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- OIG AUDITS
- FEDERAL MEDICAID ALERT – TELL HOUSE TO VOTE “NO”
- NYSACRA LEGISLATIVE DAY 2006 –
JANUARY 31, 2006
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NYSACRA NEWS & VIEWS
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OIG AUDITS
NYSACRA informed you
in December that the US Department of Health and Human Services
Office of Inspector General has initiated an audit of MSC. Below
is information from one of the our members that has recently been
audited:
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The audit lasted
1-1/2 to 2 hours.
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There were two
auditors.
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They checked one
random record (the agency serves approximately 500 people in MSC).
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The Audit Manager,
started with the entrance interview and let the agency know
that: “This is an audit, not an investigation. Only if during
their audit they uncover suspected fraud will they refer the
issue to the investigation unit. It is really an audit of NYS (OMRDD)
by the Federal Government, not the individual agencies. They
noted that Medicaid pays NYS $400 per person per month for MSC,
and since "that's a ton of money", they want to make sure that
the money is being spent on services that are meaningful (as
opposed to just saying hello every month).”
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They will review
100 random claims statewide - I believe that this equates to 67
different provider agencies - the target dates of file review
will be between 4/1/03 and 3/31/04. They are still getting
their bearings about some of the questions to ask
and documentation to review. But, they have developed a
checklist using the MSC provider manual that they would not
share with the agency because they were still in the process of
developing it.
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They will draft a
report to NYS (OMRDD) and meet with Gary Lind, Lisa Kagen and
David Picker, OMRDD, at the conclusion of their audit to discuss
their findings.
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They did a fairly
thorough review of the file. It included the approval process,
Notice of Determination (eligibility), the ISP, face to face
reports, notes (they were interested in seeing that there were
items documented that showed involvement, not just "we saw them
and they were the same as last month"), qualifications and
certifications of the MSC (and MSC supervisor), training
records, and billing records (including coding and rate
structure). They did take copies of the documents they
reviewed. Note that they focused in on a one-month period, with
a comparative that showed that the records were not just a
repeat of a previous or following month, and that all the
necessary approvals were signed and in place.
NYSACRA will keep
you posted on any further developments. Let us know if you have
had an OIG audit.
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FEDERAL MEDICAID ALERT – TELL HOUSE TO VOTE “NO” |
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You will recall
that in December there was a late night budget reconciliation
bill vote in the House. Members did not have time to read the
material, which included some proposed changes to Medicaid
that will be harmful. The Senate passed their bill with the
tie-breaking vote cast by Vice President Dick Cheney.
On January 31,
the House is scheduled to convene and cast their final vote on
the reconciliation package. New analysis by ANCOR and other
national groups discovered fine print that had gone unnoticed.
One provision in particular – Section 6086 – threatens
Medicaid’s basic entitlement structure for people with
disabilities. Although aspects of it look like a step forward
there is one area that undermines access to home and community
based services. The provision allows states to set entitlement
caps and allow waiting lists that could truly limit services
needed.
CALL
1-800-426-8073
CLICK HERE OR NYSACRA’S ACTION AND EDUCATION CENTER ON OUR
WEBSITE AND MAKE YOUR VOICE HEARD. URGE YOUR REP TO VOTE “NO”! |
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OTHER NEWS
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NYSACRA
LEGISLATIVE DAY 2006 –
JANUARY 31, 2006
NYSACRA’s
Legislative Day 2006 is Tuesday, January 31, 2006. Please
sign-up by January 17, 2006, by visiting
www.nysacra.org/nysacra/legday2006.htm or faxing your
form to 518-449-1509 or just
Click Here or print the form and fax it.
While we
welcome all Agencies to Albany for Legislative Day,
any form
received after January 3, 2006, is not guaranteed your
preferred meeting times, and if received after January 17,
2006, you will need to make your own Legislative
appointments.
You don’t need to know your whole team now, just send in the
form with your appt requests. Please also remember to send
us your
DSP Profiles and help support our message with an
Ad in the Legislative Gazette Special Section coming out the
day before Legislative Day. |
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NYSACRA is a catalyst and leading advocate for public policies,
practices and organizations that benefit people with developmental
disabilities. |
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99 PINE STREET, SUITE C110 | ALBANY, NY 12207 |
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