Federal Agency: United States Department of Agriculture Federal Programs: Child and Adult Care Food Program (10.558) Federal Award Numbers: 202120N105044, 202121N115044, 202222N115044, 202221N115044, 202121N202044, 202120N202044, 202121N109944, 202120N109944, 202121N119944, 202121H170644, 202222N202044, 202221N202044, 202222N119944, 202221N119944 Federal Award Years: 2021 and 2022 State Agency: Department of Health Reference: 2022-003 Criteria Title 2 U.S. Code of Federal Regulations Part 200 (2 CFR 200), Uniform Administrative Requirements, Cost Principles, and Audit Requirements, section 200.332(d) states all pass-through entities must monitor the activities of the subrecipient as necessary to ensure that he subaward is used for authorized purposes, in compliance with federal statutes, regulations, and the terms and conditions of the subaward, and that subaward performance goals are achieved. Pass-through entity monitoring of the subrecipient must include: (1) Reviewing financial and performance reports required by the pass-through entity. (2) Following-up and ensuring that the subrecipient takes timely and appropriate action on all deficiencies pertaining to the federal award provided to the subrecipient from the pass-through entity detected through audits, on-site reviews, and other means. (3) Issuing a management decision for audit findings pertaining to the federal award provided to the subrecipient from the pass-through entity as required by 2 CFR 200.521. Additionally, 2 CFR 200.303(a) states the nonfederal entity must Establish and maintain effective internal control over the federal award that provides reasonable assurance that the nonfederal entity is managing the federal award in compliance with federal statutes, regulations, and the terms and conditions of the federal award. Condition For 3 of 40 subrecipients selected, the Department did not review the cases by the scheduled due date for the single audit reports as required in accordance with 2 CFR 200.332(d). The Department of Health (the Department) did not have effective internal controls in place to ensure that all required single audits of the program?s subrecipients were reviewed, followed-up, or appropriate action was taken and as necessary issued a management decision pertaining to the audit finding in accordance with 2 CFR 200, as applicable. The Department maintains an internal clearinghouse tracker (the tracker) to track the subrecipients single audit status. The tracker tracks subrecipients that are exempt from single audit requirements as well as the status and follow-up required for the subrecipients with single audits. Cause The condition is due to DOH Audit Clearinghouse personnel not operating as intended, due to COVID-19 personnel reassignments, to ensure the timely review of all single audit reports for all subrecipients receiving federal funding from the Department. Possible Asserted Effect Failure to properly obtain and review subrecipient single audit reports may result in the use of federal funding not being in compliance with federal statues, regulations, and the terms and conditions of subawards. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding for the Department was included in the 2019 Single Audit Report as finding number 2019 032 at pages 90?92. Recommendation We recommend the Department to continue working on the implementation of its replacement computerized system to (1) identify all subrecipients required to have a single audit, (2) ensure that sanctions are imposed in a timely manner for subrecipients that do not submit timely single audit reports, and (3) issue management decisions within six months for all single audit reports that contain findings relevant to the Department?s programs. In the interim, we recommend that manual internal control procedures be implemented by the Department to ensure that all subrecipients that require a single audit to be completed submit the report on a timely basis and, if applicable, respond to management decision letters be issued by the Department. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Agriculture Federal Programs: Child and Adult Care Food Program (10.558) Federal Award Numbers: 202120N105044, 202121N115044, 202222N115044, 202221N115044, 202121N202044, 202120N202044, 202121N109944, 202120N109944, 202121N119944, 202121H170644, 202222N202044, 202221N202044, 202222N119944, 202221N119944 Federal Award Years: 2021 and 2022 State Agency: Department of Health Reference: 2022-003 Criteria Title 2 U.S. Code of Federal Regulations Part 200 (2 CFR 200), Uniform Administrative Requirements, Cost Principles, and Audit Requirements, section 200.332(d) states all pass-through entities must monitor the activities of the subrecipient as necessary to ensure that he subaward is used for authorized purposes, in compliance with federal statutes, regulations, and the terms and conditions of the subaward, and that subaward performance goals are achieved. Pass-through entity monitoring of the subrecipient must include: (1) Reviewing financial and performance reports required by the pass-through entity. (2) Following-up and ensuring that the subrecipient takes timely and appropriate action on all deficiencies pertaining to the federal award provided to the subrecipient from the pass-through entity detected through audits, on-site reviews, and other means. (3) Issuing a management decision for audit findings pertaining to the federal award provided to the subrecipient from the pass-through entity as required by 2 CFR 200.521. Additionally, 2 CFR 200.303(a) states the nonfederal entity must Establish and maintain effective internal control over the federal award that provides reasonable assurance that the nonfederal entity is managing the federal award in compliance with federal statutes, regulations, and the terms and conditions of the federal award. Condition For 3 of 40 subrecipients selected, the Department did not review the cases by the scheduled due date for the single audit reports as required in accordance with 2 CFR 200.332(d). The Department of Health (the Department) did not have effective internal controls in place to ensure that all required single audits of the program?s subrecipients were reviewed, followed-up, or appropriate action was taken and as necessary issued a management decision pertaining to the audit finding in accordance with 2 CFR 200, as applicable. The Department maintains an internal clearinghouse tracker (the tracker) to track the subrecipients single audit status. The tracker tracks subrecipients that are exempt from single audit requirements as well as the status and follow-up required for the subrecipients with single audits. Cause The condition is due to DOH Audit Clearinghouse personnel not operating as intended, due to COVID-19 personnel reassignments, to ensure the timely review of all single audit reports for all subrecipients receiving federal funding from the Department. Possible Asserted Effect Failure to properly obtain and review subrecipient single audit reports may result in the use of federal funding not being in compliance with federal statues, regulations, and the terms and conditions of subawards. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding for the Department was included in the 2019 Single Audit Report as finding number 2019 032 at pages 90?92. Recommendation We recommend the Department to continue working on the implementation of its replacement computerized system to (1) identify all subrecipients required to have a single audit, (2) ensure that sanctions are imposed in a timely manner for subrecipients that do not submit timely single audit reports, and (3) issue management decisions within six months for all single audit reports that contain findings relevant to the Department?s programs. In the interim, we recommend that manual internal control procedures be implemented by the Department to ensure that all subrecipients that require a single audit to be completed submit the report on a timely basis and, if applicable, respond to management decision letters be issued by the Department. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Labor Federal Program: Unemployment Insurance (17.225) Federal Award Numbers: Not Applicable Federal Award Years: Not Applicable State Agency: Department of Labor Reference: 2022-004 Criteria The Payments Integrity Information Act (PIIA) of 2019 codified the requirement for valid statistical estimates of improper payments. by Title 20 Code of Federal Regulations Part 602 (20 CFR 602), Quality Control in the Federal-State Unemployment System, prescribes a Quality Control (QC) program for the Federal-State unemployment compensation (UC) system, which is appliable to the State UC programs and the Federal unemployment benefit and allowance programs administered by the State unemployment compensation agencies under agreements between the States and the Secretary of Labor. 20 CFR 602.11(d) states to satisfy the requirements of Section 303(a)(1) and (6) of the Social Security Act (SSA) (42 USC 503), a State law must contain a provision requiring, or which is construed to require, the establishment and maintenance of a QC program in accordance with the requirements of this part. The establishment and maintenance of such a QC program in accordance with this part shall not require any change in State law concerning authority to undertake redeterminations of claims or liabilities or the finality of any determination, redetermination or decision. Each State shall establish a QC unit independent of, and not accountable to, any unit performing functions subject to evaluation by the QC unit. The organizational location of this unit shall be positioned to maximize its objectivity, to facilitate its access to information necessary to carry out its responsibilities, and to minimize organizational conflict of interest. Per 20 CFR 602.21 ? Standard methods and Procedures, Each State Shall: (a) Perform the requirements of this section in accordance with instructions issued by the Department, pursuant to ? 602.30(a) of this part, to ensure standardization of methods and procedures in a manner consistent with this part; (b) Select representative samples for QC study of at least a minimum size specified by the Department to ensure statistical validity (for benefit payments, a minimum of 400 cases of weeks paid per State per year); (c) Complete prompt and in-depth case investigations to determine the degree of accuracy and timeliness in the administration of the State UC law and Federal programs with respect to benefit determinations, benefit payments, and revenue collections; and conduct other measurements and studies necessary or appropriate for carrying out the purposes of this part; and in conducting investigations each State shall: (1) Inform claimants in writing that the information obtained from a QC investigation may affect their eligibility for benefits and inform employers in writing that the information obtained from a QC investigation of revenue may affect their tax liability, (2) Use a questionnaire, prescribed by the Department, which is designed to obtain such data as the Department deems necessary for the operation of the QC program; require completion of the questionnaire by claimants in accordance with the eligibility and reporting authority under State law, (3) Collect data identified by the Department as necessary for the operation of the QC program; however, the collection of demographic data will be limited to those data which relate to an individual's eligibility for UC benefits and necessary to conduct proportions tests to validate the selection of representative samples (the demographic data elements necessary to conduct proportions tests are claimants' date of birth, sex, and ethnic classification); and (4) Conclude all findings of inaccuracy as d(a) Perform the requirements of this section in accordance with instructions issued by the Department, pursuant to ? 602.30(a) of this part, to ensure standardization of methods and procedures in a manner consistent with this part; (d) Classify benefit case findings resulting from QC investigations as: (1) Proper payments, underpayments, or overpayments in benefit payment cases, or (2) Proper denials or underpayments in benefit denial cases; (e) Make and maintain records pertaining to the QC program, and make all such records available in a timely manner for inspection, examination, and audit by such Federal officials as the Secretary may designate or as may be required or authorized by law; (f) Furnish information and reports to the Department, including weekly transmissions of case data entered into the automated QC system and annual reports, without, in any manner, identifying individuals to whom such data pertain; and (g) Release the results of the QC program at the same time each year, providing calendar year results using a standardized format to present the data as prescribed by the Department; States will have the opportunity to release this information prior to any release by the Department. Lastly, Title 2 U.S. Code of Federal Regulations Part 200 (2 CFR 200) Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, section 303(a) states, the non-Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-Federal entity is managing the Federal award in compliance with Federal statues, regulations, and the terms and conditions of the Federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition The Benefit Accuracy Measurement (BAM) programs consists of reviews of Regular UI payments, which are paid out of the Unemployment Insurance Trust Fund, and therefore are not associated with a Federal Award Number. For the period ending September 30, 2021, New York State sampled a total of 447 Denied Claims, 3 cases short of the USDOL minimum annual allocation requirement for Denied Cases of 450. Additionally, NYS has failed the 90- and 120-day time lapse requirement for Paid Claims. For the Month of March 2022, 94.58% of cases were reviewed and closed within 90 days, less than 1% short of the required 95%. Also, for the month of March 2022, NYS reviewed and closed 96.02% and 95.41% of both paid and denied claims within 120 days, which is short of the required 98%. Cause The condition related to the failure to meet the minimum annual allocation threshold was a result of New York State not identifying in its initial sample selection of 450 that 3 of the cases selected from the last week for sampling in the 2020/2021 PIIA year did not relate to regular UI payments and were not identified in time to be replaced for evaluation under the BAM program PIIA year. The three incorrect samples were subsequently determined to be issued under a temporary program (PUA) and not able to be replaced due to the Department policies and procedures allowing for the sample item to be replaced in the subsequent week. The condition related to the time lapse requirements results from a shortage of staff and backlogged cases directly related to the COVID-19 Pandemic. As a result, the Department was unable to meet all case allocation and timely review requirements. Possible Asserted Effect Failure to perform timely completion of investigations results in the inability of UI Program to appropriately assess the degree of accuracy and timeliness in the administration of the State UC law and Federal programs with respect to benefit determinations, benefit payments, and revenue collections. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend that the Department ensures that their policies and procedures are designed to review selected cases to ensure they meet the prescribed criteria and, if necessary, be replaced as part of the final sampling week for the PIIA year. Additionally, the Department should enhance its process to ensure the completion of Paid and Denied cases are reviewed and closed timely in accordance with State Law. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Labor Federal Program: Unemployment Insurance (17.225) Federal Award Numbers: MI-34016-19-75-A-36; MI-35505-20-75-A-36; UI-27922-15-55-A-36; UI-32857-19-60-A-36; UI-34075-20-55-A-36; UI-34512-20-60-A-36; UI-34732-20-55-A-36; UI-35665-21-55-A-36; UI-35961-21-60-A-36; UI-37081-21-55-A-36; UI-37240-22-55-A-36; UI-37261-22-55-A-36 Federal Award Years: 2020 and 2021 State Agency: Department of Labor Reference: 2022-005 Criteria The Coronavirus Aid, Relief, and Economic Security Act (CARES Act), signed into law March 27, 2020, provides over $2 trillion of economic relief to workers, families, small businesses, industry sectors, and other levels of government that have been hit hard by the public health crisis created by the Coronavirus Disease 2019 (COVID-19). The CARES Act and subsequent legislation was designed to mitigate the economic effects of the COVID-19 pandemic in a variety of ways. Section 2102 of the CARES Act provided temporary benefits known as Pandemic Unemployment Assistance (PUA), for individuals who exhausted their entitlement to regular Unemployment Compensation (UC), and individuals who were not eligible for regular UC, such as those who were self-employed or who had limited recent work history. These individuals may also include certain gig economy workers, members of the clergy, and those working for religious organizations who were not covered by regular UC, as well as other workers who may not have been covered by the regular UC program under some state laws. PUA provides benefits to covered individuals, who are those individuals not eligible for regular unemployment compensation (UC or extended benefits under state or federal law or Pandemic Emergency Unemployment Compensation (PEUC), including those who have exhausted all rights to such benefits. Covered individuals also include self-employed, those seeking part-time employment, individuals lacking sufficient work history, and those who otherwise do not qualify for regular unemployment compensation or extended benefits under state or federal law or PEUC. PUA is payable to individuals who are ineligible for regular UC, and are unemployed, partially unemployed, or unable or unavailable to work due to one of the COVID-19 related reasons identified Attachment I to UIPL No. 16-20, Change 5. Section 2102(a)(3)(A)(ii)(I) of the CARES Act included 10 specific COVID-19 related reasons. The Department, under the authority provided by Section 2102(a)(3)(A)(ii)(I)(kk) of the CARES Act, has added additional COVID-19 related reasons; these are discussed in more detail in Section 4.a. of UIPL No. 16-20, Change 5. While three of these new COVID-19 related reasons were introduced to states with the publication of UIPL No. 16-20, Change 5 on February 25, 2021, all COVID-19 related reasons apply retroactively to the beginning of the PUA program. Additionally, as described in Section 4.b.i. of UIPL No. 16-20, Change 5, paraphrasing of the COVID-19 related reasons is not permissible; individuals must be permitted to select more than one COVID-19 related reason; individuals must be permitted to select different COVID-19 related reasons each week; and individuals must be permitted to file and select no COVID-19 related reasons. (1) The individual has been diagnosed with COVID-19 or is experiencing symptoms of COVID-19 and is seeking a medical diagnosis; (2) A member of the individual?s household has been diagnosed with COVID-19; (3) The individual is providing care for a family member or a member of the individual?s household who has been diagnosed with COVID-19; (4) A child or other person in the household for which the individual has primary caregiving responsibility is unable to attend school or another facility that is closed as a direct result of the COVID-19 public health emergency and such school or facility care is required for the individual to work; (5) The individual is unable to reach the place of employment because of a quarantine imposed as a direct result of the COVID-19 public health emergency; (6) The individual is unable to reach the place of employment because the individual has been advised by a health care provider to self-quarantine due to concerns related to COVID-19; (7) The individual was scheduled to commence employment and does not have a job or is unable to reach the job as a direct result of the COVID-19 public health emergency; (8) The individual has become the breadwinner or major support for a household because the head of the household has died as a direct result of COVID-19; (9) The individual has to quit his or her job as a direct result of COVID-19; (10) The individual?s place of employment is closed as a direct result of the COVID-19 public health emergency; or (11) The individual meets any additional criteria established by the Department for unemployment assistance under this section. a) An individual who works as an independent contractor with reportable income may also qualify for PUA benefits if he or she is unemployed, partially employed, or unable or unavailable to work because the COVID-19 public health emergency has severely limited his or her ability to continue performing his or her customary work activities, and has thereby forced the individual to suspend such activities; b) The individual has been denied continued unemployment benefits because the individual refused to return to work or accept an offer of work at a worksite that, in either instance, is not in compliance with local, state, or national health and safety standards directly related to COVID-19. This includes, but is not limited to, those related to facial mask wearing, physical distancing measures, or the provision of personal protective equipment consistent with public health guidelines; c) An individual provides services to an educational institution or educational service agency and the individual is unemployed or partially unemployed because of volatility in the work schedule that is directly caused by the COVID-19 public health emergency. This includes, but is not limited to, changes in schedules and partial closures; or d) An individual is an employee and their hours have been reduced or the individual was laid off as a direct result of the COVID-19 public health emergency. Section 2107 of the CARES Act created a new temporary federal program called PEUC that provided additional weeks of benefits to individuals who had exhausted their regular UC entitlement and provided funding to states to administer the program. The CARES Act originally provided up to 13 additional weeks of PEUC benefits. Section 206 of CAA and Section 9016 of the American Rescue Plan Act of 2021 (ARPA) increased the total amount of PEUC benefits available to 53 times the individual?s average weekly benefit amount, with the additional weeks of benefits payable for weeks of unemployment ending after March 14, 2021. To be eligible for PEUC, a claimant must have exhausted all rights to regular compensation under state law or federal law with respect to a benefit year that ended on or after July 1, 2019; have no rights to regular compensation with respect to a week under any other state UC law or federal UC law, or to compensation under any other federal law; are not receiving compensation with respect to a week under the UC law of Canada; and are able to work, available to work, and actively seeking work, while recognizing that states must provide flexibility in meeting the ?actively seeking work? requirement if individuals are unable to search for work because of COVID-19, including because of illness, quarantine, or movement restriction. Lastly, Title 2 U.S. Code of Federal Regulations Part 200 (2CFR 200) Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, section 303(a) states, the non-Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-Federal entity is managing the Federal award in compliance with Federal statues, regulations, and the terms and conditions of the Federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition In conjunction with our testwork over 60 samples related to PUA eligibility, the following findings were identified: I. For 28 of the 60 samples, the Department of Labor (the Department) was unable to provide evidence the claimant has submitted proof of documentation substantiating employment, self-employment, or the planned commencement of employment or self-employment in accordance with Section 241 (a) of the Continued Assistance Act. II. For 3 of the 60 samples, the incorrect benefit rate was calculated by the Department resulting in underpayments to claimants. III. For 1 of the 60 samples the Department was unable to provide support for any files related to the eligibility determination of the claimant IV. For 60 of the 60 samples, the Department did not complete the required quarterly wage checks for PUA claimants at most recent quarter change to ensure PUA claimant was not eligible for any other benefit programs. In conjunction with our testwork over 60 samples related to PEUC eligibility, the following findings were identified: V. For 60 of the 60 samples the Department did not complete required quarterly wage checks on PEUC claimants at most recent quarter change to ensure that PEUC claimant is still deemed to be an exhaustee and not eligible to establish a new benefit year for other UI programs. VI. For 2 of the 60 samples, the claimant was received PEUC before exhausting 104 days of regular UI benefits. Cause Condition II results from the incorrect effective date and/or incorrect wages used to calculate the benefit rate resulting in underpayments to the claimant. Conditions I, III, IV, and V, results from the Department not having the appropriate documentation to support the eligibility determinations made as part of the PUA and PEUC federal programs. Condition VI results from the Department using incorrect backdates resulting in the claimant not exhausting 104 days of regular UI prior to receiving PEUC benefits. Possible Asserted Effect Failure to ensure eligibility is properly determined or benefit calculations are accurately stated may result in ineligible benefit payments not in accordance with the terms and conditions of the federal awards. Questioned Costs $679 (total overpayments of temporary federal awards paid to two selected beneficiaries) Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend the Department enhance its policies and procedures to ensure that all benefit payments made under the PUA and PEUC programs have the appropriate documentation to support eligibility determinations reached and that all benefit calculations are accurately supported for the calculated amounts. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Labor Federal Program: Unemployment Insurance (17.225) Federal Award Numbers: Not Applicable Federal Award Years: Not Applicable State Agency: Department of Labor Reference: 2022-006 Criteria Under Section 904 of the Social Security Act, Unemployment Trust Fund, established in the Treasury of the United States a trust fund to be known as the ?Unemployment Trust Fund? (Fund). The Secretary of the Treasury is authorized and directed to receive and hold in the Fund all moneys deposited therein by a State agency from a State unemployment fund, or by the Railroad Retirement Board to the credit of the railroad unemployment insurance account or the railroad unemployment insurance administration fund, or otherwise deposited in or credited to the Fund or any account therein. Such deposit may be made directly with the Secretary of the Treasury, with any depositary designated by him for such purpose, or with any Federal Reserve Bank. Under section (e), the fund shall be invested as a single fund, but the Secretary of the Treasury shall maintain a separate book account for each State agency. Under Article 18 of New York State law, Title 7 Section 590, rights to benefits states that benefits shall not be paid for more than one hundred and four effective days in any benefit year, except as provided in section six hundred one and subdivision two of section five hundred ninety-nine of this chapter. Additionally, Aliens must show proof that they are authorized to work by the US Citizenship and Immigration Services (USCIS) in order to be eligible to receive a federal public benefit (42 USC 1302b-7(d) and (e)). specifically If such an individual is not a citizen or national of the United States, there must be presented either alien registration documentation or other proof of immigration registration from the Immigration and Naturalization Service that contains the individual?s alien admission number or alien file number (or numbers if the individual has more than one number), or such other documents as the State determines constitutes reasonable evidence indicating a satisfactory immigration status. In the case of such an individual who is not a citizen or national of the United States, if, at the time of application for benefits, the statement described in paragraph (1) is submitted but the documentation required under paragraph (2) is not presented or if the documentation required under paragraph (2)(A) is presented but such documentation is not verified under paragraph (3) the State shall provide a reasonable opportunity to submit to the State evidence indicating a satisfactory immigration status, and may not delay, deny, reduce, or terminate the individual?s eligibility for benefits under the program on the basis of the individual?s immigration status until such a reasonable opportunity has been provided Lastly, Title 2 U.S. Code of Federal Regulations Part 200 (2 CFR 200) Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, section 303(a) states, the non-Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition Regular UI payments, which are paid out of the Unemployment Insurance Trust Fund, and therefore are not associated with a Federal Award Number. During our testwork we noted the following: I. For 1 of 60 regular Unemployment Compensation (UC) claimants selected, the claimant received regular UC payments for greater than 104 days drawn from the Unemployment Trust Fund. Cause I. Condition I results from Unemployment Insurance (UI) system and the Department failing to identify and restrict payment to the claimants that reached the maximum limit of days allowed for regular UC benefits. The Department does not have a manual control to identify the claimants as being coded to the incorrect benefit. Possible Asserted Effect Failure to ensure eligibility is properly determined or benefit calculations are accurately stated may result in ineligible benefit payments not in accordance with the terms and conditions of the federal awards. Questioned Costs $256 (overpayments in excess of maximum regular unemployment compensation paid to one selected beneficiary) Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding for the Department was included in the 2021 Single Audit Report as finding number 2021-005 at pages 23?24. Recommendation We recommend the Department enhance its process and controls to ensure claimants that have exhausted benefits such as regular UC are not allowed to receive benefits in excess of the maximum allowable days for the program. Additionally, we recommend the Department enhance its policies and procedures to ensure that all benefit payments made under regular Unemployment Compensation (UC) have the appropriate documentation to support eligibility determinations reached and that all benefit calculations are accurately supported for the calculated amounts. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Labor Federal Program: Unemployment Insurance (17.225) Federal Award Numbers: Not Applicable Federal Award Years: Not Applicable State Agency: Department of Labor Reference: 2022-004 Criteria The Payments Integrity Information Act (PIIA) of 2019 codified the requirement for valid statistical estimates of improper payments. by Title 20 Code of Federal Regulations Part 602 (20 CFR 602), Quality Control in the Federal-State Unemployment System, prescribes a Quality Control (QC) program for the Federal-State unemployment compensation (UC) system, which is appliable to the State UC programs and the Federal unemployment benefit and allowance programs administered by the State unemployment compensation agencies under agreements between the States and the Secretary of Labor. 20 CFR 602.11(d) states to satisfy the requirements of Section 303(a)(1) and (6) of the Social Security Act (SSA) (42 USC 503), a State law must contain a provision requiring, or which is construed to require, the establishment and maintenance of a QC program in accordance with the requirements of this part. The establishment and maintenance of such a QC program in accordance with this part shall not require any change in State law concerning authority to undertake redeterminations of claims or liabilities or the finality of any determination, redetermination or decision. Each State shall establish a QC unit independent of, and not accountable to, any unit performing functions subject to evaluation by the QC unit. The organizational location of this unit shall be positioned to maximize its objectivity, to facilitate its access to information necessary to carry out its responsibilities, and to minimize organizational conflict of interest. Per 20 CFR 602.21 ? Standard methods and Procedures, Each State Shall: (a) Perform the requirements of this section in accordance with instructions issued by the Department, pursuant to ? 602.30(a) of this part, to ensure standardization of methods and procedures in a manner consistent with this part; (b) Select representative samples for QC study of at least a minimum size specified by the Department to ensure statistical validity (for benefit payments, a minimum of 400 cases of weeks paid per State per year); (c) Complete prompt and in-depth case investigations to determine the degree of accuracy and timeliness in the administration of the State UC law and Federal programs with respect to benefit determinations, benefit payments, and revenue collections; and conduct other measurements and studies necessary or appropriate for carrying out the purposes of this part; and in conducting investigations each State shall: (1) Inform claimants in writing that the information obtained from a QC investigation may affect their eligibility for benefits and inform employers in writing that the information obtained from a QC investigation of revenue may affect their tax liability, (2) Use a questionnaire, prescribed by the Department, which is designed to obtain such data as the Department deems necessary for the operation of the QC program; require completion of the questionnaire by claimants in accordance with the eligibility and reporting authority under State law, (3) Collect data identified by the Department as necessary for the operation of the QC program; however, the collection of demographic data will be limited to those data which relate to an individual's eligibility for UC benefits and necessary to conduct proportions tests to validate the selection of representative samples (the demographic data elements necessary to conduct proportions tests are claimants' date of birth, sex, and ethnic classification); and (4) Conclude all findings of inaccuracy as d(a) Perform the requirements of this section in accordance with instructions issued by the Department, pursuant to ? 602.30(a) of this part, to ensure standardization of methods and procedures in a manner consistent with this part; (d) Classify benefit case findings resulting from QC investigations as: (1) Proper payments, underpayments, or overpayments in benefit payment cases, or (2) Proper denials or underpayments in benefit denial cases; (e) Make and maintain records pertaining to the QC program, and make all such records available in a timely manner for inspection, examination, and audit by such Federal officials as the Secretary may designate or as may be required or authorized by law; (f) Furnish information and reports to the Department, including weekly transmissions of case data entered into the automated QC system and annual reports, without, in any manner, identifying individuals to whom such data pertain; and (g) Release the results of the QC program at the same time each year, providing calendar year results using a standardized format to present the data as prescribed by the Department; States will have the opportunity to release this information prior to any release by the Department. Lastly, Title 2 U.S. Code of Federal Regulations Part 200 (2 CFR 200) Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, section 303(a) states, the non-Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-Federal entity is managing the Federal award in compliance with Federal statues, regulations, and the terms and conditions of the Federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition The Benefit Accuracy Measurement (BAM) programs consists of reviews of Regular UI payments, which are paid out of the Unemployment Insurance Trust Fund, and therefore are not associated with a Federal Award Number. For the period ending September 30, 2021, New York State sampled a total of 447 Denied Claims, 3 cases short of the USDOL minimum annual allocation requirement for Denied Cases of 450. Additionally, NYS has failed the 90- and 120-day time lapse requirement for Paid Claims. For the Month of March 2022, 94.58% of cases were reviewed and closed within 90 days, less than 1% short of the required 95%. Also, for the month of March 2022, NYS reviewed and closed 96.02% and 95.41% of both paid and denied claims within 120 days, which is short of the required 98%. Cause The condition related to the failure to meet the minimum annual allocation threshold was a result of New York State not identifying in its initial sample selection of 450 that 3 of the cases selected from the last week for sampling in the 2020/2021 PIIA year did not relate to regular UI payments and were not identified in time to be replaced for evaluation under the BAM program PIIA year. The three incorrect samples were subsequently determined to be issued under a temporary program (PUA) and not able to be replaced due to the Department policies and procedures allowing for the sample item to be replaced in the subsequent week. The condition related to the time lapse requirements results from a shortage of staff and backlogged cases directly related to the COVID-19 Pandemic. As a result, the Department was unable to meet all case allocation and timely review requirements. Possible Asserted Effect Failure to perform timely completion of investigations results in the inability of UI Program to appropriately assess the degree of accuracy and timeliness in the administration of the State UC law and Federal programs with respect to benefit determinations, benefit payments, and revenue collections. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend that the Department ensures that their policies and procedures are designed to review selected cases to ensure they meet the prescribed criteria and, if necessary, be replaced as part of the final sampling week for the PIIA year. Additionally, the Department should enhance its process to ensure the completion of Paid and Denied cases are reviewed and closed timely in accordance with State Law. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Labor Federal Program: Unemployment Insurance (17.225) Federal Award Numbers: MI-34016-19-75-A-36; MI-35505-20-75-A-36; UI-27922-15-55-A-36; UI-32857-19-60-A-36; UI-34075-20-55-A-36; UI-34512-20-60-A-36; UI-34732-20-55-A-36; UI-35665-21-55-A-36; UI-35961-21-60-A-36; UI-37081-21-55-A-36; UI-37240-22-55-A-36; UI-37261-22-55-A-36 Federal Award Years: 2020 and 2021 State Agency: Department of Labor Reference: 2022-005 Criteria The Coronavirus Aid, Relief, and Economic Security Act (CARES Act), signed into law March 27, 2020, provides over $2 trillion of economic relief to workers, families, small businesses, industry sectors, and other levels of government that have been hit hard by the public health crisis created by the Coronavirus Disease 2019 (COVID-19). The CARES Act and subsequent legislation was designed to mitigate the economic effects of the COVID-19 pandemic in a variety of ways. Section 2102 of the CARES Act provided temporary benefits known as Pandemic Unemployment Assistance (PUA), for individuals who exhausted their entitlement to regular Unemployment Compensation (UC), and individuals who were not eligible for regular UC, such as those who were self-employed or who had limited recent work history. These individuals may also include certain gig economy workers, members of the clergy, and those working for religious organizations who were not covered by regular UC, as well as other workers who may not have been covered by the regular UC program under some state laws. PUA provides benefits to covered individuals, who are those individuals not eligible for regular unemployment compensation (UC or extended benefits under state or federal law or Pandemic Emergency Unemployment Compensation (PEUC), including those who have exhausted all rights to such benefits. Covered individuals also include self-employed, those seeking part-time employment, individuals lacking sufficient work history, and those who otherwise do not qualify for regular unemployment compensation or extended benefits under state or federal law or PEUC. PUA is payable to individuals who are ineligible for regular UC, and are unemployed, partially unemployed, or unable or unavailable to work due to one of the COVID-19 related reasons identified Attachment I to UIPL No. 16-20, Change 5. Section 2102(a)(3)(A)(ii)(I) of the CARES Act included 10 specific COVID-19 related reasons. The Department, under the authority provided by Section 2102(a)(3)(A)(ii)(I)(kk) of the CARES Act, has added additional COVID-19 related reasons; these are discussed in more detail in Section 4.a. of UIPL No. 16-20, Change 5. While three of these new COVID-19 related reasons were introduced to states with the publication of UIPL No. 16-20, Change 5 on February 25, 2021, all COVID-19 related reasons apply retroactively to the beginning of the PUA program. Additionally, as described in Section 4.b.i. of UIPL No. 16-20, Change 5, paraphrasing of the COVID-19 related reasons is not permissible; individuals must be permitted to select more than one COVID-19 related reason; individuals must be permitted to select different COVID-19 related reasons each week; and individuals must be permitted to file and select no COVID-19 related reasons. (1) The individual has been diagnosed with COVID-19 or is experiencing symptoms of COVID-19 and is seeking a medical diagnosis; (2) A member of the individual?s household has been diagnosed with COVID-19; (3) The individual is providing care for a family member or a member of the individual?s household who has been diagnosed with COVID-19; (4) A child or other person in the household for which the individual has primary caregiving responsibility is unable to attend school or another facility that is closed as a direct result of the COVID-19 public health emergency and such school or facility care is required for the individual to work; (5) The individual is unable to reach the place of employment because of a quarantine imposed as a direct result of the COVID-19 public health emergency; (6) The individual is unable to reach the place of employment because the individual has been advised by a health care provider to self-quarantine due to concerns related to COVID-19; (7) The individual was scheduled to commence employment and does not have a job or is unable to reach the job as a direct result of the COVID-19 public health emergency; (8) The individual has become the breadwinner or major support for a household because the head of the household has died as a direct result of COVID-19; (9) The individual has to quit his or her job as a direct result of COVID-19; (10) The individual?s place of employment is closed as a direct result of the COVID-19 public health emergency; or (11) The individual meets any additional criteria established by the Department for unemployment assistance under this section. a) An individual who works as an independent contractor with reportable income may also qualify for PUA benefits if he or she is unemployed, partially employed, or unable or unavailable to work because the COVID-19 public health emergency has severely limited his or her ability to continue performing his or her customary work activities, and has thereby forced the individual to suspend such activities; b) The individual has been denied continued unemployment benefits because the individual refused to return to work or accept an offer of work at a worksite that, in either instance, is not in compliance with local, state, or national health and safety standards directly related to COVID-19. This includes, but is not limited to, those related to facial mask wearing, physical distancing measures, or the provision of personal protective equipment consistent with public health guidelines; c) An individual provides services to an educational institution or educational service agency and the individual is unemployed or partially unemployed because of volatility in the work schedule that is directly caused by the COVID-19 public health emergency. This includes, but is not limited to, changes in schedules and partial closures; or d) An individual is an employee and their hours have been reduced or the individual was laid off as a direct result of the COVID-19 public health emergency. Section 2107 of the CARES Act created a new temporary federal program called PEUC that provided additional weeks of benefits to individuals who had exhausted their regular UC entitlement and provided funding to states to administer the program. The CARES Act originally provided up to 13 additional weeks of PEUC benefits. Section 206 of CAA and Section 9016 of the American Rescue Plan Act of 2021 (ARPA) increased the total amount of PEUC benefits available to 53 times the individual?s average weekly benefit amount, with the additional weeks of benefits payable for weeks of unemployment ending after March 14, 2021. To be eligible for PEUC, a claimant must have exhausted all rights to regular compensation under state law or federal law with respect to a benefit year that ended on or after July 1, 2019; have no rights to regular compensation with respect to a week under any other state UC law or federal UC law, or to compensation under any other federal law; are not receiving compensation with respect to a week under the UC law of Canada; and are able to work, available to work, and actively seeking work, while recognizing that states must provide flexibility in meeting the ?actively seeking work? requirement if individuals are unable to search for work because of COVID-19, including because of illness, quarantine, or movement restriction. Lastly, Title 2 U.S. Code of Federal Regulations Part 200 (2CFR 200) Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, section 303(a) states, the non-Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-Federal entity is managing the Federal award in compliance with Federal statues, regulations, and the terms and conditions of the Federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition In conjunction with our testwork over 60 samples related to PUA eligibility, the following findings were identified: I. For 28 of the 60 samples, the Department of Labor (the Department) was unable to provide evidence the claimant has submitted proof of documentation substantiating employment, self-employment, or the planned commencement of employment or self-employment in accordance with Section 241 (a) of the Continued Assistance Act. II. For 3 of the 60 samples, the incorrect benefit rate was calculated by the Department resulting in underpayments to claimants. III. For 1 of the 60 samples the Department was unable to provide support for any files related to the eligibility determination of the claimant IV. For 60 of the 60 samples, the Department did not complete the required quarterly wage checks for PUA claimants at most recent quarter change to ensure PUA claimant was not eligible for any other benefit programs. In conjunction with our testwork over 60 samples related to PEUC eligibility, the following findings were identified: V. For 60 of the 60 samples the Department did not complete required quarterly wage checks on PEUC claimants at most recent quarter change to ensure that PEUC claimant is still deemed to be an exhaustee and not eligible to establish a new benefit year for other UI programs. VI. For 2 of the 60 samples, the claimant was received PEUC before exhausting 104 days of regular UI benefits. Cause Condition II results from the incorrect effective date and/or incorrect wages used to calculate the benefit rate resulting in underpayments to the claimant. Conditions I, III, IV, and V, results from the Department not having the appropriate documentation to support the eligibility determinations made as part of the PUA and PEUC federal programs. Condition VI results from the Department using incorrect backdates resulting in the claimant not exhausting 104 days of regular UI prior to receiving PEUC benefits. Possible Asserted Effect Failure to ensure eligibility is properly determined or benefit calculations are accurately stated may result in ineligible benefit payments not in accordance with the terms and conditions of the federal awards. Questioned Costs $679 (total overpayments of temporary federal awards paid to two selected beneficiaries) Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend the Department enhance its policies and procedures to ensure that all benefit payments made under the PUA and PEUC programs have the appropriate documentation to support eligibility determinations reached and that all benefit calculations are accurately supported for the calculated amounts. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Labor Federal Program: Unemployment Insurance (17.225) Federal Award Numbers: Not Applicable Federal Award Years: Not Applicable State Agency: Department of Labor Reference: 2022-006 Criteria Under Section 904 of the Social Security Act, Unemployment Trust Fund, established in the Treasury of the United States a trust fund to be known as the ?Unemployment Trust Fund? (Fund). The Secretary of the Treasury is authorized and directed to receive and hold in the Fund all moneys deposited therein by a State agency from a State unemployment fund, or by the Railroad Retirement Board to the credit of the railroad unemployment insurance account or the railroad unemployment insurance administration fund, or otherwise deposited in or credited to the Fund or any account therein. Such deposit may be made directly with the Secretary of the Treasury, with any depositary designated by him for such purpose, or with any Federal Reserve Bank. Under section (e), the fund shall be invested as a single fund, but the Secretary of the Treasury shall maintain a separate book account for each State agency. Under Article 18 of New York State law, Title 7 Section 590, rights to benefits states that benefits shall not be paid for more than one hundred and four effective days in any benefit year, except as provided in section six hundred one and subdivision two of section five hundred ninety-nine of this chapter. Additionally, Aliens must show proof that they are authorized to work by the US Citizenship and Immigration Services (USCIS) in order to be eligible to receive a federal public benefit (42 USC 1302b-7(d) and (e)). specifically If such an individual is not a citizen or national of the United States, there must be presented either alien registration documentation or other proof of immigration registration from the Immigration and Naturalization Service that contains the individual?s alien admission number or alien file number (or numbers if the individual has more than one number), or such other documents as the State determines constitutes reasonable evidence indicating a satisfactory immigration status. In the case of such an individual who is not a citizen or national of the United States, if, at the time of application for benefits, the statement described in paragraph (1) is submitted but the documentation required under paragraph (2) is not presented or if the documentation required under paragraph (2)(A) is presented but such documentation is not verified under paragraph (3) the State shall provide a reasonable opportunity to submit to the State evidence indicating a satisfactory immigration status, and may not delay, deny, reduce, or terminate the individual?s eligibility for benefits under the program on the basis of the individual?s immigration status until such a reasonable opportunity has been provided Lastly, Title 2 U.S. Code of Federal Regulations Part 200 (2 CFR 200) Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, section 303(a) states, the non-Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition Regular UI payments, which are paid out of the Unemployment Insurance Trust Fund, and therefore are not associated with a Federal Award Number. During our testwork we noted the following: I. For 1 of 60 regular Unemployment Compensation (UC) claimants selected, the claimant received regular UC payments for greater than 104 days drawn from the Unemployment Trust Fund. Cause I. Condition I results from Unemployment Insurance (UI) system and the Department failing to identify and restrict payment to the claimants that reached the maximum limit of days allowed for regular UC benefits. The Department does not have a manual control to identify the claimants as being coded to the incorrect benefit. Possible Asserted Effect Failure to ensure eligibility is properly determined or benefit calculations are accurately stated may result in ineligible benefit payments not in accordance with the terms and conditions of the federal awards. Questioned Costs $256 (overpayments in excess of maximum regular unemployment compensation paid to one selected beneficiary) Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding for the Department was included in the 2021 Single Audit Report as finding number 2021-005 at pages 23?24. Recommendation We recommend the Department enhance its process and controls to ensure claimants that have exhausted benefits such as regular UC are not allowed to receive benefits in excess of the maximum allowable days for the program. Additionally, we recommend the Department enhance its policies and procedures to ensure that all benefit payments made under regular Unemployment Compensation (UC) have the appropriate documentation to support eligibility determinations reached and that all benefit calculations are accurately supported for the calculated amounts. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Labor Federal Program: Unemployment Insurance (17.225) Federal Award Numbers: Not Applicable Federal Award Years: Not Applicable State Agency: Department of Labor Reference: 2022-004 Criteria The Payments Integrity Information Act (PIIA) of 2019 codified the requirement for valid statistical estimates of improper payments. by Title 20 Code of Federal Regulations Part 602 (20 CFR 602), Quality Control in the Federal-State Unemployment System, prescribes a Quality Control (QC) program for the Federal-State unemployment compensation (UC) system, which is appliable to the State UC programs and the Federal unemployment benefit and allowance programs administered by the State unemployment compensation agencies under agreements between the States and the Secretary of Labor. 20 CFR 602.11(d) states to satisfy the requirements of Section 303(a)(1) and (6) of the Social Security Act (SSA) (42 USC 503), a State law must contain a provision requiring, or which is construed to require, the establishment and maintenance of a QC program in accordance with the requirements of this part. The establishment and maintenance of such a QC program in accordance with this part shall not require any change in State law concerning authority to undertake redeterminations of claims or liabilities or the finality of any determination, redetermination or decision. Each State shall establish a QC unit independent of, and not accountable to, any unit performing functions subject to evaluation by the QC unit. The organizational location of this unit shall be positioned to maximize its objectivity, to facilitate its access to information necessary to carry out its responsibilities, and to minimize organizational conflict of interest. Per 20 CFR 602.21 ? Standard methods and Procedures, Each State Shall: (a) Perform the requirements of this section in accordance with instructions issued by the Department, pursuant to ? 602.30(a) of this part, to ensure standardization of methods and procedures in a manner consistent with this part; (b) Select representative samples for QC study of at least a minimum size specified by the Department to ensure statistical validity (for benefit payments, a minimum of 400 cases of weeks paid per State per year); (c) Complete prompt and in-depth case investigations to determine the degree of accuracy and timeliness in the administration of the State UC law and Federal programs with respect to benefit determinations, benefit payments, and revenue collections; and conduct other measurements and studies necessary or appropriate for carrying out the purposes of this part; and in conducting investigations each State shall: (1) Inform claimants in writing that the information obtained from a QC investigation may affect their eligibility for benefits and inform employers in writing that the information obtained from a QC investigation of revenue may affect their tax liability, (2) Use a questionnaire, prescribed by the Department, which is designed to obtain such data as the Department deems necessary for the operation of the QC program; require completion of the questionnaire by claimants in accordance with the eligibility and reporting authority under State law, (3) Collect data identified by the Department as necessary for the operation of the QC program; however, the collection of demographic data will be limited to those data which relate to an individual's eligibility for UC benefits and necessary to conduct proportions tests to validate the selection of representative samples (the demographic data elements necessary to conduct proportions tests are claimants' date of birth, sex, and ethnic classification); and (4) Conclude all findings of inaccuracy as d(a) Perform the requirements of this section in accordance with instructions issued by the Department, pursuant to ? 602.30(a) of this part, to ensure standardization of methods and procedures in a manner consistent with this part; (d) Classify benefit case findings resulting from QC investigations as: (1) Proper payments, underpayments, or overpayments in benefit payment cases, or (2) Proper denials or underpayments in benefit denial cases; (e) Make and maintain records pertaining to the QC program, and make all such records available in a timely manner for inspection, examination, and audit by such Federal officials as the Secretary may designate or as may be required or authorized by law; (f) Furnish information and reports to the Department, including weekly transmissions of case data entered into the automated QC system and annual reports, without, in any manner, identifying individuals to whom such data pertain; and (g) Release the results of the QC program at the same time each year, providing calendar year results using a standardized format to present the data as prescribed by the Department; States will have the opportunity to release this information prior to any release by the Department. Lastly, Title 2 U.S. Code of Federal Regulations Part 200 (2 CFR 200) Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, section 303(a) states, the non-Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-Federal entity is managing the Federal award in compliance with Federal statues, regulations, and the terms and conditions of the Federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition The Benefit Accuracy Measurement (BAM) programs consists of reviews of Regular UI payments, which are paid out of the Unemployment Insurance Trust Fund, and therefore are not associated with a Federal Award Number. For the period ending September 30, 2021, New York State sampled a total of 447 Denied Claims, 3 cases short of the USDOL minimum annual allocation requirement for Denied Cases of 450. Additionally, NYS has failed the 90- and 120-day time lapse requirement for Paid Claims. For the Month of March 2022, 94.58% of cases were reviewed and closed within 90 days, less than 1% short of the required 95%. Also, for the month of March 2022, NYS reviewed and closed 96.02% and 95.41% of both paid and denied claims within 120 days, which is short of the required 98%. Cause The condition related to the failure to meet the minimum annual allocation threshold was a result of New York State not identifying in its initial sample selection of 450 that 3 of the cases selected from the last week for sampling in the 2020/2021 PIIA year did not relate to regular UI payments and were not identified in time to be replaced for evaluation under the BAM program PIIA year. The three incorrect samples were subsequently determined to be issued under a temporary program (PUA) and not able to be replaced due to the Department policies and procedures allowing for the sample item to be replaced in the subsequent week. The condition related to the time lapse requirements results from a shortage of staff and backlogged cases directly related to the COVID-19 Pandemic. As a result, the Department was unable to meet all case allocation and timely review requirements. Possible Asserted Effect Failure to perform timely completion of investigations results in the inability of UI Program to appropriately assess the degree of accuracy and timeliness in the administration of the State UC law and Federal programs with respect to benefit determinations, benefit payments, and revenue collections. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend that the Department ensures that their policies and procedures are designed to review selected cases to ensure they meet the prescribed criteria and, if necessary, be replaced as part of the final sampling week for the PIIA year. Additionally, the Department should enhance its process to ensure the completion of Paid and Denied cases are reviewed and closed timely in accordance with State Law. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Labor Federal Program: Unemployment Insurance (17.225) Federal Award Numbers: MI-34016-19-75-A-36; MI-35505-20-75-A-36; UI-27922-15-55-A-36; UI-32857-19-60-A-36; UI-34075-20-55-A-36; UI-34512-20-60-A-36; UI-34732-20-55-A-36; UI-35665-21-55-A-36; UI-35961-21-60-A-36; UI-37081-21-55-A-36; UI-37240-22-55-A-36; UI-37261-22-55-A-36 Federal Award Years: 2020 and 2021 State Agency: Department of Labor Reference: 2022-005 Criteria The Coronavirus Aid, Relief, and Economic Security Act (CARES Act), signed into law March 27, 2020, provides over $2 trillion of economic relief to workers, families, small businesses, industry sectors, and other levels of government that have been hit hard by the public health crisis created by the Coronavirus Disease 2019 (COVID-19). The CARES Act and subsequent legislation was designed to mitigate the economic effects of the COVID-19 pandemic in a variety of ways. Section 2102 of the CARES Act provided temporary benefits known as Pandemic Unemployment Assistance (PUA), for individuals who exhausted their entitlement to regular Unemployment Compensation (UC), and individuals who were not eligible for regular UC, such as those who were self-employed or who had limited recent work history. These individuals may also include certain gig economy workers, members of the clergy, and those working for religious organizations who were not covered by regular UC, as well as other workers who may not have been covered by the regular UC program under some state laws. PUA provides benefits to covered individuals, who are those individuals not eligible for regular unemployment compensation (UC or extended benefits under state or federal law or Pandemic Emergency Unemployment Compensation (PEUC), including those who have exhausted all rights to such benefits. Covered individuals also include self-employed, those seeking part-time employment, individuals lacking sufficient work history, and those who otherwise do not qualify for regular unemployment compensation or extended benefits under state or federal law or PEUC. PUA is payable to individuals who are ineligible for regular UC, and are unemployed, partially unemployed, or unable or unavailable to work due to one of the COVID-19 related reasons identified Attachment I to UIPL No. 16-20, Change 5. Section 2102(a)(3)(A)(ii)(I) of the CARES Act included 10 specific COVID-19 related reasons. The Department, under the authority provided by Section 2102(a)(3)(A)(ii)(I)(kk) of the CARES Act, has added additional COVID-19 related reasons; these are discussed in more detail in Section 4.a. of UIPL No. 16-20, Change 5. While three of these new COVID-19 related reasons were introduced to states with the publication of UIPL No. 16-20, Change 5 on February 25, 2021, all COVID-19 related reasons apply retroactively to the beginning of the PUA program. Additionally, as described in Section 4.b.i. of UIPL No. 16-20, Change 5, paraphrasing of the COVID-19 related reasons is not permissible; individuals must be permitted to select more than one COVID-19 related reason; individuals must be permitted to select different COVID-19 related reasons each week; and individuals must be permitted to file and select no COVID-19 related reasons. (1) The individual has been diagnosed with COVID-19 or is experiencing symptoms of COVID-19 and is seeking a medical diagnosis; (2) A member of the individual?s household has been diagnosed with COVID-19; (3) The individual is providing care for a family member or a member of the individual?s household who has been diagnosed with COVID-19; (4) A child or other person in the household for which the individual has primary caregiving responsibility is unable to attend school or another facility that is closed as a direct result of the COVID-19 public health emergency and such school or facility care is required for the individual to work; (5) The individual is unable to reach the place of employment because of a quarantine imposed as a direct result of the COVID-19 public health emergency; (6) The individual is unable to reach the place of employment because the individual has been advised by a health care provider to self-quarantine due to concerns related to COVID-19; (7) The individual was scheduled to commence employment and does not have a job or is unable to reach the job as a direct result of the COVID-19 public health emergency; (8) The individual has become the breadwinner or major support for a household because the head of the household has died as a direct result of COVID-19; (9) The individual has to quit his or her job as a direct result of COVID-19; (10) The individual?s place of employment is closed as a direct result of the COVID-19 public health emergency; or (11) The individual meets any additional criteria established by the Department for unemployment assistance under this section. a) An individual who works as an independent contractor with reportable income may also qualify for PUA benefits if he or she is unemployed, partially employed, or unable or unavailable to work because the COVID-19 public health emergency has severely limited his or her ability to continue performing his or her customary work activities, and has thereby forced the individual to suspend such activities; b) The individual has been denied continued unemployment benefits because the individual refused to return to work or accept an offer of work at a worksite that, in either instance, is not in compliance with local, state, or national health and safety standards directly related to COVID-19. This includes, but is not limited to, those related to facial mask wearing, physical distancing measures, or the provision of personal protective equipment consistent with public health guidelines; c) An individual provides services to an educational institution or educational service agency and the individual is unemployed or partially unemployed because of volatility in the work schedule that is directly caused by the COVID-19 public health emergency. This includes, but is not limited to, changes in schedules and partial closures; or d) An individual is an employee and their hours have been reduced or the individual was laid off as a direct result of the COVID-19 public health emergency. Section 2107 of the CARES Act created a new temporary federal program called PEUC that provided additional weeks of benefits to individuals who had exhausted their regular UC entitlement and provided funding to states to administer the program. The CARES Act originally provided up to 13 additional weeks of PEUC benefits. Section 206 of CAA and Section 9016 of the American Rescue Plan Act of 2021 (ARPA) increased the total amount of PEUC benefits available to 53 times the individual?s average weekly benefit amount, with the additional weeks of benefits payable for weeks of unemployment ending after March 14, 2021. To be eligible for PEUC, a claimant must have exhausted all rights to regular compensation under state law or federal law with respect to a benefit year that ended on or after July 1, 2019; have no rights to regular compensation with respect to a week under any other state UC law or federal UC law, or to compensation under any other federal law; are not receiving compensation with respect to a week under the UC law of Canada; and are able to work, available to work, and actively seeking work, while recognizing that states must provide flexibility in meeting the ?actively seeking work? requirement if individuals are unable to search for work because of COVID-19, including because of illness, quarantine, or movement restriction. Lastly, Title 2 U.S. Code of Federal Regulations Part 200 (2CFR 200) Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, section 303(a) states, the non-Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-Federal entity is managing the Federal award in compliance with Federal statues, regulations, and the terms and conditions of the Federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition In conjunction with our testwork over 60 samples related to PUA eligibility, the following findings were identified: I. For 28 of the 60 samples, the Department of Labor (the Department) was unable to provide evidence the claimant has submitted proof of documentation substantiating employment, self-employment, or the planned commencement of employment or self-employment in accordance with Section 241 (a) of the Continued Assistance Act. II. For 3 of the 60 samples, the incorrect benefit rate was calculated by the Department resulting in underpayments to claimants. III. For 1 of the 60 samples the Department was unable to provide support for any files related to the eligibility determination of the claimant IV. For 60 of the 60 samples, the Department did not complete the required quarterly wage checks for PUA claimants at most recent quarter change to ensure PUA claimant was not eligible for any other benefit programs. In conjunction with our testwork over 60 samples related to PEUC eligibility, the following findings were identified: V. For 60 of the 60 samples the Department did not complete required quarterly wage checks on PEUC claimants at most recent quarter change to ensure that PEUC claimant is still deemed to be an exhaustee and not eligible to establish a new benefit year for other UI programs. VI. For 2 of the 60 samples, the claimant was received PEUC before exhausting 104 days of regular UI benefits. Cause Condition II results from the incorrect effective date and/or incorrect wages used to calculate the benefit rate resulting in underpayments to the claimant. Conditions I, III, IV, and V, results from the Department not having the appropriate documentation to support the eligibility determinations made as part of the PUA and PEUC federal programs. Condition VI results from the Department using incorrect backdates resulting in the claimant not exhausting 104 days of regular UI prior to receiving PEUC benefits. Possible Asserted Effect Failure to ensure eligibility is properly determined or benefit calculations are accurately stated may result in ineligible benefit payments not in accordance with the terms and conditions of the federal awards. Questioned Costs $679 (total overpayments of temporary federal awards paid to two selected beneficiaries) Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend the Department enhance its policies and procedures to ensure that all benefit payments made under the PUA and PEUC programs have the appropriate documentation to support eligibility determinations reached and that all benefit calculations are accurately supported for the calculated amounts. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Labor Federal Program: Unemployment Insurance (17.225) Federal Award Numbers: Not Applicable Federal Award Years: Not Applicable State Agency: Department of Labor Reference: 2022-006 Criteria Under Section 904 of the Social Security Act, Unemployment Trust Fund, established in the Treasury of the United States a trust fund to be known as the ?Unemployment Trust Fund? (Fund). The Secretary of the Treasury is authorized and directed to receive and hold in the Fund all moneys deposited therein by a State agency from a State unemployment fund, or by the Railroad Retirement Board to the credit of the railroad unemployment insurance account or the railroad unemployment insurance administration fund, or otherwise deposited in or credited to the Fund or any account therein. Such deposit may be made directly with the Secretary of the Treasury, with any depositary designated by him for such purpose, or with any Federal Reserve Bank. Under section (e), the fund shall be invested as a single fund, but the Secretary of the Treasury shall maintain a separate book account for each State agency. Under Article 18 of New York State law, Title 7 Section 590, rights to benefits states that benefits shall not be paid for more than one hundred and four effective days in any benefit year, except as provided in section six hundred one and subdivision two of section five hundred ninety-nine of this chapter. Additionally, Aliens must show proof that they are authorized to work by the US Citizenship and Immigration Services (USCIS) in order to be eligible to receive a federal public benefit (42 USC 1302b-7(d) and (e)). specifically If such an individual is not a citizen or national of the United States, there must be presented either alien registration documentation or other proof of immigration registration from the Immigration and Naturalization Service that contains the individual?s alien admission number or alien file number (or numbers if the individual has more than one number), or such other documents as the State determines constitutes reasonable evidence indicating a satisfactory immigration status. In the case of such an individual who is not a citizen or national of the United States, if, at the time of application for benefits, the statement described in paragraph (1) is submitted but the documentation required under paragraph (2) is not presented or if the documentation required under paragraph (2)(A) is presented but such documentation is not verified under paragraph (3) the State shall provide a reasonable opportunity to submit to the State evidence indicating a satisfactory immigration status, and may not delay, deny, reduce, or terminate the individual?s eligibility for benefits under the program on the basis of the individual?s immigration status until such a reasonable opportunity has been provided Lastly, Title 2 U.S. Code of Federal Regulations Part 200 (2 CFR 200) Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, section 303(a) states, the non-Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition Regular UI payments, which are paid out of the Unemployment Insurance Trust Fund, and therefore are not associated with a Federal Award Number. During our testwork we noted the following: I. For 1 of 60 regular Unemployment Compensation (UC) claimants selected, the claimant received regular UC payments for greater than 104 days drawn from the Unemployment Trust Fund. Cause I. Condition I results from Unemployment Insurance (UI) system and the Department failing to identify and restrict payment to the claimants that reached the maximum limit of days allowed for regular UC benefits. The Department does not have a manual control to identify the claimants as being coded to the incorrect benefit. Possible Asserted Effect Failure to ensure eligibility is properly determined or benefit calculations are accurately stated may result in ineligible benefit payments not in accordance with the terms and conditions of the federal awards. Questioned Costs $256 (overpayments in excess of maximum regular unemployment compensation paid to one selected beneficiary) Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding for the Department was included in the 2021 Single Audit Report as finding number 2021-005 at pages 23?24. Recommendation We recommend the Department enhance its process and controls to ensure claimants that have exhausted benefits such as regular UC are not allowed to receive benefits in excess of the maximum allowable days for the program. Additionally, we recommend the Department enhance its policies and procedures to ensure that all benefit payments made under regular Unemployment Compensation (UC) have the appropriate documentation to support eligibility determinations reached and that all benefit calculations are accurately supported for the calculated amounts. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Education Federal Program: Title I Grants to Local Educational Agencies (84.010) Federal Award Numbers: S010A180032, S010A190032, S010A200032, S010A210032 Federal Award Years: 2018, 2019, 2020, 2021 State Agency: State Education Department Reference: 2022 007 Criteria 20 U.S. Code Section 6311 (20 USC 6311 or ESEA), State plans, part (b)(2)(A) requires each State plan to demonstrate that the State educational agency (SEA), in consultation with local educational agencies (LEAs), has implemented a set of high-quality student academic assessments in mathematics, reading or language arts, and science. Further, 20 USC 6311(b)(2)(B)(iii) and requires the assessment under subparagraph (A) to be used for purposes for which such assessments are valid and reliable, consistent with relevant, nationally recognized professional and technical testing standards, objectively measure academic achievement, knowledge, and skills, and be tests that do not evaluate or assess personal or family beliefs and attitudes, or publicly disclose personally identifiable information. Additionally, Title 2 U.S. Code of Federal Regulations Part 200 (2 CFR 200), Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Audits, section 200.303(a) states the nonfederal entity must establish and maintain effective internal control over the federal award that provides reasonable assurance that the nonfederal entity is managing the federal award in compliance with federal statutes, regulations, and the terms and conditions of the federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government,? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework,? issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition The State Education Department (the Department) policies and procedures require that each LEA provide to the Office of State Assessment (OSA) at the Department a completed exam storage certificate from every school that administers academic assessments in mathematics, reading or language arts, and science. This certification includes an attestation from the school of the LEA related to maintain the security of the assessments. The certification is also required to be signed by the Principal of the school attesting to the stated procedures. For 1 of 40 LEAs selected for testing, the exam storage certificate was not signed by the Principal. Cause The condition found is due to the control not operating effectively ensuring all exam certificates are signed before acceptance by the Department. Possible Asserted Effect Failure to ensure certifications from the schools are signed by the Principal may result in the inability to ensure an assessment system is maintained that is valid, reliable, and consistent with relevant professional and technical standards. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend that the Department enhance its policies and procedures to ensure attestation certificates are reviewed by the Department to ensure they are properly completed and have all required signatures and, if any required information is missing, appropriate follow-ups are made with districts to ensure compliance with the federal statutes, regulations, and terms and conditions of federal awards. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Education Federal Program: Education Stabilization Fund Cluster ? Higher Education Emergency Relief Fund (HEERF) Student Aid Portion (84.425E) Federal Award Numbers: P425E203620 (Purchase) P425E203061-20B (Stony Brook) Federal Award Years: 2022 State Agency: State University of New York Reference: 2022-009 Criteria Beginning May 6, 2020, ED required institutions that received a HEERF 18004(a)(1) student aid portion award to publicly post certain information on their website no later than 30 days after award and update the information every 45 days thereafter (by posting a new report). On August 31, 2020, ED revised the announcement by decreasing the frequency of reporting after the initial 30-day reporting period from every 45 days thereafter to every calendar quarter. Grantees posting a 45-day report on or after August 31, 2020 should instead post a report every calendar quarter, with the first quarter report due by October 10, 2020, and covering the period form their late 45-day report through the end of the calendar quarter on September 30, 2020. On May 13, 2021, ED published an additional notice for student aid public reporting under CRRSAA and ARP, which requires that institutions publicly post certain information on their website. Institutions must publicly post their report as soon as possible, but no later than 30 days after the publication of the notice or 30 days after the date ED first obligated funds under HEERF I, II, and III to the institution for Emergency Financial Aid Grants to Students, whichever comes later. The report must be updated no later than 10 days after the end of each calendar quarter (September 30, December 31, March 31 June 30). Auditors should determine if an institution was both timely and accurate in publicly posting its Student Aid Portion Reports from May 6, 2020, onward and sample these public reports and reconcile the publicly reported amounts with underlying documentation to ensure accuracy. The critical information that was required to be posted on the institution?s website included: 1) Item #3: The total amount of Emergency Financial Aid Grants distributed to students under the CARES (a)(1) subprogram and the CRRSAA and ARP (a)(1) subprograms as of the date of submission (i.e., as of the initial report and every calendar quarter thereafter). 2) Item #4: The estimated total number of students at the institution that are eligible to receive Emergency Financial Aid Grants to Students under CARES (a)(1) subprogram and the CRRSAA and ARP (a)(1) subprograms. 3) Item #5: The total number of students who have received an Emergency Financial Aid Grant to students under the CARES (a)(1) subprogram and the CRRSAA and ARP (a)(1) subprograms. 4) Item #6: The method(s) used by the institution to determine which students receive Emergency Financial Aid Grants and how much they would receive under the CARES (a)(1) subprogram and the CRRSAA and ARP (a)(1) subprograms. Lastly, Title 2 U.S. Code of Federal Regulations Part 200 (2 CFR 200) Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, section 303(a) states, the non-federal entity must establish and maintain effective internal control over the federal award that provides reasonable assurance that the non-federal entity is managing the federal award in compliance with federal statues, regulations, and the terms and conditions of the federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition Through the documentation obtained for the 16 quarterly student aid portion reports tested, we noted that the quarterly student aid reports for the quarter ending June 30, 2021 for Purchase College and Stony Brook University were made publicly available untimely as they were posted to the Institution?s website 2 and 3 days, respectively, after the due date noted in the OMB compliance supplement. Cause The condition results from a combination of the fact that this relates to a federal program with evolving requirements during the period under audit. Possible Asserted Effect Failure to implement sufficient internal controls to ensure the accuracy and timely filing of these quarterly reports in accordance with federal regulations resulted in the State?s program being noncompliant with federal statues, regulations and the terms and conditions of the federal awards. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend that the institutions enhance its process and controls to ensure reports are posted timely. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Education Federal Program: Education Stabilization Fund Cluster ? Higher Education Emergency Relief Fund (HEERF) Institutional Portion (84.425F) Federal Award Numbers: P425F203244 (Purchase College) P425F201263-20B (Stony Brook) Federal Award Years: 2022 State Agency: State University of New York Reference: 2022-008 Criteria The CARES, CRRSAA, and ARP institutional quarterly portion reporting requirements involve publicly posting completed forms on the institution?s website. The forms must be conspicuously posted on the institution?s primary website on the same page the reports of the Institution?s activities as to the emergency financial aid grants to students are posted. A new, separate form must be posted covering aggregate amounts spent for HEERF I, HEERF II, and HEERF III funds each quarterly reporting period (September 30, December 31, March 31, and June 30), concluding after an institution has expended and liquidated all (a)(1) Institutional Portion, (a)(2), and (a)(3) funds and checks the ?final report? box. Institutions must post this quarterly report form no later than 10 days after each calendar quarter (October 10, January 10, April 10, and July 10) apart from the first report Lastly, Title 2 U.S. Code of Federal Regulations Part 200 (2 CFR 200) Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, section 303(a) states, the non-federal entity must establish and maintain effective internal control over the federal award that provides reasonable assurance that the non-federal entity is managing the federal award in compliance with federal statues, regulations, and the terms and conditions of the federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition Through the documentation obtained for the 16 quarterly institutional reports tested, we noted that the quarterly institutional reports for the quarter ending June 30, 2021 for Purchase College and Stony Brook University were made publicly available untimely as they were posted to the Institution?s website 2 and 3 days, respectively, after the due date included within the instructions on the Quarterly Budget and Expenditure Reporting for HEERF I, II, and III (a)(2) Institutional Portion, (a)(2), and (a)(3) form. Cause The condition results from a combination of the fact that this relates to a federal program with evolving requirements during the period under audit. Possible Asserted Effect Failure to implement sufficient internal controls to ensure the accuracy and timely filing of these quarterly reports in accordance with federal regulations resulted in the State?s program being noncompliant with federal statutes, regulations and the terms and conditions of the federal awards. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend that the institutions enhance its process and controls to ensure reports are posted timely. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Education Federal Program: COVID-19 ? Provider Relief Fund (93.498) Federal Award Numbers: None Federal Award Years: 2022 State Agency: State University of New York Reference: 2022-010 Criteria Provider Relief Fund (PRF) Reporting Portal (A Public Health Emergency Declaration-PRA Waiver Notice was issued January 14, 2021, applicable to the financial information collected by Health Resources and Services Administration (HRSA) from eligible healthcare providers (https://aspe.hhs.gov/public-health-emergency-declaration-pra-waivers). The PRF reporting portal was launched on July 1, 2021 (https://prfreporting.hrsa.gov/s/). Auditors are expected to test this special reporting for fiscal years ending on or after June 30, 2021. Since the PRF amounts to be reported on a recipient?s Schedule of Expenditures of Federal Awards (SEFA) are based on the PRF report (see the Other Information section below), and since the PRF report is to be tested as part of the Reporting type of compliance requirement, auditors should consider delaying the commencement of the compliance audit of the PRF program until recipients have completed the PRF report. Key Line Items ? The following line items contain critical information (items are not numbered in report): 1. Nursing Home Infection Control Expenses for Payments Received During Payment Period for Payment Received Period a. Total Nursing Home Infection Control Expenses ? Cell that contains the aggregated total sum 2. Other Provider Relief Fund Expenses for Payments Received During Payment Period for Payment Received Period a. Total Other Provider Relief Fund Expenses ? Cell that contains the aggregated total sum 3. Calculation of Lost Revenues Attributable to Coronavirus a. 2019 Actuals (1) Total Column for Total Revenue/Net Charges from Patient Care (2019 Actuals) ? Each cell at the bottom of each quarter (Total revenue/Net Charges from Patient Care) and for each year, 2019, 2020 and 2021 b. 2020 Budgeted (1) Total Column for Total Revenue/Net Charges from Patient Care (Budgeted) ? Each cell at the bottom of each quarter (Total revenue/Net Charges from Patient Care) and for each year, 2020 and 2021 (2) Total Column for Total Revenue/Net Charges from Patient Care (Actuals) ? Each cell by payer and the cell at the bottom of each quarter (Total revenue/Net Charges from Patient Care) and for each year, 2020 and 2021 c. Alternate Method of Calculating Lost Revenues Attributable to Coronavirus (1) Each individual cell in the alternative method ? audit back to the narrative and underlying supporting documentation. (Note: The auditor is not responsible for determining the reasonableness of the alternative method described in the narrative.) Lastly, Title 2 U.S. Code of Federal Regulations Part 200 (2 CFR 200) Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, section 303(a) states, the non-federal entity must establish and maintain effective internal control over the federal award that provides reasonable assurance that the non-federal entity is managing the federal award in compliance with federal statues, regulations, and the terms and conditions of the federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition Through the documentation obtained for all the 5 PRF reports submitted during the period under audit by the 3 SUNY hospitals, we noted that the Period 1 and Period 2 reports of Stony Brook University hospital did not have adequate documentation of the management review performed on the PRF reports prior to submission to the HRSA portal. Cause The condition results from a failure to adequately document the internal control procedures, including review of the report, performed by the institution over the reports filed during the period under audit. Possible Asserted Effect Failure to implement sufficient internal controls to ensure the accuracy and timely filing of these reports in accordance with federal regulations resulted in the State?s program being noncompliant with federal statues, regulations and the terms and conditions of the federal awards. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend that the institution enhance internal control procedures to ensure adequate documentation to support the appropriate internal controls, to ensure the accuracy of the HRSA reports, are performed. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Health and Human Services Federal Program: Temporary Assistance for Needy Families (93.558) Federal Award Numbers: 1701NYTANF, 1801NYTANF, 1901NYTANF,2001NYTANF, 2101NYTANF, 2101NYTAN3, 2101NYTANFC6, 2201NYTAN3, 2201NYTANF, G1503NYTANF, and G1601NYTANF Federal Award Years: 2016, 2017, 2018, 2019, 2020, 2021, and 2022 State Agency: Office of Temporary and Disability Assistance Reference: 2022-011 Criteria Title 45 U.S. Code of Federal Regulations Part 75 (45 CFR 75), Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards, section 342(b)(1) states the non-federal entity must submit performance reports at the interval required by the HHS awarding agency or pass-through entity to best inform improvements in program outcomes and productivity. Intervals must be no less frequent than annually nor more frequent than quarterly except in unusual circumstances, for example where more frequent reporting is necessary for the effective monitoring of the federal award or could significantly affect program outcomes. Additionally, 45 U.S. Code of Federal Regulations Part 265 (45 CFR 265), Data Collection and Reporting Requirements, section 3(a) requires that (1) each State must collect on a monthly basis, and file on a quarterly basis, the data specified in the TANF Data Report and the TANF Financial Report; and (2) Each State that claims MOE expenditures for a separate State program(s) must collect on a monthly basis, and file on a quarterly basis, the data specified in the SSP-MOE Data Report. Lastly, 45 CFR 75.303(a) states the nonfederal entity must establish and maintain effective internal control over the federal award that provides reasonable assurance that the nonfederal entity is managing the federal award in compliance with federal statutes, regulations, and the terms and conditions of the federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government,? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework,? issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition For the Year ended March 31, 2022, the Office of Temporary and Disability Assistance (the Office) completed and submitted the required quarterly TANF Data Reports which included ACF-199 and ACF-209. As part of the submission, the State is required to provide complete and accurate information for various data elements, which include: ACF 209, SSP-MOE Data Report (OMB No. 0970-0338) Section One ? Family Level Data Item 9 ? Type of Family for Work Participation Item 15 ? Receives Subsidized Child Care Section One ? Person-Level Data Item 28 ? Date of Birth Item 34 ? Relationship to Head-of-Household Item 41 ? Work-Eligible Individual Indicator Item 42 ? Work Participation Status Section One ? Adult Work Participation Activities Items 43 ? 55 ? Work Participation Activities Item 56 ? Number of Deemed Core Hours for Overall Rate Item 57 ? Number of Deemed Core Hours for the Two-Parent Rate Section Three ? Active Cases Item 8 ? Total Number of Families ACF-199, TANF Data Report (OMB No. 0970-0338) Section One ? Family Level Data Item 12 ? Type of Family for Work Participation Item 17 ? Receives Subsidized Child Care Item 28 ? Is the TANF family exempt from the Federal time limit provisions Section One ? Person-Level Data Item 30 ? Family Affiliation Code Item 32 ? Date of Birth Item 38 ? Relationship to Head-of-Household Item 39 ? Parents with a Minor Child Item 44 ? Number of months countable toward the Federal time limit Item 48 ? Work-Eligible Individual Indicator Item 49 ? Work Participation Status Section One ? Adult Work Participation Activities Items 50 ? 62 ? Work Participation Activities Item 63 ? Number of Deemed Core Hours for Overall Rate Item 64 ? Number of Deemed Core Hours for the Two-Parent Rate Section Three ? Active Cases Item 3 ? Total Number of SSP-MOE Families The Office compiles the data utilized for these performance reports from its systems, which data is sourced, input, and updated by local district subrecipients based on its performance of activities. While the Office does perform monitoring reviews of several activities of the local district subrecipients, the monitoring reviews do not include procedures designed at a precision level that would allow the State to assess the completeness and accuracy of information being reported as part of the TANF data reports noted above. Specifically, the Office does not have procedures to ensure the codes entered into the system by its local district subrecipients are accurate, appropriate, and representative of the underlying source documentation. For 100 of 100 samples provided, we were able to validate there were no discrepancies of the key data elements from the original source documentation provided by the Office for the subrecipients to test compliance with the federal reporting requirements. Cause The condition is due to the timing of implementation of management?s internal controls over reporting and subrecipient monitoring procedures as result of prior year finding. Management did not have its procedures in place related to monitoring of the data reported by subrecipients that are utilized to compile the reporting during the current fiscal year. Corrective actions were implemented in April 2022 and intended to be followed throughout the subsequent fiscal years. Possible Asserted Effect Incomplete monitoring procedures may not provide adequate assurance for data compiled through the Office?s information technology systems, for the TANF ACS-199 and ACS-209 Federal reports. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding was included in the 2021 Single Audit Report as finding number 2021-008 on pages 32?34. Recommendation We recommend the Office continue to implement its corrective action to ensure its reporting or monitoring controls include verifying the data input by the subrecipients which the Office relies upon for compiling the ACF-199 and ACF-209 reports. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Health and Human Services Federal Program: Temporary Assistance for Needy Families (93.558) Federal Award Numbers: 1701NYTANF, 1801NYTANF, 1901NYTANF,2001NYTANF, 2101NYTANF, 2101NYTAN3, 2101NYTANFC6, 2201NYTAN3, 2201NYTANF, G1503NYTANF, and G1601NYTANF Federal Award Years: 2015, 2016, 2017, 2018, 2019, 2020, 2021 and 2022 State Agency: Office of Temporary and Disability Assistance Reference: 2022-012 Criteria Under the requirements of the Federal Funding Accountability and Transparency Act (FFATA) (Pub. L. No. 109-282), as amended by Section 6202 of Public Law 110-252, (Transparency Act) that are codified in 2 CFR Part 170, recipients (i.e., direct recipients) of grants or cooperative agreements are required to report first-tier subawards of $30,000 or more to the Federal Funding Accountability and Transparency Act Subaward Reporting System (FSRS). Aspects of the Transparency Act that relate to subaward reporting (1) under grants and cooperative agreements were implemented in OMB in 2 CFR Part 170 and (2) under contracts, by the regulatory agencies responsible for the Federal Acquisition Regulation (FAR at 5 FR 39414 et seq., July 8, 2010). The requirements pertain to recipients (i.e., direct recipients) of grants or cooperative agreements who make first-tier subawards and contractors (i.e., prime contractors) that award first-tier subcontracts. Title 45 U.S. Code of Federal Regulations Part 75 (45 CFR 75), Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards for HHS Awards, section 75.2 defines Subaward as an award provided by a pass-through entity to a subrecipient for the subrecipient to carry out part of a federal award received by the pass-through entity. It does not include payments to a contractor or payments to an individual that is a beneficiary of a federal program. A subaward may be provided through any form of legal agreement, including an agreement that the pass-through entity considers a contract. Further, 45 CFR 75.2 defines Subrecipient as a non-federal entity that receives a subaward from a passthrough entity to carry out part of a federal award; but does not include an individual that is a beneficiary of such award. A subrecipient may also be a recipient of other federal awards directly from a federal awarding agency. Additionally, 45 CFR 75.303(a) states the non-federal entity must establish and maintain effective internal control over the federal award that provides reasonable assurance that the non-federal entity is managing the federal award in compliance with federal statutes, regulations, and the terms and conditions of the federal award. These internal controls should be in compliance with guidance in "Standards for Internal Control in the Federal Government" issued by the Comptroller General of the United States or the "Internal Control Integrated Framework", issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition For the period of April 2021 to September 2021, the Office of Temporary and Disability Assistance (the Office) reported only the portion of expenditures that were passed through to the subrecipients (local districts) for the Temporary Assistance for Needy Families (TANF). Beginning in October 2021, the Office implemented new policies and processes to make ensure they reported all expenditures that passed through to the subrecipients (local districts) for TANF. However, the Office did not appropriately include all of the subrecipient expenditures over $30,000. As a result of our testwork over this period we noted the following: Transactions Tested Subaward not reported Report not timely Subaward amount incorrect Subaward missing key elements 117 8 0 48 0 Dollar Amount of Tested Transactions Subaward not reported Report not timely Subaward amount incorrect Subaward missing key elements $172,962,747 $1,300,793 $0 $1,393,853 $0 Cause For the period April 2021 ? September 2021, the Office did not report all amounts passed-through to its subrecipients (local districts) as the Office was still working on their corrective action plan from the prior year finding. For the period October 2021 ? March 2022, the Office did not appropriately identify all expenditures to subrecipients over $30,000 due to expenditures were broken down for different projects on the internal reports, which resulted in incorrect amounts being reported for the subawards as the amounts were not complete. Possible Asserted Effect Failure to submit all expenditures passed-through to subrecipients and subcontractors under subawards as defined by 45 CFR 75.2 in the Office's FFATA reporting could result in the Office reporting inaccurate and incomplete amounts to the federal government. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding was included in the 2021 Single Audit Report as finding number 2021-009 on pages 35?36. Recommendation We recommend the Office review and enhance its policies, procedures, and internal controls to ensure that all amounts passed-through to subrecipients and subcontractors under subawards as defined in 45 CFR 75.2 are reported in accordance with the FFATA federal regulations. In addition, they should use obligation date for FFATA reporting. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Health and Human Services Federal Program: Temporary Assistance for Needy Families (93.558) Federal Award Numbers: 1701NYTANF, 1801NYTANF, 1901NYTANF,2001NYTANF, 2101NYTANF, 2101NYTAN3, 2101NYTANFC6, 2201NYTAN3, 2201NYTANF, G1503NYTANF, and G1601NYTANF Federal Award Years: 2016, 2017, 2018, 2019, 2020, 2021, and 2022 State Agency: Office of Temporary and Disability Assistance Reference: 2022-011 Criteria Title 45 U.S. Code of Federal Regulations Part 75 (45 CFR 75), Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards, section 342(b)(1) states the non-federal entity must submit performance reports at the interval required by the HHS awarding agency or pass-through entity to best inform improvements in program outcomes and productivity. Intervals must be no less frequent than annually nor more frequent than quarterly except in unusual circumstances, for example where more frequent reporting is necessary for the effective monitoring of the federal award or could significantly affect program outcomes. Additionally, 45 U.S. Code of Federal Regulations Part 265 (45 CFR 265), Data Collection and Reporting Requirements, section 3(a) requires that (1) each State must collect on a monthly basis, and file on a quarterly basis, the data specified in the TANF Data Report and the TANF Financial Report; and (2) Each State that claims MOE expenditures for a separate State program(s) must collect on a monthly basis, and file on a quarterly basis, the data specified in the SSP-MOE Data Report. Lastly, 45 CFR 75.303(a) states the nonfederal entity must establish and maintain effective internal control over the federal award that provides reasonable assurance that the nonfederal entity is managing the federal award in compliance with federal statutes, regulations, and the terms and conditions of the federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government,? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework,? issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition For the Year ended March 31, 2022, the Office of Temporary and Disability Assistance (the Office) completed and submitted the required quarterly TANF Data Reports which included ACF-199 and ACF-209. As part of the submission, the State is required to provide complete and accurate information for various data elements, which include: ACF 209, SSP-MOE Data Report (OMB No. 0970-0338) Section One ? Family Level Data Item 9 ? Type of Family for Work Participation Item 15 ? Receives Subsidized Child Care Section One ? Person-Level Data Item 28 ? Date of Birth Item 34 ? Relationship to Head-of-Household Item 41 ? Work-Eligible Individual Indicator Item 42 ? Work Participation Status Section One ? Adult Work Participation Activities Items 43 ? 55 ? Work Participation Activities Item 56 ? Number of Deemed Core Hours for Overall Rate Item 57 ? Number of Deemed Core Hours for the Two-Parent Rate Section Three ? Active Cases Item 8 ? Total Number of Families ACF-199, TANF Data Report (OMB No. 0970-0338) Section One ? Family Level Data Item 12 ? Type of Family for Work Participation Item 17 ? Receives Subsidized Child Care Item 28 ? Is the TANF family exempt from the Federal time limit provisions Section One ? Person-Level Data Item 30 ? Family Affiliation Code Item 32 ? Date of Birth Item 38 ? Relationship to Head-of-Household Item 39 ? Parents with a Minor Child Item 44 ? Number of months countable toward the Federal time limit Item 48 ? Work-Eligible Individual Indicator Item 49 ? Work Participation Status Section One ? Adult Work Participation Activities Items 50 ? 62 ? Work Participation Activities Item 63 ? Number of Deemed Core Hours for Overall Rate Item 64 ? Number of Deemed Core Hours for the Two-Parent Rate Section Three ? Active Cases Item 3 ? Total Number of SSP-MOE Families The Office compiles the data utilized for these performance reports from its systems, which data is sourced, input, and updated by local district subrecipients based on its performance of activities. While the Office does perform monitoring reviews of several activities of the local district subrecipients, the monitoring reviews do not include procedures designed at a precision level that would allow the State to assess the completeness and accuracy of information being reported as part of the TANF data reports noted above. Specifically, the Office does not have procedures to ensure the codes entered into the system by its local district subrecipients are accurate, appropriate, and representative of the underlying source documentation. For 100 of 100 samples provided, we were able to validate there were no discrepancies of the key data elements from the original source documentation provided by the Office for the subrecipients to test compliance with the federal reporting requirements. Cause The condition is due to the timing of implementation of management?s internal controls over reporting and subrecipient monitoring procedures as result of prior year finding. Management did not have its procedures in place related to monitoring of the data reported by subrecipients that are utilized to compile the reporting during the current fiscal year. Corrective actions were implemented in April 2022 and intended to be followed throughout the subsequent fiscal years. Possible Asserted Effect Incomplete monitoring procedures may not provide adequate assurance for data compiled through the Office?s information technology systems, for the TANF ACS-199 and ACS-209 Federal reports. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding was included in the 2021 Single Audit Report as finding number 2021-008 on pages 32?34. Recommendation We recommend the Office continue to implement its corrective action to ensure its reporting or monitoring controls include verifying the data input by the subrecipients which the Office relies upon for compiling the ACF-199 and ACF-209 reports. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Health and Human Services Federal Program: Temporary Assistance for Needy Families (93.558) Federal Award Numbers: 1701NYTANF, 1801NYTANF, 1901NYTANF,2001NYTANF, 2101NYTANF, 2101NYTAN3, 2101NYTANFC6, 2201NYTAN3, 2201NYTANF, G1503NYTANF, and G1601NYTANF Federal Award Years: 2015, 2016, 2017, 2018, 2019, 2020, 2021 and 2022 State Agency: Office of Temporary and Disability Assistance Reference: 2022-012 Criteria Under the requirements of the Federal Funding Accountability and Transparency Act (FFATA) (Pub. L. No. 109-282), as amended by Section 6202 of Public Law 110-252, (Transparency Act) that are codified in 2 CFR Part 170, recipients (i.e., direct recipients) of grants or cooperative agreements are required to report first-tier subawards of $30,000 or more to the Federal Funding Accountability and Transparency Act Subaward Reporting System (FSRS). Aspects of the Transparency Act that relate to subaward reporting (1) under grants and cooperative agreements were implemented in OMB in 2 CFR Part 170 and (2) under contracts, by the regulatory agencies responsible for the Federal Acquisition Regulation (FAR at 5 FR 39414 et seq., July 8, 2010). The requirements pertain to recipients (i.e., direct recipients) of grants or cooperative agreements who make first-tier subawards and contractors (i.e., prime contractors) that award first-tier subcontracts. Title 45 U.S. Code of Federal Regulations Part 75 (45 CFR 75), Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards for HHS Awards, section 75.2 defines Subaward as an award provided by a pass-through entity to a subrecipient for the subrecipient to carry out part of a federal award received by the pass-through entity. It does not include payments to a contractor or payments to an individual that is a beneficiary of a federal program. A subaward may be provided through any form of legal agreement, including an agreement that the pass-through entity considers a contract. Further, 45 CFR 75.2 defines Subrecipient as a non-federal entity that receives a subaward from a passthrough entity to carry out part of a federal award; but does not include an individual that is a beneficiary of such award. A subrecipient may also be a recipient of other federal awards directly from a federal awarding agency. Additionally, 45 CFR 75.303(a) states the non-federal entity must establish and maintain effective internal control over the federal award that provides reasonable assurance that the non-federal entity is managing the federal award in compliance with federal statutes, regulations, and the terms and conditions of the federal award. These internal controls should be in compliance with guidance in "Standards for Internal Control in the Federal Government" issued by the Comptroller General of the United States or the "Internal Control Integrated Framework", issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition For the period of April 2021 to September 2021, the Office of Temporary and Disability Assistance (the Office) reported only the portion of expenditures that were passed through to the subrecipients (local districts) for the Temporary Assistance for Needy Families (TANF). Beginning in October 2021, the Office implemented new policies and processes to make ensure they reported all expenditures that passed through to the subrecipients (local districts) for TANF. However, the Office did not appropriately include all of the subrecipient expenditures over $30,000. As a result of our testwork over this period we noted the following: Transactions Tested Subaward not reported Report not timely Subaward amount incorrect Subaward missing key elements 117 8 0 48 0 Dollar Amount of Tested Transactions Subaward not reported Report not timely Subaward amount incorrect Subaward missing key elements $172,962,747 $1,300,793 $0 $1,393,853 $0 Cause For the period April 2021 ? September 2021, the Office did not report all amounts passed-through to its subrecipients (local districts) as the Office was still working on their corrective action plan from the prior year finding. For the period October 2021 ? March 2022, the Office did not appropriately identify all expenditures to subrecipients over $30,000 due to expenditures were broken down for different projects on the internal reports, which resulted in incorrect amounts being reported for the subawards as the amounts were not complete. Possible Asserted Effect Failure to submit all expenditures passed-through to subrecipients and subcontractors under subawards as defined by 45 CFR 75.2 in the Office's FFATA reporting could result in the Office reporting inaccurate and incomplete amounts to the federal government. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding was included in the 2021 Single Audit Report as finding number 2021-009 on pages 35?36. Recommendation We recommend the Office review and enhance its policies, procedures, and internal controls to ensure that all amounts passed-through to subrecipients and subcontractors under subawards as defined in 45 CFR 75.2 are reported in accordance with the FFATA federal regulations. In addition, they should use obligation date for FFATA reporting. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Health and Human Services Federal Program: Low-Income Home Energy Assistance (93.568) Federal Award Numbers: 1901NYLIEA, 2001NYLIEA, 2002NYLIE4, 2001NYE5C3, 2103NYLIEA, 2102NYLIE4, 2103NYE5C6, 2203NYLIEA Federal Award Years: 2019, 2020, 2021 and 2022 State Agency: Office of Temporary and Disability Assistance Reference: 2022-013 Criteria Under the requirements of the Federal Funding Accountability and Transparency Act (FFATA) (Pub. L. No. 109-282), as amended by Section 6202 of Public Law 110-252, (Transparency Act) that are codified in 2 CFR Part 170, recipients (i.e., direct recipients) of grants or cooperative agreements are required to report first-tier subawards of $30,000 or more to the Federal Funding Accountability and Transparency Act Subaward Reporting System (FSRS). Aspects of the Transparency Act that relate to subaward reporting (1) under grants and cooperative agreements were implemented in OMB in 2 CFR Part 170 and (2) under contracts, by the regulatory agencies responsible for the Federal Acquisition Regulation (FAR at 5 FR 39414 et seq., July 8, 2010). The requirements pertain to recipients (i.e., direct recipients) of grants or cooperative agreements who make first-tier subawards and contractors (i.e., prime contractors) that award first-tier subcontracts. Title 45 U.S. Code of Federal Regulations Part 75 (45 CFR 75), Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards for HHS Awards, section 75.2 defines Subaward as an award provided by a pass-through entity to a subrecipient for the subrecipient to carry out part of a federal award received by the pass-through entity. It does not include payments to a contractor or payments to an individual that is a beneficiary of a federal program. A subaward may be provided through any form of legal agreement, including an agreement that the pass-through entity considers a contract. Further, 45 CFR 75.2 defines Subrecipient as a non-federal entity that receives a subaward from a passthrough entity to carry out part of a federal award; but does not include an individual that is a beneficiary of such award. A subrecipient may also be a recipient of other federal awards directly from a federal awarding agency. Additionally, 45 CFR 75.303(a) states the non-federal entity must establish and maintain effective internal control over the federal award that provides reasonable assurance that the non-federal entity is managing the federal award in compliance with federal statutes, regulations, and the terms and conditions of the federal award. These internal controls should be in compliance with guidance in "Standards for Internal Control in the Federal Government" issued by the Comptroller General of the United States or the "Internal Control Integrated Framework", issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition For the period of April 2021 to September 2021, the Office of Temporary and Disability Assistance (the Office) reported only the portion of expenditures that were passed through to the subrecipients (local districts) for the Low-Income Home Energy Program (LIHEAP). Beginning in October 2021, the Office implemented new policies and processes to report all expenditures that passed through to the subrecipients (local districts) for LIHEAP. As a result of our testwork over this period we noted the following: Transactions Tested Subaward not reported Report not timely Subaward amount incorrect Subaward missing key elements 81 3 0 0 0 Dollar Amount of Tested Transactions Subaward not reported Report not timely Subaward amount incorrect Subaward missing key elements $63,042,900 $346,831 $0 $0 $0 Cause For the period April 2021 ? September 2021 the Office did not report all amounts passed-through to its subrecipients (local districts) as the Office was still working on their corrective action plan from the prior year finding. For the period October 2021 ? March 2022 the Office did not appropriately identify all expenditures to subrecipients over $30,000 due to the payments being split into two line items on internal reports which resulted in incorrect amounts being reported for the subawards as the amounts were not complete. Possible Asserted Effect Failure to submit all expenditures passed-through to subrecipients and subcontractors under subawards as defined by 45 CFR 75.2 in the Office's FFATA reporting could result in the Office reporting inaccurate and incomplete amounts to the federal government. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding was included in the 2021 Single Audit Report as finding number 2021-009 on pages 35?36. Recommendation We recommend the Office review and enhance its policies, procedures, and internal controls to ensure that all amounts passed-through to subrecipients and subcontractors under subawards as defined in 45 CFR 75.2 are reported in accordance with the FFATA federal regulations. In addition, they should use obligation date for FFATA reporting. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Health and Human Services Federal Program: Low-Income Home Energy Assistance (93.568) Federal Award Numbers: 1901NYLIEA, 2001NYLIEA, 2002NYLIE4, 2001NYE5C3, 2103NYLIEA, 2102NYLIE4, 2103NYE5C6, 2203NYLIEA Federal Award Years: 2019, 2020, 2021 and 2022 State Agency: Office of Temporary and Disability Assistance Reference: 2022-013 Criteria Under the requirements of the Federal Funding Accountability and Transparency Act (FFATA) (Pub. L. No. 109-282), as amended by Section 6202 of Public Law 110-252, (Transparency Act) that are codified in 2 CFR Part 170, recipients (i.e., direct recipients) of grants or cooperative agreements are required to report first-tier subawards of $30,000 or more to the Federal Funding Accountability and Transparency Act Subaward Reporting System (FSRS). Aspects of the Transparency Act that relate to subaward reporting (1) under grants and cooperative agreements were implemented in OMB in 2 CFR Part 170 and (2) under contracts, by the regulatory agencies responsible for the Federal Acquisition Regulation (FAR at 5 FR 39414 et seq., July 8, 2010). The requirements pertain to recipients (i.e., direct recipients) of grants or cooperative agreements who make first-tier subawards and contractors (i.e., prime contractors) that award first-tier subcontracts. Title 45 U.S. Code of Federal Regulations Part 75 (45 CFR 75), Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards for HHS Awards, section 75.2 defines Subaward as an award provided by a pass-through entity to a subrecipient for the subrecipient to carry out part of a federal award received by the pass-through entity. It does not include payments to a contractor or payments to an individual that is a beneficiary of a federal program. A subaward may be provided through any form of legal agreement, including an agreement that the pass-through entity considers a contract. Further, 45 CFR 75.2 defines Subrecipient as a non-federal entity that receives a subaward from a passthrough entity to carry out part of a federal award; but does not include an individual that is a beneficiary of such award. A subrecipient may also be a recipient of other federal awards directly from a federal awarding agency. Additionally, 45 CFR 75.303(a) states the non-federal entity must establish and maintain effective internal control over the federal award that provides reasonable assurance that the non-federal entity is managing the federal award in compliance with federal statutes, regulations, and the terms and conditions of the federal award. These internal controls should be in compliance with guidance in "Standards for Internal Control in the Federal Government" issued by the Comptroller General of the United States or the "Internal Control Integrated Framework", issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition For the period of April 2021 to September 2021, the Office of Temporary and Disability Assistance (the Office) reported only the portion of expenditures that were passed through to the subrecipients (local districts) for the Low-Income Home Energy Program (LIHEAP). Beginning in October 2021, the Office implemented new policies and processes to report all expenditures that passed through to the subrecipients (local districts) for LIHEAP. As a result of our testwork over this period we noted the following: Transactions Tested Subaward not reported Report not timely Subaward amount incorrect Subaward missing key elements 81 3 0 0 0 Dollar Amount of Tested Transactions Subaward not reported Report not timely Subaward amount incorrect Subaward missing key elements $63,042,900 $346,831 $0 $0 $0 Cause For the period April 2021 ? September 2021 the Office did not report all amounts passed-through to its subrecipients (local districts) as the Office was still working on their corrective action plan from the prior year finding. For the period October 2021 ? March 2022 the Office did not appropriately identify all expenditures to subrecipients over $30,000 due to the payments being split into two line items on internal reports which resulted in incorrect amounts being reported for the subawards as the amounts were not complete. Possible Asserted Effect Failure to submit all expenditures passed-through to subrecipients and subcontractors under subawards as defined by 45 CFR 75.2 in the Office's FFATA reporting could result in the Office reporting inaccurate and incomplete amounts to the federal government. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding was included in the 2021 Single Audit Report as finding number 2021-009 on pages 35?36. Recommendation We recommend the Office review and enhance its policies, procedures, and internal controls to ensure that all amounts passed-through to subrecipients and subcontractors under subawards as defined in 45 CFR 75.2 are reported in accordance with the FFATA federal regulations. In addition, they should use obligation date for FFATA reporting. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Health and Human Services Federal Program: Foster Care Title IV E (93.658) Federal Award Numbers: 1801NYFOST, 1901NYFOST, 2001NYFOST, 2101NYFOST, 2201NYFOST Federal Award Years: 2018, 2019, 2020, 2021, and 2022 State Agency: Office of Children and Family Services Reference: 2022-014 Criteria Title U.S. Code of Federal Regulations Part 75 (45 CFR 75), Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards, Section 75.303(c) requires the nonfederal entity to evaluate and monitor the non-federal entity?s compliance with statutes, regulations and the terms of the federal awards. The non-federal entity assumes responsibility for administering federal funds in a manner consistent with underlying agreements, program objectives, and the terms and conditions of the federal award (45 CFR 75.400(b)). Each state must expend and account for the federal award in accordance with state laws and procedures for expending the state?s own funds. Such monitoring activities should ensure that federal funds expended funds for foster care maintenance payments on behalf of eligible children are in accordance with the Title IV-E agency?s foster care maintenance payment schedule in accordance with Title 45 U.S. Code of Federal Regulations Part 1356 (45 CFR 1356), Requirements Applicable of Title IV-E, section 1356.21. Further, Title IV-E agencies establish rates for maintenance payments (e.g. payments to foster parents, childcare institutions or directly to youth). Payment rates may be established for Title IV-E administrative expenditures (e.g. payments to child placement agencies or other contractors, which may be either subrecipients or vendors) and for other services. Payment rates must provide for property allocation of costs between Foster Care maintenance payments, administrative expenditures, and other services in conformance with cost principles. The Title IV-E agency?s plan approved by ACF must provide for periodic review of payment rates for Foster Care maintenance payments at reasonable, specific, time-limited periods established by the Title IV-E agency to assure the rate?s continuing appropriateness for the administration of the Title IV-E program (42 USC 671(a)(11); 45 CFR Section 1356.21(m)(1); 45 CFR Section 1356.60(a)(1) and (c)). Lastly, 45 CFR 75.303(a) states the non-federal entity must establish and maintain effective internal control over the federal award that provides reasonable assurance that the non-federal entity is managing the federal award in compliance with federal statutes, regulations, and the terms and conditions of the federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government,? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework,? issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition During the fiscal year ended March 31, 2022, the Office of Children and Families (the Office) passed through $418,870,974 under the Title IV-E Foster Care federal program (Assistance Listing Number 93.658), to local districts (or subrecipients) to provide programmatic services under the Foster Care program. As part of the funding arrangement, the local districts are responsible for determining participant eligibility for services and establishing financial assistance rates to be paid on behalf of eligible participants. Based upon the level and type of services that the local districts determine the participant is eligible for, the local district will determine the appropriate amount of benefits that the participant is eligible to receive. These services are paid for directly by the local district offices and requests for reimbursement are subsequently provided from the Office for Foster Care. On an annual basis, the Office performs a review of the reasonableness of the rates used to reimburse Foster Care services and establishes maximum rates that can be used by the District Offices. While this maximum rate is established, the District Offices establish their own rates for services. The payment system used to process Foster Care claims will not allow for the reimbursement of costs that exceeds the maximum amount set by the Office. During our testwork over the subrecipient monitoring process, we noted that the Office?s monitoring procedures did not include a review to ensure that the district office had periodically reviewed their established service rates to ensure the reasonableness of the rate being used. The Office?s procedures were limited to ensuring that the rates utilized in request for reimbursement by the local districts did not exceed the maximum rates established by the Office. Cause The condition found was primarily due to the Office not having implemented its new policies and procedures surrounding the rates used by the district offices requiring local districts to use the rates developed by the Office until after the State fiscal year, which have been determined to be reasonable for the State of New York as a whole. Possible Asserted Effect Insufficient procedures to perform subrecipient monitoring activities in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e) could result in the Office not timely identifying noncompliance by the subrecipients with federal statutes, regulations, and the terms and conditions of the subaward and prevent the Office?s ability to timely seek corrective action from the subrecipient. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding was included in the 2021 Single Audit Report as finding number 2021 012 on pages 41-43. Recommendation We recommend the Office continue to implement its new policy surrounding the use of uniform rates and to implement the necessary internal controls and related procedures to ensure that all districts have implemented the new rate structure once the new rates go into effect. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Health and Human Services Federal Program: Foster Care Title IV E (93.658) Federal Award Numbers: 1801NYFOST, 1901NYFOST, 2001NYFOST, 2101NYFOST, 2201NYFOST Federal Award Years: 2018, 2019, 2020, 2021, and 2022 State Agency: Office of Children and Family Services Reference: 2022-014 Criteria Title U.S. Code of Federal Regulations Part 75 (45 CFR 75), Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards, Section 75.303(c) requires the nonfederal entity to evaluate and monitor the non-federal entity?s compliance with statutes, regulations and the terms of the federal awards. The non-federal entity assumes responsibility for administering federal funds in a manner consistent with underlying agreements, program objectives, and the terms and conditions of the federal award (45 CFR 75.400(b)). Each state must expend and account for the federal award in accordance with state laws and procedures for expending the state?s own funds. Such monitoring activities should ensure that federal funds expended funds for foster care maintenance payments on behalf of eligible children are in accordance with the Title IV-E agency?s foster care maintenance payment schedule in accordance with Title 45 U.S. Code of Federal Regulations Part 1356 (45 CFR 1356), Requirements Applicable of Title IV-E, section 1356.21. Further, Title IV-E agencies establish rates for maintenance payments (e.g. payments to foster parents, childcare institutions or directly to youth). Payment rates may be established for Title IV-E administrative expenditures (e.g. payments to child placement agencies or other contractors, which may be either subrecipients or vendors) and for other services. Payment rates must provide for property allocation of costs between Foster Care maintenance payments, administrative expenditures, and other services in conformance with cost principles. The Title IV-E agency?s plan approved by ACF must provide for periodic review of payment rates for Foster Care maintenance payments at reasonable, specific, time-limited periods established by the Title IV-E agency to assure the rate?s continuing appropriateness for the administration of the Title IV-E program (42 USC 671(a)(11); 45 CFR Section 1356.21(m)(1); 45 CFR Section 1356.60(a)(1) and (c)). Lastly, 45 CFR 75.303(a) states the non-federal entity must establish and maintain effective internal control over the federal award that provides reasonable assurance that the non-federal entity is managing the federal award in compliance with federal statutes, regulations, and the terms and conditions of the federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government,? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework,? issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition During the fiscal year ended March 31, 2022, the Office of Children and Families (the Office) passed through $418,870,974 under the Title IV-E Foster Care federal program (Assistance Listing Number 93.658), to local districts (or subrecipients) to provide programmatic services under the Foster Care program. As part of the funding arrangement, the local districts are responsible for determining participant eligibility for services and establishing financial assistance rates to be paid on behalf of eligible participants. Based upon the level and type of services that the local districts determine the participant is eligible for, the local district will determine the appropriate amount of benefits that the participant is eligible to receive. These services are paid for directly by the local district offices and requests for reimbursement are subsequently provided from the Office for Foster Care. On an annual basis, the Office performs a review of the reasonableness of the rates used to reimburse Foster Care services and establishes maximum rates that can be used by the District Offices. While this maximum rate is established, the District Offices establish their own rates for services. The payment system used to process Foster Care claims will not allow for the reimbursement of costs that exceeds the maximum amount set by the Office. During our testwork over the subrecipient monitoring process, we noted that the Office?s monitoring procedures did not include a review to ensure that the district office had periodically reviewed their established service rates to ensure the reasonableness of the rate being used. The Office?s procedures were limited to ensuring that the rates utilized in request for reimbursement by the local districts did not exceed the maximum rates established by the Office. Cause The condition found was primarily due to the Office not having implemented its new policies and procedures surrounding the rates used by the district offices requiring local districts to use the rates developed by the Office until after the State fiscal year, which have been determined to be reasonable for the State of New York as a whole. Possible Asserted Effect Insufficient procedures to perform subrecipient monitoring activities in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e) could result in the Office not timely identifying noncompliance by the subrecipients with federal statutes, regulations, and the terms and conditions of the subaward and prevent the Office?s ability to timely seek corrective action from the subrecipient. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding was included in the 2021 Single Audit Report as finding number 2021 012 on pages 41-43. Recommendation We recommend the Office continue to implement its new policy surrounding the use of uniform rates and to implement the necessary internal controls and related procedures to ensure that all districts have implemented the new rate structure once the new rates go into effect. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Health and Human Services Federal Program: Social Services Block Grant (93.667) Federal Award Numbers: 2001NYSOSR, 2010NYSOSR, 2001NYTANF, 2101NYTANF Federal Award Years: 2020 and 2021 State Agency: Office of Children and Family Services Reference: 2022-015 Criteria Title 45 U.S. Code of Federal Regulations Part 75 (45 CFR 75), Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards, section 75.352(d) states all pass-through entities must monitor the activities of the subrecipient as necessary to ensure that the subaward issued for authorized purposes, in compliance with federal statutes, regulations, and the terms and conditions of the subaward, and that subaward performance goals are achieved. Pass-through entity monitoring of the subrecipient must include: (1) Reviewing financial and performance reports required by the pass-through entity. (2) Following-up and ensuring that the subrecipient takes timely and appropriate action on all deficiencies pertaining to the Federal award provided to the subrecipient from the pass-through entity detected through audits, on-site reviews, and other means. Additionally, 45 CFR 75.352(c) requires the nonfederal entity to evaluate and the nonfederal entity?s compliance with statutes, regulations and the terms of the federal awards. The nonfederal entity assumes responsibility for administering federal funds in a manner consistent with underlying agreements, program objectives, and the terms and conditions of the federal award (45 CFR 75.400(b)). Each state must expend and account for the federal award in accordance with state laws and procedures for expending the state?s own funds. Such monitoring activities should ensure that the expended funds were for allowable costs in accordance with federal regulations as well as to eligible individuals that would be subject to reporting on the annual Post Expenditure Report required to be filed under 42 U.S. Code (USC) 1397e. Further, 45 CFR 75.352(e) sates, depending upon the pass-through entity?s assessment of risk posed by the subrecipient, the following monitoring tools may be useful for the pass-through entity to ensure proper accountability and compliance with program requirements and achievement of performance goals: (1) Providing subrecipients with training and technical assistance on program-related matters; (2) Performing on-site reviews of the subrecipient?s program operations; and (3) Arranging for agreed-upon procedures engagements as described in 45 CFR 75.425. Lastly, 45 CFR 75.303(a) states the non-federal entity must establish and maintain effective internal control over the federal award that provides reasonable assurance that the non-federal entity is managing the federal award in compliance with federal statutes, regulations, and the terms and conditions of the federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government,? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework,? issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition During the fiscal year ended March 31, 2022, the Office of Children and Families (the Office) passed through $294,836,063 under the Social Services Block Grant (SSBG) federal program (Assistance Listing Number 93.667), to local districts (or subrecipients) to provide programmatic services under the SSBG program. As part of the funding arrangement, the local districts are responsible for the administration of the federal program, including ensuring that costs incurred under the federal program are in compliance with federal regulations. During the fiscal year ended March 31, 2022, we noted that while the Office performed its annual risk assessment process over its subrecipients, the Office had not yet fully implemented its system of internal controls or policies and procedures related to its subrecipient monitoring activities over the local districts to ensure the federal funds spent by the local districts were spent in compliance with federal statutes, regulations, the terms and conditions of the subaward and that subaward performance goals were achieved. This would include ensuring that costs incurred by the local district were for allowable services. As a result, there was no formal during the award monitoring activities performed during the audit period. In addition to the above, we noted that on an annual basis, the Office submits the Post-Expenditure Report to the Federal Office of Community Services. As part of the federal reporting process, the Office is required to report the number of eligible individuals who received services paid for in part or in whole with federal funds under the SSBG program. All participant services are provided directly by the local district offices. In order to obtain the number of eligible individuals by services category to be included on the report, the Department obtains the information directly from the Welfare Reporting and Tracking Systems (WRTS). The WRTS system contains data from the State?s Welfare Management System (WMS) and the Benefits Issuance Control System (BICS). As it is the responsibility of the district offices to determine eligibility for services, the Office is relying on the district offices to have data entered complete and accurate information within the WMS and BICS systems. During our testwork, there did not appear to be any monitoring procedures performed by the Office to ensure that the information entered by the district office was complete and accurate and that benefits were only provided to eligible participants. Cause The condition found was primarily due to the timing of the implementation of its new monitoring procedures. While the Office had selected 3 subrecipients to perform monitoring procedures over, only an initial request for information was sent to the subrecipient as of March 31, 2022 and the actual monitoring review took place during the subsequent fiscal year. Further, we noted it does not appear that the new procedures once implemented will review to ensure that the participant was eligible to receive services, which would assist in ensuring that the data reported on the Post-Expenditure Report is accurate. Possible Asserted Effect The lack of executed monitoring procedures over subawards provided to subrecipients could result in the use of federal funding provided under the federal award not being in compliance with federal statutes, regulations, and the terms and conditions of the subaward. Questioned Costs Cannot be determined. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding was included in the 2021 Single Audit Report as finding number 2021 013 on pages 44-46. Recommendation We recommend the Office continue to enhance its subrecipient monitoring policies, procedures and internal control to help ensure the Office is monitoring subrecipients in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). The Office should work towards the implementation of their monitoring procedures outlined within their policies and procedures to ensure that it is able to identify the federal statutes, regulations and terms and conditions it must comply with and implement measures whereby it can evaluate and monitor its compliance and to take prompt action when instances of noncompliance are identified and to take reasonable measures. Such monitoring activities should be performed at a precision level that would detect and identify errors in the coding of services and related expenditures that could result in unallowable costs being reimbursed to the subrecipients as well as verifying participants were eligible to receive services to assist in assuring that the data reported within the annual Post-Expenditure Report is complete and accurate. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Health and Human Services Federal Program: Medicaid Cluster (93.775, 93.777, 93.778) Federal Award Numbers: 2205NY5MAP, 2105NY5MAP, 2005NY5MAP, 1805NY5MAP Federal Award Years: 2018, 2020, 2021 and 2022 State Agency: Department of Health Reference: 2022-016 Criteria Title 42 U.S. Code of Federal Regulations Section 1903(r) (42 U.S.C. 1396b) states in order to receive payments under subsection (a) for use of automated data systems in administration of the State plan under this title, a State must, in addition to meeting the requirements of paragraph (3), have in operation mechanized claims processing and information retrieval systems that meet the requirements of this subsection and that the Secretary has found? (A) are adequate to provide efficient, economical, and effective administration of such State plan; (B) are compatible with the claims processing and information retrieval systems used in the administration of title XVIII, and for this purpose? (i) have a uniform identification coding system for providers, other payees, and beneficiaries under this title or title XVIII; (ii) provide liaison between States and carriers and intermediaries with agreements under title XVIII to facilitate timely exchange of appropriate data; (iii) provide for exchange of data between the States and the Secretary with respect to persons sanctioned under this title or title XVIII; and (iv) [152] effective for claims filed on or after October 1, 2010, incorporate compatible methodologies of the National Correct Coding Initiative administered by the Secretary (or any successor initiative to promote correct coding and to control improper coding leading to inappropriate payment) and such other methodologies of that Initiative (or such other national correct coding methodologies) as the Secretary identifies in accordance with paragraph (4); Paragraph (4) states for purposes of paragraph (1)(B)(iv), the Secretary shall do the following: (A) Not later than September 1, 2010: (i) Identify those methodologies of the National Correct Coding Initiative administered by the Secretary (or any successor initiative to promote correct coding and to control improper coding leading to inappropriate payment) which are compatible to claims filed under this title. (ii) Identify those methodologies of such Initiative (or such other national correct coding methodologies) that should be incorporated into claims filed under this title with respect to items or services for which States provide medical assistance under this title and no national correct coding methodologies have been established under such Initiative with respect to title XVIII. (iii) Notify States of? (B) Not later than March 1, 2011, submit a report to Congress that includes the notice to States under clause (iii) of subparagraph (A) and an analysis supporting the identification of the methodologies made under clauses (i) and (ii) of subparagraph (A). Additionally, Title 45 U.S. Code of Federal Regulations Part 75, Uniform Administrative, Requirements, Cost Principles, and Audit Requirements for HHS Awards (45 CFR 75), Appendix XI OMB Compliance supplement also states the NCCI Medicaid Policy Manual and the NCCI Medicaid Technical Guidance Manual contain additional requirements for implementation of the NCCI methodologies. Further, Section 7.1.1 Confidentiality Agreements Requirements for Contracted Parties of the NCCI Technical Guidance Manual states a state Medicaid agency may share these quarterly state Medicaid NCCI edit files which are posted on the MII on the RISSNET portal with the contracted fiscal agent that processes its fee-for service claims or with any of its contracted Medicaid managed-care entities that is using the Medicaid NCCI methodologies in its processing of claims or encounter data, if appropriate confidentiality agreements are in place. The state Medicaid agency, its fiscal agent, and its managed-care entities may also share those files at that time with any contractor or subcontractor (including, but not limited to, COTS software vendors) which is assisting with the implementation of the state?s Medicaid NCCI program in the processing of claims or encounter data, only when appropriate confidentiality agreements are in place. The state Medicaid agency need not have a direct contract with such vendors. Additionally, section 7.1.2 Confidentiality Agreements Requirements for Contracted Parties of the NCCI Technical Guidance Manual states at a minimum, the following elements must be included in the confidentiality agreements for any contracted party using the Medicaid NCCI files posted on the MII: ? Disclosure shall be limited to only those responsible for the implementation of the quarterly state Medicaid NCCI edit files. Disclosure shall not be made prior to the start of the new calendar quarter. ? After the start of the new calendar quarter, a Contracted Party may disclose only non-confidential information contained in the Medicaid NCCI edit files that is also available to the general public found on the Medicaid NCCI webpage. ? The Contracted Party agrees to use any non-public information from the quarterly state Medicaid NCCI edit files only for any business purposes directly related to the implementation of the Medicaid NCCI methodologies in the particular state. ? New, revised, or deleted Medicaid NCCI edits shall not be published or otherwise shared with individuals, medical societies, or any other entities unless it is a Contracted Party prior to the posting of the Medicaid NCCI edits on the Medicaid NCCI webpage. ? Implementation of New, revised, or deleted Medicaid NCCI edits shall not occur prior to the first day of the calendar quarter. ? Only a state Medicaid agency has the discretion to release additional information for selected individual edits or limited ranges of edits from the files posted on the MII. ? State Medicaid agencies must impose penalties, up to and including loss of contract, for violations of any confidentiality agreement relating to use of the MII edit files. Lastly, 45 CFR 75.303(a) the non-federal entity must establish and maintain effective internal control over the federal award that provides reasonable assurance that the non-federal entity is managing the federal award in compliance with federal statutes, regulations, and the terms and conditions of the federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition The Department of Health (the Department) did not have a Confidentiality Agreement in place as required by the NCCI Technical Guidance manual, sections 7.1.1 and 7.1.2 as of March 31, 2022 with its service organizations and third party providers that have access to NCCI data. DOS also implemented internal controls to ensure anyone accessing NCCI data in the future has the confidentiality agreements in place prior to the access being obtained. As a result of the delayed implementation of the updated agreement, the Department was not in the compliance with this requirement for the period under audit and did not have controls in place to ensure compliance during the period under audit. Cause The condition found is due to the timing of management working on implementing its revised policies and procedures to ensure that confidentiality agreements were implemented with its third party providers. Subsequent to the March 31, 2022, the Department concluded its internal evaluation related to which organizations received NCCI data. As a result, the Department identified one organization that receives the NCCI data, General Dynamics Information Technology (GDIT) and excluded an updated Data Use Agreement (DUA) with GDIT for the required NCCI confidentiality language on December 2, 2022. Possible Asserted Effect Failure to implement the required NCCI Confidentiality Agreement may result in the NCCI edit information being available to non-contracted individuals, medical societies, or any other entities and the State being non-compliance with CMS?s NCCI requirements. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding was included in the 2021 Single Audit Report as finding number 2021-015 on pages 50-53. Recommendation We recommend the Department continue to follow its revised policies and procedures including internal controls to ensure any service organizations with access to NCCI data maintain a confidentiality agreement to be compliant with CMS NCCI Technical Guidance manual, sections 7.1.1 and 7.1.2. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Health and Human Services Federal Program: Medicaid Cluster (93.775, 93.777, 93.778) Federal Award Numbers: 2205NY5MAP, 2105NY5MAP, 2005NY5MAP, 1805NY5MAP Federal Award Years: 2018, 2020, 2021 and 2022 State Agency: Department of Health Reference: 2022-016 Criteria Title 42 U.S. Code of Federal Regulations Section 1903(r) (42 U.S.C. 1396b) states in order to receive payments under subsection (a) for use of automated data systems in administration of the State plan under this title, a State must, in addition to meeting the requirements of paragraph (3), have in operation mechanized claims processing and information retrieval systems that meet the requirements of this subsection and that the Secretary has found? (A) are adequate to provide efficient, economical, and effective administration of such State plan; (B) are compatible with the claims processing and information retrieval systems used in the administration of title XVIII, and for this purpose? (i) have a uniform identification coding system for providers, other payees, and beneficiaries under this title or title XVIII; (ii) provide liaison between States and carriers and intermediaries with agreements under title XVIII to facilitate timely exchange of appropriate data; (iii) provide for exchange of data between the States and the Secretary with respect to persons sanctioned under this title or title XVIII; and (iv) [152] effective for claims filed on or after October 1, 2010, incorporate compatible methodologies of the National Correct Coding Initiative administered by the Secretary (or any successor initiative to promote correct coding and to control improper coding leading to inappropriate payment) and such other methodologies of that Initiative (or such other national correct coding methodologies) as the Secretary identifies in accordance with paragraph (4); Paragraph (4) states for purposes of paragraph (1)(B)(iv), the Secretary shall do the following: (A) Not later than September 1, 2010: (i) Identify those methodologies of the National Correct Coding Initiative administered by the Secretary (or any successor initiative to promote correct coding and to control improper coding leading to inappropriate payment) which are compatible to claims filed under this title. (ii) Identify those methodologies of such Initiative (or such other national correct coding methodologies) that should be incorporated into claims filed under this title with respect to items or services for which States provide medical assistance under this title and no national correct coding methodologies have been established under such Initiative with respect to title XVIII. (iii) Notify States of? (B) Not later than March 1, 2011, submit a report to Congress that includes the notice to States under clause (iii) of subparagraph (A) and an analysis supporting the identification of the methodologies made under clauses (i) and (ii) of subparagraph (A). Additionally, Title 45 U.S. Code of Federal Regulations Part 75, Uniform Administrative, Requirements, Cost Principles, and Audit Requirements for HHS Awards (45 CFR 75), Appendix XI OMB Compliance supplement also states the NCCI Medicaid Policy Manual and the NCCI Medicaid Technical Guidance Manual contain additional requirements for implementation of the NCCI methodologies. Further, Section 7.1.1 Confidentiality Agreements Requirements for Contracted Parties of the NCCI Technical Guidance Manual states a state Medicaid agency may share these quarterly state Medicaid NCCI edit files which are posted on the MII on the RISSNET portal with the contracted fiscal agent that processes its fee-for service claims or with any of its contracted Medicaid managed-care entities that is using the Medicaid NCCI methodologies in its processing of claims or encounter data, if appropriate confidentiality agreements are in place. The state Medicaid agency, its fiscal agent, and its managed-care entities may also share those files at that time with any contractor or subcontractor (including, but not limited to, COTS software vendors) which is assisting with the implementation of the state?s Medicaid NCCI program in the processing of claims or encounter data, only when appropriate confidentiality agreements are in place. The state Medicaid agency need not have a direct contract with such vendors. Additionally, section 7.1.2 Confidentiality Agreements Requirements for Contracted Parties of the NCCI Technical Guidance Manual states at a minimum, the following elements must be included in the confidentiality agreements for any contracted party using the Medicaid NCCI files posted on the MII: ? Disclosure shall be limited to only those responsible for the implementation of the quarterly state Medicaid NCCI edit files. Disclosure shall not be made prior to the start of the new calendar quarter. ? After the start of the new calendar quarter, a Contracted Party may disclose only non-confidential information contained in the Medicaid NCCI edit files that is also available to the general public found on the Medicaid NCCI webpage. ? The Contracted Party agrees to use any non-public information from the quarterly state Medicaid NCCI edit files only for any business purposes directly related to the implementation of the Medicaid NCCI methodologies in the particular state. ? New, revised, or deleted Medicaid NCCI edits shall not be published or otherwise shared with individuals, medical societies, or any other entities unless it is a Contracted Party prior to the posting of the Medicaid NCCI edits on the Medicaid NCCI webpage. ? Implementation of New, revised, or deleted Medicaid NCCI edits shall not occur prior to the first day of the calendar quarter. ? Only a state Medicaid agency has the discretion to release additional information for selected individual edits or limited ranges of edits from the files posted on the MII. ? State Medicaid agencies must impose penalties, up to and including loss of contract, for violations of any confidentiality agreement relating to use of the MII edit files. Lastly, 45 CFR 75.303(a) the non-federal entity must establish and maintain effective internal control over the federal award that provides reasonable assurance that the non-federal entity is managing the federal award in compliance with federal statutes, regulations, and the terms and conditions of the federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition The Department of Health (the Department) did not have a Confidentiality Agreement in place as required by the NCCI Technical Guidance manual, sections 7.1.1 and 7.1.2 as of March 31, 2022 with its service organizations and third party providers that have access to NCCI data. DOS also implemented internal controls to ensure anyone accessing NCCI data in the future has the confidentiality agreements in place prior to the access being obtained. As a result of the delayed implementation of the updated agreement, the Department was not in the compliance with this requirement for the period under audit and did not have controls in place to ensure compliance during the period under audit. Cause The condition found is due to the timing of management working on implementing its revised policies and procedures to ensure that confidentiality agreements were implemented with its third party providers. Subsequent to the March 31, 2022, the Department concluded its internal evaluation related to which organizations received NCCI data. As a result, the Department identified one organization that receives the NCCI data, General Dynamics Information Technology (GDIT) and excluded an updated Data Use Agreement (DUA) with GDIT for the required NCCI confidentiality language on December 2, 2022. Possible Asserted Effect Failure to implement the required NCCI Confidentiality Agreement may result in the NCCI edit information being available to non-contracted individuals, medical societies, or any other entities and the State being non-compliance with CMS?s NCCI requirements. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding was included in the 2021 Single Audit Report as finding number 2021-015 on pages 50-53. Recommendation We recommend the Department continue to follow its revised policies and procedures including internal controls to ensure any service organizations with access to NCCI data maintain a confidentiality agreement to be compliant with CMS NCCI Technical Guidance manual, sections 7.1.1 and 7.1.2. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Health and Human Services Federal Program: Medicaid Cluster (93.775, 93.777, 93.778) Federal Award Numbers: 2205NY5MAP, 2105NY5MAP, 2005NY5MAP, 1805NY5MAP Federal Award Years: 2018, 2020, 2021 and 2022 State Agency: Department of Health Reference: 2022-016 Criteria Title 42 U.S. Code of Federal Regulations Section 1903(r) (42 U.S.C. 1396b) states in order to receive payments under subsection (a) for use of automated data systems in administration of the State plan under this title, a State must, in addition to meeting the requirements of paragraph (3), have in operation mechanized claims processing and information retrieval systems that meet the requirements of this subsection and that the Secretary has found? (A) are adequate to provide efficient, economical, and effective administration of such State plan; (B) are compatible with the claims processing and information retrieval systems used in the administration of title XVIII, and for this purpose? (i) have a uniform identification coding system for providers, other payees, and beneficiaries under this title or title XVIII; (ii) provide liaison between States and carriers and intermediaries with agreements under title XVIII to facilitate timely exchange of appropriate data; (iii) provide for exchange of data between the States and the Secretary with respect to persons sanctioned under this title or title XVIII; and (iv) [152] effective for claims filed on or after October 1, 2010, incorporate compatible methodologies of the National Correct Coding Initiative administered by the Secretary (or any successor initiative to promote correct coding and to control improper coding leading to inappropriate payment) and such other methodologies of that Initiative (or such other national correct coding methodologies) as the Secretary identifies in accordance with paragraph (4); Paragraph (4) states for purposes of paragraph (1)(B)(iv), the Secretary shall do the following: (A) Not later than September 1, 2010: (i) Identify those methodologies of the National Correct Coding Initiative administered by the Secretary (or any successor initiative to promote correct coding and to control improper coding leading to inappropriate payment) which are compatible to claims filed under this title. (ii) Identify those methodologies of such Initiative (or such other national correct coding methodologies) that should be incorporated into claims filed under this title with respect to items or services for which States provide medical assistance under this title and no national correct coding methodologies have been established under such Initiative with respect to title XVIII. (iii) Notify States of? (B) Not later than March 1, 2011, submit a report to Congress that includes the notice to States under clause (iii) of subparagraph (A) and an analysis supporting the identification of the methodologies made under clauses (i) and (ii) of subparagraph (A). Additionally, Title 45 U.S. Code of Federal Regulations Part 75, Uniform Administrative, Requirements, Cost Principles, and Audit Requirements for HHS Awards (45 CFR 75), Appendix XI OMB Compliance supplement also states the NCCI Medicaid Policy Manual and the NCCI Medicaid Technical Guidance Manual contain additional requirements for implementation of the NCCI methodologies. Further, Section 7.1.1 Confidentiality Agreements Requirements for Contracted Parties of the NCCI Technical Guidance Manual states a state Medicaid agency may share these quarterly state Medicaid NCCI edit files which are posted on the MII on the RISSNET portal with the contracted fiscal agent that processes its fee-for service claims or with any of its contracted Medicaid managed-care entities that is using the Medicaid NCCI methodologies in its processing of claims or encounter data, if appropriate confidentiality agreements are in place. The state Medicaid agency, its fiscal agent, and its managed-care entities may also share those files at that time with any contractor or subcontractor (including, but not limited to, COTS software vendors) which is assisting with the implementation of the state?s Medicaid NCCI program in the processing of claims or encounter data, only when appropriate confidentiality agreements are in place. The state Medicaid agency need not have a direct contract with such vendors. Additionally, section 7.1.2 Confidentiality Agreements Requirements for Contracted Parties of the NCCI Technical Guidance Manual states at a minimum, the following elements must be included in the confidentiality agreements for any contracted party using the Medicaid NCCI files posted on the MII: ? Disclosure shall be limited to only those responsible for the implementation of the quarterly state Medicaid NCCI edit files. Disclosure shall not be made prior to the start of the new calendar quarter. ? After the start of the new calendar quarter, a Contracted Party may disclose only non-confidential information contained in the Medicaid NCCI edit files that is also available to the general public found on the Medicaid NCCI webpage. ? The Contracted Party agrees to use any non-public information from the quarterly state Medicaid NCCI edit files only for any business purposes directly related to the implementation of the Medicaid NCCI methodologies in the particular state. ? New, revised, or deleted Medicaid NCCI edits shall not be published or otherwise shared with individuals, medical societies, or any other entities unless it is a Contracted Party prior to the posting of the Medicaid NCCI edits on the Medicaid NCCI webpage. ? Implementation of New, revised, or deleted Medicaid NCCI edits shall not occur prior to the first day of the calendar quarter. ? Only a state Medicaid agency has the discretion to release additional information for selected individual edits or limited ranges of edits from the files posted on the MII. ? State Medicaid agencies must impose penalties, up to and including loss of contract, for violations of any confidentiality agreement relating to use of the MII edit files. Lastly, 45 CFR 75.303(a) the non-federal entity must establish and maintain effective internal control over the federal award that provides reasonable assurance that the non-federal entity is managing the federal award in compliance with federal statutes, regulations, and the terms and conditions of the federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition The Department of Health (the Department) did not have a Confidentiality Agreement in place as required by the NCCI Technical Guidance manual, sections 7.1.1 and 7.1.2 as of March 31, 2022 with its service organizations and third party providers that have access to NCCI data. DOS also implemented internal controls to ensure anyone accessing NCCI data in the future has the confidentiality agreements in place prior to the access being obtained. As a result of the delayed implementation of the updated agreement, the Department was not in the compliance with this requirement for the period under audit and did not have controls in place to ensure compliance during the period under audit. Cause The condition found is due to the timing of management working on implementing its revised policies and procedures to ensure that confidentiality agreements were implemented with its third party providers. Subsequent to the March 31, 2022, the Department concluded its internal evaluation related to which organizations received NCCI data. As a result, the Department identified one organization that receives the NCCI data, General Dynamics Information Technology (GDIT) and excluded an updated Data Use Agreement (DUA) with GDIT for the required NCCI confidentiality language on December 2, 2022. Possible Asserted Effect Failure to implement the required NCCI Confidentiality Agreement may result in the NCCI edit information being available to non-contracted individuals, medical societies, or any other entities and the State being non-compliance with CMS?s NCCI requirements. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding was included in the 2021 Single Audit Report as finding number 2021-015 on pages 50-53. Recommendation We recommend the Department continue to follow its revised policies and procedures including internal controls to ensure any service organizations with access to NCCI data maintain a confidentiality agreement to be compliant with CMS NCCI Technical Guidance manual, sections 7.1.1 and 7.1.2. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Health and Human Services Federal Program: Medicaid Cluster (93.775, 93.777, 93.778) Federal Award Numbers: 2205NY5MAP, 2105NY5MAP, 2005NY5MAP, 1805NY5MAP Federal Award Years: 2018, 2020, 2021 and 2022 State Agency: Department of Health Reference: 2022-016 Criteria Title 42 U.S. Code of Federal Regulations Section 1903(r) (42 U.S.C. 1396b) states in order to receive payments under subsection (a) for use of automated data systems in administration of the State plan under this title, a State must, in addition to meeting the requirements of paragraph (3), have in operation mechanized claims processing and information retrieval systems that meet the requirements of this subsection and that the Secretary has found? (A) are adequate to provide efficient, economical, and effective administration of such State plan; (B) are compatible with the claims processing and information retrieval systems used in the administration of title XVIII, and for this purpose? (i) have a uniform identification coding system for providers, other payees, and beneficiaries under this title or title XVIII; (ii) provide liaison between States and carriers and intermediaries with agreements under title XVIII to facilitate timely exchange of appropriate data; (iii) provide for exchange of data between the States and the Secretary with respect to persons sanctioned under this title or title XVIII; and (iv) [152] effective for claims filed on or after October 1, 2010, incorporate compatible methodologies of the National Correct Coding Initiative administered by the Secretary (or any successor initiative to promote correct coding and to control improper coding leading to inappropriate payment) and such other methodologies of that Initiative (or such other national correct coding methodologies) as the Secretary identifies in accordance with paragraph (4); Paragraph (4) states for purposes of paragraph (1)(B)(iv), the Secretary shall do the following: (A) Not later than September 1, 2010: (i) Identify those methodologies of the National Correct Coding Initiative administered by the Secretary (or any successor initiative to promote correct coding and to control improper coding leading to inappropriate payment) which are compatible to claims filed under this title. (ii) Identify those methodologies of such Initiative (or such other national correct coding methodologies) that should be incorporated into claims filed under this title with respect to items or services for which States provide medical assistance under this title and no national correct coding methodologies have been established under such Initiative with respect to title XVIII. (iii) Notify States of? (B) Not later than March 1, 2011, submit a report to Congress that includes the notice to States under clause (iii) of subparagraph (A) and an analysis supporting the identification of the methodologies made under clauses (i) and (ii) of subparagraph (A). Additionally, Title 45 U.S. Code of Federal Regulations Part 75, Uniform Administrative, Requirements, Cost Principles, and Audit Requirements for HHS Awards (45 CFR 75), Appendix XI OMB Compliance supplement also states the NCCI Medicaid Policy Manual and the NCCI Medicaid Technical Guidance Manual contain additional requirements for implementation of the NCCI methodologies. Further, Section 7.1.1 Confidentiality Agreements Requirements for Contracted Parties of the NCCI Technical Guidance Manual states a state Medicaid agency may share these quarterly state Medicaid NCCI edit files which are posted on the MII on the RISSNET portal with the contracted fiscal agent that processes its fee-for service claims or with any of its contracted Medicaid managed-care entities that is using the Medicaid NCCI methodologies in its processing of claims or encounter data, if appropriate confidentiality agreements are in place. The state Medicaid agency, its fiscal agent, and its managed-care entities may also share those files at that time with any contractor or subcontractor (including, but not limited to, COTS software vendors) which is assisting with the implementation of the state?s Medicaid NCCI program in the processing of claims or encounter data, only when appropriate confidentiality agreements are in place. The state Medicaid agency need not have a direct contract with such vendors. Additionally, section 7.1.2 Confidentiality Agreements Requirements for Contracted Parties of the NCCI Technical Guidance Manual states at a minimum, the following elements must be included in the confidentiality agreements for any contracted party using the Medicaid NCCI files posted on the MII: ? Disclosure shall be limited to only those responsible for the implementation of the quarterly state Medicaid NCCI edit files. Disclosure shall not be made prior to the start of the new calendar quarter. ? After the start of the new calendar quarter, a Contracted Party may disclose only non-confidential information contained in the Medicaid NCCI edit files that is also available to the general public found on the Medicaid NCCI webpage. ? The Contracted Party agrees to use any non-public information from the quarterly state Medicaid NCCI edit files only for any business purposes directly related to the implementation of the Medicaid NCCI methodologies in the particular state. ? New, revised, or deleted Medicaid NCCI edits shall not be published or otherwise shared with individuals, medical societies, or any other entities unless it is a Contracted Party prior to the posting of the Medicaid NCCI edits on the Medicaid NCCI webpage. ? Implementation of New, revised, or deleted Medicaid NCCI edits shall not occur prior to the first day of the calendar quarter. ? Only a state Medicaid agency has the discretion to release additional information for selected individual edits or limited ranges of edits from the files posted on the MII. ? State Medicaid agencies must impose penalties, up to and including loss of contract, for violations of any confidentiality agreement relating to use of the MII edit files. Lastly, 45 CFR 75.303(a) the non-federal entity must establish and maintain effective internal control over the federal award that provides reasonable assurance that the non-federal entity is managing the federal award in compliance with federal statutes, regulations, and the terms and conditions of the federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition The Department of Health (the Department) did not have a Confidentiality Agreement in place as required by the NCCI Technical Guidance manual, sections 7.1.1 and 7.1.2 as of March 31, 2022 with its service organizations and third party providers that have access to NCCI data. DOS also implemented internal controls to ensure anyone accessing NCCI data in the future has the confidentiality agreements in place prior to the access being obtained. As a result of the delayed implementation of the updated agreement, the Department was not in the compliance with this requirement for the period under audit and did not have controls in place to ensure compliance during the period under audit. Cause The condition found is due to the timing of management working on implementing its revised policies and procedures to ensure that confidentiality agreements were implemented with its third party providers. Subsequent to the March 31, 2022, the Department concluded its internal evaluation related to which organizations received NCCI data. As a result, the Department identified one organization that receives the NCCI data, General Dynamics Information Technology (GDIT) and excluded an updated Data Use Agreement (DUA) with GDIT for the required NCCI confidentiality language on December 2, 2022. Possible Asserted Effect Failure to implement the required NCCI Confidentiality Agreement may result in the NCCI edit information being available to non-contracted individuals, medical societies, or any other entities and the State being non-compliance with CMS?s NCCI requirements. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding was included in the 2021 Single Audit Report as finding number 2021-015 on pages 50-53. Recommendation We recommend the Department continue to follow its revised policies and procedures including internal controls to ensure any service organizations with access to NCCI data maintain a confidentiality agreement to be compliant with CMS NCCI Technical Guidance manual, sections 7.1.1 and 7.1.2. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Health and Human Services Federal Program: Medicaid Cluster (93.775, 93.777, 93.778) Federal Award Numbers: 2205NY5MAP, 2105NY5MAP, 2005NY5MAP, 1805NY5MAP Federal Award Years: 2018, 2020, 2021 and 2022 State Agency: Department of Health Reference: 2022-016 Criteria Title 42 U.S. Code of Federal Regulations Section 1903(r) (42 U.S.C. 1396b) states in order to receive payments under subsection (a) for use of automated data systems in administration of the State plan under this title, a State must, in addition to meeting the requirements of paragraph (3), have in operation mechanized claims processing and information retrieval systems that meet the requirements of this subsection and that the Secretary has found? (A) are adequate to provide efficient, economical, and effective administration of such State plan; (B) are compatible with the claims processing and information retrieval systems used in the administration of title XVIII, and for this purpose? (i) have a uniform identification coding system for providers, other payees, and beneficiaries under this title or title XVIII; (ii) provide liaison between States and carriers and intermediaries with agreements under title XVIII to facilitate timely exchange of appropriate data; (iii) provide for exchange of data between the States and the Secretary with respect to persons sanctioned under this title or title XVIII; and (iv) [152] effective for claims filed on or after October 1, 2010, incorporate compatible methodologies of the National Correct Coding Initiative administered by the Secretary (or any successor initiative to promote correct coding and to control improper coding leading to inappropriate payment) and such other methodologies of that Initiative (or such other national correct coding methodologies) as the Secretary identifies in accordance with paragraph (4); Paragraph (4) states for purposes of paragraph (1)(B)(iv), the Secretary shall do the following: (A) Not later than September 1, 2010: (i) Identify those methodologies of the National Correct Coding Initiative administered by the Secretary (or any successor initiative to promote correct coding and to control improper coding leading to inappropriate payment) which are compatible to claims filed under this title. (ii) Identify those methodologies of such Initiative (or such other national correct coding methodologies) that should be incorporated into claims filed under this title with respect to items or services for which States provide medical assistance under this title and no national correct coding methodologies have been established under such Initiative with respect to title XVIII. (iii) Notify States of? (B) Not later than March 1, 2011, submit a report to Congress that includes the notice to States under clause (iii) of subparagraph (A) and an analysis supporting the identification of the methodologies made under clauses (i) and (ii) of subparagraph (A). Additionally, Title 45 U.S. Code of Federal Regulations Part 75, Uniform Administrative, Requirements, Cost Principles, and Audit Requirements for HHS Awards (45 CFR 75), Appendix XI OMB Compliance supplement also states the NCCI Medicaid Policy Manual and the NCCI Medicaid Technical Guidance Manual contain additional requirements for implementation of the NCCI methodologies. Further, Section 7.1.1 Confidentiality Agreements Requirements for Contracted Parties of the NCCI Technical Guidance Manual states a state Medicaid agency may share these quarterly state Medicaid NCCI edit files which are posted on the MII on the RISSNET portal with the contracted fiscal agent that processes its fee-for service claims or with any of its contracted Medicaid managed-care entities that is using the Medicaid NCCI methodologies in its processing of claims or encounter data, if appropriate confidentiality agreements are in place. The state Medicaid agency, its fiscal agent, and its managed-care entities may also share those files at that time with any contractor or subcontractor (including, but not limited to, COTS software vendors) which is assisting with the implementation of the state?s Medicaid NCCI program in the processing of claims or encounter data, only when appropriate confidentiality agreements are in place. The state Medicaid agency need not have a direct contract with such vendors. Additionally, section 7.1.2 Confidentiality Agreements Requirements for Contracted Parties of the NCCI Technical Guidance Manual states at a minimum, the following elements must be included in the confidentiality agreements for any contracted party using the Medicaid NCCI files posted on the MII: ? Disclosure shall be limited to only those responsible for the implementation of the quarterly state Medicaid NCCI edit files. Disclosure shall not be made prior to the start of the new calendar quarter. ? After the start of the new calendar quarter, a Contracted Party may disclose only non-confidential information contained in the Medicaid NCCI edit files that is also available to the general public found on the Medicaid NCCI webpage. ? The Contracted Party agrees to use any non-public information from the quarterly state Medicaid NCCI edit files only for any business purposes directly related to the implementation of the Medicaid NCCI methodologies in the particular state. ? New, revised, or deleted Medicaid NCCI edits shall not be published or otherwise shared with individuals, medical societies, or any other entities unless it is a Contracted Party prior to the posting of the Medicaid NCCI edits on the Medicaid NCCI webpage. ? Implementation of New, revised, or deleted Medicaid NCCI edits shall not occur prior to the first day of the calendar quarter. ? Only a state Medicaid agency has the discretion to release additional information for selected individual edits or limited ranges of edits from the files posted on the MII. ? State Medicaid agencies must impose penalties, up to and including loss of contract, for violations of any confidentiality agreement relating to use of the MII edit files. Lastly, 45 CFR 75.303(a) the non-federal entity must establish and maintain effective internal control over the federal award that provides reasonable assurance that the non-federal entity is managing the federal award in compliance with federal statutes, regulations, and the terms and conditions of the federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition The Department of Health (the Department) did not have a Confidentiality Agreement in place as required by the NCCI Technical Guidance manual, sections 7.1.1 and 7.1.2 as of March 31, 2022 with its service organizations and third party providers that have access to NCCI data. DOS also implemented internal controls to ensure anyone accessing NCCI data in the future has the confidentiality agreements in place prior to the access being obtained. As a result of the delayed implementation of the updated agreement, the Department was not in the compliance with this requirement for the period under audit and did not have controls in place to ensure compliance during the period under audit. Cause The condition found is due to the timing of management working on implementing its revised policies and procedures to ensure that confidentiality agreements were implemented with its third party providers. Subsequent to the March 31, 2022, the Department concluded its internal evaluation related to which organizations received NCCI data. As a result, the Department identified one organization that receives the NCCI data, General Dynamics Information Technology (GDIT) and excluded an updated Data Use Agreement (DUA) with GDIT for the required NCCI confidentiality language on December 2, 2022. Possible Asserted Effect Failure to implement the required NCCI Confidentiality Agreement may result in the NCCI edit information being available to non-contracted individuals, medical societies, or any other entities and the State being non-compliance with CMS?s NCCI requirements. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding was included in the 2021 Single Audit Report as finding number 2021-015 on pages 50-53. Recommendation We recommend the Department continue to follow its revised policies and procedures including internal controls to ensure any service organizations with access to NCCI data maintain a confidentiality agreement to be compliant with CMS NCCI Technical Guidance manual, sections 7.1.1 and 7.1.2. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Health and Human Services Federal Program: Medicaid Cluster (93.775, 93.777, 93.778) Federal Award Numbers: 2205NY5MAP, 2105NY5MAP, 2005NY5MAP, 1805NY5MAP Federal Award Years: 2018, 2020, 2021 and 2022 State Agency: Department of Health Reference: 2022-016 Criteria Title 42 U.S. Code of Federal Regulations Section 1903(r) (42 U.S.C. 1396b) states in order to receive payments under subsection (a) for use of automated data systems in administration of the State plan under this title, a State must, in addition to meeting the requirements of paragraph (3), have in operation mechanized claims processing and information retrieval systems that meet the requirements of this subsection and that the Secretary has found? (A) are adequate to provide efficient, economical, and effective administration of such State plan; (B) are compatible with the claims processing and information retrieval systems used in the administration of title XVIII, and for this purpose? (i) have a uniform identification coding system for providers, other payees, and beneficiaries under this title or title XVIII; (ii) provide liaison between States and carriers and intermediaries with agreements under title XVIII to facilitate timely exchange of appropriate data; (iii) provide for exchange of data between the States and the Secretary with respect to persons sanctioned under this title or title XVIII; and (iv) [152] effective for claims filed on or after October 1, 2010, incorporate compatible methodologies of the National Correct Coding Initiative administered by the Secretary (or any successor initiative to promote correct coding and to control improper coding leading to inappropriate payment) and such other methodologies of that Initiative (or such other national correct coding methodologies) as the Secretary identifies in accordance with paragraph (4); Paragraph (4) states for purposes of paragraph (1)(B)(iv), the Secretary shall do the following: (A) Not later than September 1, 2010: (i) Identify those methodologies of the National Correct Coding Initiative administered by the Secretary (or any successor initiative to promote correct coding and to control improper coding leading to inappropriate payment) which are compatible to claims filed under this title. (ii) Identify those methodologies of such Initiative (or such other national correct coding methodologies) that should be incorporated into claims filed under this title with respect to items or services for which States provide medical assistance under this title and no national correct coding methodologies have been established under such Initiative with respect to title XVIII. (iii) Notify States of? (B) Not later than March 1, 2011, submit a report to Congress that includes the notice to States under clause (iii) of subparagraph (A) and an analysis supporting the identification of the methodologies made under clauses (i) and (ii) of subparagraph (A). Additionally, Title 45 U.S. Code of Federal Regulations Part 75, Uniform Administrative, Requirements, Cost Principles, and Audit Requirements for HHS Awards (45 CFR 75), Appendix XI OMB Compliance supplement also states the NCCI Medicaid Policy Manual and the NCCI Medicaid Technical Guidance Manual contain additional requirements for implementation of the NCCI methodologies. Further, Section 7.1.1 Confidentiality Agreements Requirements for Contracted Parties of the NCCI Technical Guidance Manual states a state Medicaid agency may share these quarterly state Medicaid NCCI edit files which are posted on the MII on the RISSNET portal with the contracted fiscal agent that processes its fee-for service claims or with any of its contracted Medicaid managed-care entities that is using the Medicaid NCCI methodologies in its processing of claims or encounter data, if appropriate confidentiality agreements are in place. The state Medicaid agency, its fiscal agent, and its managed-care entities may also share those files at that time with any contractor or subcontractor (including, but not limited to, COTS software vendors) which is assisting with the implementation of the state?s Medicaid NCCI program in the processing of claims or encounter data, only when appropriate confidentiality agreements are in place. The state Medicaid agency need not have a direct contract with such vendors. Additionally, section 7.1.2 Confidentiality Agreements Requirements for Contracted Parties of the NCCI Technical Guidance Manual states at a minimum, the following elements must be included in the confidentiality agreements for any contracted party using the Medicaid NCCI files posted on the MII: ? Disclosure shall be limited to only those responsible for the implementation of the quarterly state Medicaid NCCI edit files. Disclosure shall not be made prior to the start of the new calendar quarter. ? After the start of the new calendar quarter, a Contracted Party may disclose only non-confidential information contained in the Medicaid NCCI edit files that is also available to the general public found on the Medicaid NCCI webpage. ? The Contracted Party agrees to use any non-public information from the quarterly state Medicaid NCCI edit files only for any business purposes directly related to the implementation of the Medicaid NCCI methodologies in the particular state. ? New, revised, or deleted Medicaid NCCI edits shall not be published or otherwise shared with individuals, medical societies, or any other entities unless it is a Contracted Party prior to the posting of the Medicaid NCCI edits on the Medicaid NCCI webpage. ? Implementation of New, revised, or deleted Medicaid NCCI edits shall not occur prior to the first day of the calendar quarter. ? Only a state Medicaid agency has the discretion to release additional information for selected individual edits or limited ranges of edits from the files posted on the MII. ? State Medicaid agencies must impose penalties, up to and including loss of contract, for violations of any confidentiality agreement relating to use of the MII edit files. Lastly, 45 CFR 75.303(a) the non-federal entity must establish and maintain effective internal control over the federal award that provides reasonable assurance that the non-federal entity is managing the federal award in compliance with federal statutes, regulations, and the terms and conditions of the federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition The Department of Health (the Department) did not have a Confidentiality Agreement in place as required by the NCCI Technical Guidance manual, sections 7.1.1 and 7.1.2 as of March 31, 2022 with its service organizations and third party providers that have access to NCCI data. DOS also implemented internal controls to ensure anyone accessing NCCI data in the future has the confidentiality agreements in place prior to the access being obtained. As a result of the delayed implementation of the updated agreement, the Department was not in the compliance with this requirement for the period under audit and did not have controls in place to ensure compliance during the period under audit. Cause The condition found is due to the timing of management working on implementing its revised policies and procedures to ensure that confidentiality agreements were implemented with its third party providers. Subsequent to the March 31, 2022, the Department concluded its internal evaluation related to which organizations received NCCI data. As a result, the Department identified one organization that receives the NCCI data, General Dynamics Information Technology (GDIT) and excluded an updated Data Use Agreement (DUA) with GDIT for the required NCCI confidentiality language on December 2, 2022. Possible Asserted Effect Failure to implement the required NCCI Confidentiality Agreement may result in the NCCI edit information being available to non-contracted individuals, medical societies, or any other entities and the State being non-compliance with CMS?s NCCI requirements. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding was included in the 2021 Single Audit Report as finding number 2021-015 on pages 50-53. Recommendation We recommend the Department continue to follow its revised policies and procedures including internal controls to ensure any service organizations with access to NCCI data maintain a confidentiality agreement to be compliant with CMS NCCI Technical Guidance manual, sections 7.1.1 and 7.1.2. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Agriculture Federal Programs: Child and Adult Care Food Program (10.558) Federal Award Numbers: 202120N105044, 202121N115044, 202222N115044, 202221N115044, 202121N202044, 202120N202044, 202121N109944, 202120N109944, 202121N119944, 202121H170644, 202222N202044, 202221N202044, 202222N119944, 202221N119944 Federal Award Years: 2021 and 2022 State Agency: Department of Health Reference: 2022-003 Criteria Title 2 U.S. Code of Federal Regulations Part 200 (2 CFR 200), Uniform Administrative Requirements, Cost Principles, and Audit Requirements, section 200.332(d) states all pass-through entities must monitor the activities of the subrecipient as necessary to ensure that he subaward is used for authorized purposes, in compliance with federal statutes, regulations, and the terms and conditions of the subaward, and that subaward performance goals are achieved. Pass-through entity monitoring of the subrecipient must include: (1) Reviewing financial and performance reports required by the pass-through entity. (2) Following-up and ensuring that the subrecipient takes timely and appropriate action on all deficiencies pertaining to the federal award provided to the subrecipient from the pass-through entity detected through audits, on-site reviews, and other means. (3) Issuing a management decision for audit findings pertaining to the federal award provided to the subrecipient from the pass-through entity as required by 2 CFR 200.521. Additionally, 2 CFR 200.303(a) states the nonfederal entity must Establish and maintain effective internal control over the federal award that provides reasonable assurance that the nonfederal entity is managing the federal award in compliance with federal statutes, regulations, and the terms and conditions of the federal award. Condition For 3 of 40 subrecipients selected, the Department did not review the cases by the scheduled due date for the single audit reports as required in accordance with 2 CFR 200.332(d). The Department of Health (the Department) did not have effective internal controls in place to ensure that all required single audits of the program?s subrecipients were reviewed, followed-up, or appropriate action was taken and as necessary issued a management decision pertaining to the audit finding in accordance with 2 CFR 200, as applicable. The Department maintains an internal clearinghouse tracker (the tracker) to track the subrecipients single audit status. The tracker tracks subrecipients that are exempt from single audit requirements as well as the status and follow-up required for the subrecipients with single audits. Cause The condition is due to DOH Audit Clearinghouse personnel not operating as intended, due to COVID-19 personnel reassignments, to ensure the timely review of all single audit reports for all subrecipients receiving federal funding from the Department. Possible Asserted Effect Failure to properly obtain and review subrecipient single audit reports may result in the use of federal funding not being in compliance with federal statues, regulations, and the terms and conditions of subawards. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding for the Department was included in the 2019 Single Audit Report as finding number 2019 032 at pages 90?92. Recommendation We recommend the Department to continue working on the implementation of its replacement computerized system to (1) identify all subrecipients required to have a single audit, (2) ensure that sanctions are imposed in a timely manner for subrecipients that do not submit timely single audit reports, and (3) issue management decisions within six months for all single audit reports that contain findings relevant to the Department?s programs. In the interim, we recommend that manual internal control procedures be implemented by the Department to ensure that all subrecipients that require a single audit to be completed submit the report on a timely basis and, if applicable, respond to management decision letters be issued by the Department. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Agriculture Federal Programs: Child and Adult Care Food Program (10.558) Federal Award Numbers: 202120N105044, 202121N115044, 202222N115044, 202221N115044, 202121N202044, 202120N202044, 202121N109944, 202120N109944, 202121N119944, 202121H170644, 202222N202044, 202221N202044, 202222N119944, 202221N119944 Federal Award Years: 2021 and 2022 State Agency: Department of Health Reference: 2022-003 Criteria Title 2 U.S. Code of Federal Regulations Part 200 (2 CFR 200), Uniform Administrative Requirements, Cost Principles, and Audit Requirements, section 200.332(d) states all pass-through entities must monitor the activities of the subrecipient as necessary to ensure that he subaward is used for authorized purposes, in compliance with federal statutes, regulations, and the terms and conditions of the subaward, and that subaward performance goals are achieved. Pass-through entity monitoring of the subrecipient must include: (1) Reviewing financial and performance reports required by the pass-through entity. (2) Following-up and ensuring that the subrecipient takes timely and appropriate action on all deficiencies pertaining to the federal award provided to the subrecipient from the pass-through entity detected through audits, on-site reviews, and other means. (3) Issuing a management decision for audit findings pertaining to the federal award provided to the subrecipient from the pass-through entity as required by 2 CFR 200.521. Additionally, 2 CFR 200.303(a) states the nonfederal entity must Establish and maintain effective internal control over the federal award that provides reasonable assurance that the nonfederal entity is managing the federal award in compliance with federal statutes, regulations, and the terms and conditions of the federal award. Condition For 3 of 40 subrecipients selected, the Department did not review the cases by the scheduled due date for the single audit reports as required in accordance with 2 CFR 200.332(d). The Department of Health (the Department) did not have effective internal controls in place to ensure that all required single audits of the program?s subrecipients were reviewed, followed-up, or appropriate action was taken and as necessary issued a management decision pertaining to the audit finding in accordance with 2 CFR 200, as applicable. The Department maintains an internal clearinghouse tracker (the tracker) to track the subrecipients single audit status. The tracker tracks subrecipients that are exempt from single audit requirements as well as the status and follow-up required for the subrecipients with single audits. Cause The condition is due to DOH Audit Clearinghouse personnel not operating as intended, due to COVID-19 personnel reassignments, to ensure the timely review of all single audit reports for all subrecipients receiving federal funding from the Department. Possible Asserted Effect Failure to properly obtain and review subrecipient single audit reports may result in the use of federal funding not being in compliance with federal statues, regulations, and the terms and conditions of subawards. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding for the Department was included in the 2019 Single Audit Report as finding number 2019 032 at pages 90?92. Recommendation We recommend the Department to continue working on the implementation of its replacement computerized system to (1) identify all subrecipients required to have a single audit, (2) ensure that sanctions are imposed in a timely manner for subrecipients that do not submit timely single audit reports, and (3) issue management decisions within six months for all single audit reports that contain findings relevant to the Department?s programs. In the interim, we recommend that manual internal control procedures be implemented by the Department to ensure that all subrecipients that require a single audit to be completed submit the report on a timely basis and, if applicable, respond to management decision letters be issued by the Department. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Labor Federal Program: Unemployment Insurance (17.225) Federal Award Numbers: Not Applicable Federal Award Years: Not Applicable State Agency: Department of Labor Reference: 2022-004 Criteria The Payments Integrity Information Act (PIIA) of 2019 codified the requirement for valid statistical estimates of improper payments. by Title 20 Code of Federal Regulations Part 602 (20 CFR 602), Quality Control in the Federal-State Unemployment System, prescribes a Quality Control (QC) program for the Federal-State unemployment compensation (UC) system, which is appliable to the State UC programs and the Federal unemployment benefit and allowance programs administered by the State unemployment compensation agencies under agreements between the States and the Secretary of Labor. 20 CFR 602.11(d) states to satisfy the requirements of Section 303(a)(1) and (6) of the Social Security Act (SSA) (42 USC 503), a State law must contain a provision requiring, or which is construed to require, the establishment and maintenance of a QC program in accordance with the requirements of this part. The establishment and maintenance of such a QC program in accordance with this part shall not require any change in State law concerning authority to undertake redeterminations of claims or liabilities or the finality of any determination, redetermination or decision. Each State shall establish a QC unit independent of, and not accountable to, any unit performing functions subject to evaluation by the QC unit. The organizational location of this unit shall be positioned to maximize its objectivity, to facilitate its access to information necessary to carry out its responsibilities, and to minimize organizational conflict of interest. Per 20 CFR 602.21 ? Standard methods and Procedures, Each State Shall: (a) Perform the requirements of this section in accordance with instructions issued by the Department, pursuant to ? 602.30(a) of this part, to ensure standardization of methods and procedures in a manner consistent with this part; (b) Select representative samples for QC study of at least a minimum size specified by the Department to ensure statistical validity (for benefit payments, a minimum of 400 cases of weeks paid per State per year); (c) Complete prompt and in-depth case investigations to determine the degree of accuracy and timeliness in the administration of the State UC law and Federal programs with respect to benefit determinations, benefit payments, and revenue collections; and conduct other measurements and studies necessary or appropriate for carrying out the purposes of this part; and in conducting investigations each State shall: (1) Inform claimants in writing that the information obtained from a QC investigation may affect their eligibility for benefits and inform employers in writing that the information obtained from a QC investigation of revenue may affect their tax liability, (2) Use a questionnaire, prescribed by the Department, which is designed to obtain such data as the Department deems necessary for the operation of the QC program; require completion of the questionnaire by claimants in accordance with the eligibility and reporting authority under State law, (3) Collect data identified by the Department as necessary for the operation of the QC program; however, the collection of demographic data will be limited to those data which relate to an individual's eligibility for UC benefits and necessary to conduct proportions tests to validate the selection of representative samples (the demographic data elements necessary to conduct proportions tests are claimants' date of birth, sex, and ethnic classification); and (4) Conclude all findings of inaccuracy as d(a) Perform the requirements of this section in accordance with instructions issued by the Department, pursuant to ? 602.30(a) of this part, to ensure standardization of methods and procedures in a manner consistent with this part; (d) Classify benefit case findings resulting from QC investigations as: (1) Proper payments, underpayments, or overpayments in benefit payment cases, or (2) Proper denials or underpayments in benefit denial cases; (e) Make and maintain records pertaining to the QC program, and make all such records available in a timely manner for inspection, examination, and audit by such Federal officials as the Secretary may designate or as may be required or authorized by law; (f) Furnish information and reports to the Department, including weekly transmissions of case data entered into the automated QC system and annual reports, without, in any manner, identifying individuals to whom such data pertain; and (g) Release the results of the QC program at the same time each year, providing calendar year results using a standardized format to present the data as prescribed by the Department; States will have the opportunity to release this information prior to any release by the Department. Lastly, Title 2 U.S. Code of Federal Regulations Part 200 (2 CFR 200) Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, section 303(a) states, the non-Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-Federal entity is managing the Federal award in compliance with Federal statues, regulations, and the terms and conditions of the Federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition The Benefit Accuracy Measurement (BAM) programs consists of reviews of Regular UI payments, which are paid out of the Unemployment Insurance Trust Fund, and therefore are not associated with a Federal Award Number. For the period ending September 30, 2021, New York State sampled a total of 447 Denied Claims, 3 cases short of the USDOL minimum annual allocation requirement for Denied Cases of 450. Additionally, NYS has failed the 90- and 120-day time lapse requirement for Paid Claims. For the Month of March 2022, 94.58% of cases were reviewed and closed within 90 days, less than 1% short of the required 95%. Also, for the month of March 2022, NYS reviewed and closed 96.02% and 95.41% of both paid and denied claims within 120 days, which is short of the required 98%. Cause The condition related to the failure to meet the minimum annual allocation threshold was a result of New York State not identifying in its initial sample selection of 450 that 3 of the cases selected from the last week for sampling in the 2020/2021 PIIA year did not relate to regular UI payments and were not identified in time to be replaced for evaluation under the BAM program PIIA year. The three incorrect samples were subsequently determined to be issued under a temporary program (PUA) and not able to be replaced due to the Department policies and procedures allowing for the sample item to be replaced in the subsequent week. The condition related to the time lapse requirements results from a shortage of staff and backlogged cases directly related to the COVID-19 Pandemic. As a result, the Department was unable to meet all case allocation and timely review requirements. Possible Asserted Effect Failure to perform timely completion of investigations results in the inability of UI Program to appropriately assess the degree of accuracy and timeliness in the administration of the State UC law and Federal programs with respect to benefit determinations, benefit payments, and revenue collections. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend that the Department ensures that their policies and procedures are designed to review selected cases to ensure they meet the prescribed criteria and, if necessary, be replaced as part of the final sampling week for the PIIA year. Additionally, the Department should enhance its process to ensure the completion of Paid and Denied cases are reviewed and closed timely in accordance with State Law. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Labor Federal Program: Unemployment Insurance (17.225) Federal Award Numbers: MI-34016-19-75-A-36; MI-35505-20-75-A-36; UI-27922-15-55-A-36; UI-32857-19-60-A-36; UI-34075-20-55-A-36; UI-34512-20-60-A-36; UI-34732-20-55-A-36; UI-35665-21-55-A-36; UI-35961-21-60-A-36; UI-37081-21-55-A-36; UI-37240-22-55-A-36; UI-37261-22-55-A-36 Federal Award Years: 2020 and 2021 State Agency: Department of Labor Reference: 2022-005 Criteria The Coronavirus Aid, Relief, and Economic Security Act (CARES Act), signed into law March 27, 2020, provides over $2 trillion of economic relief to workers, families, small businesses, industry sectors, and other levels of government that have been hit hard by the public health crisis created by the Coronavirus Disease 2019 (COVID-19). The CARES Act and subsequent legislation was designed to mitigate the economic effects of the COVID-19 pandemic in a variety of ways. Section 2102 of the CARES Act provided temporary benefits known as Pandemic Unemployment Assistance (PUA), for individuals who exhausted their entitlement to regular Unemployment Compensation (UC), and individuals who were not eligible for regular UC, such as those who were self-employed or who had limited recent work history. These individuals may also include certain gig economy workers, members of the clergy, and those working for religious organizations who were not covered by regular UC, as well as other workers who may not have been covered by the regular UC program under some state laws. PUA provides benefits to covered individuals, who are those individuals not eligible for regular unemployment compensation (UC or extended benefits under state or federal law or Pandemic Emergency Unemployment Compensation (PEUC), including those who have exhausted all rights to such benefits. Covered individuals also include self-employed, those seeking part-time employment, individuals lacking sufficient work history, and those who otherwise do not qualify for regular unemployment compensation or extended benefits under state or federal law or PEUC. PUA is payable to individuals who are ineligible for regular UC, and are unemployed, partially unemployed, or unable or unavailable to work due to one of the COVID-19 related reasons identified Attachment I to UIPL No. 16-20, Change 5. Section 2102(a)(3)(A)(ii)(I) of the CARES Act included 10 specific COVID-19 related reasons. The Department, under the authority provided by Section 2102(a)(3)(A)(ii)(I)(kk) of the CARES Act, has added additional COVID-19 related reasons; these are discussed in more detail in Section 4.a. of UIPL No. 16-20, Change 5. While three of these new COVID-19 related reasons were introduced to states with the publication of UIPL No. 16-20, Change 5 on February 25, 2021, all COVID-19 related reasons apply retroactively to the beginning of the PUA program. Additionally, as described in Section 4.b.i. of UIPL No. 16-20, Change 5, paraphrasing of the COVID-19 related reasons is not permissible; individuals must be permitted to select more than one COVID-19 related reason; individuals must be permitted to select different COVID-19 related reasons each week; and individuals must be permitted to file and select no COVID-19 related reasons. (1) The individual has been diagnosed with COVID-19 or is experiencing symptoms of COVID-19 and is seeking a medical diagnosis; (2) A member of the individual?s household has been diagnosed with COVID-19; (3) The individual is providing care for a family member or a member of the individual?s household who has been diagnosed with COVID-19; (4) A child or other person in the household for which the individual has primary caregiving responsibility is unable to attend school or another facility that is closed as a direct result of the COVID-19 public health emergency and such school or facility care is required for the individual to work; (5) The individual is unable to reach the place of employment because of a quarantine imposed as a direct result of the COVID-19 public health emergency; (6) The individual is unable to reach the place of employment because the individual has been advised by a health care provider to self-quarantine due to concerns related to COVID-19; (7) The individual was scheduled to commence employment and does not have a job or is unable to reach the job as a direct result of the COVID-19 public health emergency; (8) The individual has become the breadwinner or major support for a household because the head of the household has died as a direct result of COVID-19; (9) The individual has to quit his or her job as a direct result of COVID-19; (10) The individual?s place of employment is closed as a direct result of the COVID-19 public health emergency; or (11) The individual meets any additional criteria established by the Department for unemployment assistance under this section. a) An individual who works as an independent contractor with reportable income may also qualify for PUA benefits if he or she is unemployed, partially employed, or unable or unavailable to work because the COVID-19 public health emergency has severely limited his or her ability to continue performing his or her customary work activities, and has thereby forced the individual to suspend such activities; b) The individual has been denied continued unemployment benefits because the individual refused to return to work or accept an offer of work at a worksite that, in either instance, is not in compliance with local, state, or national health and safety standards directly related to COVID-19. This includes, but is not limited to, those related to facial mask wearing, physical distancing measures, or the provision of personal protective equipment consistent with public health guidelines; c) An individual provides services to an educational institution or educational service agency and the individual is unemployed or partially unemployed because of volatility in the work schedule that is directly caused by the COVID-19 public health emergency. This includes, but is not limited to, changes in schedules and partial closures; or d) An individual is an employee and their hours have been reduced or the individual was laid off as a direct result of the COVID-19 public health emergency. Section 2107 of the CARES Act created a new temporary federal program called PEUC that provided additional weeks of benefits to individuals who had exhausted their regular UC entitlement and provided funding to states to administer the program. The CARES Act originally provided up to 13 additional weeks of PEUC benefits. Section 206 of CAA and Section 9016 of the American Rescue Plan Act of 2021 (ARPA) increased the total amount of PEUC benefits available to 53 times the individual?s average weekly benefit amount, with the additional weeks of benefits payable for weeks of unemployment ending after March 14, 2021. To be eligible for PEUC, a claimant must have exhausted all rights to regular compensation under state law or federal law with respect to a benefit year that ended on or after July 1, 2019; have no rights to regular compensation with respect to a week under any other state UC law or federal UC law, or to compensation under any other federal law; are not receiving compensation with respect to a week under the UC law of Canada; and are able to work, available to work, and actively seeking work, while recognizing that states must provide flexibility in meeting the ?actively seeking work? requirement if individuals are unable to search for work because of COVID-19, including because of illness, quarantine, or movement restriction. Lastly, Title 2 U.S. Code of Federal Regulations Part 200 (2CFR 200) Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, section 303(a) states, the non-Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-Federal entity is managing the Federal award in compliance with Federal statues, regulations, and the terms and conditions of the Federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition In conjunction with our testwork over 60 samples related to PUA eligibility, the following findings were identified: I. For 28 of the 60 samples, the Department of Labor (the Department) was unable to provide evidence the claimant has submitted proof of documentation substantiating employment, self-employment, or the planned commencement of employment or self-employment in accordance with Section 241 (a) of the Continued Assistance Act. II. For 3 of the 60 samples, the incorrect benefit rate was calculated by the Department resulting in underpayments to claimants. III. For 1 of the 60 samples the Department was unable to provide support for any files related to the eligibility determination of the claimant IV. For 60 of the 60 samples, the Department did not complete the required quarterly wage checks for PUA claimants at most recent quarter change to ensure PUA claimant was not eligible for any other benefit programs. In conjunction with our testwork over 60 samples related to PEUC eligibility, the following findings were identified: V. For 60 of the 60 samples the Department did not complete required quarterly wage checks on PEUC claimants at most recent quarter change to ensure that PEUC claimant is still deemed to be an exhaustee and not eligible to establish a new benefit year for other UI programs. VI. For 2 of the 60 samples, the claimant was received PEUC before exhausting 104 days of regular UI benefits. Cause Condition II results from the incorrect effective date and/or incorrect wages used to calculate the benefit rate resulting in underpayments to the claimant. Conditions I, III, IV, and V, results from the Department not having the appropriate documentation to support the eligibility determinations made as part of the PUA and PEUC federal programs. Condition VI results from the Department using incorrect backdates resulting in the claimant not exhausting 104 days of regular UI prior to receiving PEUC benefits. Possible Asserted Effect Failure to ensure eligibility is properly determined or benefit calculations are accurately stated may result in ineligible benefit payments not in accordance with the terms and conditions of the federal awards. Questioned Costs $679 (total overpayments of temporary federal awards paid to two selected beneficiaries) Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend the Department enhance its policies and procedures to ensure that all benefit payments made under the PUA and PEUC programs have the appropriate documentation to support eligibility determinations reached and that all benefit calculations are accurately supported for the calculated amounts. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Labor Federal Program: Unemployment Insurance (17.225) Federal Award Numbers: Not Applicable Federal Award Years: Not Applicable State Agency: Department of Labor Reference: 2022-006 Criteria Under Section 904 of the Social Security Act, Unemployment Trust Fund, established in the Treasury of the United States a trust fund to be known as the ?Unemployment Trust Fund? (Fund). The Secretary of the Treasury is authorized and directed to receive and hold in the Fund all moneys deposited therein by a State agency from a State unemployment fund, or by the Railroad Retirement Board to the credit of the railroad unemployment insurance account or the railroad unemployment insurance administration fund, or otherwise deposited in or credited to the Fund or any account therein. Such deposit may be made directly with the Secretary of the Treasury, with any depositary designated by him for such purpose, or with any Federal Reserve Bank. Under section (e), the fund shall be invested as a single fund, but the Secretary of the Treasury shall maintain a separate book account for each State agency. Under Article 18 of New York State law, Title 7 Section 590, rights to benefits states that benefits shall not be paid for more than one hundred and four effective days in any benefit year, except as provided in section six hundred one and subdivision two of section five hundred ninety-nine of this chapter. Additionally, Aliens must show proof that they are authorized to work by the US Citizenship and Immigration Services (USCIS) in order to be eligible to receive a federal public benefit (42 USC 1302b-7(d) and (e)). specifically If such an individual is not a citizen or national of the United States, there must be presented either alien registration documentation or other proof of immigration registration from the Immigration and Naturalization Service that contains the individual?s alien admission number or alien file number (or numbers if the individual has more than one number), or such other documents as the State determines constitutes reasonable evidence indicating a satisfactory immigration status. In the case of such an individual who is not a citizen or national of the United States, if, at the time of application for benefits, the statement described in paragraph (1) is submitted but the documentation required under paragraph (2) is not presented or if the documentation required under paragraph (2)(A) is presented but such documentation is not verified under paragraph (3) the State shall provide a reasonable opportunity to submit to the State evidence indicating a satisfactory immigration status, and may not delay, deny, reduce, or terminate the individual?s eligibility for benefits under the program on the basis of the individual?s immigration status until such a reasonable opportunity has been provided Lastly, Title 2 U.S. Code of Federal Regulations Part 200 (2 CFR 200) Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, section 303(a) states, the non-Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition Regular UI payments, which are paid out of the Unemployment Insurance Trust Fund, and therefore are not associated with a Federal Award Number. During our testwork we noted the following: I. For 1 of 60 regular Unemployment Compensation (UC) claimants selected, the claimant received regular UC payments for greater than 104 days drawn from the Unemployment Trust Fund. Cause I. Condition I results from Unemployment Insurance (UI) system and the Department failing to identify and restrict payment to the claimants that reached the maximum limit of days allowed for regular UC benefits. The Department does not have a manual control to identify the claimants as being coded to the incorrect benefit. Possible Asserted Effect Failure to ensure eligibility is properly determined or benefit calculations are accurately stated may result in ineligible benefit payments not in accordance with the terms and conditions of the federal awards. Questioned Costs $256 (overpayments in excess of maximum regular unemployment compensation paid to one selected beneficiary) Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding for the Department was included in the 2021 Single Audit Report as finding number 2021-005 at pages 23?24. Recommendation We recommend the Department enhance its process and controls to ensure claimants that have exhausted benefits such as regular UC are not allowed to receive benefits in excess of the maximum allowable days for the program. Additionally, we recommend the Department enhance its policies and procedures to ensure that all benefit payments made under regular Unemployment Compensation (UC) have the appropriate documentation to support eligibility determinations reached and that all benefit calculations are accurately supported for the calculated amounts. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Labor Federal Program: Unemployment Insurance (17.225) Federal Award Numbers: Not Applicable Federal Award Years: Not Applicable State Agency: Department of Labor Reference: 2022-004 Criteria The Payments Integrity Information Act (PIIA) of 2019 codified the requirement for valid statistical estimates of improper payments. by Title 20 Code of Federal Regulations Part 602 (20 CFR 602), Quality Control in the Federal-State Unemployment System, prescribes a Quality Control (QC) program for the Federal-State unemployment compensation (UC) system, which is appliable to the State UC programs and the Federal unemployment benefit and allowance programs administered by the State unemployment compensation agencies under agreements between the States and the Secretary of Labor. 20 CFR 602.11(d) states to satisfy the requirements of Section 303(a)(1) and (6) of the Social Security Act (SSA) (42 USC 503), a State law must contain a provision requiring, or which is construed to require, the establishment and maintenance of a QC program in accordance with the requirements of this part. The establishment and maintenance of such a QC program in accordance with this part shall not require any change in State law concerning authority to undertake redeterminations of claims or liabilities or the finality of any determination, redetermination or decision. Each State shall establish a QC unit independent of, and not accountable to, any unit performing functions subject to evaluation by the QC unit. The organizational location of this unit shall be positioned to maximize its objectivity, to facilitate its access to information necessary to carry out its responsibilities, and to minimize organizational conflict of interest. Per 20 CFR 602.21 ? Standard methods and Procedures, Each State Shall: (a) Perform the requirements of this section in accordance with instructions issued by the Department, pursuant to ? 602.30(a) of this part, to ensure standardization of methods and procedures in a manner consistent with this part; (b) Select representative samples for QC study of at least a minimum size specified by the Department to ensure statistical validity (for benefit payments, a minimum of 400 cases of weeks paid per State per year); (c) Complete prompt and in-depth case investigations to determine the degree of accuracy and timeliness in the administration of the State UC law and Federal programs with respect to benefit determinations, benefit payments, and revenue collections; and conduct other measurements and studies necessary or appropriate for carrying out the purposes of this part; and in conducting investigations each State shall: (1) Inform claimants in writing that the information obtained from a QC investigation may affect their eligibility for benefits and inform employers in writing that the information obtained from a QC investigation of revenue may affect their tax liability, (2) Use a questionnaire, prescribed by the Department, which is designed to obtain such data as the Department deems necessary for the operation of the QC program; require completion of the questionnaire by claimants in accordance with the eligibility and reporting authority under State law, (3) Collect data identified by the Department as necessary for the operation of the QC program; however, the collection of demographic data will be limited to those data which relate to an individual's eligibility for UC benefits and necessary to conduct proportions tests to validate the selection of representative samples (the demographic data elements necessary to conduct proportions tests are claimants' date of birth, sex, and ethnic classification); and (4) Conclude all findings of inaccuracy as d(a) Perform the requirements of this section in accordance with instructions issued by the Department, pursuant to ? 602.30(a) of this part, to ensure standardization of methods and procedures in a manner consistent with this part; (d) Classify benefit case findings resulting from QC investigations as: (1) Proper payments, underpayments, or overpayments in benefit payment cases, or (2) Proper denials or underpayments in benefit denial cases; (e) Make and maintain records pertaining to the QC program, and make all such records available in a timely manner for inspection, examination, and audit by such Federal officials as the Secretary may designate or as may be required or authorized by law; (f) Furnish information and reports to the Department, including weekly transmissions of case data entered into the automated QC system and annual reports, without, in any manner, identifying individuals to whom such data pertain; and (g) Release the results of the QC program at the same time each year, providing calendar year results using a standardized format to present the data as prescribed by the Department; States will have the opportunity to release this information prior to any release by the Department. Lastly, Title 2 U.S. Code of Federal Regulations Part 200 (2 CFR 200) Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, section 303(a) states, the non-Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-Federal entity is managing the Federal award in compliance with Federal statues, regulations, and the terms and conditions of the Federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition The Benefit Accuracy Measurement (BAM) programs consists of reviews of Regular UI payments, which are paid out of the Unemployment Insurance Trust Fund, and therefore are not associated with a Federal Award Number. For the period ending September 30, 2021, New York State sampled a total of 447 Denied Claims, 3 cases short of the USDOL minimum annual allocation requirement for Denied Cases of 450. Additionally, NYS has failed the 90- and 120-day time lapse requirement for Paid Claims. For the Month of March 2022, 94.58% of cases were reviewed and closed within 90 days, less than 1% short of the required 95%. Also, for the month of March 2022, NYS reviewed and closed 96.02% and 95.41% of both paid and denied claims within 120 days, which is short of the required 98%. Cause The condition related to the failure to meet the minimum annual allocation threshold was a result of New York State not identifying in its initial sample selection of 450 that 3 of the cases selected from the last week for sampling in the 2020/2021 PIIA year did not relate to regular UI payments and were not identified in time to be replaced for evaluation under the BAM program PIIA year. The three incorrect samples were subsequently determined to be issued under a temporary program (PUA) and not able to be replaced due to the Department policies and procedures allowing for the sample item to be replaced in the subsequent week. The condition related to the time lapse requirements results from a shortage of staff and backlogged cases directly related to the COVID-19 Pandemic. As a result, the Department was unable to meet all case allocation and timely review requirements. Possible Asserted Effect Failure to perform timely completion of investigations results in the inability of UI Program to appropriately assess the degree of accuracy and timeliness in the administration of the State UC law and Federal programs with respect to benefit determinations, benefit payments, and revenue collections. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend that the Department ensures that their policies and procedures are designed to review selected cases to ensure they meet the prescribed criteria and, if necessary, be replaced as part of the final sampling week for the PIIA year. Additionally, the Department should enhance its process to ensure the completion of Paid and Denied cases are reviewed and closed timely in accordance with State Law. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Labor Federal Program: Unemployment Insurance (17.225) Federal Award Numbers: MI-34016-19-75-A-36; MI-35505-20-75-A-36; UI-27922-15-55-A-36; UI-32857-19-60-A-36; UI-34075-20-55-A-36; UI-34512-20-60-A-36; UI-34732-20-55-A-36; UI-35665-21-55-A-36; UI-35961-21-60-A-36; UI-37081-21-55-A-36; UI-37240-22-55-A-36; UI-37261-22-55-A-36 Federal Award Years: 2020 and 2021 State Agency: Department of Labor Reference: 2022-005 Criteria The Coronavirus Aid, Relief, and Economic Security Act (CARES Act), signed into law March 27, 2020, provides over $2 trillion of economic relief to workers, families, small businesses, industry sectors, and other levels of government that have been hit hard by the public health crisis created by the Coronavirus Disease 2019 (COVID-19). The CARES Act and subsequent legislation was designed to mitigate the economic effects of the COVID-19 pandemic in a variety of ways. Section 2102 of the CARES Act provided temporary benefits known as Pandemic Unemployment Assistance (PUA), for individuals who exhausted their entitlement to regular Unemployment Compensation (UC), and individuals who were not eligible for regular UC, such as those who were self-employed or who had limited recent work history. These individuals may also include certain gig economy workers, members of the clergy, and those working for religious organizations who were not covered by regular UC, as well as other workers who may not have been covered by the regular UC program under some state laws. PUA provides benefits to covered individuals, who are those individuals not eligible for regular unemployment compensation (UC or extended benefits under state or federal law or Pandemic Emergency Unemployment Compensation (PEUC), including those who have exhausted all rights to such benefits. Covered individuals also include self-employed, those seeking part-time employment, individuals lacking sufficient work history, and those who otherwise do not qualify for regular unemployment compensation or extended benefits under state or federal law or PEUC. PUA is payable to individuals who are ineligible for regular UC, and are unemployed, partially unemployed, or unable or unavailable to work due to one of the COVID-19 related reasons identified Attachment I to UIPL No. 16-20, Change 5. Section 2102(a)(3)(A)(ii)(I) of the CARES Act included 10 specific COVID-19 related reasons. The Department, under the authority provided by Section 2102(a)(3)(A)(ii)(I)(kk) of the CARES Act, has added additional COVID-19 related reasons; these are discussed in more detail in Section 4.a. of UIPL No. 16-20, Change 5. While three of these new COVID-19 related reasons were introduced to states with the publication of UIPL No. 16-20, Change 5 on February 25, 2021, all COVID-19 related reasons apply retroactively to the beginning of the PUA program. Additionally, as described in Section 4.b.i. of UIPL No. 16-20, Change 5, paraphrasing of the COVID-19 related reasons is not permissible; individuals must be permitted to select more than one COVID-19 related reason; individuals must be permitted to select different COVID-19 related reasons each week; and individuals must be permitted to file and select no COVID-19 related reasons. (1) The individual has been diagnosed with COVID-19 or is experiencing symptoms of COVID-19 and is seeking a medical diagnosis; (2) A member of the individual?s household has been diagnosed with COVID-19; (3) The individual is providing care for a family member or a member of the individual?s household who has been diagnosed with COVID-19; (4) A child or other person in the household for which the individual has primary caregiving responsibility is unable to attend school or another facility that is closed as a direct result of the COVID-19 public health emergency and such school or facility care is required for the individual to work; (5) The individual is unable to reach the place of employment because of a quarantine imposed as a direct result of the COVID-19 public health emergency; (6) The individual is unable to reach the place of employment because the individual has been advised by a health care provider to self-quarantine due to concerns related to COVID-19; (7) The individual was scheduled to commence employment and does not have a job or is unable to reach the job as a direct result of the COVID-19 public health emergency; (8) The individual has become the breadwinner or major support for a household because the head of the household has died as a direct result of COVID-19; (9) The individual has to quit his or her job as a direct result of COVID-19; (10) The individual?s place of employment is closed as a direct result of the COVID-19 public health emergency; or (11) The individual meets any additional criteria established by the Department for unemployment assistance under this section. a) An individual who works as an independent contractor with reportable income may also qualify for PUA benefits if he or she is unemployed, partially employed, or unable or unavailable to work because the COVID-19 public health emergency has severely limited his or her ability to continue performing his or her customary work activities, and has thereby forced the individual to suspend such activities; b) The individual has been denied continued unemployment benefits because the individual refused to return to work or accept an offer of work at a worksite that, in either instance, is not in compliance with local, state, or national health and safety standards directly related to COVID-19. This includes, but is not limited to, those related to facial mask wearing, physical distancing measures, or the provision of personal protective equipment consistent with public health guidelines; c) An individual provides services to an educational institution or educational service agency and the individual is unemployed or partially unemployed because of volatility in the work schedule that is directly caused by the COVID-19 public health emergency. This includes, but is not limited to, changes in schedules and partial closures; or d) An individual is an employee and their hours have been reduced or the individual was laid off as a direct result of the COVID-19 public health emergency. Section 2107 of the CARES Act created a new temporary federal program called PEUC that provided additional weeks of benefits to individuals who had exhausted their regular UC entitlement and provided funding to states to administer the program. The CARES Act originally provided up to 13 additional weeks of PEUC benefits. Section 206 of CAA and Section 9016 of the American Rescue Plan Act of 2021 (ARPA) increased the total amount of PEUC benefits available to 53 times the individual?s average weekly benefit amount, with the additional weeks of benefits payable for weeks of unemployment ending after March 14, 2021. To be eligible for PEUC, a claimant must have exhausted all rights to regular compensation under state law or federal law with respect to a benefit year that ended on or after July 1, 2019; have no rights to regular compensation with respect to a week under any other state UC law or federal UC law, or to compensation under any other federal law; are not receiving compensation with respect to a week under the UC law of Canada; and are able to work, available to work, and actively seeking work, while recognizing that states must provide flexibility in meeting the ?actively seeking work? requirement if individuals are unable to search for work because of COVID-19, including because of illness, quarantine, or movement restriction. Lastly, Title 2 U.S. Code of Federal Regulations Part 200 (2CFR 200) Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, section 303(a) states, the non-Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-Federal entity is managing the Federal award in compliance with Federal statues, regulations, and the terms and conditions of the Federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition In conjunction with our testwork over 60 samples related to PUA eligibility, the following findings were identified: I. For 28 of the 60 samples, the Department of Labor (the Department) was unable to provide evidence the claimant has submitted proof of documentation substantiating employment, self-employment, or the planned commencement of employment or self-employment in accordance with Section 241 (a) of the Continued Assistance Act. II. For 3 of the 60 samples, the incorrect benefit rate was calculated by the Department resulting in underpayments to claimants. III. For 1 of the 60 samples the Department was unable to provide support for any files related to the eligibility determination of the claimant IV. For 60 of the 60 samples, the Department did not complete the required quarterly wage checks for PUA claimants at most recent quarter change to ensure PUA claimant was not eligible for any other benefit programs. In conjunction with our testwork over 60 samples related to PEUC eligibility, the following findings were identified: V. For 60 of the 60 samples the Department did not complete required quarterly wage checks on PEUC claimants at most recent quarter change to ensure that PEUC claimant is still deemed to be an exhaustee and not eligible to establish a new benefit year for other UI programs. VI. For 2 of the 60 samples, the claimant was received PEUC before exhausting 104 days of regular UI benefits. Cause Condition II results from the incorrect effective date and/or incorrect wages used to calculate the benefit rate resulting in underpayments to the claimant. Conditions I, III, IV, and V, results from the Department not having the appropriate documentation to support the eligibility determinations made as part of the PUA and PEUC federal programs. Condition VI results from the Department using incorrect backdates resulting in the claimant not exhausting 104 days of regular UI prior to receiving PEUC benefits. Possible Asserted Effect Failure to ensure eligibility is properly determined or benefit calculations are accurately stated may result in ineligible benefit payments not in accordance with the terms and conditions of the federal awards. Questioned Costs $679 (total overpayments of temporary federal awards paid to two selected beneficiaries) Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend the Department enhance its policies and procedures to ensure that all benefit payments made under the PUA and PEUC programs have the appropriate documentation to support eligibility determinations reached and that all benefit calculations are accurately supported for the calculated amounts. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Labor Federal Program: Unemployment Insurance (17.225) Federal Award Numbers: Not Applicable Federal Award Years: Not Applicable State Agency: Department of Labor Reference: 2022-006 Criteria Under Section 904 of the Social Security Act, Unemployment Trust Fund, established in the Treasury of the United States a trust fund to be known as the ?Unemployment Trust Fund? (Fund). The Secretary of the Treasury is authorized and directed to receive and hold in the Fund all moneys deposited therein by a State agency from a State unemployment fund, or by the Railroad Retirement Board to the credit of the railroad unemployment insurance account or the railroad unemployment insurance administration fund, or otherwise deposited in or credited to the Fund or any account therein. Such deposit may be made directly with the Secretary of the Treasury, with any depositary designated by him for such purpose, or with any Federal Reserve Bank. Under section (e), the fund shall be invested as a single fund, but the Secretary of the Treasury shall maintain a separate book account for each State agency. Under Article 18 of New York State law, Title 7 Section 590, rights to benefits states that benefits shall not be paid for more than one hundred and four effective days in any benefit year, except as provided in section six hundred one and subdivision two of section five hundred ninety-nine of this chapter. Additionally, Aliens must show proof that they are authorized to work by the US Citizenship and Immigration Services (USCIS) in order to be eligible to receive a federal public benefit (42 USC 1302b-7(d) and (e)). specifically If such an individual is not a citizen or national of the United States, there must be presented either alien registration documentation or other proof of immigration registration from the Immigration and Naturalization Service that contains the individual?s alien admission number or alien file number (or numbers if the individual has more than one number), or such other documents as the State determines constitutes reasonable evidence indicating a satisfactory immigration status. In the case of such an individual who is not a citizen or national of the United States, if, at the time of application for benefits, the statement described in paragraph (1) is submitted but the documentation required under paragraph (2) is not presented or if the documentation required under paragraph (2)(A) is presented but such documentation is not verified under paragraph (3) the State shall provide a reasonable opportunity to submit to the State evidence indicating a satisfactory immigration status, and may not delay, deny, reduce, or terminate the individual?s eligibility for benefits under the program on the basis of the individual?s immigration status until such a reasonable opportunity has been provided Lastly, Title 2 U.S. Code of Federal Regulations Part 200 (2 CFR 200) Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, section 303(a) states, the non-Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition Regular UI payments, which are paid out of the Unemployment Insurance Trust Fund, and therefore are not associated with a Federal Award Number. During our testwork we noted the following: I. For 1 of 60 regular Unemployment Compensation (UC) claimants selected, the claimant received regular UC payments for greater than 104 days drawn from the Unemployment Trust Fund. Cause I. Condition I results from Unemployment Insurance (UI) system and the Department failing to identify and restrict payment to the claimants that reached the maximum limit of days allowed for regular UC benefits. The Department does not have a manual control to identify the claimants as being coded to the incorrect benefit. Possible Asserted Effect Failure to ensure eligibility is properly determined or benefit calculations are accurately stated may result in ineligible benefit payments not in accordance with the terms and conditions of the federal awards. Questioned Costs $256 (overpayments in excess of maximum regular unemployment compensation paid to one selected beneficiary) Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding for the Department was included in the 2021 Single Audit Report as finding number 2021-005 at pages 23?24. Recommendation We recommend the Department enhance its process and controls to ensure claimants that have exhausted benefits such as regular UC are not allowed to receive benefits in excess of the maximum allowable days for the program. Additionally, we recommend the Department enhance its policies and procedures to ensure that all benefit payments made under regular Unemployment Compensation (UC) have the appropriate documentation to support eligibility determinations reached and that all benefit calculations are accurately supported for the calculated amounts. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Labor Federal Program: Unemployment Insurance (17.225) Federal Award Numbers: Not Applicable Federal Award Years: Not Applicable State Agency: Department of Labor Reference: 2022-004 Criteria The Payments Integrity Information Act (PIIA) of 2019 codified the requirement for valid statistical estimates of improper payments. by Title 20 Code of Federal Regulations Part 602 (20 CFR 602), Quality Control in the Federal-State Unemployment System, prescribes a Quality Control (QC) program for the Federal-State unemployment compensation (UC) system, which is appliable to the State UC programs and the Federal unemployment benefit and allowance programs administered by the State unemployment compensation agencies under agreements between the States and the Secretary of Labor. 20 CFR 602.11(d) states to satisfy the requirements of Section 303(a)(1) and (6) of the Social Security Act (SSA) (42 USC 503), a State law must contain a provision requiring, or which is construed to require, the establishment and maintenance of a QC program in accordance with the requirements of this part. The establishment and maintenance of such a QC program in accordance with this part shall not require any change in State law concerning authority to undertake redeterminations of claims or liabilities or the finality of any determination, redetermination or decision. Each State shall establish a QC unit independent of, and not accountable to, any unit performing functions subject to evaluation by the QC unit. The organizational location of this unit shall be positioned to maximize its objectivity, to facilitate its access to information necessary to carry out its responsibilities, and to minimize organizational conflict of interest. Per 20 CFR 602.21 ? Standard methods and Procedures, Each State Shall: (a) Perform the requirements of this section in accordance with instructions issued by the Department, pursuant to ? 602.30(a) of this part, to ensure standardization of methods and procedures in a manner consistent with this part; (b) Select representative samples for QC study of at least a minimum size specified by the Department to ensure statistical validity (for benefit payments, a minimum of 400 cases of weeks paid per State per year); (c) Complete prompt and in-depth case investigations to determine the degree of accuracy and timeliness in the administration of the State UC law and Federal programs with respect to benefit determinations, benefit payments, and revenue collections; and conduct other measurements and studies necessary or appropriate for carrying out the purposes of this part; and in conducting investigations each State shall: (1) Inform claimants in writing that the information obtained from a QC investigation may affect their eligibility for benefits and inform employers in writing that the information obtained from a QC investigation of revenue may affect their tax liability, (2) Use a questionnaire, prescribed by the Department, which is designed to obtain such data as the Department deems necessary for the operation of the QC program; require completion of the questionnaire by claimants in accordance with the eligibility and reporting authority under State law, (3) Collect data identified by the Department as necessary for the operation of the QC program; however, the collection of demographic data will be limited to those data which relate to an individual's eligibility for UC benefits and necessary to conduct proportions tests to validate the selection of representative samples (the demographic data elements necessary to conduct proportions tests are claimants' date of birth, sex, and ethnic classification); and (4) Conclude all findings of inaccuracy as d(a) Perform the requirements of this section in accordance with instructions issued by the Department, pursuant to ? 602.30(a) of this part, to ensure standardization of methods and procedures in a manner consistent with this part; (d) Classify benefit case findings resulting from QC investigations as: (1) Proper payments, underpayments, or overpayments in benefit payment cases, or (2) Proper denials or underpayments in benefit denial cases; (e) Make and maintain records pertaining to the QC program, and make all such records available in a timely manner for inspection, examination, and audit by such Federal officials as the Secretary may designate or as may be required or authorized by law; (f) Furnish information and reports to the Department, including weekly transmissions of case data entered into the automated QC system and annual reports, without, in any manner, identifying individuals to whom such data pertain; and (g) Release the results of the QC program at the same time each year, providing calendar year results using a standardized format to present the data as prescribed by the Department; States will have the opportunity to release this information prior to any release by the Department. Lastly, Title 2 U.S. Code of Federal Regulations Part 200 (2 CFR 200) Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, section 303(a) states, the non-Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-Federal entity is managing the Federal award in compliance with Federal statues, regulations, and the terms and conditions of the Federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition The Benefit Accuracy Measurement (BAM) programs consists of reviews of Regular UI payments, which are paid out of the Unemployment Insurance Trust Fund, and therefore are not associated with a Federal Award Number. For the period ending September 30, 2021, New York State sampled a total of 447 Denied Claims, 3 cases short of the USDOL minimum annual allocation requirement for Denied Cases of 450. Additionally, NYS has failed the 90- and 120-day time lapse requirement for Paid Claims. For the Month of March 2022, 94.58% of cases were reviewed and closed within 90 days, less than 1% short of the required 95%. Also, for the month of March 2022, NYS reviewed and closed 96.02% and 95.41% of both paid and denied claims within 120 days, which is short of the required 98%. Cause The condition related to the failure to meet the minimum annual allocation threshold was a result of New York State not identifying in its initial sample selection of 450 that 3 of the cases selected from the last week for sampling in the 2020/2021 PIIA year did not relate to regular UI payments and were not identified in time to be replaced for evaluation under the BAM program PIIA year. The three incorrect samples were subsequently determined to be issued under a temporary program (PUA) and not able to be replaced due to the Department policies and procedures allowing for the sample item to be replaced in the subsequent week. The condition related to the time lapse requirements results from a shortage of staff and backlogged cases directly related to the COVID-19 Pandemic. As a result, the Department was unable to meet all case allocation and timely review requirements. Possible Asserted Effect Failure to perform timely completion of investigations results in the inability of UI Program to appropriately assess the degree of accuracy and timeliness in the administration of the State UC law and Federal programs with respect to benefit determinations, benefit payments, and revenue collections. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend that the Department ensures that their policies and procedures are designed to review selected cases to ensure they meet the prescribed criteria and, if necessary, be replaced as part of the final sampling week for the PIIA year. Additionally, the Department should enhance its process to ensure the completion of Paid and Denied cases are reviewed and closed timely in accordance with State Law. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Labor Federal Program: Unemployment Insurance (17.225) Federal Award Numbers: MI-34016-19-75-A-36; MI-35505-20-75-A-36; UI-27922-15-55-A-36; UI-32857-19-60-A-36; UI-34075-20-55-A-36; UI-34512-20-60-A-36; UI-34732-20-55-A-36; UI-35665-21-55-A-36; UI-35961-21-60-A-36; UI-37081-21-55-A-36; UI-37240-22-55-A-36; UI-37261-22-55-A-36 Federal Award Years: 2020 and 2021 State Agency: Department of Labor Reference: 2022-005 Criteria The Coronavirus Aid, Relief, and Economic Security Act (CARES Act), signed into law March 27, 2020, provides over $2 trillion of economic relief to workers, families, small businesses, industry sectors, and other levels of government that have been hit hard by the public health crisis created by the Coronavirus Disease 2019 (COVID-19). The CARES Act and subsequent legislation was designed to mitigate the economic effects of the COVID-19 pandemic in a variety of ways. Section 2102 of the CARES Act provided temporary benefits known as Pandemic Unemployment Assistance (PUA), for individuals who exhausted their entitlement to regular Unemployment Compensation (UC), and individuals who were not eligible for regular UC, such as those who were self-employed or who had limited recent work history. These individuals may also include certain gig economy workers, members of the clergy, and those working for religious organizations who were not covered by regular UC, as well as other workers who may not have been covered by the regular UC program under some state laws. PUA provides benefits to covered individuals, who are those individuals not eligible for regular unemployment compensation (UC or extended benefits under state or federal law or Pandemic Emergency Unemployment Compensation (PEUC), including those who have exhausted all rights to such benefits. Covered individuals also include self-employed, those seeking part-time employment, individuals lacking sufficient work history, and those who otherwise do not qualify for regular unemployment compensation or extended benefits under state or federal law or PEUC. PUA is payable to individuals who are ineligible for regular UC, and are unemployed, partially unemployed, or unable or unavailable to work due to one of the COVID-19 related reasons identified Attachment I to UIPL No. 16-20, Change 5. Section 2102(a)(3)(A)(ii)(I) of the CARES Act included 10 specific COVID-19 related reasons. The Department, under the authority provided by Section 2102(a)(3)(A)(ii)(I)(kk) of the CARES Act, has added additional COVID-19 related reasons; these are discussed in more detail in Section 4.a. of UIPL No. 16-20, Change 5. While three of these new COVID-19 related reasons were introduced to states with the publication of UIPL No. 16-20, Change 5 on February 25, 2021, all COVID-19 related reasons apply retroactively to the beginning of the PUA program. Additionally, as described in Section 4.b.i. of UIPL No. 16-20, Change 5, paraphrasing of the COVID-19 related reasons is not permissible; individuals must be permitted to select more than one COVID-19 related reason; individuals must be permitted to select different COVID-19 related reasons each week; and individuals must be permitted to file and select no COVID-19 related reasons. (1) The individual has been diagnosed with COVID-19 or is experiencing symptoms of COVID-19 and is seeking a medical diagnosis; (2) A member of the individual?s household has been diagnosed with COVID-19; (3) The individual is providing care for a family member or a member of the individual?s household who has been diagnosed with COVID-19; (4) A child or other person in the household for which the individual has primary caregiving responsibility is unable to attend school or another facility that is closed as a direct result of the COVID-19 public health emergency and such school or facility care is required for the individual to work; (5) The individual is unable to reach the place of employment because of a quarantine imposed as a direct result of the COVID-19 public health emergency; (6) The individual is unable to reach the place of employment because the individual has been advised by a health care provider to self-quarantine due to concerns related to COVID-19; (7) The individual was scheduled to commence employment and does not have a job or is unable to reach the job as a direct result of the COVID-19 public health emergency; (8) The individual has become the breadwinner or major support for a household because the head of the household has died as a direct result of COVID-19; (9) The individual has to quit his or her job as a direct result of COVID-19; (10) The individual?s place of employment is closed as a direct result of the COVID-19 public health emergency; or (11) The individual meets any additional criteria established by the Department for unemployment assistance under this section. a) An individual who works as an independent contractor with reportable income may also qualify for PUA benefits if he or she is unemployed, partially employed, or unable or unavailable to work because the COVID-19 public health emergency has severely limited his or her ability to continue performing his or her customary work activities, and has thereby forced the individual to suspend such activities; b) The individual has been denied continued unemployment benefits because the individual refused to return to work or accept an offer of work at a worksite that, in either instance, is not in compliance with local, state, or national health and safety standards directly related to COVID-19. This includes, but is not limited to, those related to facial mask wearing, physical distancing measures, or the provision of personal protective equipment consistent with public health guidelines; c) An individual provides services to an educational institution or educational service agency and the individual is unemployed or partially unemployed because of volatility in the work schedule that is directly caused by the COVID-19 public health emergency. This includes, but is not limited to, changes in schedules and partial closures; or d) An individual is an employee and their hours have been reduced or the individual was laid off as a direct result of the COVID-19 public health emergency. Section 2107 of the CARES Act created a new temporary federal program called PEUC that provided additional weeks of benefits to individuals who had exhausted their regular UC entitlement and provided funding to states to administer the program. The CARES Act originally provided up to 13 additional weeks of PEUC benefits. Section 206 of CAA and Section 9016 of the American Rescue Plan Act of 2021 (ARPA) increased the total amount of PEUC benefits available to 53 times the individual?s average weekly benefit amount, with the additional weeks of benefits payable for weeks of unemployment ending after March 14, 2021. To be eligible for PEUC, a claimant must have exhausted all rights to regular compensation under state law or federal law with respect to a benefit year that ended on or after July 1, 2019; have no rights to regular compensation with respect to a week under any other state UC law or federal UC law, or to compensation under any other federal law; are not receiving compensation with respect to a week under the UC law of Canada; and are able to work, available to work, and actively seeking work, while recognizing that states must provide flexibility in meeting the ?actively seeking work? requirement if individuals are unable to search for work because of COVID-19, including because of illness, quarantine, or movement restriction. Lastly, Title 2 U.S. Code of Federal Regulations Part 200 (2CFR 200) Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, section 303(a) states, the non-Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-Federal entity is managing the Federal award in compliance with Federal statues, regulations, and the terms and conditions of the Federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition In conjunction with our testwork over 60 samples related to PUA eligibility, the following findings were identified: I. For 28 of the 60 samples, the Department of Labor (the Department) was unable to provide evidence the claimant has submitted proof of documentation substantiating employment, self-employment, or the planned commencement of employment or self-employment in accordance with Section 241 (a) of the Continued Assistance Act. II. For 3 of the 60 samples, the incorrect benefit rate was calculated by the Department resulting in underpayments to claimants. III. For 1 of the 60 samples the Department was unable to provide support for any files related to the eligibility determination of the claimant IV. For 60 of the 60 samples, the Department did not complete the required quarterly wage checks for PUA claimants at most recent quarter change to ensure PUA claimant was not eligible for any other benefit programs. In conjunction with our testwork over 60 samples related to PEUC eligibility, the following findings were identified: V. For 60 of the 60 samples the Department did not complete required quarterly wage checks on PEUC claimants at most recent quarter change to ensure that PEUC claimant is still deemed to be an exhaustee and not eligible to establish a new benefit year for other UI programs. VI. For 2 of the 60 samples, the claimant was received PEUC before exhausting 104 days of regular UI benefits. Cause Condition II results from the incorrect effective date and/or incorrect wages used to calculate the benefit rate resulting in underpayments to the claimant. Conditions I, III, IV, and V, results from the Department not having the appropriate documentation to support the eligibility determinations made as part of the PUA and PEUC federal programs. Condition VI results from the Department using incorrect backdates resulting in the claimant not exhausting 104 days of regular UI prior to receiving PEUC benefits. Possible Asserted Effect Failure to ensure eligibility is properly determined or benefit calculations are accurately stated may result in ineligible benefit payments not in accordance with the terms and conditions of the federal awards. Questioned Costs $679 (total overpayments of temporary federal awards paid to two selected beneficiaries) Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend the Department enhance its policies and procedures to ensure that all benefit payments made under the PUA and PEUC programs have the appropriate documentation to support eligibility determinations reached and that all benefit calculations are accurately supported for the calculated amounts. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Labor Federal Program: Unemployment Insurance (17.225) Federal Award Numbers: Not Applicable Federal Award Years: Not Applicable State Agency: Department of Labor Reference: 2022-006 Criteria Under Section 904 of the Social Security Act, Unemployment Trust Fund, established in the Treasury of the United States a trust fund to be known as the ?Unemployment Trust Fund? (Fund). The Secretary of the Treasury is authorized and directed to receive and hold in the Fund all moneys deposited therein by a State agency from a State unemployment fund, or by the Railroad Retirement Board to the credit of the railroad unemployment insurance account or the railroad unemployment insurance administration fund, or otherwise deposited in or credited to the Fund or any account therein. Such deposit may be made directly with the Secretary of the Treasury, with any depositary designated by him for such purpose, or with any Federal Reserve Bank. Under section (e), the fund shall be invested as a single fund, but the Secretary of the Treasury shall maintain a separate book account for each State agency. Under Article 18 of New York State law, Title 7 Section 590, rights to benefits states that benefits shall not be paid for more than one hundred and four effective days in any benefit year, except as provided in section six hundred one and subdivision two of section five hundred ninety-nine of this chapter. Additionally, Aliens must show proof that they are authorized to work by the US Citizenship and Immigration Services (USCIS) in order to be eligible to receive a federal public benefit (42 USC 1302b-7(d) and (e)). specifically If such an individual is not a citizen or national of the United States, there must be presented either alien registration documentation or other proof of immigration registration from the Immigration and Naturalization Service that contains the individual?s alien admission number or alien file number (or numbers if the individual has more than one number), or such other documents as the State determines constitutes reasonable evidence indicating a satisfactory immigration status. In the case of such an individual who is not a citizen or national of the United States, if, at the time of application for benefits, the statement described in paragraph (1) is submitted but the documentation required under paragraph (2) is not presented or if the documentation required under paragraph (2)(A) is presented but such documentation is not verified under paragraph (3) the State shall provide a reasonable opportunity to submit to the State evidence indicating a satisfactory immigration status, and may not delay, deny, reduce, or terminate the individual?s eligibility for benefits under the program on the basis of the individual?s immigration status until such a reasonable opportunity has been provided Lastly, Title 2 U.S. Code of Federal Regulations Part 200 (2 CFR 200) Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, section 303(a) states, the non-Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition Regular UI payments, which are paid out of the Unemployment Insurance Trust Fund, and therefore are not associated with a Federal Award Number. During our testwork we noted the following: I. For 1 of 60 regular Unemployment Compensation (UC) claimants selected, the claimant received regular UC payments for greater than 104 days drawn from the Unemployment Trust Fund. Cause I. Condition I results from Unemployment Insurance (UI) system and the Department failing to identify and restrict payment to the claimants that reached the maximum limit of days allowed for regular UC benefits. The Department does not have a manual control to identify the claimants as being coded to the incorrect benefit. Possible Asserted Effect Failure to ensure eligibility is properly determined or benefit calculations are accurately stated may result in ineligible benefit payments not in accordance with the terms and conditions of the federal awards. Questioned Costs $256 (overpayments in excess of maximum regular unemployment compensation paid to one selected beneficiary) Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding for the Department was included in the 2021 Single Audit Report as finding number 2021-005 at pages 23?24. Recommendation We recommend the Department enhance its process and controls to ensure claimants that have exhausted benefits such as regular UC are not allowed to receive benefits in excess of the maximum allowable days for the program. Additionally, we recommend the Department enhance its policies and procedures to ensure that all benefit payments made under regular Unemployment Compensation (UC) have the appropriate documentation to support eligibility determinations reached and that all benefit calculations are accurately supported for the calculated amounts. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Education Federal Program: Title I Grants to Local Educational Agencies (84.010) Federal Award Numbers: S010A180032, S010A190032, S010A200032, S010A210032 Federal Award Years: 2018, 2019, 2020, 2021 State Agency: State Education Department Reference: 2022 007 Criteria 20 U.S. Code Section 6311 (20 USC 6311 or ESEA), State plans, part (b)(2)(A) requires each State plan to demonstrate that the State educational agency (SEA), in consultation with local educational agencies (LEAs), has implemented a set of high-quality student academic assessments in mathematics, reading or language arts, and science. Further, 20 USC 6311(b)(2)(B)(iii) and requires the assessment under subparagraph (A) to be used for purposes for which such assessments are valid and reliable, consistent with relevant, nationally recognized professional and technical testing standards, objectively measure academic achievement, knowledge, and skills, and be tests that do not evaluate or assess personal or family beliefs and attitudes, or publicly disclose personally identifiable information. Additionally, Title 2 U.S. Code of Federal Regulations Part 200 (2 CFR 200), Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Audits, section 200.303(a) states the nonfederal entity must establish and maintain effective internal control over the federal award that provides reasonable assurance that the nonfederal entity is managing the federal award in compliance with federal statutes, regulations, and the terms and conditions of the federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government,? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework,? issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition The State Education Department (the Department) policies and procedures require that each LEA provide to the Office of State Assessment (OSA) at the Department a completed exam storage certificate from every school that administers academic assessments in mathematics, reading or language arts, and science. This certification includes an attestation from the school of the LEA related to maintain the security of the assessments. The certification is also required to be signed by the Principal of the school attesting to the stated procedures. For 1 of 40 LEAs selected for testing, the exam storage certificate was not signed by the Principal. Cause The condition found is due to the control not operating effectively ensuring all exam certificates are signed before acceptance by the Department. Possible Asserted Effect Failure to ensure certifications from the schools are signed by the Principal may result in the inability to ensure an assessment system is maintained that is valid, reliable, and consistent with relevant professional and technical standards. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend that the Department enhance its policies and procedures to ensure attestation certificates are reviewed by the Department to ensure they are properly completed and have all required signatures and, if any required information is missing, appropriate follow-ups are made with districts to ensure compliance with the federal statutes, regulations, and terms and conditions of federal awards. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Education Federal Program: Education Stabilization Fund Cluster ? Higher Education Emergency Relief Fund (HEERF) Student Aid Portion (84.425E) Federal Award Numbers: P425E203620 (Purchase) P425E203061-20B (Stony Brook) Federal Award Years: 2022 State Agency: State University of New York Reference: 2022-009 Criteria Beginning May 6, 2020, ED required institutions that received a HEERF 18004(a)(1) student aid portion award to publicly post certain information on their website no later than 30 days after award and update the information every 45 days thereafter (by posting a new report). On August 31, 2020, ED revised the announcement by decreasing the frequency of reporting after the initial 30-day reporting period from every 45 days thereafter to every calendar quarter. Grantees posting a 45-day report on or after August 31, 2020 should instead post a report every calendar quarter, with the first quarter report due by October 10, 2020, and covering the period form their late 45-day report through the end of the calendar quarter on September 30, 2020. On May 13, 2021, ED published an additional notice for student aid public reporting under CRRSAA and ARP, which requires that institutions publicly post certain information on their website. Institutions must publicly post their report as soon as possible, but no later than 30 days after the publication of the notice or 30 days after the date ED first obligated funds under HEERF I, II, and III to the institution for Emergency Financial Aid Grants to Students, whichever comes later. The report must be updated no later than 10 days after the end of each calendar quarter (September 30, December 31, March 31 June 30). Auditors should determine if an institution was both timely and accurate in publicly posting its Student Aid Portion Reports from May 6, 2020, onward and sample these public reports and reconcile the publicly reported amounts with underlying documentation to ensure accuracy. The critical information that was required to be posted on the institution?s website included: 1) Item #3: The total amount of Emergency Financial Aid Grants distributed to students under the CARES (a)(1) subprogram and the CRRSAA and ARP (a)(1) subprograms as of the date of submission (i.e., as of the initial report and every calendar quarter thereafter). 2) Item #4: The estimated total number of students at the institution that are eligible to receive Emergency Financial Aid Grants to Students under CARES (a)(1) subprogram and the CRRSAA and ARP (a)(1) subprograms. 3) Item #5: The total number of students who have received an Emergency Financial Aid Grant to students under the CARES (a)(1) subprogram and the CRRSAA and ARP (a)(1) subprograms. 4) Item #6: The method(s) used by the institution to determine which students receive Emergency Financial Aid Grants and how much they would receive under the CARES (a)(1) subprogram and the CRRSAA and ARP (a)(1) subprograms. Lastly, Title 2 U.S. Code of Federal Regulations Part 200 (2 CFR 200) Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, section 303(a) states, the non-federal entity must establish and maintain effective internal control over the federal award that provides reasonable assurance that the non-federal entity is managing the federal award in compliance with federal statues, regulations, and the terms and conditions of the federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition Through the documentation obtained for the 16 quarterly student aid portion reports tested, we noted that the quarterly student aid reports for the quarter ending June 30, 2021 for Purchase College and Stony Brook University were made publicly available untimely as they were posted to the Institution?s website 2 and 3 days, respectively, after the due date noted in the OMB compliance supplement. Cause The condition results from a combination of the fact that this relates to a federal program with evolving requirements during the period under audit. Possible Asserted Effect Failure to implement sufficient internal controls to ensure the accuracy and timely filing of these quarterly reports in accordance with federal regulations resulted in the State?s program being noncompliant with federal statues, regulations and the terms and conditions of the federal awards. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend that the institutions enhance its process and controls to ensure reports are posted timely. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Education Federal Program: Education Stabilization Fund Cluster ? Higher Education Emergency Relief Fund (HEERF) Institutional Portion (84.425F) Federal Award Numbers: P425F203244 (Purchase College) P425F201263-20B (Stony Brook) Federal Award Years: 2022 State Agency: State University of New York Reference: 2022-008 Criteria The CARES, CRRSAA, and ARP institutional quarterly portion reporting requirements involve publicly posting completed forms on the institution?s website. The forms must be conspicuously posted on the institution?s primary website on the same page the reports of the Institution?s activities as to the emergency financial aid grants to students are posted. A new, separate form must be posted covering aggregate amounts spent for HEERF I, HEERF II, and HEERF III funds each quarterly reporting period (September 30, December 31, March 31, and June 30), concluding after an institution has expended and liquidated all (a)(1) Institutional Portion, (a)(2), and (a)(3) funds and checks the ?final report? box. Institutions must post this quarterly report form no later than 10 days after each calendar quarter (October 10, January 10, April 10, and July 10) apart from the first report Lastly, Title 2 U.S. Code of Federal Regulations Part 200 (2 CFR 200) Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, section 303(a) states, the non-federal entity must establish and maintain effective internal control over the federal award that provides reasonable assurance that the non-federal entity is managing the federal award in compliance with federal statues, regulations, and the terms and conditions of the federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition Through the documentation obtained for the 16 quarterly institutional reports tested, we noted that the quarterly institutional reports for the quarter ending June 30, 2021 for Purchase College and Stony Brook University were made publicly available untimely as they were posted to the Institution?s website 2 and 3 days, respectively, after the due date included within the instructions on the Quarterly Budget and Expenditure Reporting for HEERF I, II, and III (a)(2) Institutional Portion, (a)(2), and (a)(3) form. Cause The condition results from a combination of the fact that this relates to a federal program with evolving requirements during the period under audit. Possible Asserted Effect Failure to implement sufficient internal controls to ensure the accuracy and timely filing of these quarterly reports in accordance with federal regulations resulted in the State?s program being noncompliant with federal statutes, regulations and the terms and conditions of the federal awards. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend that the institutions enhance its process and controls to ensure reports are posted timely. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Education Federal Program: COVID-19 ? Provider Relief Fund (93.498) Federal Award Numbers: None Federal Award Years: 2022 State Agency: State University of New York Reference: 2022-010 Criteria Provider Relief Fund (PRF) Reporting Portal (A Public Health Emergency Declaration-PRA Waiver Notice was issued January 14, 2021, applicable to the financial information collected by Health Resources and Services Administration (HRSA) from eligible healthcare providers (https://aspe.hhs.gov/public-health-emergency-declaration-pra-waivers). The PRF reporting portal was launched on July 1, 2021 (https://prfreporting.hrsa.gov/s/). Auditors are expected to test this special reporting for fiscal years ending on or after June 30, 2021. Since the PRF amounts to be reported on a recipient?s Schedule of Expenditures of Federal Awards (SEFA) are based on the PRF report (see the Other Information section below), and since the PRF report is to be tested as part of the Reporting type of compliance requirement, auditors should consider delaying the commencement of the compliance audit of the PRF program until recipients have completed the PRF report. Key Line Items ? The following line items contain critical information (items are not numbered in report): 1. Nursing Home Infection Control Expenses for Payments Received During Payment Period for Payment Received Period a. Total Nursing Home Infection Control Expenses ? Cell that contains the aggregated total sum 2. Other Provider Relief Fund Expenses for Payments Received During Payment Period for Payment Received Period a. Total Other Provider Relief Fund Expenses ? Cell that contains the aggregated total sum 3. Calculation of Lost Revenues Attributable to Coronavirus a. 2019 Actuals (1) Total Column for Total Revenue/Net Charges from Patient Care (2019 Actuals) ? Each cell at the bottom of each quarter (Total revenue/Net Charges from Patient Care) and for each year, 2019, 2020 and 2021 b. 2020 Budgeted (1) Total Column for Total Revenue/Net Charges from Patient Care (Budgeted) ? Each cell at the bottom of each quarter (Total revenue/Net Charges from Patient Care) and for each year, 2020 and 2021 (2) Total Column for Total Revenue/Net Charges from Patient Care (Actuals) ? Each cell by payer and the cell at the bottom of each quarter (Total revenue/Net Charges from Patient Care) and for each year, 2020 and 2021 c. Alternate Method of Calculating Lost Revenues Attributable to Coronavirus (1) Each individual cell in the alternative method ? audit back to the narrative and underlying supporting documentation. (Note: The auditor is not responsible for determining the reasonableness of the alternative method described in the narrative.) Lastly, Title 2 U.S. Code of Federal Regulations Part 200 (2 CFR 200) Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, section 303(a) states, the non-federal entity must establish and maintain effective internal control over the federal award that provides reasonable assurance that the non-federal entity is managing the federal award in compliance with federal statues, regulations, and the terms and conditions of the federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition Through the documentation obtained for all the 5 PRF reports submitted during the period under audit by the 3 SUNY hospitals, we noted that the Period 1 and Period 2 reports of Stony Brook University hospital did not have adequate documentation of the management review performed on the PRF reports prior to submission to the HRSA portal. Cause The condition results from a failure to adequately document the internal control procedures, including review of the report, performed by the institution over the reports filed during the period under audit. Possible Asserted Effect Failure to implement sufficient internal controls to ensure the accuracy and timely filing of these reports in accordance with federal regulations resulted in the State?s program being noncompliant with federal statues, regulations and the terms and conditions of the federal awards. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend that the institution enhance internal control procedures to ensure adequate documentation to support the appropriate internal controls, to ensure the accuracy of the HRSA reports, are performed. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Health and Human Services Federal Program: Temporary Assistance for Needy Families (93.558) Federal Award Numbers: 1701NYTANF, 1801NYTANF, 1901NYTANF,2001NYTANF, 2101NYTANF, 2101NYTAN3, 2101NYTANFC6, 2201NYTAN3, 2201NYTANF, G1503NYTANF, and G1601NYTANF Federal Award Years: 2016, 2017, 2018, 2019, 2020, 2021, and 2022 State Agency: Office of Temporary and Disability Assistance Reference: 2022-011 Criteria Title 45 U.S. Code of Federal Regulations Part 75 (45 CFR 75), Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards, section 342(b)(1) states the non-federal entity must submit performance reports at the interval required by the HHS awarding agency or pass-through entity to best inform improvements in program outcomes and productivity. Intervals must be no less frequent than annually nor more frequent than quarterly except in unusual circumstances, for example where more frequent reporting is necessary for the effective monitoring of the federal award or could significantly affect program outcomes. Additionally, 45 U.S. Code of Federal Regulations Part 265 (45 CFR 265), Data Collection and Reporting Requirements, section 3(a) requires that (1) each State must collect on a monthly basis, and file on a quarterly basis, the data specified in the TANF Data Report and the TANF Financial Report; and (2) Each State that claims MOE expenditures for a separate State program(s) must collect on a monthly basis, and file on a quarterly basis, the data specified in the SSP-MOE Data Report. Lastly, 45 CFR 75.303(a) states the nonfederal entity must establish and maintain effective internal control over the federal award that provides reasonable assurance that the nonfederal entity is managing the federal award in compliance with federal statutes, regulations, and the terms and conditions of the federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government,? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework,? issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition For the Year ended March 31, 2022, the Office of Temporary and Disability Assistance (the Office) completed and submitted the required quarterly TANF Data Reports which included ACF-199 and ACF-209. As part of the submission, the State is required to provide complete and accurate information for various data elements, which include: ACF 209, SSP-MOE Data Report (OMB No. 0970-0338) Section One ? Family Level Data Item 9 ? Type of Family for Work Participation Item 15 ? Receives Subsidized Child Care Section One ? Person-Level Data Item 28 ? Date of Birth Item 34 ? Relationship to Head-of-Household Item 41 ? Work-Eligible Individual Indicator Item 42 ? Work Participation Status Section One ? Adult Work Participation Activities Items 43 ? 55 ? Work Participation Activities Item 56 ? Number of Deemed Core Hours for Overall Rate Item 57 ? Number of Deemed Core Hours for the Two-Parent Rate Section Three ? Active Cases Item 8 ? Total Number of Families ACF-199, TANF Data Report (OMB No. 0970-0338) Section One ? Family Level Data Item 12 ? Type of Family for Work Participation Item 17 ? Receives Subsidized Child Care Item 28 ? Is the TANF family exempt from the Federal time limit provisions Section One ? Person-Level Data Item 30 ? Family Affiliation Code Item 32 ? Date of Birth Item 38 ? Relationship to Head-of-Household Item 39 ? Parents with a Minor Child Item 44 ? Number of months countable toward the Federal time limit Item 48 ? Work-Eligible Individual Indicator Item 49 ? Work Participation Status Section One ? Adult Work Participation Activities Items 50 ? 62 ? Work Participation Activities Item 63 ? Number of Deemed Core Hours for Overall Rate Item 64 ? Number of Deemed Core Hours for the Two-Parent Rate Section Three ? Active Cases Item 3 ? Total Number of SSP-MOE Families The Office compiles the data utilized for these performance reports from its systems, which data is sourced, input, and updated by local district subrecipients based on its performance of activities. While the Office does perform monitoring reviews of several activities of the local district subrecipients, the monitoring reviews do not include procedures designed at a precision level that would allow the State to assess the completeness and accuracy of information being reported as part of the TANF data reports noted above. Specifically, the Office does not have procedures to ensure the codes entered into the system by its local district subrecipients are accurate, appropriate, and representative of the underlying source documentation. For 100 of 100 samples provided, we were able to validate there were no discrepancies of the key data elements from the original source documentation provided by the Office for the subrecipients to test compliance with the federal reporting requirements. Cause The condition is due to the timing of implementation of management?s internal controls over reporting and subrecipient monitoring procedures as result of prior year finding. Management did not have its procedures in place related to monitoring of the data reported by subrecipients that are utilized to compile the reporting during the current fiscal year. Corrective actions were implemented in April 2022 and intended to be followed throughout the subsequent fiscal years. Possible Asserted Effect Incomplete monitoring procedures may not provide adequate assurance for data compiled through the Office?s information technology systems, for the TANF ACS-199 and ACS-209 Federal reports. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding was included in the 2021 Single Audit Report as finding number 2021-008 on pages 32?34. Recommendation We recommend the Office continue to implement its corrective action to ensure its reporting or monitoring controls include verifying the data input by the subrecipients which the Office relies upon for compiling the ACF-199 and ACF-209 reports. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Health and Human Services Federal Program: Temporary Assistance for Needy Families (93.558) Federal Award Numbers: 1701NYTANF, 1801NYTANF, 1901NYTANF,2001NYTANF, 2101NYTANF, 2101NYTAN3, 2101NYTANFC6, 2201NYTAN3, 2201NYTANF, G1503NYTANF, and G1601NYTANF Federal Award Years: 2015, 2016, 2017, 2018, 2019, 2020, 2021 and 2022 State Agency: Office of Temporary and Disability Assistance Reference: 2022-012 Criteria Under the requirements of the Federal Funding Accountability and Transparency Act (FFATA) (Pub. L. No. 109-282), as amended by Section 6202 of Public Law 110-252, (Transparency Act) that are codified in 2 CFR Part 170, recipients (i.e., direct recipients) of grants or cooperative agreements are required to report first-tier subawards of $30,000 or more to the Federal Funding Accountability and Transparency Act Subaward Reporting System (FSRS). Aspects of the Transparency Act that relate to subaward reporting (1) under grants and cooperative agreements were implemented in OMB in 2 CFR Part 170 and (2) under contracts, by the regulatory agencies responsible for the Federal Acquisition Regulation (FAR at 5 FR 39414 et seq., July 8, 2010). The requirements pertain to recipients (i.e., direct recipients) of grants or cooperative agreements who make first-tier subawards and contractors (i.e., prime contractors) that award first-tier subcontracts. Title 45 U.S. Code of Federal Regulations Part 75 (45 CFR 75), Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards for HHS Awards, section 75.2 defines Subaward as an award provided by a pass-through entity to a subrecipient for the subrecipient to carry out part of a federal award received by the pass-through entity. It does not include payments to a contractor or payments to an individual that is a beneficiary of a federal program. A subaward may be provided through any form of legal agreement, including an agreement that the pass-through entity considers a contract. Further, 45 CFR 75.2 defines Subrecipient as a non-federal entity that receives a subaward from a passthrough entity to carry out part of a federal award; but does not include an individual that is a beneficiary of such award. A subrecipient may also be a recipient of other federal awards directly from a federal awarding agency. Additionally, 45 CFR 75.303(a) states the non-federal entity must establish and maintain effective internal control over the federal award that provides reasonable assurance that the non-federal entity is managing the federal award in compliance with federal statutes, regulations, and the terms and conditions of the federal award. These internal controls should be in compliance with guidance in "Standards for Internal Control in the Federal Government" issued by the Comptroller General of the United States or the "Internal Control Integrated Framework", issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition For the period of April 2021 to September 2021, the Office of Temporary and Disability Assistance (the Office) reported only the portion of expenditures that were passed through to the subrecipients (local districts) for the Temporary Assistance for Needy Families (TANF). Beginning in October 2021, the Office implemented new policies and processes to make ensure they reported all expenditures that passed through to the subrecipients (local districts) for TANF. However, the Office did not appropriately include all of the subrecipient expenditures over $30,000. As a result of our testwork over this period we noted the following: Transactions Tested Subaward not reported Report not timely Subaward amount incorrect Subaward missing key elements 117 8 0 48 0 Dollar Amount of Tested Transactions Subaward not reported Report not timely Subaward amount incorrect Subaward missing key elements $172,962,747 $1,300,793 $0 $1,393,853 $0 Cause For the period April 2021 ? September 2021, the Office did not report all amounts passed-through to its subrecipients (local districts) as the Office was still working on their corrective action plan from the prior year finding. For the period October 2021 ? March 2022, the Office did not appropriately identify all expenditures to subrecipients over $30,000 due to expenditures were broken down for different projects on the internal reports, which resulted in incorrect amounts being reported for the subawards as the amounts were not complete. Possible Asserted Effect Failure to submit all expenditures passed-through to subrecipients and subcontractors under subawards as defined by 45 CFR 75.2 in the Office's FFATA reporting could result in the Office reporting inaccurate and incomplete amounts to the federal government. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding was included in the 2021 Single Audit Report as finding number 2021-009 on pages 35?36. Recommendation We recommend the Office review and enhance its policies, procedures, and internal controls to ensure that all amounts passed-through to subrecipients and subcontractors under subawards as defined in 45 CFR 75.2 are reported in accordance with the FFATA federal regulations. In addition, they should use obligation date for FFATA reporting. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Health and Human Services Federal Program: Temporary Assistance for Needy Families (93.558) Federal Award Numbers: 1701NYTANF, 1801NYTANF, 1901NYTANF,2001NYTANF, 2101NYTANF, 2101NYTAN3, 2101NYTANFC6, 2201NYTAN3, 2201NYTANF, G1503NYTANF, and G1601NYTANF Federal Award Years: 2016, 2017, 2018, 2019, 2020, 2021, and 2022 State Agency: Office of Temporary and Disability Assistance Reference: 2022-011 Criteria Title 45 U.S. Code of Federal Regulations Part 75 (45 CFR 75), Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards, section 342(b)(1) states the non-federal entity must submit performance reports at the interval required by the HHS awarding agency or pass-through entity to best inform improvements in program outcomes and productivity. Intervals must be no less frequent than annually nor more frequent than quarterly except in unusual circumstances, for example where more frequent reporting is necessary for the effective monitoring of the federal award or could significantly affect program outcomes. Additionally, 45 U.S. Code of Federal Regulations Part 265 (45 CFR 265), Data Collection and Reporting Requirements, section 3(a) requires that (1) each State must collect on a monthly basis, and file on a quarterly basis, the data specified in the TANF Data Report and the TANF Financial Report; and (2) Each State that claims MOE expenditures for a separate State program(s) must collect on a monthly basis, and file on a quarterly basis, the data specified in the SSP-MOE Data Report. Lastly, 45 CFR 75.303(a) states the nonfederal entity must establish and maintain effective internal control over the federal award that provides reasonable assurance that the nonfederal entity is managing the federal award in compliance with federal statutes, regulations, and the terms and conditions of the federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government,? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework,? issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition For the Year ended March 31, 2022, the Office of Temporary and Disability Assistance (the Office) completed and submitted the required quarterly TANF Data Reports which included ACF-199 and ACF-209. As part of the submission, the State is required to provide complete and accurate information for various data elements, which include: ACF 209, SSP-MOE Data Report (OMB No. 0970-0338) Section One ? Family Level Data Item 9 ? Type of Family for Work Participation Item 15 ? Receives Subsidized Child Care Section One ? Person-Level Data Item 28 ? Date of Birth Item 34 ? Relationship to Head-of-Household Item 41 ? Work-Eligible Individual Indicator Item 42 ? Work Participation Status Section One ? Adult Work Participation Activities Items 43 ? 55 ? Work Participation Activities Item 56 ? Number of Deemed Core Hours for Overall Rate Item 57 ? Number of Deemed Core Hours for the Two-Parent Rate Section Three ? Active Cases Item 8 ? Total Number of Families ACF-199, TANF Data Report (OMB No. 0970-0338) Section One ? Family Level Data Item 12 ? Type of Family for Work Participation Item 17 ? Receives Subsidized Child Care Item 28 ? Is the TANF family exempt from the Federal time limit provisions Section One ? Person-Level Data Item 30 ? Family Affiliation Code Item 32 ? Date of Birth Item 38 ? Relationship to Head-of-Household Item 39 ? Parents with a Minor Child Item 44 ? Number of months countable toward the Federal time limit Item 48 ? Work-Eligible Individual Indicator Item 49 ? Work Participation Status Section One ? Adult Work Participation Activities Items 50 ? 62 ? Work Participation Activities Item 63 ? Number of Deemed Core Hours for Overall Rate Item 64 ? Number of Deemed Core Hours for the Two-Parent Rate Section Three ? Active Cases Item 3 ? Total Number of SSP-MOE Families The Office compiles the data utilized for these performance reports from its systems, which data is sourced, input, and updated by local district subrecipients based on its performance of activities. While the Office does perform monitoring reviews of several activities of the local district subrecipients, the monitoring reviews do not include procedures designed at a precision level that would allow the State to assess the completeness and accuracy of information being reported as part of the TANF data reports noted above. Specifically, the Office does not have procedures to ensure the codes entered into the system by its local district subrecipients are accurate, appropriate, and representative of the underlying source documentation. For 100 of 100 samples provided, we were able to validate there were no discrepancies of the key data elements from the original source documentation provided by the Office for the subrecipients to test compliance with the federal reporting requirements. Cause The condition is due to the timing of implementation of management?s internal controls over reporting and subrecipient monitoring procedures as result of prior year finding. Management did not have its procedures in place related to monitoring of the data reported by subrecipients that are utilized to compile the reporting during the current fiscal year. Corrective actions were implemented in April 2022 and intended to be followed throughout the subsequent fiscal years. Possible Asserted Effect Incomplete monitoring procedures may not provide adequate assurance for data compiled through the Office?s information technology systems, for the TANF ACS-199 and ACS-209 Federal reports. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding was included in the 2021 Single Audit Report as finding number 2021-008 on pages 32?34. Recommendation We recommend the Office continue to implement its corrective action to ensure its reporting or monitoring controls include verifying the data input by the subrecipients which the Office relies upon for compiling the ACF-199 and ACF-209 reports. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Health and Human Services Federal Program: Temporary Assistance for Needy Families (93.558) Federal Award Numbers: 1701NYTANF, 1801NYTANF, 1901NYTANF,2001NYTANF, 2101NYTANF, 2101NYTAN3, 2101NYTANFC6, 2201NYTAN3, 2201NYTANF, G1503NYTANF, and G1601NYTANF Federal Award Years: 2015, 2016, 2017, 2018, 2019, 2020, 2021 and 2022 State Agency: Office of Temporary and Disability Assistance Reference: 2022-012 Criteria Under the requirements of the Federal Funding Accountability and Transparency Act (FFATA) (Pub. L. No. 109-282), as amended by Section 6202 of Public Law 110-252, (Transparency Act) that are codified in 2 CFR Part 170, recipients (i.e., direct recipients) of grants or cooperative agreements are required to report first-tier subawards of $30,000 or more to the Federal Funding Accountability and Transparency Act Subaward Reporting System (FSRS). Aspects of the Transparency Act that relate to subaward reporting (1) under grants and cooperative agreements were implemented in OMB in 2 CFR Part 170 and (2) under contracts, by the regulatory agencies responsible for the Federal Acquisition Regulation (FAR at 5 FR 39414 et seq., July 8, 2010). The requirements pertain to recipients (i.e., direct recipients) of grants or cooperative agreements who make first-tier subawards and contractors (i.e., prime contractors) that award first-tier subcontracts. Title 45 U.S. Code of Federal Regulations Part 75 (45 CFR 75), Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards for HHS Awards, section 75.2 defines Subaward as an award provided by a pass-through entity to a subrecipient for the subrecipient to carry out part of a federal award received by the pass-through entity. It does not include payments to a contractor or payments to an individual that is a beneficiary of a federal program. A subaward may be provided through any form of legal agreement, including an agreement that the pass-through entity considers a contract. Further, 45 CFR 75.2 defines Subrecipient as a non-federal entity that receives a subaward from a passthrough entity to carry out part of a federal award; but does not include an individual that is a beneficiary of such award. A subrecipient may also be a recipient of other federal awards directly from a federal awarding agency. Additionally, 45 CFR 75.303(a) states the non-federal entity must establish and maintain effective internal control over the federal award that provides reasonable assurance that the non-federal entity is managing the federal award in compliance with federal statutes, regulations, and the terms and conditions of the federal award. These internal controls should be in compliance with guidance in "Standards for Internal Control in the Federal Government" issued by the Comptroller General of the United States or the "Internal Control Integrated Framework", issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition For the period of April 2021 to September 2021, the Office of Temporary and Disability Assistance (the Office) reported only the portion of expenditures that were passed through to the subrecipients (local districts) for the Temporary Assistance for Needy Families (TANF). Beginning in October 2021, the Office implemented new policies and processes to make ensure they reported all expenditures that passed through to the subrecipients (local districts) for TANF. However, the Office did not appropriately include all of the subrecipient expenditures over $30,000. As a result of our testwork over this period we noted the following: Transactions Tested Subaward not reported Report not timely Subaward amount incorrect Subaward missing key elements 117 8 0 48 0 Dollar Amount of Tested Transactions Subaward not reported Report not timely Subaward amount incorrect Subaward missing key elements $172,962,747 $1,300,793 $0 $1,393,853 $0 Cause For the period April 2021 ? September 2021, the Office did not report all amounts passed-through to its subrecipients (local districts) as the Office was still working on their corrective action plan from the prior year finding. For the period October 2021 ? March 2022, the Office did not appropriately identify all expenditures to subrecipients over $30,000 due to expenditures were broken down for different projects on the internal reports, which resulted in incorrect amounts being reported for the subawards as the amounts were not complete. Possible Asserted Effect Failure to submit all expenditures passed-through to subrecipients and subcontractors under subawards as defined by 45 CFR 75.2 in the Office's FFATA reporting could result in the Office reporting inaccurate and incomplete amounts to the federal government. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding was included in the 2021 Single Audit Report as finding number 2021-009 on pages 35?36. Recommendation We recommend the Office review and enhance its policies, procedures, and internal controls to ensure that all amounts passed-through to subrecipients and subcontractors under subawards as defined in 45 CFR 75.2 are reported in accordance with the FFATA federal regulations. In addition, they should use obligation date for FFATA reporting. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Health and Human Services Federal Program: Low-Income Home Energy Assistance (93.568) Federal Award Numbers: 1901NYLIEA, 2001NYLIEA, 2002NYLIE4, 2001NYE5C3, 2103NYLIEA, 2102NYLIE4, 2103NYE5C6, 2203NYLIEA Federal Award Years: 2019, 2020, 2021 and 2022 State Agency: Office of Temporary and Disability Assistance Reference: 2022-013 Criteria Under the requirements of the Federal Funding Accountability and Transparency Act (FFATA) (Pub. L. No. 109-282), as amended by Section 6202 of Public Law 110-252, (Transparency Act) that are codified in 2 CFR Part 170, recipients (i.e., direct recipients) of grants or cooperative agreements are required to report first-tier subawards of $30,000 or more to the Federal Funding Accountability and Transparency Act Subaward Reporting System (FSRS). Aspects of the Transparency Act that relate to subaward reporting (1) under grants and cooperative agreements were implemented in OMB in 2 CFR Part 170 and (2) under contracts, by the regulatory agencies responsible for the Federal Acquisition Regulation (FAR at 5 FR 39414 et seq., July 8, 2010). The requirements pertain to recipients (i.e., direct recipients) of grants or cooperative agreements who make first-tier subawards and contractors (i.e., prime contractors) that award first-tier subcontracts. Title 45 U.S. Code of Federal Regulations Part 75 (45 CFR 75), Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards for HHS Awards, section 75.2 defines Subaward as an award provided by a pass-through entity to a subrecipient for the subrecipient to carry out part of a federal award received by the pass-through entity. It does not include payments to a contractor or payments to an individual that is a beneficiary of a federal program. A subaward may be provided through any form of legal agreement, including an agreement that the pass-through entity considers a contract. Further, 45 CFR 75.2 defines Subrecipient as a non-federal entity that receives a subaward from a passthrough entity to carry out part of a federal award; but does not include an individual that is a beneficiary of such award. A subrecipient may also be a recipient of other federal awards directly from a federal awarding agency. Additionally, 45 CFR 75.303(a) states the non-federal entity must establish and maintain effective internal control over the federal award that provides reasonable assurance that the non-federal entity is managing the federal award in compliance with federal statutes, regulations, and the terms and conditions of the federal award. These internal controls should be in compliance with guidance in "Standards for Internal Control in the Federal Government" issued by the Comptroller General of the United States or the "Internal Control Integrated Framework", issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition For the period of April 2021 to September 2021, the Office of Temporary and Disability Assistance (the Office) reported only the portion of expenditures that were passed through to the subrecipients (local districts) for the Low-Income Home Energy Program (LIHEAP). Beginning in October 2021, the Office implemented new policies and processes to report all expenditures that passed through to the subrecipients (local districts) for LIHEAP. As a result of our testwork over this period we noted the following: Transactions Tested Subaward not reported Report not timely Subaward amount incorrect Subaward missing key elements 81 3 0 0 0 Dollar Amount of Tested Transactions Subaward not reported Report not timely Subaward amount incorrect Subaward missing key elements $63,042,900 $346,831 $0 $0 $0 Cause For the period April 2021 ? September 2021 the Office did not report all amounts passed-through to its subrecipients (local districts) as the Office was still working on their corrective action plan from the prior year finding. For the period October 2021 ? March 2022 the Office did not appropriately identify all expenditures to subrecipients over $30,000 due to the payments being split into two line items on internal reports which resulted in incorrect amounts being reported for the subawards as the amounts were not complete. Possible Asserted Effect Failure to submit all expenditures passed-through to subrecipients and subcontractors under subawards as defined by 45 CFR 75.2 in the Office's FFATA reporting could result in the Office reporting inaccurate and incomplete amounts to the federal government. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding was included in the 2021 Single Audit Report as finding number 2021-009 on pages 35?36. Recommendation We recommend the Office review and enhance its policies, procedures, and internal controls to ensure that all amounts passed-through to subrecipients and subcontractors under subawards as defined in 45 CFR 75.2 are reported in accordance with the FFATA federal regulations. In addition, they should use obligation date for FFATA reporting. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Health and Human Services Federal Program: Low-Income Home Energy Assistance (93.568) Federal Award Numbers: 1901NYLIEA, 2001NYLIEA, 2002NYLIE4, 2001NYE5C3, 2103NYLIEA, 2102NYLIE4, 2103NYE5C6, 2203NYLIEA Federal Award Years: 2019, 2020, 2021 and 2022 State Agency: Office of Temporary and Disability Assistance Reference: 2022-013 Criteria Under the requirements of the Federal Funding Accountability and Transparency Act (FFATA) (Pub. L. No. 109-282), as amended by Section 6202 of Public Law 110-252, (Transparency Act) that are codified in 2 CFR Part 170, recipients (i.e., direct recipients) of grants or cooperative agreements are required to report first-tier subawards of $30,000 or more to the Federal Funding Accountability and Transparency Act Subaward Reporting System (FSRS). Aspects of the Transparency Act that relate to subaward reporting (1) under grants and cooperative agreements were implemented in OMB in 2 CFR Part 170 and (2) under contracts, by the regulatory agencies responsible for the Federal Acquisition Regulation (FAR at 5 FR 39414 et seq., July 8, 2010). The requirements pertain to recipients (i.e., direct recipients) of grants or cooperative agreements who make first-tier subawards and contractors (i.e., prime contractors) that award first-tier subcontracts. Title 45 U.S. Code of Federal Regulations Part 75 (45 CFR 75), Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards for HHS Awards, section 75.2 defines Subaward as an award provided by a pass-through entity to a subrecipient for the subrecipient to carry out part of a federal award received by the pass-through entity. It does not include payments to a contractor or payments to an individual that is a beneficiary of a federal program. A subaward may be provided through any form of legal agreement, including an agreement that the pass-through entity considers a contract. Further, 45 CFR 75.2 defines Subrecipient as a non-federal entity that receives a subaward from a passthrough entity to carry out part of a federal award; but does not include an individual that is a beneficiary of such award. A subrecipient may also be a recipient of other federal awards directly from a federal awarding agency. Additionally, 45 CFR 75.303(a) states the non-federal entity must establish and maintain effective internal control over the federal award that provides reasonable assurance that the non-federal entity is managing the federal award in compliance with federal statutes, regulations, and the terms and conditions of the federal award. These internal controls should be in compliance with guidance in "Standards for Internal Control in the Federal Government" issued by the Comptroller General of the United States or the "Internal Control Integrated Framework", issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition For the period of April 2021 to September 2021, the Office of Temporary and Disability Assistance (the Office) reported only the portion of expenditures that were passed through to the subrecipients (local districts) for the Low-Income Home Energy Program (LIHEAP). Beginning in October 2021, the Office implemented new policies and processes to report all expenditures that passed through to the subrecipients (local districts) for LIHEAP. As a result of our testwork over this period we noted the following: Transactions Tested Subaward not reported Report not timely Subaward amount incorrect Subaward missing key elements 81 3 0 0 0 Dollar Amount of Tested Transactions Subaward not reported Report not timely Subaward amount incorrect Subaward missing key elements $63,042,900 $346,831 $0 $0 $0 Cause For the period April 2021 ? September 2021 the Office did not report all amounts passed-through to its subrecipients (local districts) as the Office was still working on their corrective action plan from the prior year finding. For the period October 2021 ? March 2022 the Office did not appropriately identify all expenditures to subrecipients over $30,000 due to the payments being split into two line items on internal reports which resulted in incorrect amounts being reported for the subawards as the amounts were not complete. Possible Asserted Effect Failure to submit all expenditures passed-through to subrecipients and subcontractors under subawards as defined by 45 CFR 75.2 in the Office's FFATA reporting could result in the Office reporting inaccurate and incomplete amounts to the federal government. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding was included in the 2021 Single Audit Report as finding number 2021-009 on pages 35?36. Recommendation We recommend the Office review and enhance its policies, procedures, and internal controls to ensure that all amounts passed-through to subrecipients and subcontractors under subawards as defined in 45 CFR 75.2 are reported in accordance with the FFATA federal regulations. In addition, they should use obligation date for FFATA reporting. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Health and Human Services Federal Program: Foster Care Title IV E (93.658) Federal Award Numbers: 1801NYFOST, 1901NYFOST, 2001NYFOST, 2101NYFOST, 2201NYFOST Federal Award Years: 2018, 2019, 2020, 2021, and 2022 State Agency: Office of Children and Family Services Reference: 2022-014 Criteria Title U.S. Code of Federal Regulations Part 75 (45 CFR 75), Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards, Section 75.303(c) requires the nonfederal entity to evaluate and monitor the non-federal entity?s compliance with statutes, regulations and the terms of the federal awards. The non-federal entity assumes responsibility for administering federal funds in a manner consistent with underlying agreements, program objectives, and the terms and conditions of the federal award (45 CFR 75.400(b)). Each state must expend and account for the federal award in accordance with state laws and procedures for expending the state?s own funds. Such monitoring activities should ensure that federal funds expended funds for foster care maintenance payments on behalf of eligible children are in accordance with the Title IV-E agency?s foster care maintenance payment schedule in accordance with Title 45 U.S. Code of Federal Regulations Part 1356 (45 CFR 1356), Requirements Applicable of Title IV-E, section 1356.21. Further, Title IV-E agencies establish rates for maintenance payments (e.g. payments to foster parents, childcare institutions or directly to youth). Payment rates may be established for Title IV-E administrative expenditures (e.g. payments to child placement agencies or other contractors, which may be either subrecipients or vendors) and for other services. Payment rates must provide for property allocation of costs between Foster Care maintenance payments, administrative expenditures, and other services in conformance with cost principles. The Title IV-E agency?s plan approved by ACF must provide for periodic review of payment rates for Foster Care maintenance payments at reasonable, specific, time-limited periods established by the Title IV-E agency to assure the rate?s continuing appropriateness for the administration of the Title IV-E program (42 USC 671(a)(11); 45 CFR Section 1356.21(m)(1); 45 CFR Section 1356.60(a)(1) and (c)). Lastly, 45 CFR 75.303(a) states the non-federal entity must establish and maintain effective internal control over the federal award that provides reasonable assurance that the non-federal entity is managing the federal award in compliance with federal statutes, regulations, and the terms and conditions of the federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government,? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework,? issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition During the fiscal year ended March 31, 2022, the Office of Children and Families (the Office) passed through $418,870,974 under the Title IV-E Foster Care federal program (Assistance Listing Number 93.658), to local districts (or subrecipients) to provide programmatic services under the Foster Care program. As part of the funding arrangement, the local districts are responsible for determining participant eligibility for services and establishing financial assistance rates to be paid on behalf of eligible participants. Based upon the level and type of services that the local districts determine the participant is eligible for, the local district will determine the appropriate amount of benefits that the participant is eligible to receive. These services are paid for directly by the local district offices and requests for reimbursement are subsequently provided from the Office for Foster Care. On an annual basis, the Office performs a review of the reasonableness of the rates used to reimburse Foster Care services and establishes maximum rates that can be used by the District Offices. While this maximum rate is established, the District Offices establish their own rates for services. The payment system used to process Foster Care claims will not allow for the reimbursement of costs that exceeds the maximum amount set by the Office. During our testwork over the subrecipient monitoring process, we noted that the Office?s monitoring procedures did not include a review to ensure that the district office had periodically reviewed their established service rates to ensure the reasonableness of the rate being used. The Office?s procedures were limited to ensuring that the rates utilized in request for reimbursement by the local districts did not exceed the maximum rates established by the Office. Cause The condition found was primarily due to the Office not having implemented its new policies and procedures surrounding the rates used by the district offices requiring local districts to use the rates developed by the Office until after the State fiscal year, which have been determined to be reasonable for the State of New York as a whole. Possible Asserted Effect Insufficient procedures to perform subrecipient monitoring activities in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e) could result in the Office not timely identifying noncompliance by the subrecipients with federal statutes, regulations, and the terms and conditions of the subaward and prevent the Office?s ability to timely seek corrective action from the subrecipient. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding was included in the 2021 Single Audit Report as finding number 2021 012 on pages 41-43. Recommendation We recommend the Office continue to implement its new policy surrounding the use of uniform rates and to implement the necessary internal controls and related procedures to ensure that all districts have implemented the new rate structure once the new rates go into effect. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Health and Human Services Federal Program: Foster Care Title IV E (93.658) Federal Award Numbers: 1801NYFOST, 1901NYFOST, 2001NYFOST, 2101NYFOST, 2201NYFOST Federal Award Years: 2018, 2019, 2020, 2021, and 2022 State Agency: Office of Children and Family Services Reference: 2022-014 Criteria Title U.S. Code of Federal Regulations Part 75 (45 CFR 75), Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards, Section 75.303(c) requires the nonfederal entity to evaluate and monitor the non-federal entity?s compliance with statutes, regulations and the terms of the federal awards. The non-federal entity assumes responsibility for administering federal funds in a manner consistent with underlying agreements, program objectives, and the terms and conditions of the federal award (45 CFR 75.400(b)). Each state must expend and account for the federal award in accordance with state laws and procedures for expending the state?s own funds. Such monitoring activities should ensure that federal funds expended funds for foster care maintenance payments on behalf of eligible children are in accordance with the Title IV-E agency?s foster care maintenance payment schedule in accordance with Title 45 U.S. Code of Federal Regulations Part 1356 (45 CFR 1356), Requirements Applicable of Title IV-E, section 1356.21. Further, Title IV-E agencies establish rates for maintenance payments (e.g. payments to foster parents, childcare institutions or directly to youth). Payment rates may be established for Title IV-E administrative expenditures (e.g. payments to child placement agencies or other contractors, which may be either subrecipients or vendors) and for other services. Payment rates must provide for property allocation of costs between Foster Care maintenance payments, administrative expenditures, and other services in conformance with cost principles. The Title IV-E agency?s plan approved by ACF must provide for periodic review of payment rates for Foster Care maintenance payments at reasonable, specific, time-limited periods established by the Title IV-E agency to assure the rate?s continuing appropriateness for the administration of the Title IV-E program (42 USC 671(a)(11); 45 CFR Section 1356.21(m)(1); 45 CFR Section 1356.60(a)(1) and (c)). Lastly, 45 CFR 75.303(a) states the non-federal entity must establish and maintain effective internal control over the federal award that provides reasonable assurance that the non-federal entity is managing the federal award in compliance with federal statutes, regulations, and the terms and conditions of the federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government,? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework,? issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition During the fiscal year ended March 31, 2022, the Office of Children and Families (the Office) passed through $418,870,974 under the Title IV-E Foster Care federal program (Assistance Listing Number 93.658), to local districts (or subrecipients) to provide programmatic services under the Foster Care program. As part of the funding arrangement, the local districts are responsible for determining participant eligibility for services and establishing financial assistance rates to be paid on behalf of eligible participants. Based upon the level and type of services that the local districts determine the participant is eligible for, the local district will determine the appropriate amount of benefits that the participant is eligible to receive. These services are paid for directly by the local district offices and requests for reimbursement are subsequently provided from the Office for Foster Care. On an annual basis, the Office performs a review of the reasonableness of the rates used to reimburse Foster Care services and establishes maximum rates that can be used by the District Offices. While this maximum rate is established, the District Offices establish their own rates for services. The payment system used to process Foster Care claims will not allow for the reimbursement of costs that exceeds the maximum amount set by the Office. During our testwork over the subrecipient monitoring process, we noted that the Office?s monitoring procedures did not include a review to ensure that the district office had periodically reviewed their established service rates to ensure the reasonableness of the rate being used. The Office?s procedures were limited to ensuring that the rates utilized in request for reimbursement by the local districts did not exceed the maximum rates established by the Office. Cause The condition found was primarily due to the Office not having implemented its new policies and procedures surrounding the rates used by the district offices requiring local districts to use the rates developed by the Office until after the State fiscal year, which have been determined to be reasonable for the State of New York as a whole. Possible Asserted Effect Insufficient procedures to perform subrecipient monitoring activities in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e) could result in the Office not timely identifying noncompliance by the subrecipients with federal statutes, regulations, and the terms and conditions of the subaward and prevent the Office?s ability to timely seek corrective action from the subrecipient. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding was included in the 2021 Single Audit Report as finding number 2021 012 on pages 41-43. Recommendation We recommend the Office continue to implement its new policy surrounding the use of uniform rates and to implement the necessary internal controls and related procedures to ensure that all districts have implemented the new rate structure once the new rates go into effect. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Health and Human Services Federal Program: Social Services Block Grant (93.667) Federal Award Numbers: 2001NYSOSR, 2010NYSOSR, 2001NYTANF, 2101NYTANF Federal Award Years: 2020 and 2021 State Agency: Office of Children and Family Services Reference: 2022-015 Criteria Title 45 U.S. Code of Federal Regulations Part 75 (45 CFR 75), Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards, section 75.352(d) states all pass-through entities must monitor the activities of the subrecipient as necessary to ensure that the subaward issued for authorized purposes, in compliance with federal statutes, regulations, and the terms and conditions of the subaward, and that subaward performance goals are achieved. Pass-through entity monitoring of the subrecipient must include: (1) Reviewing financial and performance reports required by the pass-through entity. (2) Following-up and ensuring that the subrecipient takes timely and appropriate action on all deficiencies pertaining to the Federal award provided to the subrecipient from the pass-through entity detected through audits, on-site reviews, and other means. Additionally, 45 CFR 75.352(c) requires the nonfederal entity to evaluate and the nonfederal entity?s compliance with statutes, regulations and the terms of the federal awards. The nonfederal entity assumes responsibility for administering federal funds in a manner consistent with underlying agreements, program objectives, and the terms and conditions of the federal award (45 CFR 75.400(b)). Each state must expend and account for the federal award in accordance with state laws and procedures for expending the state?s own funds. Such monitoring activities should ensure that the expended funds were for allowable costs in accordance with federal regulations as well as to eligible individuals that would be subject to reporting on the annual Post Expenditure Report required to be filed under 42 U.S. Code (USC) 1397e. Further, 45 CFR 75.352(e) sates, depending upon the pass-through entity?s assessment of risk posed by the subrecipient, the following monitoring tools may be useful for the pass-through entity to ensure proper accountability and compliance with program requirements and achievement of performance goals: (1) Providing subrecipients with training and technical assistance on program-related matters; (2) Performing on-site reviews of the subrecipient?s program operations; and (3) Arranging for agreed-upon procedures engagements as described in 45 CFR 75.425. Lastly, 45 CFR 75.303(a) states the non-federal entity must establish and maintain effective internal control over the federal award that provides reasonable assurance that the non-federal entity is managing the federal award in compliance with federal statutes, regulations, and the terms and conditions of the federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government,? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework,? issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition During the fiscal year ended March 31, 2022, the Office of Children and Families (the Office) passed through $294,836,063 under the Social Services Block Grant (SSBG) federal program (Assistance Listing Number 93.667), to local districts (or subrecipients) to provide programmatic services under the SSBG program. As part of the funding arrangement, the local districts are responsible for the administration of the federal program, including ensuring that costs incurred under the federal program are in compliance with federal regulations. During the fiscal year ended March 31, 2022, we noted that while the Office performed its annual risk assessment process over its subrecipients, the Office had not yet fully implemented its system of internal controls or policies and procedures related to its subrecipient monitoring activities over the local districts to ensure the federal funds spent by the local districts were spent in compliance with federal statutes, regulations, the terms and conditions of the subaward and that subaward performance goals were achieved. This would include ensuring that costs incurred by the local district were for allowable services. As a result, there was no formal during the award monitoring activities performed during the audit period. In addition to the above, we noted that on an annual basis, the Office submits the Post-Expenditure Report to the Federal Office of Community Services. As part of the federal reporting process, the Office is required to report the number of eligible individuals who received services paid for in part or in whole with federal funds under the SSBG program. All participant services are provided directly by the local district offices. In order to obtain the number of eligible individuals by services category to be included on the report, the Department obtains the information directly from the Welfare Reporting and Tracking Systems (WRTS). The WRTS system contains data from the State?s Welfare Management System (WMS) and the Benefits Issuance Control System (BICS). As it is the responsibility of the district offices to determine eligibility for services, the Office is relying on the district offices to have data entered complete and accurate information within the WMS and BICS systems. During our testwork, there did not appear to be any monitoring procedures performed by the Office to ensure that the information entered by the district office was complete and accurate and that benefits were only provided to eligible participants. Cause The condition found was primarily due to the timing of the implementation of its new monitoring procedures. While the Office had selected 3 subrecipients to perform monitoring procedures over, only an initial request for information was sent to the subrecipient as of March 31, 2022 and the actual monitoring review took place during the subsequent fiscal year. Further, we noted it does not appear that the new procedures once implemented will review to ensure that the participant was eligible to receive services, which would assist in ensuring that the data reported on the Post-Expenditure Report is accurate. Possible Asserted Effect The lack of executed monitoring procedures over subawards provided to subrecipients could result in the use of federal funding provided under the federal award not being in compliance with federal statutes, regulations, and the terms and conditions of the subaward. Questioned Costs Cannot be determined. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding was included in the 2021 Single Audit Report as finding number 2021 013 on pages 44-46. Recommendation We recommend the Office continue to enhance its subrecipient monitoring policies, procedures and internal control to help ensure the Office is monitoring subrecipients in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). The Office should work towards the implementation of their monitoring procedures outlined within their policies and procedures to ensure that it is able to identify the federal statutes, regulations and terms and conditions it must comply with and implement measures whereby it can evaluate and monitor its compliance and to take prompt action when instances of noncompliance are identified and to take reasonable measures. Such monitoring activities should be performed at a precision level that would detect and identify errors in the coding of services and related expenditures that could result in unallowable costs being reimbursed to the subrecipients as well as verifying participants were eligible to receive services to assist in assuring that the data reported within the annual Post-Expenditure Report is complete and accurate. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Health and Human Services Federal Program: Medicaid Cluster (93.775, 93.777, 93.778) Federal Award Numbers: 2205NY5MAP, 2105NY5MAP, 2005NY5MAP, 1805NY5MAP Federal Award Years: 2018, 2020, 2021 and 2022 State Agency: Department of Health Reference: 2022-016 Criteria Title 42 U.S. Code of Federal Regulations Section 1903(r) (42 U.S.C. 1396b) states in order to receive payments under subsection (a) for use of automated data systems in administration of the State plan under this title, a State must, in addition to meeting the requirements of paragraph (3), have in operation mechanized claims processing and information retrieval systems that meet the requirements of this subsection and that the Secretary has found? (A) are adequate to provide efficient, economical, and effective administration of such State plan; (B) are compatible with the claims processing and information retrieval systems used in the administration of title XVIII, and for this purpose? (i) have a uniform identification coding system for providers, other payees, and beneficiaries under this title or title XVIII; (ii) provide liaison between States and carriers and intermediaries with agreements under title XVIII to facilitate timely exchange of appropriate data; (iii) provide for exchange of data between the States and the Secretary with respect to persons sanctioned under this title or title XVIII; and (iv) [152] effective for claims filed on or after October 1, 2010, incorporate compatible methodologies of the National Correct Coding Initiative administered by the Secretary (or any successor initiative to promote correct coding and to control improper coding leading to inappropriate payment) and such other methodologies of that Initiative (or such other national correct coding methodologies) as the Secretary identifies in accordance with paragraph (4); Paragraph (4) states for purposes of paragraph (1)(B)(iv), the Secretary shall do the following: (A) Not later than September 1, 2010: (i) Identify those methodologies of the National Correct Coding Initiative administered by the Secretary (or any successor initiative to promote correct coding and to control improper coding leading to inappropriate payment) which are compatible to claims filed under this title. (ii) Identify those methodologies of such Initiative (or such other national correct coding methodologies) that should be incorporated into claims filed under this title with respect to items or services for which States provide medical assistance under this title and no national correct coding methodologies have been established under such Initiative with respect to title XVIII. (iii) Notify States of? (B) Not later than March 1, 2011, submit a report to Congress that includes the notice to States under clause (iii) of subparagraph (A) and an analysis supporting the identification of the methodologies made under clauses (i) and (ii) of subparagraph (A). Additionally, Title 45 U.S. Code of Federal Regulations Part 75, Uniform Administrative, Requirements, Cost Principles, and Audit Requirements for HHS Awards (45 CFR 75), Appendix XI OMB Compliance supplement also states the NCCI Medicaid Policy Manual and the NCCI Medicaid Technical Guidance Manual contain additional requirements for implementation of the NCCI methodologies. Further, Section 7.1.1 Confidentiality Agreements Requirements for Contracted Parties of the NCCI Technical Guidance Manual states a state Medicaid agency may share these quarterly state Medicaid NCCI edit files which are posted on the MII on the RISSNET portal with the contracted fiscal agent that processes its fee-for service claims or with any of its contracted Medicaid managed-care entities that is using the Medicaid NCCI methodologies in its processing of claims or encounter data, if appropriate confidentiality agreements are in place. The state Medicaid agency, its fiscal agent, and its managed-care entities may also share those files at that time with any contractor or subcontractor (including, but not limited to, COTS software vendors) which is assisting with the implementation of the state?s Medicaid NCCI program in the processing of claims or encounter data, only when appropriate confidentiality agreements are in place. The state Medicaid agency need not have a direct contract with such vendors. Additionally, section 7.1.2 Confidentiality Agreements Requirements for Contracted Parties of the NCCI Technical Guidance Manual states at a minimum, the following elements must be included in the confidentiality agreements for any contracted party using the Medicaid NCCI files posted on the MII: ? Disclosure shall be limited to only those responsible for the implementation of the quarterly state Medicaid NCCI edit files. Disclosure shall not be made prior to the start of the new calendar quarter. ? After the start of the new calendar quarter, a Contracted Party may disclose only non-confidential information contained in the Medicaid NCCI edit files that is also available to the general public found on the Medicaid NCCI webpage. ? The Contracted Party agrees to use any non-public information from the quarterly state Medicaid NCCI edit files only for any business purposes directly related to the implementation of the Medicaid NCCI methodologies in the particular state. ? New, revised, or deleted Medicaid NCCI edits shall not be published or otherwise shared with individuals, medical societies, or any other entities unless it is a Contracted Party prior to the posting of the Medicaid NCCI edits on the Medicaid NCCI webpage. ? Implementation of New, revised, or deleted Medicaid NCCI edits shall not occur prior to the first day of the calendar quarter. ? Only a state Medicaid agency has the discretion to release additional information for selected individual edits or limited ranges of edits from the files posted on the MII. ? State Medicaid agencies must impose penalties, up to and including loss of contract, for violations of any confidentiality agreement relating to use of the MII edit files. Lastly, 45 CFR 75.303(a) the non-federal entity must establish and maintain effective internal control over the federal award that provides reasonable assurance that the non-federal entity is managing the federal award in compliance with federal statutes, regulations, and the terms and conditions of the federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition The Department of Health (the Department) did not have a Confidentiality Agreement in place as required by the NCCI Technical Guidance manual, sections 7.1.1 and 7.1.2 as of March 31, 2022 with its service organizations and third party providers that have access to NCCI data. DOS also implemented internal controls to ensure anyone accessing NCCI data in the future has the confidentiality agreements in place prior to the access being obtained. As a result of the delayed implementation of the updated agreement, the Department was not in the compliance with this requirement for the period under audit and did not have controls in place to ensure compliance during the period under audit. Cause The condition found is due to the timing of management working on implementing its revised policies and procedures to ensure that confidentiality agreements were implemented with its third party providers. Subsequent to the March 31, 2022, the Department concluded its internal evaluation related to which organizations received NCCI data. As a result, the Department identified one organization that receives the NCCI data, General Dynamics Information Technology (GDIT) and excluded an updated Data Use Agreement (DUA) with GDIT for the required NCCI confidentiality language on December 2, 2022. Possible Asserted Effect Failure to implement the required NCCI Confidentiality Agreement may result in the NCCI edit information being available to non-contracted individuals, medical societies, or any other entities and the State being non-compliance with CMS?s NCCI requirements. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding was included in the 2021 Single Audit Report as finding number 2021-015 on pages 50-53. Recommendation We recommend the Department continue to follow its revised policies and procedures including internal controls to ensure any service organizations with access to NCCI data maintain a confidentiality agreement to be compliant with CMS NCCI Technical Guidance manual, sections 7.1.1 and 7.1.2. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Health and Human Services Federal Program: Medicaid Cluster (93.775, 93.777, 93.778) Federal Award Numbers: 2205NY5MAP, 2105NY5MAP, 2005NY5MAP, 1805NY5MAP Federal Award Years: 2018, 2020, 2021 and 2022 State Agency: Department of Health Reference: 2022-016 Criteria Title 42 U.S. Code of Federal Regulations Section 1903(r) (42 U.S.C. 1396b) states in order to receive payments under subsection (a) for use of automated data systems in administration of the State plan under this title, a State must, in addition to meeting the requirements of paragraph (3), have in operation mechanized claims processing and information retrieval systems that meet the requirements of this subsection and that the Secretary has found? (A) are adequate to provide efficient, economical, and effective administration of such State plan; (B) are compatible with the claims processing and information retrieval systems used in the administration of title XVIII, and for this purpose? (i) have a uniform identification coding system for providers, other payees, and beneficiaries under this title or title XVIII; (ii) provide liaison between States and carriers and intermediaries with agreements under title XVIII to facilitate timely exchange of appropriate data; (iii) provide for exchange of data between the States and the Secretary with respect to persons sanctioned under this title or title XVIII; and (iv) [152] effective for claims filed on or after October 1, 2010, incorporate compatible methodologies of the National Correct Coding Initiative administered by the Secretary (or any successor initiative to promote correct coding and to control improper coding leading to inappropriate payment) and such other methodologies of that Initiative (or such other national correct coding methodologies) as the Secretary identifies in accordance with paragraph (4); Paragraph (4) states for purposes of paragraph (1)(B)(iv), the Secretary shall do the following: (A) Not later than September 1, 2010: (i) Identify those methodologies of the National Correct Coding Initiative administered by the Secretary (or any successor initiative to promote correct coding and to control improper coding leading to inappropriate payment) which are compatible to claims filed under this title. (ii) Identify those methodologies of such Initiative (or such other national correct coding methodologies) that should be incorporated into claims filed under this title with respect to items or services for which States provide medical assistance under this title and no national correct coding methodologies have been established under such Initiative with respect to title XVIII. (iii) Notify States of? (B) Not later than March 1, 2011, submit a report to Congress that includes the notice to States under clause (iii) of subparagraph (A) and an analysis supporting the identification of the methodologies made under clauses (i) and (ii) of subparagraph (A). Additionally, Title 45 U.S. Code of Federal Regulations Part 75, Uniform Administrative, Requirements, Cost Principles, and Audit Requirements for HHS Awards (45 CFR 75), Appendix XI OMB Compliance supplement also states the NCCI Medicaid Policy Manual and the NCCI Medicaid Technical Guidance Manual contain additional requirements for implementation of the NCCI methodologies. Further, Section 7.1.1 Confidentiality Agreements Requirements for Contracted Parties of the NCCI Technical Guidance Manual states a state Medicaid agency may share these quarterly state Medicaid NCCI edit files which are posted on the MII on the RISSNET portal with the contracted fiscal agent that processes its fee-for service claims or with any of its contracted Medicaid managed-care entities that is using the Medicaid NCCI methodologies in its processing of claims or encounter data, if appropriate confidentiality agreements are in place. The state Medicaid agency, its fiscal agent, and its managed-care entities may also share those files at that time with any contractor or subcontractor (including, but not limited to, COTS software vendors) which is assisting with the implementation of the state?s Medicaid NCCI program in the processing of claims or encounter data, only when appropriate confidentiality agreements are in place. The state Medicaid agency need not have a direct contract with such vendors. Additionally, section 7.1.2 Confidentiality Agreements Requirements for Contracted Parties of the NCCI Technical Guidance Manual states at a minimum, the following elements must be included in the confidentiality agreements for any contracted party using the Medicaid NCCI files posted on the MII: ? Disclosure shall be limited to only those responsible for the implementation of the quarterly state Medicaid NCCI edit files. Disclosure shall not be made prior to the start of the new calendar quarter. ? After the start of the new calendar quarter, a Contracted Party may disclose only non-confidential information contained in the Medicaid NCCI edit files that is also available to the general public found on the Medicaid NCCI webpage. ? The Contracted Party agrees to use any non-public information from the quarterly state Medicaid NCCI edit files only for any business purposes directly related to the implementation of the Medicaid NCCI methodologies in the particular state. ? New, revised, or deleted Medicaid NCCI edits shall not be published or otherwise shared with individuals, medical societies, or any other entities unless it is a Contracted Party prior to the posting of the Medicaid NCCI edits on the Medicaid NCCI webpage. ? Implementation of New, revised, or deleted Medicaid NCCI edits shall not occur prior to the first day of the calendar quarter. ? Only a state Medicaid agency has the discretion to release additional information for selected individual edits or limited ranges of edits from the files posted on the MII. ? State Medicaid agencies must impose penalties, up to and including loss of contract, for violations of any confidentiality agreement relating to use of the MII edit files. Lastly, 45 CFR 75.303(a) the non-federal entity must establish and maintain effective internal control over the federal award that provides reasonable assurance that the non-federal entity is managing the federal award in compliance with federal statutes, regulations, and the terms and conditions of the federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition The Department of Health (the Department) did not have a Confidentiality Agreement in place as required by the NCCI Technical Guidance manual, sections 7.1.1 and 7.1.2 as of March 31, 2022 with its service organizations and third party providers that have access to NCCI data. DOS also implemented internal controls to ensure anyone accessing NCCI data in the future has the confidentiality agreements in place prior to the access being obtained. As a result of the delayed implementation of the updated agreement, the Department was not in the compliance with this requirement for the period under audit and did not have controls in place to ensure compliance during the period under audit. Cause The condition found is due to the timing of management working on implementing its revised policies and procedures to ensure that confidentiality agreements were implemented with its third party providers. Subsequent to the March 31, 2022, the Department concluded its internal evaluation related to which organizations received NCCI data. As a result, the Department identified one organization that receives the NCCI data, General Dynamics Information Technology (GDIT) and excluded an updated Data Use Agreement (DUA) with GDIT for the required NCCI confidentiality language on December 2, 2022. Possible Asserted Effect Failure to implement the required NCCI Confidentiality Agreement may result in the NCCI edit information being available to non-contracted individuals, medical societies, or any other entities and the State being non-compliance with CMS?s NCCI requirements. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding was included in the 2021 Single Audit Report as finding number 2021-015 on pages 50-53. Recommendation We recommend the Department continue to follow its revised policies and procedures including internal controls to ensure any service organizations with access to NCCI data maintain a confidentiality agreement to be compliant with CMS NCCI Technical Guidance manual, sections 7.1.1 and 7.1.2. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Health and Human Services Federal Program: Medicaid Cluster (93.775, 93.777, 93.778) Federal Award Numbers: 2205NY5MAP, 2105NY5MAP, 2005NY5MAP, 1805NY5MAP Federal Award Years: 2018, 2020, 2021 and 2022 State Agency: Department of Health Reference: 2022-016 Criteria Title 42 U.S. Code of Federal Regulations Section 1903(r) (42 U.S.C. 1396b) states in order to receive payments under subsection (a) for use of automated data systems in administration of the State plan under this title, a State must, in addition to meeting the requirements of paragraph (3), have in operation mechanized claims processing and information retrieval systems that meet the requirements of this subsection and that the Secretary has found? (A) are adequate to provide efficient, economical, and effective administration of such State plan; (B) are compatible with the claims processing and information retrieval systems used in the administration of title XVIII, and for this purpose? (i) have a uniform identification coding system for providers, other payees, and beneficiaries under this title or title XVIII; (ii) provide liaison between States and carriers and intermediaries with agreements under title XVIII to facilitate timely exchange of appropriate data; (iii) provide for exchange of data between the States and the Secretary with respect to persons sanctioned under this title or title XVIII; and (iv) [152] effective for claims filed on or after October 1, 2010, incorporate compatible methodologies of the National Correct Coding Initiative administered by the Secretary (or any successor initiative to promote correct coding and to control improper coding leading to inappropriate payment) and such other methodologies of that Initiative (or such other national correct coding methodologies) as the Secretary identifies in accordance with paragraph (4); Paragraph (4) states for purposes of paragraph (1)(B)(iv), the Secretary shall do the following: (A) Not later than September 1, 2010: (i) Identify those methodologies of the National Correct Coding Initiative administered by the Secretary (or any successor initiative to promote correct coding and to control improper coding leading to inappropriate payment) which are compatible to claims filed under this title. (ii) Identify those methodologies of such Initiative (or such other national correct coding methodologies) that should be incorporated into claims filed under this title with respect to items or services for which States provide medical assistance under this title and no national correct coding methodologies have been established under such Initiative with respect to title XVIII. (iii) Notify States of? (B) Not later than March 1, 2011, submit a report to Congress that includes the notice to States under clause (iii) of subparagraph (A) and an analysis supporting the identification of the methodologies made under clauses (i) and (ii) of subparagraph (A). Additionally, Title 45 U.S. Code of Federal Regulations Part 75, Uniform Administrative, Requirements, Cost Principles, and Audit Requirements for HHS Awards (45 CFR 75), Appendix XI OMB Compliance supplement also states the NCCI Medicaid Policy Manual and the NCCI Medicaid Technical Guidance Manual contain additional requirements for implementation of the NCCI methodologies. Further, Section 7.1.1 Confidentiality Agreements Requirements for Contracted Parties of the NCCI Technical Guidance Manual states a state Medicaid agency may share these quarterly state Medicaid NCCI edit files which are posted on the MII on the RISSNET portal with the contracted fiscal agent that processes its fee-for service claims or with any of its contracted Medicaid managed-care entities that is using the Medicaid NCCI methodologies in its processing of claims or encounter data, if appropriate confidentiality agreements are in place. The state Medicaid agency, its fiscal agent, and its managed-care entities may also share those files at that time with any contractor or subcontractor (including, but not limited to, COTS software vendors) which is assisting with the implementation of the state?s Medicaid NCCI program in the processing of claims or encounter data, only when appropriate confidentiality agreements are in place. The state Medicaid agency need not have a direct contract with such vendors. Additionally, section 7.1.2 Confidentiality Agreements Requirements for Contracted Parties of the NCCI Technical Guidance Manual states at a minimum, the following elements must be included in the confidentiality agreements for any contracted party using the Medicaid NCCI files posted on the MII: ? Disclosure shall be limited to only those responsible for the implementation of the quarterly state Medicaid NCCI edit files. Disclosure shall not be made prior to the start of the new calendar quarter. ? After the start of the new calendar quarter, a Contracted Party may disclose only non-confidential information contained in the Medicaid NCCI edit files that is also available to the general public found on the Medicaid NCCI webpage. ? The Contracted Party agrees to use any non-public information from the quarterly state Medicaid NCCI edit files only for any business purposes directly related to the implementation of the Medicaid NCCI methodologies in the particular state. ? New, revised, or deleted Medicaid NCCI edits shall not be published or otherwise shared with individuals, medical societies, or any other entities unless it is a Contracted Party prior to the posting of the Medicaid NCCI edits on the Medicaid NCCI webpage. ? Implementation of New, revised, or deleted Medicaid NCCI edits shall not occur prior to the first day of the calendar quarter. ? Only a state Medicaid agency has the discretion to release additional information for selected individual edits or limited ranges of edits from the files posted on the MII. ? State Medicaid agencies must impose penalties, up to and including loss of contract, for violations of any confidentiality agreement relating to use of the MII edit files. Lastly, 45 CFR 75.303(a) the non-federal entity must establish and maintain effective internal control over the federal award that provides reasonable assurance that the non-federal entity is managing the federal award in compliance with federal statutes, regulations, and the terms and conditions of the federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition The Department of Health (the Department) did not have a Confidentiality Agreement in place as required by the NCCI Technical Guidance manual, sections 7.1.1 and 7.1.2 as of March 31, 2022 with its service organizations and third party providers that have access to NCCI data. DOS also implemented internal controls to ensure anyone accessing NCCI data in the future has the confidentiality agreements in place prior to the access being obtained. As a result of the delayed implementation of the updated agreement, the Department was not in the compliance with this requirement for the period under audit and did not have controls in place to ensure compliance during the period under audit. Cause The condition found is due to the timing of management working on implementing its revised policies and procedures to ensure that confidentiality agreements were implemented with its third party providers. Subsequent to the March 31, 2022, the Department concluded its internal evaluation related to which organizations received NCCI data. As a result, the Department identified one organization that receives the NCCI data, General Dynamics Information Technology (GDIT) and excluded an updated Data Use Agreement (DUA) with GDIT for the required NCCI confidentiality language on December 2, 2022. Possible Asserted Effect Failure to implement the required NCCI Confidentiality Agreement may result in the NCCI edit information being available to non-contracted individuals, medical societies, or any other entities and the State being non-compliance with CMS?s NCCI requirements. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding was included in the 2021 Single Audit Report as finding number 2021-015 on pages 50-53. Recommendation We recommend the Department continue to follow its revised policies and procedures including internal controls to ensure any service organizations with access to NCCI data maintain a confidentiality agreement to be compliant with CMS NCCI Technical Guidance manual, sections 7.1.1 and 7.1.2. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Health and Human Services Federal Program: Medicaid Cluster (93.775, 93.777, 93.778) Federal Award Numbers: 2205NY5MAP, 2105NY5MAP, 2005NY5MAP, 1805NY5MAP Federal Award Years: 2018, 2020, 2021 and 2022 State Agency: Department of Health Reference: 2022-016 Criteria Title 42 U.S. Code of Federal Regulations Section 1903(r) (42 U.S.C. 1396b) states in order to receive payments under subsection (a) for use of automated data systems in administration of the State plan under this title, a State must, in addition to meeting the requirements of paragraph (3), have in operation mechanized claims processing and information retrieval systems that meet the requirements of this subsection and that the Secretary has found? (A) are adequate to provide efficient, economical, and effective administration of such State plan; (B) are compatible with the claims processing and information retrieval systems used in the administration of title XVIII, and for this purpose? (i) have a uniform identification coding system for providers, other payees, and beneficiaries under this title or title XVIII; (ii) provide liaison between States and carriers and intermediaries with agreements under title XVIII to facilitate timely exchange of appropriate data; (iii) provide for exchange of data between the States and the Secretary with respect to persons sanctioned under this title or title XVIII; and (iv) [152] effective for claims filed on or after October 1, 2010, incorporate compatible methodologies of the National Correct Coding Initiative administered by the Secretary (or any successor initiative to promote correct coding and to control improper coding leading to inappropriate payment) and such other methodologies of that Initiative (or such other national correct coding methodologies) as the Secretary identifies in accordance with paragraph (4); Paragraph (4) states for purposes of paragraph (1)(B)(iv), the Secretary shall do the following: (A) Not later than September 1, 2010: (i) Identify those methodologies of the National Correct Coding Initiative administered by the Secretary (or any successor initiative to promote correct coding and to control improper coding leading to inappropriate payment) which are compatible to claims filed under this title. (ii) Identify those methodologies of such Initiative (or such other national correct coding methodologies) that should be incorporated into claims filed under this title with respect to items or services for which States provide medical assistance under this title and no national correct coding methodologies have been established under such Initiative with respect to title XVIII. (iii) Notify States of? (B) Not later than March 1, 2011, submit a report to Congress that includes the notice to States under clause (iii) of subparagraph (A) and an analysis supporting the identification of the methodologies made under clauses (i) and (ii) of subparagraph (A). Additionally, Title 45 U.S. Code of Federal Regulations Part 75, Uniform Administrative, Requirements, Cost Principles, and Audit Requirements for HHS Awards (45 CFR 75), Appendix XI OMB Compliance supplement also states the NCCI Medicaid Policy Manual and the NCCI Medicaid Technical Guidance Manual contain additional requirements for implementation of the NCCI methodologies. Further, Section 7.1.1 Confidentiality Agreements Requirements for Contracted Parties of the NCCI Technical Guidance Manual states a state Medicaid agency may share these quarterly state Medicaid NCCI edit files which are posted on the MII on the RISSNET portal with the contracted fiscal agent that processes its fee-for service claims or with any of its contracted Medicaid managed-care entities that is using the Medicaid NCCI methodologies in its processing of claims or encounter data, if appropriate confidentiality agreements are in place. The state Medicaid agency, its fiscal agent, and its managed-care entities may also share those files at that time with any contractor or subcontractor (including, but not limited to, COTS software vendors) which is assisting with the implementation of the state?s Medicaid NCCI program in the processing of claims or encounter data, only when appropriate confidentiality agreements are in place. The state Medicaid agency need not have a direct contract with such vendors. Additionally, section 7.1.2 Confidentiality Agreements Requirements for Contracted Parties of the NCCI Technical Guidance Manual states at a minimum, the following elements must be included in the confidentiality agreements for any contracted party using the Medicaid NCCI files posted on the MII: ? Disclosure shall be limited to only those responsible for the implementation of the quarterly state Medicaid NCCI edit files. Disclosure shall not be made prior to the start of the new calendar quarter. ? After the start of the new calendar quarter, a Contracted Party may disclose only non-confidential information contained in the Medicaid NCCI edit files that is also available to the general public found on the Medicaid NCCI webpage. ? The Contracted Party agrees to use any non-public information from the quarterly state Medicaid NCCI edit files only for any business purposes directly related to the implementation of the Medicaid NCCI methodologies in the particular state. ? New, revised, or deleted Medicaid NCCI edits shall not be published or otherwise shared with individuals, medical societies, or any other entities unless it is a Contracted Party prior to the posting of the Medicaid NCCI edits on the Medicaid NCCI webpage. ? Implementation of New, revised, or deleted Medicaid NCCI edits shall not occur prior to the first day of the calendar quarter. ? Only a state Medicaid agency has the discretion to release additional information for selected individual edits or limited ranges of edits from the files posted on the MII. ? State Medicaid agencies must impose penalties, up to and including loss of contract, for violations of any confidentiality agreement relating to use of the MII edit files. Lastly, 45 CFR 75.303(a) the non-federal entity must establish and maintain effective internal control over the federal award that provides reasonable assurance that the non-federal entity is managing the federal award in compliance with federal statutes, regulations, and the terms and conditions of the federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition The Department of Health (the Department) did not have a Confidentiality Agreement in place as required by the NCCI Technical Guidance manual, sections 7.1.1 and 7.1.2 as of March 31, 2022 with its service organizations and third party providers that have access to NCCI data. DOS also implemented internal controls to ensure anyone accessing NCCI data in the future has the confidentiality agreements in place prior to the access being obtained. As a result of the delayed implementation of the updated agreement, the Department was not in the compliance with this requirement for the period under audit and did not have controls in place to ensure compliance during the period under audit. Cause The condition found is due to the timing of management working on implementing its revised policies and procedures to ensure that confidentiality agreements were implemented with its third party providers. Subsequent to the March 31, 2022, the Department concluded its internal evaluation related to which organizations received NCCI data. As a result, the Department identified one organization that receives the NCCI data, General Dynamics Information Technology (GDIT) and excluded an updated Data Use Agreement (DUA) with GDIT for the required NCCI confidentiality language on December 2, 2022. Possible Asserted Effect Failure to implement the required NCCI Confidentiality Agreement may result in the NCCI edit information being available to non-contracted individuals, medical societies, or any other entities and the State being non-compliance with CMS?s NCCI requirements. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding was included in the 2021 Single Audit Report as finding number 2021-015 on pages 50-53. Recommendation We recommend the Department continue to follow its revised policies and procedures including internal controls to ensure any service organizations with access to NCCI data maintain a confidentiality agreement to be compliant with CMS NCCI Technical Guidance manual, sections 7.1.1 and 7.1.2. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Health and Human Services Federal Program: Medicaid Cluster (93.775, 93.777, 93.778) Federal Award Numbers: 2205NY5MAP, 2105NY5MAP, 2005NY5MAP, 1805NY5MAP Federal Award Years: 2018, 2020, 2021 and 2022 State Agency: Department of Health Reference: 2022-016 Criteria Title 42 U.S. Code of Federal Regulations Section 1903(r) (42 U.S.C. 1396b) states in order to receive payments under subsection (a) for use of automated data systems in administration of the State plan under this title, a State must, in addition to meeting the requirements of paragraph (3), have in operation mechanized claims processing and information retrieval systems that meet the requirements of this subsection and that the Secretary has found? (A) are adequate to provide efficient, economical, and effective administration of such State plan; (B) are compatible with the claims processing and information retrieval systems used in the administration of title XVIII, and for this purpose? (i) have a uniform identification coding system for providers, other payees, and beneficiaries under this title or title XVIII; (ii) provide liaison between States and carriers and intermediaries with agreements under title XVIII to facilitate timely exchange of appropriate data; (iii) provide for exchange of data between the States and the Secretary with respect to persons sanctioned under this title or title XVIII; and (iv) [152] effective for claims filed on or after October 1, 2010, incorporate compatible methodologies of the National Correct Coding Initiative administered by the Secretary (or any successor initiative to promote correct coding and to control improper coding leading to inappropriate payment) and such other methodologies of that Initiative (or such other national correct coding methodologies) as the Secretary identifies in accordance with paragraph (4); Paragraph (4) states for purposes of paragraph (1)(B)(iv), the Secretary shall do the following: (A) Not later than September 1, 2010: (i) Identify those methodologies of the National Correct Coding Initiative administered by the Secretary (or any successor initiative to promote correct coding and to control improper coding leading to inappropriate payment) which are compatible to claims filed under this title. (ii) Identify those methodologies of such Initiative (or such other national correct coding methodologies) that should be incorporated into claims filed under this title with respect to items or services for which States provide medical assistance under this title and no national correct coding methodologies have been established under such Initiative with respect to title XVIII. (iii) Notify States of? (B) Not later than March 1, 2011, submit a report to Congress that includes the notice to States under clause (iii) of subparagraph (A) and an analysis supporting the identification of the methodologies made under clauses (i) and (ii) of subparagraph (A). Additionally, Title 45 U.S. Code of Federal Regulations Part 75, Uniform Administrative, Requirements, Cost Principles, and Audit Requirements for HHS Awards (45 CFR 75), Appendix XI OMB Compliance supplement also states the NCCI Medicaid Policy Manual and the NCCI Medicaid Technical Guidance Manual contain additional requirements for implementation of the NCCI methodologies. Further, Section 7.1.1 Confidentiality Agreements Requirements for Contracted Parties of the NCCI Technical Guidance Manual states a state Medicaid agency may share these quarterly state Medicaid NCCI edit files which are posted on the MII on the RISSNET portal with the contracted fiscal agent that processes its fee-for service claims or with any of its contracted Medicaid managed-care entities that is using the Medicaid NCCI methodologies in its processing of claims or encounter data, if appropriate confidentiality agreements are in place. The state Medicaid agency, its fiscal agent, and its managed-care entities may also share those files at that time with any contractor or subcontractor (including, but not limited to, COTS software vendors) which is assisting with the implementation of the state?s Medicaid NCCI program in the processing of claims or encounter data, only when appropriate confidentiality agreements are in place. The state Medicaid agency need not have a direct contract with such vendors. Additionally, section 7.1.2 Confidentiality Agreements Requirements for Contracted Parties of the NCCI Technical Guidance Manual states at a minimum, the following elements must be included in the confidentiality agreements for any contracted party using the Medicaid NCCI files posted on the MII: ? Disclosure shall be limited to only those responsible for the implementation of the quarterly state Medicaid NCCI edit files. Disclosure shall not be made prior to the start of the new calendar quarter. ? After the start of the new calendar quarter, a Contracted Party may disclose only non-confidential information contained in the Medicaid NCCI edit files that is also available to the general public found on the Medicaid NCCI webpage. ? The Contracted Party agrees to use any non-public information from the quarterly state Medicaid NCCI edit files only for any business purposes directly related to the implementation of the Medicaid NCCI methodologies in the particular state. ? New, revised, or deleted Medicaid NCCI edits shall not be published or otherwise shared with individuals, medical societies, or any other entities unless it is a Contracted Party prior to the posting of the Medicaid NCCI edits on the Medicaid NCCI webpage. ? Implementation of New, revised, or deleted Medicaid NCCI edits shall not occur prior to the first day of the calendar quarter. ? Only a state Medicaid agency has the discretion to release additional information for selected individual edits or limited ranges of edits from the files posted on the MII. ? State Medicaid agencies must impose penalties, up to and including loss of contract, for violations of any confidentiality agreement relating to use of the MII edit files. Lastly, 45 CFR 75.303(a) the non-federal entity must establish and maintain effective internal control over the federal award that provides reasonable assurance that the non-federal entity is managing the federal award in compliance with federal statutes, regulations, and the terms and conditions of the federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition The Department of Health (the Department) did not have a Confidentiality Agreement in place as required by the NCCI Technical Guidance manual, sections 7.1.1 and 7.1.2 as of March 31, 2022 with its service organizations and third party providers that have access to NCCI data. DOS also implemented internal controls to ensure anyone accessing NCCI data in the future has the confidentiality agreements in place prior to the access being obtained. As a result of the delayed implementation of the updated agreement, the Department was not in the compliance with this requirement for the period under audit and did not have controls in place to ensure compliance during the period under audit. Cause The condition found is due to the timing of management working on implementing its revised policies and procedures to ensure that confidentiality agreements were implemented with its third party providers. Subsequent to the March 31, 2022, the Department concluded its internal evaluation related to which organizations received NCCI data. As a result, the Department identified one organization that receives the NCCI data, General Dynamics Information Technology (GDIT) and excluded an updated Data Use Agreement (DUA) with GDIT for the required NCCI confidentiality language on December 2, 2022. Possible Asserted Effect Failure to implement the required NCCI Confidentiality Agreement may result in the NCCI edit information being available to non-contracted individuals, medical societies, or any other entities and the State being non-compliance with CMS?s NCCI requirements. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding was included in the 2021 Single Audit Report as finding number 2021-015 on pages 50-53. Recommendation We recommend the Department continue to follow its revised policies and procedures including internal controls to ensure any service organizations with access to NCCI data maintain a confidentiality agreement to be compliant with CMS NCCI Technical Guidance manual, sections 7.1.1 and 7.1.2. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.
Federal Agency: United States Department of Health and Human Services Federal Program: Medicaid Cluster (93.775, 93.777, 93.778) Federal Award Numbers: 2205NY5MAP, 2105NY5MAP, 2005NY5MAP, 1805NY5MAP Federal Award Years: 2018, 2020, 2021 and 2022 State Agency: Department of Health Reference: 2022-016 Criteria Title 42 U.S. Code of Federal Regulations Section 1903(r) (42 U.S.C. 1396b) states in order to receive payments under subsection (a) for use of automated data systems in administration of the State plan under this title, a State must, in addition to meeting the requirements of paragraph (3), have in operation mechanized claims processing and information retrieval systems that meet the requirements of this subsection and that the Secretary has found? (A) are adequate to provide efficient, economical, and effective administration of such State plan; (B) are compatible with the claims processing and information retrieval systems used in the administration of title XVIII, and for this purpose? (i) have a uniform identification coding system for providers, other payees, and beneficiaries under this title or title XVIII; (ii) provide liaison between States and carriers and intermediaries with agreements under title XVIII to facilitate timely exchange of appropriate data; (iii) provide for exchange of data between the States and the Secretary with respect to persons sanctioned under this title or title XVIII; and (iv) [152] effective for claims filed on or after October 1, 2010, incorporate compatible methodologies of the National Correct Coding Initiative administered by the Secretary (or any successor initiative to promote correct coding and to control improper coding leading to inappropriate payment) and such other methodologies of that Initiative (or such other national correct coding methodologies) as the Secretary identifies in accordance with paragraph (4); Paragraph (4) states for purposes of paragraph (1)(B)(iv), the Secretary shall do the following: (A) Not later than September 1, 2010: (i) Identify those methodologies of the National Correct Coding Initiative administered by the Secretary (or any successor initiative to promote correct coding and to control improper coding leading to inappropriate payment) which are compatible to claims filed under this title. (ii) Identify those methodologies of such Initiative (or such other national correct coding methodologies) that should be incorporated into claims filed under this title with respect to items or services for which States provide medical assistance under this title and no national correct coding methodologies have been established under such Initiative with respect to title XVIII. (iii) Notify States of? (B) Not later than March 1, 2011, submit a report to Congress that includes the notice to States under clause (iii) of subparagraph (A) and an analysis supporting the identification of the methodologies made under clauses (i) and (ii) of subparagraph (A). Additionally, Title 45 U.S. Code of Federal Regulations Part 75, Uniform Administrative, Requirements, Cost Principles, and Audit Requirements for HHS Awards (45 CFR 75), Appendix XI OMB Compliance supplement also states the NCCI Medicaid Policy Manual and the NCCI Medicaid Technical Guidance Manual contain additional requirements for implementation of the NCCI methodologies. Further, Section 7.1.1 Confidentiality Agreements Requirements for Contracted Parties of the NCCI Technical Guidance Manual states a state Medicaid agency may share these quarterly state Medicaid NCCI edit files which are posted on the MII on the RISSNET portal with the contracted fiscal agent that processes its fee-for service claims or with any of its contracted Medicaid managed-care entities that is using the Medicaid NCCI methodologies in its processing of claims or encounter data, if appropriate confidentiality agreements are in place. The state Medicaid agency, its fiscal agent, and its managed-care entities may also share those files at that time with any contractor or subcontractor (including, but not limited to, COTS software vendors) which is assisting with the implementation of the state?s Medicaid NCCI program in the processing of claims or encounter data, only when appropriate confidentiality agreements are in place. The state Medicaid agency need not have a direct contract with such vendors. Additionally, section 7.1.2 Confidentiality Agreements Requirements for Contracted Parties of the NCCI Technical Guidance Manual states at a minimum, the following elements must be included in the confidentiality agreements for any contracted party using the Medicaid NCCI files posted on the MII: ? Disclosure shall be limited to only those responsible for the implementation of the quarterly state Medicaid NCCI edit files. Disclosure shall not be made prior to the start of the new calendar quarter. ? After the start of the new calendar quarter, a Contracted Party may disclose only non-confidential information contained in the Medicaid NCCI edit files that is also available to the general public found on the Medicaid NCCI webpage. ? The Contracted Party agrees to use any non-public information from the quarterly state Medicaid NCCI edit files only for any business purposes directly related to the implementation of the Medicaid NCCI methodologies in the particular state. ? New, revised, or deleted Medicaid NCCI edits shall not be published or otherwise shared with individuals, medical societies, or any other entities unless it is a Contracted Party prior to the posting of the Medicaid NCCI edits on the Medicaid NCCI webpage. ? Implementation of New, revised, or deleted Medicaid NCCI edits shall not occur prior to the first day of the calendar quarter. ? Only a state Medicaid agency has the discretion to release additional information for selected individual edits or limited ranges of edits from the files posted on the MII. ? State Medicaid agencies must impose penalties, up to and including loss of contract, for violations of any confidentiality agreement relating to use of the MII edit files. Lastly, 45 CFR 75.303(a) the non-federal entity must establish and maintain effective internal control over the federal award that provides reasonable assurance that the non-federal entity is managing the federal award in compliance with federal statutes, regulations, and the terms and conditions of the federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition The Department of Health (the Department) did not have a Confidentiality Agreement in place as required by the NCCI Technical Guidance manual, sections 7.1.1 and 7.1.2 as of March 31, 2022 with its service organizations and third party providers that have access to NCCI data. DOS also implemented internal controls to ensure anyone accessing NCCI data in the future has the confidentiality agreements in place prior to the access being obtained. As a result of the delayed implementation of the updated agreement, the Department was not in the compliance with this requirement for the period under audit and did not have controls in place to ensure compliance during the period under audit. Cause The condition found is due to the timing of management working on implementing its revised policies and procedures to ensure that confidentiality agreements were implemented with its third party providers. Subsequent to the March 31, 2022, the Department concluded its internal evaluation related to which organizations received NCCI data. As a result, the Department identified one organization that receives the NCCI data, General Dynamics Information Technology (GDIT) and excluded an updated Data Use Agreement (DUA) with GDIT for the required NCCI confidentiality language on December 2, 2022. Possible Asserted Effect Failure to implement the required NCCI Confidentiality Agreement may result in the NCCI edit information being available to non-contracted individuals, medical societies, or any other entities and the State being non-compliance with CMS?s NCCI requirements. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding was included in the 2021 Single Audit Report as finding number 2021-015 on pages 50-53. Recommendation We recommend the Department continue to follow its revised policies and procedures including internal controls to ensure any service organizations with access to NCCI data maintain a confidentiality agreement to be compliant with CMS NCCI Technical Guidance manual, sections 7.1.1 and 7.1.2. Views of Responsible Officials Recommendation accepted. Reference the corrective action plan for further details.