Audit 12012

Condition: Required screening and valid license verification for 4 of 25 providers tested was not properly supported by the Department's records. Management has made progress on the prior year finding. A program was implemented to address the transfer of screening records from the legacy system into the current MMIS system and to provide monthly screenings of providers. However, due to the timing of the corrective actions, there are certain providers remaining in the system without the required screening documentation. Criteria: 42 CFR 455.410 states that the Department must require all enrolled providers to be screened. Per 42 CFR 455.412, the Department must verify the provider’s license has not expired and is valid. Context: A sample of 25 providers who received payment during the year were tested to determine whether a required screening was performed before the provider was enrolled. For 4 of 25 providers tested, the Department was not able to provide documentation that the required screening was performed. Cause: In certain instances, information from the legacy system was not transferred to the current MMIS. Additionally, certain providers who received single-case approvals were being excluded from the revalidation processes in place. Effect: There is no documentation to show that a provider screening and license verification were conducted to show compliance with Medicaid requirements. Questioned Cost: None. Repeat Finding: This is a repeat finding. Recommendation: We recommend that the Department review and update controls to ensure proper screening and license verification is performed for all providers and that documentation of the screening and verification is retained in all cases. Current Status/Plan of Action: MAD successfully provided screening and license verification for all providers, except for MCOR providers. MCOR requests are submitted by MCOs, therefore this process does not require providers to submit license or other credentials to enroll with New Mexico Medicaid. MAD recently changed MCOR approval term to two years from the date of approval, thus MCORs will be excluded from revalidation process. The program is currently working on a system memo to include MCORs to the monthly screening process. Responsible Person: MAD Compliance Officer and PPSB Bureau Chief.

Condition: Reports required to be submitted under the Federal Funding Accountability and Transparency Act (FFATA) were not submitted timely during the year ended June 30, 2023. Management has made progress on the prior year finding. Certain reports were submitted for fiscal year 2023 that were not submitted for the prior year. However, certain reports were not submitted timely during fiscal year 2023 due to the timing of the prior year finding. Criteria: Under the requirements of FFATA (Pub. L. No. 109-282), as amended by Section 6202 of Public Law 110-252, the Department is required to submit reports to the Federal Funding Accountability and Transparency Act Subaward Reporting System for any subawards of $30,000 or more. Reports are due by the end of the month following the month in which the prime awardee awards any sub-award equal to or greater than $30,000. Context: FFATA reports were submitted for the programs, however, they were not submitted within their due dates. Cause: The Department has not implemented the proper controls to ensure all required FFATA reports are submitted to the federal agency timely. Effect: FFATA reports were submitted after their due dates. Questioned Costs: None Repeat Finding: This is a repeat and modified finding. Recommendation: We recommend that the Department ensure that adequate controls are in place to ensure that report due dates are met. Current Status/Plan of Action: ASD Staff from the Contracts and Procurement and Grants Management Bureau are working with Division Staff to gather the appropriate data to report and submit the Federal Funding Accountability and Transparency Act (FFATA). ASD did submit the FFATA report, however, we will work to ensure that this report is submitted timely. We will complete resolution of this finding during fiscal year 2024. Responsible Person: Grants Bureau Chief and Procurement Bureau Chief.

Condition: Reports required to be submitted under the Federal Funding Accountability and Transparency Act (FFATA) were not submitted timely during the year ended June 30, 2023. Management has made progress on the prior year finding. Certain reports were submitted for fiscal year 2023 that were not submitted for the prior year. However, certain reports were not submitted timely during fiscal year 2023 due to the timing of the prior year finding. Criteria: Under the requirements of FFATA (Pub. L. No. 109-282), as amended by Section 6202 of Public Law 110-252, the Department is required to submit reports to the Federal Funding Accountability and Transparency Act Subaward Reporting System for any subawards of $30,000 or more. Reports are due by the end of the month following the month in which the prime awardee awards any sub-award equal to or greater than $30,000. Context: FFATA reports were submitted for the programs, however, they were not submitted within their due dates. Cause: The Department has not implemented the proper controls to ensure all required FFATA reports are submitted to the federal agency timely. Effect: FFATA reports were submitted after their due dates. Questioned Costs: None Repeat Finding: This is a repeat and modified finding. Recommendation: We recommend that the Department ensure that adequate controls are in place to ensure that report due dates are met. Current Status/Plan of Action: ASD Staff from the Contracts and Procurement and Grants Management Bureau are working with Division Staff to gather the appropriate data to report and submit the Federal Funding Accountability and Transparency Act (FFATA). ASD did submit the FFATA report, however, we will work to ensure that this report is submitted timely. We will complete resolution of this finding during fiscal year 2024. Responsible Person: Grants Bureau Chief and Procurement Bureau Chief.

Condition: Required screening and valid license verification for 4 of 25 providers tested was not properly supported by the Department's records. Management has made progress on the prior year finding. A program was implemented to address the transfer of screening records from the legacy system into the current MMIS system and to provide monthly screenings of providers. However, due to the timing of the corrective actions, there are certain providers remaining in the system without the required screening documentation. Criteria: 42 CFR 455.410 states that the Department must require all enrolled providers to be screened. Per 42 CFR 455.412, the Department must verify the provider’s license has not expired and is valid. Context: A sample of 25 providers who received payment during the year were tested to determine whether a required screening was performed before the provider was enrolled. For 4 of 25 providers tested, the Department was not able to provide documentation that the required screening was performed. Cause: In certain instances, information from the legacy system was not transferred to the current MMIS. Additionally, certain providers who received single-case approvals were being excluded from the revalidation processes in place. Effect: There is no documentation to show that a provider screening and license verification were conducted to show compliance with Medicaid requirements. Questioned Cost: None. Repeat Finding: This is a repeat finding. Recommendation: We recommend that the Department review and update controls to ensure proper screening and license verification is performed for all providers and that documentation of the screening and verification is retained in all cases. Current Status/Plan of Action: MAD successfully provided screening and license verification for all providers, except for MCOR providers. MCOR requests are submitted by MCOs, therefore this process does not require providers to submit license or other credentials to enroll with New Mexico Medicaid. MAD recently changed MCOR approval term to two years from the date of approval, thus MCORs will be excluded from revalidation process. The program is currently working on a system memo to include MCORs to the monthly screening process. Responsible Person: MAD Compliance Officer and PPSB Bureau Chief.

Condition: Reports required to be submitted under the Federal Funding Accountability and Transparency Act (FFATA) were not submitted timely during the year ended June 30, 2023. Management has made progress on the prior year finding. Certain reports were submitted for fiscal year 2023 that were not submitted for the prior year. However, certain reports were not submitted timely during fiscal year 2023 due to the timing of the prior year finding. Criteria: Under the requirements of FFATA (Pub. L. No. 109-282), as amended by Section 6202 of Public Law 110-252, the Department is required to submit reports to the Federal Funding Accountability and Transparency Act Subaward Reporting System for any subawards of $30,000 or more. Reports are due by the end of the month following the month in which the prime awardee awards any sub-award equal to or greater than $30,000. Context: FFATA reports were submitted for the programs, however, they were not submitted within their due dates. Cause: The Department has not implemented the proper controls to ensure all required FFATA reports are submitted to the federal agency timely. Effect: FFATA reports were submitted after their due dates. Questioned Costs: None Repeat Finding: This is a repeat and modified finding. Recommendation: We recommend that the Department ensure that adequate controls are in place to ensure that report due dates are met. Current Status/Plan of Action: ASD Staff from the Contracts and Procurement and Grants Management Bureau are working with Division Staff to gather the appropriate data to report and submit the Federal Funding Accountability and Transparency Act (FFATA). ASD did submit the FFATA report, however, we will work to ensure that this report is submitted timely. We will complete resolution of this finding during fiscal year 2024. Responsible Person: Grants Bureau Chief and Procurement Bureau Chief.

Condition: Reports required to be submitted under the Federal Funding Accountability and Transparency Act (FFATA) were not submitted timely during the year ended June 30, 2023. Management has made progress on the prior year finding. Certain reports were submitted for fiscal year 2023 that were not submitted for the prior year. However, certain reports were not submitted timely during fiscal year 2023 due to the timing of the prior year finding. Criteria: Under the requirements of FFATA (Pub. L. No. 109-282), as amended by Section 6202 of Public Law 110-252, the Department is required to submit reports to the Federal Funding Accountability and Transparency Act Subaward Reporting System for any subawards of $30,000 or more. Reports are due by the end of the month following the month in which the prime awardee awards any sub-award equal to or greater than $30,000. Context: FFATA reports were submitted for the programs, however, they were not submitted within their due dates. Cause: The Department has not implemented the proper controls to ensure all required FFATA reports are submitted to the federal agency timely. Effect: FFATA reports were submitted after their due dates. Questioned Costs: None Repeat Finding: This is a repeat and modified finding. Recommendation: We recommend that the Department ensure that adequate controls are in place to ensure that report due dates are met. Current Status/Plan of Action: ASD Staff from the Contracts and Procurement and Grants Management Bureau are working with Division Staff to gather the appropriate data to report and submit the Federal Funding Accountability and Transparency Act (FFATA). ASD did submit the FFATA report, however, we will work to ensure that this report is submitted timely. We will complete resolution of this finding during fiscal year 2024. Responsible Person: Grants Bureau Chief and Procurement Bureau Chief.