Since our 2003 report, the Brain and Spinal Cord Injury Program has improved its performance data reliability by eliminating duplicate client records and retaining documentation for performance measures. However, its efforts to assess client outcomes one year after service completion have been unsuccessful.

The program should take additional steps to recover allowable costs from Medicaid by

• billing Medicaid for case management services provided to eligible adults,
• recouping case management fees paid by Medicaid to the Children's Medical Services (CMS) Program once the federal government approves CMS's new billing system, and
• pursuing Medicaid reimbursement for costs allowable under the Medicaid waiver when it privatizes oversight and billing.