Office of Program Policy Analysis and Government Accountability
Office of Program Policy Analysis and Government Accountability

MAXIMUS's Prior Service Authorization Process Meets Contract Requirements, But Improvements Are Needed

Report 06-17, February 2006




Report Summary

  • The Agency for Persons with Disabilities has contracted with MAXIMUS, Inc., to perform prior service authorization reviews for Home and Community-Based Services Waiver clients. These reviews are intended to ensure that requested services are medically necessary and that their duration and scope are within established service limitations.
  • MAXIMUS has met contractual requirements for employing qualified staff and has implemented procedures to help assure that its staff are making consistent determinations. However, there is insufficient communication between MAXIMUS reviewers and waiver support coordinators regarding the reviewers' concerns with client support and cost plans. The agency's notices regarding the fair hearing process do not inform clients and their guardians regarding the quasi-judicial nature of the fair hearing process for appealing MAXIMUS's determinations. Stake-holders expressed concern that the fair hearings process is unnecessarily adversarial and intimidating.


Related Reports
  1. iBudget Implementation Continues as the Agency for Persons with Disabilities Responds to Legal Challenges
    Report 14-09 March 2014
  2. Agency for Persons with Disabilities Has Made Several Changes to the Prior Service Authorization Process
    Report 08-49 August 2008
  3. APD Should Take Steps to Ensure New Needs Assessment and Individual Budget Process Is Timely and Effective
    Report 08-15 March 2008
  4. APD Waiting List Should Be Improved for Agency's Planning and Budgeting Purposes
    Report 06-54 July 2006
Copies of this report in print or alternate accessible format may be obtained by email OPPAGA@oppaga.fl.gov, telephone (850) 488-0021, or mail 111 W. Madison St., Room 312 Tallahassee, FL 32399-1475.
Copies of this report in print or alternate accessible format may be obtained by email OPPAGA@oppaga.fl.gov, telephone (850) 488-0021, or mail 111 W. Madison St., Room 312 Tallahassee, FL 32399-1475.
social services, health, human services, developmental disabilities, MAXIMUS, prior service authorization, waiver support coordinator, fair hearings, medical necessity, developmental services, medicaid waiver, home and community-based services waiver, family supported living waiver, CDC, waiver