that does not\n\n, McBurney, D. H., & White, T. L (201)7). Re5earch M ethat/5. Thomson Wadswortll, Belmont, CA.\n\x0c Page30f6\n\n\n\n\nJames P Edert\nAugust 27, 2009\nPage 3\n\n\n\nlake these factors Into account In estimatiog the Incidence of noncompliant claims overall will not be\naccurate.\n\nThe sampling frame for the estimates of noncompliance reported In the draft report is described as \' a\ncomputer fde contalnlog 86,533 student-months representing all claims provided by schooI-based health\nproviders in New Jetsey wfth payment dates from July 27, 2003, through October 4, 2006: The sample\nunit was an Individual student\xc2\xb7month representing all services provided to an Individual st\\ldenl for a\nmonth during the audil period that were billed for Federal Medicaid reimbursement by Maximu s.\n\nDespite the heterogeneity of types of claims filed and likely correlations among types of claims and types\nof claim deficiencies and disability groups, the only variable used to define the sampling frame for the\naudit was the level of relmbtJrsement. The population of student-months Identifted for the audit was\nstratifted in this way.\n\nTable 1. GIG sample results and estimates\n\n\nNom"" (Fedefal Share) Size\n\n\n\n\nThis sampling frame does not accurately estimate noncompliant claims because key factors likely to be\nhighly correlated with noncompliance estimates such as type of servloe-rehabilitation, evaluation, and\ntransportation-and disability groups are not taken into account along with the dollar amount of the claims.\n\nEven this analysis does not accurately reflect the characteristics of the defined strata as shown by the\nlable below. The purpose of defining a sampling frame Is to take the proportionality of the subgroups in\nthe sample and population into account In deriving the population estmates. As shown in Table 2, this\nwas not done for this analysis. The total value of claims in Stratum 1 was 51\'" of the lotal. In the sample,\nhowever, the value of claims for Stratum 1 was only 18 "" of the total value. The sample thaI was drawn\ndoes not accurately reflect the relative value of claims in each stratum.\n\nTable 2. OIG sample results and estimates with population and sample percentages\n\n I\n Claims\n\n\n\n\nT11e draft report Is silent as 10 the JustifICation for setecting a sample size of only 50 sludent-monlh claim s\nfrom a stratum with a total of 70.445 student-months and a sample size of only 50 siu<lent-month claims\nfrom a stratum with a total of 16,088 student-months for a lotal of only 100 student\xc2\xb7month daims from a\ntotal of 86,533 studenl-month claims. These samples do not appear large enough for an accurate\nestimate of overpayment for unallowable school-based Medicaid dalms In New Jersey. As discussed in\nthe analysis of the sampling methodology, there Is a great deal of variance in types of claims filed and the\namount of those claims. When II Is known thai population characteristics vary greaUy, It Is usual for\n\x0c Page 4of6\n\n\n\n\nJames P Edert\nAugust 27, 2009\nPage 4\n\n\n\nresearchers studying that characteristic to setect fairly targe samples in order to obtain valid estimates of\nthe population characteristic. Given the broad range of types of and amounts of claims, il does not appear\nthat the results found for this very small sample of claims generalize aCfOSS the entire population of\nschool-based Medicaid ctaims in New Jetsey during the period under investigation.\n\nThe sampling frame chosen for this Investigation does not seem adequate to provide a valid estimate of\nthe amount of overpayment associated with unallowable claims for schoot-based Medicaid services In\nNew Jersey. The sampling frame chosen fails to account for many key variables such as type of service\nand type of disability served likely to be correlated with both the value of claims and types of defICIencies\nin claims. In addition, given the known variance across types of claims and the amount of claims across\nthe state, the sample sizes chosen were too small to justify generalil:8tion of the resolts to the en1ire\npopulation of claims in the state.\n\nA nalysIs of Citations for no R.,.".\'\nThe State does not concur with the auditor\'s interpretation of acceptable referral documentation. The\naudit results cited instances where a sludent\'s referral was determined to be outdated. There is no\ndefinitive ~idance as to how long a referral from a qualified physician or licensed practitioner is valid to\nsupport serviCes, as per the federal Medicaid guidelines at 42 CFR\xc2\xa7 440.110(c). The New Jersey State\nPlan does not have any limitations on the dates for referrals, arid does not contradict CMS regulations.\nTherefore, citations 1-4 and 1-10 where a referral was found on file but was deemed to be out of date\nshould be reconsidered and discounted from the findings. For citation 1-4, the OIG was provided a copy\nof the referral lor the four (4) ST services with a total FFP of $75.42: and for citation 1-10, the OIG was\nprovided a copy of the referral(s) for the two (2) OT and two (2) PT services with a total federal financia l\nparticipation (FFP) of $102.46.\n\nAdditionally, some of the citations, specifICally 1-28, 2-15 and 2-29, are related to speech referrals that\nwere made by Individuals having the ASHA certification and not a NJ state license. While we agree thai\nthe provider of the refen-al did no! have the NJ license, we believe that the federal standard is to accept\nthe ASHA certifICation for speech therapy. Therefore those referrals should be deemed In compliance.\nF01 citation 1\xc2\xb728 there are six (5) ST services with a total FFP of $163.21 that we believe shoutd be\nallowed; for citatioo 2-15 there are five (5) ST services with a total FFP of $4G6.03that we believe should\nbe allowed; and fOf citation 2-29 there are seven (7) ST services with a total FFP of $175.96 that we\nbelieve should be allowed.\n\nIn addition, the audit results did not Indicate what serves as acceptabte documentation of a referral for\nservices. In some cases, the IEP was indicated as being the source of referral. However, there is no\nindication of other documentatloo that was accepted by lhe team. For the purposes of this audit, further\nguidance should be given to the State as to what documentation Is acceptable fOf the puf?OSes of\nsubstantiating a referral fOf services. The districts should then be allowed additional time to produce the\ndocumentation requested. Until further guidance can be provided, the fifteen ctaims cited strictly fOf a\nlack of referral should be put aside arid discounted Irom Ihe findings, for a lotal FFP of $377.10. Citation\nnumbers for this issue Include 1-2 and 1-25.\n\n\n Ii i i\n\n that \n\n\n Three (3) OT services for citation 1-27 - total FFP is $75.82\n Fifteen (15) ST services lor citation 2-32 - tolal FFP is $1 ,224.08\n\xe2\x80\xa2 \t Six (6) PT services fOf citation 2-32 - total FFP is $244.62 (3 PT overlaps with 15 ST)\n Three (3) PT services for citation 2-45 - total FFP is $244.82\n\x0c Page 50f6\n\n\n\n\nJames P Edert\nAugust 27, 2OO9\nPage 5\n\n\n\n Att,ndan"\nIn Citation 2-39 there was service cioctJmentation tn place, but the attendance data did not match, per the\nauditor. It seems the service documentation should take precedence, and that this is a valid claim . There\nare muttiple reasons that attendance data may be in error, Including attendance policy discrepancies and\nsystem and logistical challenges in collecting and maintaining attendance data. Valid service\ndocumentation data should be accepted as proof of service delivery. Therefore, we believe that the 1\ncounsel ing sefVice with a total FFP of $81 .81 should be allowed.\n\nII. RECOMMENDATION:\n\nNew Jersey should provide proper and timely guidance on Federal Medicaid criteria to its school-based\nhealth providers.\n\n RESPONSE:\n\nNew Jersey has taken a number of steps to provide guidance to the school districts. Several staff are\ndevoted to administering the project, including coordination of relevant State agency efforts and\ncommunication to school districts. This includes an updated provider manual, a reference website, and\ntraining sessions. Since the lime period of this audit, New Jersey has taken additional steps Il"lcluding:\n\n \xe2\x80\xa2 The State Issued a competitive bid process and In 2005 hired a new vendor to administer the project.\nTogether we have updated the Handbook \'Ntllch now Includes citations to both Federal and State\nguidelines.\n \xe2\x80\xa2 Training sessions are done both regionally and on a on&-on-one basis with distriCt admlnistfators.\n Regional meetings are held twice e year and ace well attended by districts. The vendor is required to\nCOVel" the regulatiOfls of the program at these meetings.\n\xe2\x80\xa2 In addition, each district subm itting claims has partiCipated In an administrator training with the\nvendor, where the regulations are covered directly with the district.\n\xe2\x80\xa2 The State updated the reference website to now Include the Provider Handbook, as well as other\npolicy documents that explicitly state how 10 conectly Implement the program.\n\xe2\x80\xa2 The vendor has provided a loll free number and an online message board for districts to access.\n.. T he State implemented an electronic tool for school districts to use to docum8flt health related\nserviCes and implemented mandatory compliance checks where districts provide additional data before\nclaims are processed.\n\nIII. RECOMMENDATION:\n\nNew Jersey should Improve its monitoring of school-baSed health providers\' claims to ensure compliance\nwith Federal and State requirements .\n\n RESPONSE:\n\nNew Jersey has improve<! its monitoring of the school-based health providers. The current vendor has\nimplemented stronger post claiming quality assurance procedures, which Includes a yearty OIl-site\nmonitoring of a sample set of districts provided by the Stale. Any lapses In compliance are expliciUy\nstated to the district with suggestions on how to align their internal processes to match Federal and State\nregulations . Claims Ihat do not comply with Federal and State requirements are appropriately adjusted.\n\x0c Page 60f6\n\n\n\n\nJames P Edert\nAugust 27, 2009\nPage 6\n\n\n\nThe professionalism and courtesy of !he auditors throughout this audit Is noteworthy and greatly\nappreciated. The opportunity 10 review and comment on this draft audit report is also greatly appreciated.\nIf you have any questions Of require additionallnfOfmatlon, please contacl me or David Lowenthal at 6(}9.\n588-7933.\n\n\n\n A-.t\n\n 1::"~\n DlrectQ(\n\nJRG:L\nc: \t Jennifer Velez\n David Lowenthal\n\x0c'


text:
Sólyom László köztársasági elnök mandátuma 2010. augusztus 5-én lejár. Államfőnk - Alkotmányunk alapján - egy alkalommal újraválasztható. De vajon újraválasztják? - Az Országgyűlés elnöke június 29-ére írta ki a köztársaságielnök-választást.
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 Személyi kérdésekről, a bíróságok informatikai jellegű feladatairól - Összefoglaló az OIT június 1-jei üléséről
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 Nyilvános adat a rektorok fizetése - Precedens értékű ítélet a Fővárosi Ítélőtáblán
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 Roma diákok iskolai elkülönítése miatt kártérítést ítélt meg az LB


type: caselaw

jurisdiction: EU

text:
 4.8.2007
 FR
 Journal officiel de l'Union européenne
 C 183/24
 Recours introduit le 12 juin 2007 — Commission des Communautés européennes/République portugaise
 (Affaire C-284/07)
 (2007/C 183/43)
 Langue de procédure: le portugais
 Parties
 Partie requérante: Commission des Communautés européennes (représentants: A. Caeiros et D. Kukovec, agents)
 Partie défenderesse: République portugaise
 Conclusions de la partie requérante
 —
 constater que, en n'adoptant pas les dispositions législatives, réglementaires et administratives nécessaires pour se conformer à la directive 2005/51/CE (1) de la Commission, du 7 septembre 2005, modifiant l'annexe XX de la directive 2004/17/CE et l'annexe VIII de la directive 2004/18/CE du Parlement européen et du Conseil sur les marchés publics, la République portugaise a manqué aux obligations qui lui incombent en vertu de l'article 3, premier alinéa, de la directive 2005/51/CE précitée;
 —
 subsidiairement, constater que, en tout état de cause, en ne communiquant pas à la Commission les dispositions ainsi adoptées, la République portugaise a manqué aux obligations qui lui incombent en vertu des dispositions précitées;
 —
 condamner la République portugaise aux dépens.
 Moyens et principaux arguments
 Le délai de transposition de la directive a expiré le 31 janvier 2006.
 (1) JO L 257, p. 127.


text:
 25.8.2014
 ET
 Euroopa Liidu Teataja
 C 282/13
 Euroopa Kohtu (viies koda) 12. juuni 2014. aasta otsus (Lietuvos vyriausiasis administracinis teismas – Leedu eelotsusetaotlus) – Užsienio reikalų ministerija, Finansinių nusikaltimų tyrimo tarnyba versus Vladimir Peftiev, BelTechExport ZAO, Sport-pari ZAO, BT Telecommunications PUE
 (Kohtuasi C-314/13) (1)
 ((Eelotsusetaotlus - Ühine välis- ja julgeolekupoliitika - Valgevene vastu võetud piiravad meetmed - Rahaliste vahendite ja majandusressursside külmutamine - Erandid - Õigusabiteenuste osutamisega seotud tasud - Liikmesriigi pädeva asutuse kaalutlusõigus - Õigus tõhusale kohtulikule kaitsele - Rahaliste vahendite ebaseaduslik päritolu - Puudumine))
 2014/C 282/18
 Kohtumenetluse keel: leedu
 Eelotsusetaotluse esitanud kohus
 Lietuvos vyriausiasis administracinis teismas
 Põhikohtuasja pooled
 Hagejad: Užsienio reikalų ministerija, Finansinių nusikaltimų tyrimo tarnyba
 Kostjad: Vladimir Peftiev, BelTechExport ZAO, Sport-pari ZAO, BT Telecommunications PUE
 Resolutsioon
 1.
 Nõukogu 18. mai 2006. aasta määruse (EÜ) nr 765/2006, milles käsitletakse piiravaid meetmeid Valgevene suhtes, muudetud nõukogu 31. jaanuari 2011. aasta rakendusmäärusega (EL) nr 84/2011 ja nõukogu 20. juuni 2011. aasta määrusega (EL) nr 588/2011, artikli 3 lõike 1 punkti b tuleb tõlgendada nii, et juhul kui liikmesriigi pädev asutus teeb otsuse erandi kohaldamise taotluse kohta, mis on esitatud selle sätte alusel eesmärgiga esitada hagi, mille ese on vaidlustada Euroopa Liidu kehtestatud piiravad meetmed, siis ei ole tal absoluutne kaalutlusõigus, vaid ta peab oma pädevust kasutades austada Euroopa Liidu põhiõiguste harta artikli 47 teise lõigu teises lauses ette nähtud õigusi ning seda, et sellise hagi esitamisel Euroopa Liidu Üldkohtule on esindamine advokaadi poolt kohustuslik.
 Liikmesriigi pädeval asutusel on õigus kontrollida, et rahalised vahendid, mille vabastamist taotletakse, on ette nähtud üksnes õigusabiteenuste osutamisega seotud mõistlike tasude maksmiseks ja nendest teenustest tulenevate kulude hüvitamiseks. Ta võib kehtestada ka tingimusi, mida ta peab vajalikuks, et tagada eelkõige, et ei eirata ettenähtud sanktsiooni eesmärki ega kuritarvitata lubatud erandit.
 2.
 Määruse nr 765/2006, muudetud rakendusmäärusega nr 84/2011 ja määrusega nr 588/2011, artikli 3 lõike 1 punkti b tuleb tõlgendada nii, et sellises olukorras nagu põhikohtuasjas, milles rahalised vahendid ja majandusressursid külmutati nimetatud määruse alusel, tuleb õigusabiteenuste eest tasumiseks ette nähtud erandit hinnata kooskõlas selle sättega, mis ei viita kuidagi rahaliste vahendite päritolule ja nende võimalikule õigusvastaselt omandamisele.
 (1) ELT C 233, 10.8.2013.


text:
 14.9.2015
 NL
 Publicatieblad van de Europese Unie
 C 302/28
 Verzoek om een prejudiciële beslissing ingediend door de Cour administrative (Luxemburg) op 24 juli 2015 — Adrien Kauffmann/Ministre de l’Enseignement supérieur et de la recherche
 (Zaak C-402/15)
 (2015/C 302/36)
 Procestaal: Frans
 Verwijzende rechter
 Cour administrative
 Partijen in het hoofdgeding
 Verzoekende partij: Adrien Kauffmann
 Verwerende partij: Ministre de l’Enseignement supérieur et de la recherche
 Prejudiciële vragen
 Wordt met de vereisten van non-discriminatie ingevolge het bepaalde in artikel 7, lid 2, van verordening (EU) nr. 492/2011 (1) van het Europees Parlement en de Raad van 5 april 2011 betreffende het vrije verkeer van werknemers binnen de Unie, gelezen in samenhang met artikel 45, lid 2, VWEU, in het kader van het in de beschouwing betrekken van de reële mate van verbondenheid van een student, niet ingezetene, aanvrager van financiële ondersteuning voor hoger onderwijs, met de samenleving en de arbeidsmarkt in Luxemburg — de lidstaat waar een grensarbeider werknemer is geweest of zijn werkzaamheid heeft uitgeoefend in de omstandigheden bedoeld in artikel 2 bis van de wet van 22 juni 2000 betreffende financiële ondersteuning van de staat voor hoger onderwijs, ingevoerd bij de wet van 19 juli 2013 als rechtstreeks gevolg van het arrest van het Hof van Justitie van 20 juni 2013 (zaak C-20/12) (2) — naar behoren rekening gehouden,
 —
 wanneer de voorwaarde dat bedoelde student het „kind” van die grensarbeider is aldus wordt begrepen dat hij diens „rechtstreekse bloedverwant in neergaande lijn en in de eerste graad, welke verwantschap rechtens vaststaat” dient te zijn, waarbij het accent wordt gelegd op de tussen de student en de grensarbeider vastgestelde verwantschapsbetrekking, waarop bovenbedoelde verbondenheid wordt geacht te berusten, of
 —
 moet het accent worden gelegd op het feit dat de grensarbeider „in het onderhoud van de student blijft voorzien” zonder dat tussen hem en de student noodzakelijkerwijs een juridische band bestaat, onder meer wanneer er een voldoende band in de vorm van samenwonen bestaat die hem verbindt met een van de ouders van de student met wie deze een rechtens vaststaande verwantschapsbetrekking heeft?
 —
 Moet in dit tweede geval de — per definitie niet verplichte — bijdrage van de grensarbeider, ingeval zij niet de enige bijdrage is maar een bijdrage naast die van de ouder of de ouders die een juridische verwantschapsbetrekking met de student en dus in beginsel een wettelijke onderhoudsplicht hebben, aan bepaalde criteria op het gebied van de consistentie voldoen?
 (1) PB L 141, blz. 1.
 (2) EU:C:2013:411.


type: contracts

text:
 30.7.2015
 DE
 Amtsblatt der Europäischen Union
 L 202/53
 BESCHLUSS DES GEMEINSAMEN EWR-AUSSCHUSSES
 Nr. 199/2014
 vom 25. September 2014
 zur Änderung von Anhang XXI (Statistik) des EWR-Abkommens [2015/1267]
 DER GEMEINSAME EWR-AUSSCHUSS —
 gestützt auf das Abkommen über den Europäischen Wirtschaftsraum (im Folgenden „EWR-Abkommen“), insbesondere auf Artikel 98,
 in Erwägung nachstehender Gründe:
 (1)
 Die Durchführungsverordnung (EU) Nr. 228/2014 der Kommission vom 10. März 2014 zur Änderung der Verordnung (EG) Nr. 601/2006 zur Durchführung der Verordnung (EG) Nr. 184/2005 des Europäischen Parlaments und des Rates betreffend die gemeinschaftliche Statistik der Zahlungsbilanz, des internationalen Dienstleistungsverkehrs und der Direktinvestitionen im Hinblick auf das Format und das Verfahren der Datenübertragung (1) ist in das EWR-Abkommen aufzunehmen.
 (2)
 Anhang XXI des EWR-Abkommens sollte daher entsprechend geändert werden —
 HAT FOLGENDEN BESCHLUSS ERLASSEN:
 Artikel 1
 In Anhang XXI des EWR-Abkommens wird unter Nummer 19sa (Verordnung (EG) Nr. 601/2006 der Kommission) Folgendes angefügt:
 „, geändert durch:
 —
 32014 R 0228: Durchführungsverordnung (EU) Nr. 228/2014 der Kommission vom 10. März 2014 (ABl. L 70 vom 11.3.2014, S. 16)“.
 Artikel 2
 Der Wortlaut der Durchführungsverordnung (EU) Nr. 228/2014 in isländischer und norwegischer Sprache, der in der EWR-Beilage des Amtsblatts der Europäischen Union veröffentlicht wird, ist verbindlich.
 Artikel 3
 Dieser Beschluss tritt am 26. September 2014 in Kraft, sofern alle Mitteilungen nach Artikel 103 Absatz 1 des EWR-Abkommens vorliegen (2).
 Artikel 4
 Dieser Beschluss wird im EWR-Abschnitt und in der EWR-Beilage des Amtsblatts der Europäischen Union veröffentlicht.
 Geschehen zu Brüssel am 25. September 2014.
 Für den Gemeinsamen EWR-Ausschuss
 Der Präsident
 Kurt JÄGER
 (1) ABl. L 70 vom 11.3.2014, S. 16.
 (2) Ein Bestehen verfassungsrechtlicher Anforderungen wurde nicht mitgeteilt.


type: wikipedia

text:
A magyar egyetemeken, főiskolákon és kutatóintézetekben a hazai szokások és a törvényi szabályozás alapján az oktatói-kutatói pályának – emelkedő hierarchia szerint – az alábbi beosztásait (valójában ezek munkakörök és egyúttal címek) különböztetik meg:
 Munkakörök
 Oktató
 Oktatói munkakörben:
 tanársegéd
 adjunktus
 főiskolai docens, illetve egyetemi docens
 főiskolai tanár, illetve egyetemi tanár
 Kutató
 Kutatói munkakörben, illetve kutatóintézetekben és egyetemeken levő akadémiai kutatóhelyeken:
 tudományos segédmunkatárs
 tudományos munkatárs vagy tudományos kutató
 tudományos főmunkatárs
 tudományos tanácsadó
 kutatóprofesszor
 Az oktatói munkaköri elnevezések (az alábbi kiegészítéssel) egyúttal munkaköri címek is, melyet az adott munkakörben lévő az adott alkalmazás fennállása alatt (annak megszűnéséig) használhat is.
 Az egyetemi tanár (és a vonatkozó törvényi szabályozás hatálybalépéséig a cím használatára jogosultságot szerzett főiskolai tanár) jogosult a professzori cím használatára, ameddig a miniszterelnök, illetve a köztársasági elnök a tanári cím használatának jogát nem vonja meg.
 Nevek megadásakor előbb általában a tudományos fokozatot, majd a nevet és a beosztást (címet) adják meg (például Dr. X. Y. docens). Kivétel ez alól a professzorok megszólítása: pl. Igen tisztelt Professzor Úr (vagy Asszony)! De szokásos a beszélt nyelvben az X. Y. professzor forma is.
 Egyéb beosztások
 Léteznek az oktatói-kutatói munkaköröktől eltérő tanári munkakörök is a felsőoktatásban. A leggyakoribb ilyen munkakörök: nyelvtanár, testnevelő tanár, művésztanár, gyakorlati oktató, kollégiumi tanár, mérnöktanár, műszaki tanár.
 A nem főállásban alkalmazott oktatók státusza óraadó. Bizonyos esetekben az intézmény szenátusa a következő címeket adományozhatja az óraadóknak:
 egyetemi magántanár – ha rendelkezik doktori fokozattal, habilitációs oklevéllel és kiemelkedő nemzetközi szaktekintély,
 címzetes főiskolai vagy egyetemi docens, illetve címzetes főiskolai vagy egyetemi tanár – ha doktori fokozattal rendelkezik és országosan elismert szaktekintély,
 mesteroktató – ha kiemelkedő gyakorlati oktatói munkát végez, de ehhez nem szükséges még a PhD sem.
 Jegyzetek
 Kapcsolódó szócikkek
 Kancellár (oktatás)
 Tudományos fokozat
 A tudományos teljesítmény mérése
 Felsőoktatás
 Magyar felsőoktatás