FAC Explorer

Finding 636276 (2022-039)

Significant Deficiency Repeat Finding
Requirement
AB
Questioned Costs
$1
Year
2022
Accepted
2023-03-29
Audit: 55212
Organization: State of Nebraska (NE)
Auditor: Nebraska Auditor of Public Accounts

AI Summary

  • Core Issue: Inadequate documentation and billing discrepancies for personal assistance services (PAS) led to significant questioned costs, including billing for unauthorized services and excessive hours.
  • Impacted Requirements: Compliance with federal regulations and state laws regarding service documentation, billing accuracy, and verification processes was not met, as evidenced by repeated findings since 2014.
  • Recommended Follow-Up: Implement stronger internal controls and enhance the electronic visit verification (EVV) system to ensure accurate documentation and compliance with service needs assessments.

Finding Text

Program: AL 93.778 ? Medical Assistance Program; AL 93.778 ? COVID-19 Medical Assistance Program ? Allowability Grant Number & Year: #2105NE5MAP, FFY 2021; #2205NE5MAP, FFY 2022 Federal Grantor Agency: U.S. Department of Health and Human Services Criteria: Per 45 CFR ? 75.302(a) (October 1, 2021), each state must expend and account for the Federal award in accordance with State laws and procedures for expending and accounting for the State?s own funds. Per 45 CFR ? 75.403 (October 1, 2021), costs must be necessary, reasonable, and adequately documented. Title 471 NAC 15-003.02(1) (effective June 2, 2004, through June 5, 2022) states that personal assistance services not documented in the service plan are non-allowable services. Title 471 NAC 15-006 (effective June 2, 2004, through June 5, 2022) requires that the provider bill only for services provided and authorized, perform the personal assistance services noted on the service plan, and accurately document services provided on Form MC-37 ?Service Provider Timesheet.? Title 471 NAC 15-006.06C (effective June 2, 2004, through June 5, 2022) requires that, after receiving a provider?s timesheet and billing document, the beneficiary?s social service worker or designee must verify that ?the hours worked and services provided fall within the parameters of those authorized? by the service needs assessment. Title 471 NAC 15-003.02(H) (effective June 6, 2022) requires that the provider perform the personal assistance services noted on the service plan, accurately document services provided in the Electronic Visit Verification (EVV) system, and confirm that services were received as authorized according to Agency procedures. The Provider?s Guide for Billing PAS Recap states, ?Gather participant?s signature at each visit in EVV APP.? A good internal control plan requires procedures to ensure services provided agree to the service needs assessment. Section 1903(l)(5)(A) of the Social Security Act states the following: The term ?electronic visit verification system? means, with respect to personal care services or home health care services, a system under which visits conducted as part of such services are electronically verified with respect to ? (i) the type of service performed; (ii) the individual receiving the service; (iii) the date of the service; (iv) the location of service delivery; (v) the individual providing the service; and (vi) the time the service begins and ends. Condition: During testing of personal assistance service (PAS) claims, we noted the following: ? Services provided lacked adequate supporting documentation. This included, among other related shortcomings identified, a lack of information from the EVV specifying the activities or tasks performed by the provider. ? Services billed exceeded the number of hours authorized under the service needs assessments. ? Providers billed for unreasonable amounts of time ? including, among other things, for more daily hours than are in a 24-hour period and for unfeasible scenarios, such as the supposed performance of a week?s worth of duties for one client in a single day. One provider received compensation, including overtime pay, for six months during which no client services appear to have been performed. ? Providers received overtime pay for unauthorized services, meaning that they were compensated at an increased rate for services ineligible for payment in the first place. ? Client guardians or parents were paid for providing services, which violates governing regulations prohibiting such arrangements. ? Providers received incorrect pay rates for services rendered, resulting in significant overpayments. A similar finding has been noted in prior audits since 2014. Repeat Finding: 2021-048 Questioned Costs: $51,331 known See Schedule of Findings and Questioned Costs for chart/table. Statistical Sample: No Context: The Agency offers personal assistance services (assistance with hygiene, mobility, housekeeping, etc.) to Medicaid recipients with disabilities and chronic conditions. The services to be provided are based on individual needs and criteria that must be determined in a written service needs assessment (SNA). The Agency implemented an electronic visit verification system for PAS providers on January 3, 2021, as required by Section 12006(a) of the 21st Century CURES Act, passed by Congress in 2016. The EVV system electronically captured and verified provider visit information, and providers were required to submit claims to the Agency electronically through this application. We selected five provider payments for testing, and from there, one week of services submitted through the EVV system. A week of service billed by the provider may include multiple claims and clients. The Agency was unable to provide documentation from the EVV system of client signatures and the specific activities or tasks performed by the provider. Claim detail provided included the start and stop times and location of the visit, but there was no record of what tasks were provided on each day and for how long to ensure compliance with the SNA. Therefore, we questioned the entire claims initially selected for testing, resulting in questioned costs of $4,011. It should be noted these deficiencies were identified in the prior audit, and no enhancements have been made to the EVV system to address these issues. We also identified other issues with the billings submitted by each provider. Therefore, we reviewed additional claims submitted by the providers. We reviewed the claim information in NFOCUS that identified the total number of quarterly units billed each day. We noted the following issues with the five providers tested: Provider 1 The provider was authorized for up to 226 quarterly units or 56.5 hours of service per week. The provider billed and was paid for 25 hours of service on July 30, 2021, and for 24.5 hours of service on September 28, 2021. It is impossible for a provider to provide more than 24 hours of service in one day. The provider also billed for hours that exceeded the SNA limit for the claim tested and for an additional four weeks reviewed during the fiscal year. Below is a summary of the weeks that exceeded the SNA. See Schedule of Findings and Questioned Costs for chart/table. In addition to the services billed that exceeded the SNA, we also noted the provider was the client?s guardian and parent. Per CFR 42 ? 440.167, personal care services cannot be provided by a member of the individual?s family. A family member is defined as a legally responsible relative. The provider is a legally responsible relative of the client as the guardian and is not allowed to get paid for these services. The Nebraska Medicaid State Plan also states that services are provided by those who are not legally responsible relatives. Title 471 NAC 15-006.01A(3), effective through June 5, 2022, also stated that a legally responsible relative cannot provide services for the client. Therefore, all payments made during fiscal year 2022 are questioned. Along with the initial claim tested, the provider was paid an additional $20,944 that is not allowable. Provider #2 The provider was authorized 160 quarterly units or 40 hours of service per week. For the claim tested, the provider exceeded the SNA by 180 quarterly units or 45 hours. This included 24 hours of care billed on both October 20, 2021, and October 22, 2021. These hours were questioned above due to inadequate documentation. The provider exceeded the weekly authorized hours for 11 weeks reviewed and billed between 2 to 33.25 hours over the SNA each week, resulting in additional questioned costs of $980. We also noted that the provider worked full time at a public school during the school year; therefore, it is likely hours billed for PAS on weekdays overlap with time worked at the school. This provider was also noted as billing over the authorized limit during last year?s audit, and no overpayments were established and the overbilling has continued. Provider #3 The Agency authorized this provider to provide 486 quarterly units or 121.5 hours of service per week for four different clients. It is not reasonable to authorize this many hours of service for one provider, as it would take over 17 hours every day of the week in order to perform all the tasks noted on the SNA. For the week tested, the provider billed 476 quarterly units or 119 hours for the week. Each SNA of these clients included some services to be performed every day of the week. For one client, the provider billed a week of services on one day. As an example, 20 minutes for a bath or shower was authorized seven times for the week or once a day. It is not reasonable that seven baths or showers were provided on one day. For this same client, assistance with meal preparation was authorized three times per day for seven days. It is not reasonable that assistance with meal preparation was provided 21 times on one day. These claims were questioned above for inadequate documentation. We reviewed an additional two weeks of services, and the provider billed for tasks authorized for seven days per week but did not provide services each of the seven days a week for all clients. For example, if a client was authorized for a bath seven times for the week, but the provider performed services on only two days, we considered the hours charged for five baths to be overbilled. This resulted in additional questioned costs of $372. It should be noted that only these two weeks were reviewed, so there may be additional questioned costs for other weeks based on the frequency of tasks authorized. See Schedule of Findings and Questioned Costs for chart/table. The provider was also paid overtime hours for these two weeks. In addition to being overpaid due to billing for tasks that were not provided as authorized, the provider received overtime pay for this overbilling, resulting in an additional $183 in questioned costs. Providers are paid at time and one-half for services in excess of 40 hours each week. Per the Agency, there is a claims overtime team that reviews the service authorizations to ensure they are not exceeded. For the two weeks reviewed alone, the provider was paid for 78.45 and 63.27 hours of overtime. Provider 4 The provider was authorized 84 quarterly units or 21 hours for one client and 146 quarterly hours units or 36.50 hours per week for another. For the claims tested, the EVV claim detail supported the number of hours billed; however, six hours of service for one client was shown to be provided by another provider, and an additional two hours was shown as provided at the provider?s address. The claim was questioned above for inadequate documentation. We also noted that the incorrect rate was paid to the provider during all of fiscal year 2022, resulting in $22,800 additional questioned costs for fiscal year 2022. The agreement between the Agency and the provider could not be located in NFOCUS, and it was requested from the Agency on June 22, 2022, and was provided on June 29, 2022. Per a narrative in NFOCUS, the agreement was missing and was found in a file on a Resource Development worker?s laptop. The agreement was completed but not signed by the provider, so it was emailed to the provider, and the signed copy was returned on June 28, 2022. Per the agreement, the rate was $2.45 per quarterly unit or $9.80 per hour. This rate agrees to the quarterly hour rate for basic personal assistance care as of July 1, 2021, per Title 471 NAC 000-515. The rate for specialized personal assistance was $2.74 per quarterly hour as of July 1, 2021; however, no evidence was provided that the provider qualified for this rate. The provider?s agreement began on August 2, 2021. The following rates were paid: See Schedule of Findings and Questioned Costs for chart/table. Provider 5 This provider was authorized 584 quarterly units or 146 hours of service per week for four different clients. This is unreasonable as it would take over 20 hours every day of the week to perform all of the tasks noted on the SNA for all clients. The EVV claim detail supported the number of hours billed; however, the verification method noted ?NON? for each entry with manual edits. A provider who is manually entering visits in the provider portal through a computer can deny tracking of the location. Although the hours billed did not exceed the SNAs for the week tested, the provider billed 101.25 hours for the week with care up to 18 and 20 hours of service per day. This provider was tested during the prior-year audit with overlapping of services and billing over the SNA. We reviewed additional claims paid during the fiscal year. The provider overbilled 3.25 hours one week for a client with questioned costs of $22. The provider also billed over the SNA for a second client for 17 weeks from July 2021 through November 2021. This client was authorized to receive 79 quarterly units or 19.75 hours of service each week. The provider billed between 10.25 to 22.25 hours over the authorized hours, resulting in questioned costs of $2,019. We did not review the specific activities noted on the SNA and did not obtain actual time of services; therefore, there could be additional questioned costs for activities not performed according to the SNA. On November 5, 2021, during the PAS renewal, this second client told the Agency that the provider had not been in the client?s apartment in over a year. The service authorization for the client was open with the provider through December 4, 2021. Services were billed from June 2021 through November 22, 2021. Based on the client?s phone call with the Agency, the provider did not provide care from June 2021 through November 2021, so all those payments may be questionable. The provider was also paid overtime for most weeks that the provider overbilled for the two clients. As stated earlier, the overtime team reviews the claims paid and the service authorizations. It is evident the Agency was aware the provider was billing over the authorized hours for the two clients, because it only allowed overtime for hours provided or up to the maximum authorized hours, whichever was less, to be included in the weekly total. No overpayments were established for billing over the authorization for the two clients. Again, there could be additional questioned costs for overtime hours if the provider did not provide care for the second client from June 2021 through November 2021. Federal payment errors noted totaled $51,331. The Federal payments tested totaled $85,074, and the total Federal share of PAS payments for the fiscal year was $5,935,883. The total State share of PAS payments for the fiscal year was $3,462,220 for a total of $9,398,103. Due to the EVV system deficiencies, we consider all dollars to be at risk. Cause: Procedures were not adequate to prevent and/or detect errors. Effect: An inadequate review of PAS claims increases the risk of services provided not being in accordance with the recipient?s needs, as well as a risk of services being billed but not provided. There is a significant risk for fraud or abuse occurring and not being detected. State and Federal funds appear to have been misspent. Recommendation: We recommend the Agency implement procedures to ensure payments are allowable, adequately supported, and in accordance with State and Federal regulations. Management Response: The Agency agrees with the finding.

Categories

Questioned Costs Allowable Costs / Cost Principles Eligibility Internal Control / Segregation of Duties

Other Findings in this Audit

  • 59797 2022-023
    Significant Deficiency Repeat
  • 59798 2022-024
    Significant Deficiency Repeat
  • 59799 2022-049
    Significant Deficiency
  • 59800 2022-050
    Material Weakness Repeat
  • 59801 2022-019
    -
  • 59802 2022-021
    -
  • 59803 2022-025
    Material Weakness Repeat
  • 59804 2022-026
    Significant Deficiency Repeat
  • 59805 2022-025
    Material Weakness Repeat
  • 59806 2022-027
    Material Weakness Repeat
  • 59807 2022-023
    Significant Deficiency Repeat
  • 59808 2022-024
    Significant Deficiency Repeat
  • 59809 2022-028
    Material Weakness
  • 59810 2022-029
    Significant Deficiency
  • 59811 2022-030
    -
  • 59812 2022-031
    -
  • 59813 2022-023
    Significant Deficiency Repeat
  • 59814 2022-019
    -
  • 59815 2022-032
    Significant Deficiency Repeat
  • 59816 2022-033
    - Repeat
  • 59817 2022-032
    Significant Deficiency Repeat
  • 59818 2022-022
    - Repeat
  • 59819 2022-023
    Significant Deficiency Repeat
  • 59820 2022-034
    Material Weakness Repeat
  • 59821 2022-035
    - Repeat
  • 59822 2022-036
    Significant Deficiency Repeat
  • 59823 2022-037
    - Repeat
  • 59824 2022-038
    -
  • 59825 2022-034
    Material Weakness Repeat
  • 59826 2022-035
    - Repeat
  • 59827 2022-037
    - Repeat
  • 59828 2022-024
    Significant Deficiency Repeat
  • 59829 2022-019
    -
  • 59830 2022-018
    Significant Deficiency Repeat
  • 59831 2022-042
    - Repeat
  • 59832 2022-017
    - Repeat
  • 59833 2022-018
    Significant Deficiency Repeat
  • 59834 2022-039
    Significant Deficiency Repeat
  • 59835 2022-040
    Significant Deficiency Repeat
  • 59836 2022-041
    Significant Deficiency Repeat
  • 59837 2022-042
    - Repeat
  • 59838 2022-043
    - Repeat
  • 59839 2022-044
    - Repeat
  • 59840 2022-045
    Significant Deficiency
  • 59841 2022-039
    Significant Deficiency Repeat
  • 59842 2022-040
    Significant Deficiency Repeat
  • 59843 2022-043
    - Repeat
  • 59844 2022-046
    Material Weakness Repeat
  • 59845 2022-046
    Material Weakness Repeat
  • 59846 2022-047
    - Repeat
  • 59847 2022-048
    -
  • 59848 2022-056
    -
  • 59849 2022-057
    Material Weakness Repeat
  • 59850 2022-058
    Significant Deficiency Repeat
  • 59851 2022-051
    Material Weakness Repeat
  • 59852 2022-052
    - Repeat
  • 59853 2022-053
    -
  • 59854 2022-054
    -
  • 59855 2022-055
    Material Weakness
  • 59856 2022-020
    Material Weakness
  • 636239 2022-023
    Significant Deficiency Repeat
  • 636240 2022-024
    Significant Deficiency Repeat
  • 636241 2022-049
    Significant Deficiency
  • 636242 2022-050
    Material Weakness Repeat
  • 636243 2022-019
    -
  • 636244 2022-021
    -
  • 636245 2022-025
    Material Weakness Repeat
  • 636246 2022-026
    Significant Deficiency Repeat
  • 636247 2022-025
    Material Weakness Repeat
  • 636248 2022-027
    Material Weakness Repeat
  • 636249 2022-023
    Significant Deficiency Repeat
  • 636250 2022-024
    Significant Deficiency Repeat
  • 636251 2022-028
    Material Weakness
  • 636252 2022-029
    Significant Deficiency
  • 636253 2022-030
    -
  • 636254 2022-031
    -
  • 636255 2022-023
    Significant Deficiency Repeat
  • 636256 2022-019
    -
  • 636257 2022-032
    Significant Deficiency Repeat
  • 636258 2022-033
    - Repeat
  • 636259 2022-032
    Significant Deficiency Repeat
  • 636260 2022-022
    - Repeat
  • 636261 2022-023
    Significant Deficiency Repeat
  • 636262 2022-034
    Material Weakness Repeat
  • 636263 2022-035
    - Repeat
  • 636264 2022-036
    Significant Deficiency Repeat
  • 636265 2022-037
    - Repeat
  • 636266 2022-038
    -
  • 636267 2022-034
    Material Weakness Repeat
  • 636268 2022-035
    - Repeat
  • 636269 2022-037
    - Repeat
  • 636270 2022-024
    Significant Deficiency Repeat
  • 636271 2022-019
    -
  • 636272 2022-018
    Significant Deficiency Repeat
  • 636273 2022-042
    - Repeat
  • 636274 2022-017
    - Repeat
  • 636275 2022-018
    Significant Deficiency Repeat
  • 636277 2022-040
    Significant Deficiency Repeat
  • 636278 2022-041
    Significant Deficiency Repeat
  • 636279 2022-042
    - Repeat
  • 636280 2022-043
    - Repeat
  • 636281 2022-044
    - Repeat
  • 636282 2022-045
    Significant Deficiency
  • 636283 2022-039
    Significant Deficiency Repeat
  • 636284 2022-040
    Significant Deficiency Repeat
  • 636285 2022-043
    - Repeat
  • 636286 2022-046
    Material Weakness Repeat
  • 636287 2022-046
    Material Weakness Repeat
  • 636288 2022-047
    - Repeat
  • 636289 2022-048
    -
  • 636290 2022-056
    -
  • 636291 2022-057
    Material Weakness Repeat
  • 636292 2022-058
    Significant Deficiency Repeat
  • 636293 2022-051
    Material Weakness Repeat
  • 636294 2022-052
    - Repeat
  • 636295 2022-053
    -
  • 636296 2022-054
    -
  • 636297 2022-055
    Material Weakness
  • 636298 2022-020
    Material Weakness

Programs in Audit

ALN Program Name Expenditures
93.778 Medical Assistance Program $163.43M
93.575 Child Care and Development Block Grant $112.41M
84.010 Title I Grants to Local Educational Agencies $91.78M
10.542 Pandemic Ebt Food Benefits $77.58M
97.036 Disaster Grants - Public Assistance (presidentially Declared Disasters) $74.10M
21.019 Coronavirus Relief Fund $74.10M
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $44.62M
10.553 School Breakfast Program $36.68M
21.027 Coronavirus State and Local Fiscal Recovery Funds $31.44M
93.596 Child Care Mandatory and Matching Funds of the Child Care and Development Fund $30.94M
12.401 National Guard Military Operations and Maintenance (o&m) Projects $29.38M
21.023 Emergency Rental Assistance Program $26.43M
10.551 Supplemental Nutrition Assistance Program $24.69M
93.563 Child Support Enforcement $22.26M
12.400 Military Construction, National Guard $21.84M
64.015 Veterans State Nursing Home Care $17.83M
84.126 Rehabilitation Services_vocational Rehabilitation Grants to States $16.54M
10.555 National School Lunch Program $15.60M
20.933 National Infrastructure Investments $14.48M
66.468 Capitalization Grants for Drinking Water State Revolving Funds $13.21M
20.205 Highway Planning and Construction $12.55M
93.667 Social Services Block Grant $12.05M
66.458 Capitalization Grants for Clean Water State Revolving Funds $12.03M
10.559 Summer Food Service Program for Children $11.93M
16.575 Crime Victim Assistance $10.97M
15.611 Wildlife Restoration and Basic Hunter Education $10.89M
96.001 Social Security_disability Insurance $10.87M
93.268 Immunization Cooperative Agreements $10.84M
84.367 Improving Teacher Quality State Grants $10.84M
84.048 Career and Technical Education -- Basic Grants to States $7.52M
84.011 Migrant Education_state Grant Program $7.03M
84.287 Twenty-First Century Community Learning Centers $6.79M
93.566 Refugee and Entrant Assistance_state Administered Programs $6.71M
10.569 Emergency Food Assistance Program (food Commodities) $6.71M
20.106 Airport Improvement Program $6.35M
21.026 Homeowner Assistance Fund $6.27M
93.354 Public Health Emergency Response: Cooperative Agreement for Emergency Response: Public Health Crisis Response $5.64M
17.207 Employment Service/wagner-Peyser Funded Activities $5.56M
93.434 Every Student Succeeds Act/preschool Development Grants $5.49M
93.069 Public Health Emergency Preparedness $5.27M
14.275 Housing Trust Fund $5.10M
93.767 Children's Health Insurance Program $4.99M
84.424 Student Support and Academic Enrichment Program $4.95M
20.509 Formula Grants for Rural Areas and Tribal Transit Program $4.82M
15.605 Sport Fish Restoration Program $4.75M
84.369 Grants for State Assessments and Related Activities $4.45M
93.558 Temporary Assistance for Needy Families $4.44M
84.365 English Language Acquisition State Grants $4.39M
17.225 Unemployment Insurance $4.01M
93.243 Substance Abuse and Mental Health Services_projects of Regional and National Significance $3.59M
93.994 Maternal and Child Health Services Block Grant to the States $3.58M
93.155 Rural Health Research Centers $3.51M
97.067 Homeland Security Grant Program $3.50M
14.231 Emergency Solutions Grant Program $3.44M
84.002 Adult Education - Basic Grants to States $3.30M
93.569 Community Services Block Grant $3.27M
93.788 Opioid Str $3.24M
20.218 National Motor Carrier Safety $3.19M
66.460 Nonpoint Source Implementation Grants $3.02M
20.600 State and Community Highway Safety $2.99M
93.568 Low-Income Home Energy Assistance $2.98M
14.239 Home Investment Partnerships Program $2.76M
10.582 Fresh Fruit and Vegetable Program $2.64M
17.259 Wia Youth Activities $2.61M
20.219 Recreational Trails Program $2.60M
93.659 Adoption Assistance $2.60M
81.042 Weatherization Assistance for Low-Income Persons $2.40M
93.898 Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations $2.37M
93.991 Preventive Health and Health Services Block Grant $2.29M
45.310 Grants to States $2.29M
17.278 Wia Dislocated Worker Formula Grants $2.21M
17.258 Wia Adult Program $2.16M
14.228 Community Development Block Grants/state's Program and Non-Entitlement Grants in Hawaii $2.15M
93.982 Mental Health Disaster Assistance and Emergency Mental Health $2.13M
20.616 National Priority Safety Programs $2.00M
93.391 Activities to Support State, Tribal, Local and Territorial (stlt) Health Department Response to Public Health Or Healthcare Crises $1.86M
84.027 Special Education_grants to States $1.66M
64.014 Veterans State Domiciliary Care $1.64M
16.554 National Criminal History Improvement Program (nchip) $1.64M
10.557 Special Supplemental Nutrition Program for Women, Infants, and Children $1.57M
93.674 John H. Chafee Foster Care Program for Successful Transition to Adulthood $1.51M
16.588 Violence Against Women Formula Grants $1.51M
94.006 Americorps $1.43M
16.034 Coronavirus Emergency Supplemental Funding Program $1.43M
15.916 Outdoor Recreation_acquisition, Development and Planning $1.39M
84.372 Statewide Longitudinal Data Systems $1.32M
95.001 High Intensity Drug Trafficking Areas Program $1.30M
66.432 State Public Water System Supervision $1.28M
84.368 Grants for Enhanced Assessment Instruments $1.22M
10.649 Pandemic Ebt Administrative Costs $1.15M
15.634 State Wildlife Grants $1.07M
93.241 State Rural Hospital Flexibility Program $1.06M
39.003 Donation of Federal Surplus Personal Property $1.05M
10.025 Plant and Animal Disease, Pest Control, and Animal Care $1.03M
93.775 State Medicaid Fraud Control Units $1.03M
10.561 State Administrative Matching Grants for the Supplemental Nutrition Assistance Program $1.01M
93.940 Hiv Prevention Activities_health Department Based $957,334
20.615 E-911 Grant Program $952,859
93.053 Nutrition Services Incentive Program $936,434
93.426 Improving the Health of Americans Through Prevention and Management of Diabetes and Heart Disease and Stroke $925,382
97.042 Emergency Management Performance Grants $901,906
17.801 Jobs for Veterans State Grants $876,272
15.904 Historic Preservation Fund Grants-in-Aid $846,001
10.093 Voluntary Public Access and Habitat Incentive Program $843,606
17.002 Labor Force Statistics $768,113
45.025 Promotion of the Arts_partnership Agreements $767,800
93.665 Emergency Grants to Address Mental and Substance Use Disorders During Covid-19 $758,435
10.170 Specialty Crop Block Grant Program - Farm Bill $742,745
20.200 Highway Research and Development Program $734,076
16.738 Edward Byrne Memorial Justice Assistance Grant Program $725,424
93.387 National and State Tobacco Control Program (b) $724,126
16.741 Dna Backlog Reduction Program $716,023
10.560 State Administrative Expenses for Child Nutrition $667,178
84.013 Title I State Agency Program for Neglected and Delinquent Children and Youth $629,350
97.012 Boating Safety Financial Assistance $598,775
17.504 Consultation Agreements $593,638
93.045 Special Programs for the Aging_title Iii, Part C_nutrition Services $589,520
93.110 Maternal and Child Health Federal Consolidated Programs $581,946
66.805 Leaking Underground Storage Tank Trust Fund Corrective Action Program $572,966
97.045 Cooperating Technical Partners $568,402
66.040 State Clean Diesel Grant Program $548,647
17.245 Trade Adjustment Assistance $525,526
84.323 Special Education - State Personnel Development $522,557
30.001 Employment Discrimination_title Vii of the Civil Rights Act of 1964 $521,820
20.505 Metropolitan Transportation Planning and State and Non-Metropolitan Planning and Research $516,987
93.603 Adoption Incentive Payments $514,479
66.817 State and Tribal Response Program Grants $498,652
93.658 Foster Care_title IV-E $493,150
84.196 Education for Homeless Children and Youth $476,518
93.436 Well-Integrated Screening and Evaluation for Women Across the Nation (wisewoman) $467,444
84.184 Safe and Drug-Free Schools and Communities_national Programs $465,405
66.802 Superfund State, Political Subdivision, and Indian Tribe Site-Specific Cooperative Agreements $460,386
97.047 Pre-Disaster Mitigation $451,317
93.669 Child Abuse and Neglect State Grants $445,383
93.165 Grants to States for Loan Repayment $435,569
81.041 State Energy Program $431,987
20.700 Pipeline Safety Program State Base Grant $424,097
93.959 Block Grants for Prevention and Treatment of Substance Abuse $415,208
16.813 Nics Act Record Improvement Program $404,903
96.006 Supplemental Security Income $403,332
93.324 State Health Insurance Assistance Program $396,751
93.435 Innovative State and Local Public Health Strategies to Prevent and Manage Diabetes and Heart Disease and Stroke- $373,048
64.005 Grants to States for Construction of State Home Facilities $371,994
97.008 Non-Profit Security Program $365,390
93.464 Acl Assistive Technology $362,282
84.377 School Improvement Grants $358,234
10.568 Emergency Food Assistance Program (administrative Costs) $351,246
20.513 Enhanced Mobility of Seniors and Individuals with Disabilities $340,791
20.237 Commercial Vehicle Information Systems and Networks $324,316
10.525 Farm and Ranch Stress Assistance Network Competitive Grants Program (b) $323,542
66.804 Underground Storage Tank (ust) Prevention, Detection, and Compliance Program $322,784
16.543 Missing Children's Assistance $318,586
10.666 Schools and Roads - Grants to Counties $316,280
93.981 Improving Student Health and Academic Achievement Through Nutrition, Physical Activity and the Management of Chronic Conditions in Schools $313,121
66.034 Surveys, Studies, Research, Investigations, Demonstrations, and Special Purpose Activities Relating to the Clean Air Act $309,653
16.017 Sexual Assault Services Formula Program $306,165
93.150 Projects for Assistance in Transition From Homelessness (path) $292,186
84.421 Disability Innovation Fund (dif) $288,373
14.401 Fair Housing Assistance Program_state and Local $265,465
94.003 State Commissions $264,412
93.800 Organized Approaches to Increase Colorectal Cancer Screening $261,820
20.703 Interagency Hazardous Materials Public Sector Training and Planning Grants $261,817
93.913 Grants to States for Operation of Offices of Rural Health $259,701
66.444 Lead Testing in School and Child Care Program Drinking Water (sdwa 1464(d)) (a) $251,059
93.197 Childhood Lead Poisoning Prevention Projects_state and Local Childhood Lead Poisoning Prevention and Surveillance of Blood Lead Levels in Children $249,706
20.611 Incentive Grant Program to Prohibit Racial Profiling $247,915
93.092 Affordable Care Act (aca) Personal Responsibility Education Program $228,328
93.116 Project Grants and Cooperative Agreements for Tuberculosis Control Programs $226,126
66.419 Water Pollution Control State, Interstate, and Tribal Program Support $220,151
17.277 Workforce Investment Act (wia) National Emergency Grants $217,870
93.556 Promoting Safe and Stable Families $216,274
16.582 Crime Victim Assistance/discretionary Grants $213,073
93.234 Traumatic Brain Injury State Demonstration Grant Program $210,836
84.181 Special Education-Grants for Infants and Families $209,696
93.251 Early Hearing Detection and Intervention $208,381
66.605 Performance Partnership Grants $203,309
59.061 State Trade and Export Promotion Pilot Grant Program $202,149
94.009 Training and Technical Assistance $201,461
10.U01 Nebraska Rural Rehabilitation Program $201,050
84.173 Special Education_preschool Grants $199,256
84.051 Career and Technical Education -- National Programs $198,985
93.643 Children's Justice Grants to States $195,000
16.827 Justice Reinvestment Initiative $194,319
93.599 Chafee Education and Training Vouchers Program (etv) $193,000
84.426 Randolph-Sheppard Financial Relief and Restoration Payments $192,635
93.747 Elder Abuse Prevention Interventions Program $192,621
10.576 Senior Farmers Market Nutrition Program $187,152
15.524 Recreation Resources Management $184,677
93.777 State Survey and Certification of Health Care Providers and Suppliers (title Xviii) Medicare $184,344
93.235 Affordable Care Act (aca) Abstinence Education Program $183,843
93.547 Affordable Care Act ? National Health Service Corps $183,468
93.071 Medicare Enrollment Assistance Program $177,373
66.032 State Indoor Radon Grants $175,597
93.671 Family Violence Prevention and Services/domestic Violence Shelter and Supportive Services $170,340
97.041 National Dam Safety Program $170,325
93.413 The State Flexibility to Stabilize the Market Grant Program $164,631
93.977 Preventive Health Services_sexually Transmitted Diseases Control Grants $161,676
93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs $159,804
16.576 Crime Victim Compensation $155,268
93.471 Title IV-E Kinship Navigator Program (a) $154,676
93.958 Block Grants for Community Mental Health Services $153,616
17.273 Temporary Labor Certification for Foreign Workers $147,106
15.608 Fish and Wildlife Management Assistance $146,467
12.112 Payments to States in Lieu of Real Estate Taxes $144,709
93.270 Adult Viral Hepatitis Prevention and Control $144,189
10.558 Child and Adult Care Food Program $142,176
16.750 Support for Adam Walsh Act Implementation Grant Program $140,985
17.271 Work Opportunity Tax Credit Program (wotc) $138,522
16.839 Stop School Violence $137,689
20.215 Highway Training and Education $134,121
16.742 Paul Coverdell Forensic Sciences Improvement Grant Program $130,646
93.645 Stephanie Tubbs Jones Child Welfare Services Program $130,144
97.023 Community Assistance Program State Support Services Element (cap-Ssse) $128,022
93.600 Head Start $125,360
10.435 State Mediation Grants $124,119
93.043 Special Programs for the Aging_title Iii, Part D_disease Prevention and Health Promotion Services $123,544
17.285 Apprenticeship USA Grants $122,896
84.161 Rehabilitation Services_client Assistance Program $122,707
15.626 Enhanced Hunter Education and Safety Program $114,275
93.314 Early Hearing Detection and Intervention Information System (ehdi-Is) Surveillance Program $112,733
93.262 Occupational Safety and Health Program $112,383
93.044 Special Programs for the Aging_title Iii, Part B_grants for Supportive Services and Senior Centers $111,017
16.320 Services for Trafficking Victims $107,070
93.301 Small Rural Hospital Improvement Grant Program $104,828
12.113 State Memorandum of Agreement Program for the Reimbursement of Technical Services $103,594
93.048 Special Programs for the Aging_title Iv_and Title Ii_discretionary Projects $103,466
66.461 Regional Wetland Program Development Grants $101,164
93.127 Emergency Medical Services for Children $98,481
93.052 National Family Caregiver Support, Title Iii, Part E $92,492
20.614 National Highway Traffic Safety Administration (nhtsa) Discretionary Safety Grants $91,612
93.136 Injury Prevention and Control Research and State and Community Based Programs $87,553
93.U01 Medicated Feed Inspection Contract $86,811
93.279 Drug Abuse and Addiction Research Programs $86,457
93.597 Grants to States for Access and Visitation Programs $85,685
66.433 State Underground Water Source Protection $83,116
93.104 Comprehensive Community Mental Health Services for Children with Serious Emotional Disturbances (sed) $83,085
17.235 Senior Community Service Employment Program $76,629
93.734 Empowering Older Adults and Adults with Disabilities Through Chronic Disease Self-Management Education Programs ? Financed by Prevention and Public Health Funds (pphf) $75,449
93.917 Hiv Care Formula Grants $74,232
84.326 Special Education_technical Assistance and Dissemination to Improve Services and Results for Children with Disabilities $73,594
10.579 Child Nutrition Discretionary Grants Limited Availability $72,971
66.608 Environmental Information Exchange Network Grant Program and Related Assistance $70,965
15.615 Cooperative Endangered Species Conservation Fund $60,358
66.454 Water Quality Management Planning $58,874
15.637 Migratory Bird Joint Ventures $57,512
16.550 State Justice Statistics Program for Statistical Analysis Centers $54,509
10.574 Team Nutrition Grants $54,328
16.542 Just Juvenile Justice & Delinquency $52,484
45.312 National Leadership Grants $51,212
16.812 Second Chance Act Reentry Initiative $48,376
97.029 Flood Mitigation Assistance $48,207
10.575 Farm to School Grant Program $46,582
81.119 State Energy Program Special Projects $44,656
93.870 Maternal, Infant and Early Childhood Home Visiting Grant $44,474
10.556 Special Milk Program for Children $42,625
17.005 Compensation and Working Conditions $41,789
84.358 Rural Education $38,442
10.572 Wic Farmers' Market Nutrition Program (fmnp) $38,014
10.072 Wetlands Reserve Program $37,866
84.425 Education Stabilization Fund $37,832
84.325 Special Education - Personnel Development to Improve Services and Results for Children with Disabilities $37,281
66.204 Multipurpose Grants to States and Tribes $33,690
93.336 Behavioral Risk Factor Surveillance System $32,000
93.U03 Food Inspection Contract $31,886
16.816 John R. Justice Prosecutors and Defenders Incentive Act $31,084
97.043 State Fire Training Systems Grants $25,430
93.881 The Health Insurance Enforcement and Consumer Protections Grant Program $24,592
66.442 Assistance for Small and Disadvantaged Communities Drinking Water Grant Program (sdwa 1459a) (a) $23,550
93.090 Guardianship Assistance $23,502
15.511 Cultural Resources Management $23,090
84.187 Supported Employment Services for Individuals with the Most Significant Disabilities $22,470
32.U01 Fcc - Certification $21,975
10.931 Agricultural Conservation Easement Program $21,633
16.540 Juvenile Justice and Delinquency Prevention_allocation to States $21,602
16.922 Equitable Sharing Program $21,595
84.144 Migrant Education_coordination Program $21,142
10.565 Commodity Supplemental Food Program $20,076
10.578 Wic Grants to States (wgs) $20,075
10.664 Cooperative Forestry Assistance $19,950
20.232 Commercial Driver's License Program Improvement Grant $18,336
93.041 Special Programs for the Aging_title Vii, Chapter 3_programs for Prevention of Elder Abuse, Neglect, and Exploitation $17,433
93.042 Special Programs for the Aging_title Vii, Chapter 2_long Term Care Ombudsman Services for Older Individuals $15,839
14.241 Housing Opportunities for Persons with Aids $10,112
84.235 Rehabilitation Services Demonstration and Training Programs $10,065
93.586 State Court Improvement Program $8,840
16.734 Special Data Collections and Statistical Studies $8,699
97.039 Hazard Mitigation Grant $8,658
16.U01 Dea Grants $7,594
93.630 Developmental Disabilities Basic Support and Advocacy Grants $6,765
81.138 State Heating Oil and Propane Program $6,755
97.050 Presidential Declared Disaster Assistance to Individuals and Households - Other Needs $6,326
84.310 Statewide Family Engagement Centers $4,964
66.707 Tsca Title IV State Lead Grants Certification of Lead-Based Paint Professionals $4,719
10.932 Regional Conservation Partnership Program $3,919
15.631 Partners for Fish and Wildlife $3,616
16.593 Residential Substance Abuse Treatment for State Prisoners $3,156
16.751 Edward Byrne Memorial Competitive Grant Program $2,798
93.103 Food and Drug Administration_research $2,573
93.079 Cooperative Agreements to Promote Adolescent Health Through School-Based Hiv/std Prevention and School-Based Surveillance $2,242
15.224 Cultural Resource Management $2,215
15.517 Fish and Wildlife Coordination Act $1,268
16.754 Harold Rogers Prescription Drug Monitoring Program $558
90.404 2018 Hava Election Security Grants $500
17.270 Reintegration of Ex-Offenders $139
10.477 Meat, Poultry, and Egg Products Inspection $3
97.004 State Domestic Preparedness Equipment Support Program $-347
93.521 The Affordable Care Act: Building Epidemiology, Laboratory, and Health Information Systems Capacity in the Epidemiology and Laboratory Capacity for Infectious Disease (elc) and Emerging Infections Program (eip) Cooperative Agreements;pphf $-4,535
93.889 National Bioterrorism Hospital Preparedness Program $-14,451
84.177 Rehabilitation Services_independent Living Services for Older Individuals Who Are Blind $-95,967