Corrective Action Plans

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Finding 24219 (2022-004)
Significant Deficiency 2022
Finding: 2022-004 Name of Contact Person: Tammy Mixon, Medicaid Supervisor Corrective Action: "Of the nine cases found as errors during this audit, 100% of the errors were found prior to the agency having an opportunity to train based on the findings from previous fiscal...
Finding: 2022-004 Name of Contact Person: Tammy Mixon, Medicaid Supervisor Corrective Action: "Of the nine cases found as errors during this audit, 100% of the errors were found prior to the agency having an opportunity to train based on the findings from previous fiscal year audit. The findings occurred during the timeframe prior to training from previous period findings. This has been discussed in our monthly Medicaid meeting on August 24, 2021. As a result of that meeting and discussions of the findings, a line was added to the agency's second party review form to look for errors regarding the worker's check of all electronic sources, as well as the documentation on the file of such checks. " Proposed Completion Date: This was discussed in monthly Medicaid meeting held on August 24, 2021. The second party review form was changed and implemented for use September 1, 2021.
Finding 24218 (2022-003)
Significant Deficiency 2022
Finding: 2022-003 Name of Contact Person: Tammy Mixon, Medicaid Supervisor Corrective Action: "Of the eleven cases found the agency consents these are repeat findings, however two of the eleven cases during this timeframe would be correct, due to changes in COVID rules as...
Finding: 2022-003 Name of Contact Person: Tammy Mixon, Medicaid Supervisor Corrective Action: "Of the eleven cases found the agency consents these are repeat findings, however two of the eleven cases during this timeframe would be correct, due to changes in COVID rules as it relates to eligibility. During COVID the agency was under constant changes in policy and procedure from DHB, therefore making workers more vulnerable to oversights. The majority of the findings have been discussed in our September 2022 Monthly Medicaid Meeting. The additional findings will be discussed in the next monthly Medicaid meeting. A training will occur in the month of November, 2022 to fully insure the issues are addressed. These items will be reinforced during monthly Medicaid Staff meetings. " Proposed Completion Date: This will be discussed in next monthly Medicaid meeting in October 2022. Training will occur in November 2022 or sooner.
Finding 24217 (2022-002)
Significant Deficiency 2022
Finding: 2022-002 Name of Contact Person: Tammy Mixon, Medicaid Supervisor Corrective Action: "Of the eight errors found during this audit, only four were repeat findings from previous audit year. Those four findings occurred prior to the training from August 24, 2021, wh...
Finding: 2022-002 Name of Contact Person: Tammy Mixon, Medicaid Supervisor Corrective Action: "Of the eight errors found during this audit, only four were repeat findings from previous audit year. Those four findings occurred prior to the training from August 24, 2021, which was as a result of the previous year findings. Therefore, the workers had not been trained on the proper procedures at the time in which these errors occurred, as they were in the previous timeframe. Further, two of the four cases mentioned were correct later in the file due to COVID 19 waivers, but the audit did not cover the timeframe in which the corrections were found. Of the four findings that were not repeat, the agency has obtained training materials from the Operation Support Team for the State of NC for training to correct. The agency rebuts that this is a repeat finding. as the findings occurred during the timeframe prior to training from previous period findings. Further, only half of the findings were the same as the previous period. The agency denies this is a Significant Deficiency, as there were eight findings out of sixty cases pulled, and half of those findings fell within a timeframe prior to training to correct the issue. These findings were discussed in the monthly Medicaid meeting September 2022. OST training materials have been obtained and will be used for training to prevent future errors. Second party review form was also updated to capture in-kind income for prevention of future errors. " Proposed Completion Date: The training occurred on August 30, 2022 and September 7, 2022. Second party review form was made available for use October 1, 2022.
Finding 2022-001 Federal Agency Name: U.S. Department of State Program Name: Refugee Admissions - Reception and Placement CFDA # 19.510 Finding Summary: In connection with the audit procedures performed over the Refugee Admission - Reception and Placement program, we noted instances when indirect co...
Finding 2022-001 Federal Agency Name: U.S. Department of State Program Name: Refugee Admissions - Reception and Placement CFDA # 19.510 Finding Summary: In connection with the audit procedures performed over the Refugee Admission - Reception and Placement program, we noted instances when indirect cost calculations included an insignificant amount of ineligible costs. Responsible Individuals: Rose Olivas, Contract Compliance Director and Dawn Miera, Finance Director Corrective Action Plan: Contract Compliance and Finance will meet every time we receive a new type of grant. The two teams will go over allowable costs and which costs are allowed to be applied to the de minimis rate. All applicable spreadsheets will be updated separately for each new contract and training for billing preparers and reviewers will be ongoing. Anticipated Completion Date: Ongoing
2022-003: Supporting Documentation Recommendation: We recommend the organization design controls to ensure an adequate review process is in place to review costs charged to grants are properly supported by documentation. Explanation of disagreement with audit finding: There is no disagreement with ...
2022-003: Supporting Documentation Recommendation: We recommend the organization design controls to ensure an adequate review process is in place to review costs charged to grants are properly supported by documentation. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action planned in response to finding: We will better enforce a policy that expenses must be sufficiently supported by documentation before payment is made. Name(s) of the contact person(s) responsible for corrective action: Joseph Ferlo, President & CEO Planned completion date for corrective action plan: June 30, 2023
View Audit 21081 Questioned Costs: $1
Compliance requirement - Special tests and provisions ? Enrollment Reporting Institutional Comments on Findings and Recommendations: (a) The institution agrees with the auditor on this finding in that there was one (1) case where the information of enrollment of this student was not available for ex...
Compliance requirement - Special tests and provisions ? Enrollment Reporting Institutional Comments on Findings and Recommendations: (a) The institution agrees with the auditor on this finding in that there was one (1) case where the information of enrollment of this student was not available for examination. After multiples student search, the institution was unable to locate through the NSLDS the reported status update for said student. (b) The institution also agrees with the auditor in that there were (6) six cases where he noted that institution failed to report the student's status before the thirty (30) day deadline for the NSLDS web reporting. (c) The institution also agrees with the auditor in that there was one (1) instance where the institution submitted one (1) of its's enrollment report updates after the 15 days required timeline. Actions Taken or Planned: The institution would continue to submit its Enrollment Reports monthly in order to notify changes of student status to the Department of Education on a timely basis and to maintain the information of student's enrollment status more effectively.
Compliance requirement ? Special test and provisions - Return of Title IV Funds Institutional Comments on Findings and Recommendations: I. Compliance Requirements ? Applicable After a Student Begins Attendance: a. The institution agrees with the auditors on this finding in which there were two (2) ...
Compliance requirement ? Special test and provisions - Return of Title IV Funds Institutional Comments on Findings and Recommendations: I. Compliance Requirements ? Applicable After a Student Begins Attendance: a. The institution agrees with the auditors on this finding in which there were two (2) cases where the auditors noted that the institution failed to determine that the students withdrew within 14 days after the student's last day of attendance. II. Compliance Requirements ? Applicable for a student who does not begin attendance: b. The Institution agrees with the auditors on this finding in which there was one (1) case were the student did not comply with the Incomplete course requirement and an unofficial withdrawal was not performed. Before the audit process was completed, the institution performed a R2T4 calculation and returned to the US Department of Education, the $439.00 associated with this finding. This process was evidenced to the auditors for their records. c. The Institution agrees with the auditors on this finding in which there was one (1) case were the student had stopped attending the enrolled courses without completing at least 60% of the payment period. Before the audit process was completed, the institution had returned to the US Department of Education, the $581.00 associated with this finding. This process was evidenced to the auditors for their records. d. The institution agrees with the auditors that in the cases mentioned in item b and c in that it failed to determine that the students withdrew within 14 days after the student's last day of attendance. e. The institution agrees with the auditors that in the cases mentioned in item b and c in that it failed to return Title IV funds after the 45 days' time frame. Actions Taken or Planned: The institution is aware of the importance to comply with Return of Title IV funds (R2T4) reporting requirements and deadlines. Also, the relation to students last day of attendance (date of withdrawal) vs date of school's determination that the students withdrew and the date of the return of any Title IV funds resulting from an R2T4 calculation. The issues as related to these findings were identified as ones being an oversight and lack in compliance with some of the academic processes as required by R2T4 and has already been discussed with the Academic Dean of the institution who in turn has revisited these matters with Faculty and administrative staff under her supervision including the Registrar. The already instituted task force that meets every Friday of each week to identify and review cases that could affect the R2T4 procedure and requirement has continued to review and evaluate information received from the faculty through the Academic Dean and from information the Registrar's office receives of students that are not attending classes in order to process all applicable withdrawals to assure that the return of Title IV funds procedures and the return of funds if any, are processed timely within the 14 days requirement of the student's last day of attendance and within the 45 days from the date that the institution determined that the student withdrew. Before the audit process was completed, the institution had returned to the US Department of Education, the $439.00 and $581.00 associated with this finding. This process was evidenced to the auditors for their records.
Compliance requirement ? Other ? Policies and Procedures requirements. Institutional Comments on Findings and Recommendations: 1 The institution agrees with the auditors on this finding in which the current University Catalog containing the updated general disclosures for enrolled or prospective st...
Compliance requirement ? Other ? Policies and Procedures requirements. Institutional Comments on Findings and Recommendations: 1 The institution agrees with the auditors on this finding in which the current University Catalog containing the updated general disclosures for enrolled or prospective students were not updated on time for the fiscal year. 2 The institution agrees with the auditors on this finding in which the Drug and Alcohol Abuse Prevention Program did not fully comply with the distribution requirement in writing for each student. It also agrees that the institution did not perform a recent biennial review of its Drug and Alcohol Abuse Prevention Program. Actions Taken or Planned: The institution has already updated, published, and distributed its Catalog to accurately represent the vision and goals, our academic offerings and administrative policies and procedures of our operation. As related to the institutions Drug and Alcohol Abuse Prevention Program, the same was also updated, revised, published, and distributed to all active students and staff. The updated Drug and Alcohol Abuse Prevention Program is also available for distribution for all prospective students and any potential employees through the Admissions and Human Resources offices respectively. The same would also be posted on the Web page of the institution. Evidence of both issues were submitted to the auditors.
2022?001 Direct Loan Awarding Federal Direct Student Loans ? Assistance Listing No. 84.268 Auditors? Recommendation: We recommend that the University ensures they have appropriate policies and procedures, as well as safeguards in place to ensure loan eligibility is correctly determined. Explanation ...
2022?001 Direct Loan Awarding Federal Direct Student Loans ? Assistance Listing No. 84.268 Auditors? Recommendation: We recommend that the University ensures they have appropriate policies and procedures, as well as safeguards in place to ensure loan eligibility is correctly determined. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: Point has completed the following: 1. Extensive training delivered by external vendor, Enrollment Fuel, in October 2022 focusing on financial aid awarding and cost of attendance. 2. Point University has contracted with Financial Aid Services, Inc. (FAS), whose services begin in April 2023. As an approved third-party financial servicing vendor, FAS will conduct student packaging and review to determine appropriate loan amounts are awarded for all degree-seeking students. 3. The institution will be is changing from BBAY to SAY packaging beginning in Fall 2023 for all students. Uniform packaging procedures for all students which will improve accuracy. 4. The institution is transitioning student information system to Ellucian Colleague, which is being configured for more automated packaging, which will reduce manual errors. Name(s) of the contact person(s) responsible for corrective action: Rusty Hassell, Chief Enrollment Officer; Rachal Wortham, Director of Financial Aid Quality and Compliance; Holly Hardnett, Director of Financial Aid Planned completion date for corrective action plan: 1. October 2022 ? training complete 2. April 2023 ? FAS implementation complete 3. August 2023 4. August 2023
View Audit 20116 Questioned Costs: $1
Finding 2022-014 U.S. Department of Health and Human Services AL No. 93.568 Total Low-Income Home Energy Assistance Significant Deficiency over Eligibility Repeat Finding: No Auditee?s Corrective Action Plan: The Office of Home and Energy Programs (OHEP) bureau of The Mayors Office of Childr...
Finding 2022-014 U.S. Department of Health and Human Services AL No. 93.568 Total Low-Income Home Energy Assistance Significant Deficiency over Eligibility Repeat Finding: No Auditee?s Corrective Action Plan: The Office of Home and Energy Programs (OHEP) bureau of The Mayors Office of Children and Family Success (MOCFS) agency has implemented a plan to locate needed files from previous and current fiscal years. The agency has implemented a scanning and uploading Standard Operating Procedure (SOP) that requires each case file to be digitally attached to its application and supporting documents. This will remedy this finding in its totality. Contact Person: OHEP Director ? Rigel Moore Completion Date: March 10, 2023
View Audit 23759 Questioned Costs: $1
2022-002 Housing Voucher Cluster ? Assistance Listing No. 14.871 Recommendation: The Authority should review their policies to ensure all required documentation is maintained for all individuals who are on the waiting list. Explanation of disagreement with audit finding: There is no disagreement wi...
2022-002 Housing Voucher Cluster ? Assistance Listing No. 14.871 Recommendation: The Authority should review their policies to ensure all required documentation is maintained for all individuals who are on the waiting list. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action planned/taken in response to finding: NOHA has reviewed its policies regarding documentation maintenance for all individuals on the waiting list. Quality control review of waiting list data entry was put in place after October 2020. The oldest application on the current waiting list is dated 2018. NOHA anticipates this finding will continue until the waiting list application dates reach 10/2020. Name(s) of the contact person(s) responsible for corrective action: Sandra Soucie, HCV Manager, HCVManager@nwoha.org Planned completion date for corrective action plan: 3/31/2023
2022-001 Housing Voucher Cluster ? Assistance Listing No. 14.871 Recommendation: The Authority should review their processes for eligibility determination and documentation to ensure all information is properly documented and maintained in the files. Explanation of disagreement with audit finding: T...
2022-001 Housing Voucher Cluster ? Assistance Listing No. 14.871 Recommendation: The Authority should review their processes for eligibility determination and documentation to ensure all information is properly documented and maintained in the files. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action planned/taken in response to finding: The Northwest Oregon Housing Authority has reviewed eligibility determination and documentation processes. Staff have received training regarding proper documentation. NOHA has conducted quality control file reviews on approximately 10% of transactions between July 1, 2022, to January 31, 2023, to review and ensure file quality. QC reviews will continue on an ongoing basis. Name(s) of the contact person(s) responsible for corrective action: Sandra Soucie, HCV Manager, HCVManager@nwoha.org Planned completion date for corrective action plan: 1/31/2023
Finding 2022-008 U.S. Department of Housing and Urban Development (HUD) AL No. 14.241 Housing Opportunities for Persons with AIDS Significant Deficiency and Internal Control Deficiency over Eligibility Repeat Finding: No Auditee?s Corrective Action Plan: MOHS does have a written process in ...
Finding 2022-008 U.S. Department of Housing and Urban Development (HUD) AL No. 14.241 Housing Opportunities for Persons with AIDS Significant Deficiency and Internal Control Deficiency over Eligibility Repeat Finding: No Auditee?s Corrective Action Plan: MOHS does have a written process in place for review of participant eligibility. The Housing Coordinator performs quality assurance reviews of participant eligibility and verifies documentation is maintained in the records. During the review period, the Housing Coordinator position was vacant. MOHS has started the process to fill the position. MOHS anticipates the Housing Coordinator position will be filled by Summer 2023. Contact Person: Compliance Supervisor ? Donata Patrick Completion Date: July 2023
Finding 23711 (2022-036)
Significant Deficiency 2022
Finding 2022-036 Crime Victim Assistance, ALN 16.575 - Subrecipient Eligibility Management Views MDHHS agrees with the finding. Planned Corrective Action MDHHS Division of Victim Services (DVS) has distributed a comprehensive checklist to all Victims of Crime Act (VOCA) grant applicants that will...
Finding 2022-036 Crime Victim Assistance, ALN 16.575 - Subrecipient Eligibility Management Views MDHHS agrees with the finding. Planned Corrective Action MDHHS Division of Victim Services (DVS) has distributed a comprehensive checklist to all Victims of Crime Act (VOCA) grant applicants that will require certification of eligibility for funding by the applicant and DVS prior to awarding funds. This checklist has been incorporated into the rollover application for fiscal year 2024. Anticipated Completion Date The checklist will be certified by all grant applicants and DVS by October 1, 2023, for the fiscal year 2024 award period. Responsible Individual(s) Twanisha Glass, MDHHS Patsy Baker, MDHHS
Finding 23696 (2022-031)
Significant Deficiency 2022
Finding 2022-031 Pandemic EBT Food Benefits, ALN 10.542 - Overpayment of Benefits Management Views MDHHS agrees with the finding. Planned Corrective Action During the school year, the two students in the identified case were enrolled in GSRP and issued benefits on January 28, 2022, based on the s...
Finding 2022-031 Pandemic EBT Food Benefits, ALN 10.542 - Overpayment of Benefits Management Views MDHHS agrees with the finding. Planned Corrective Action During the school year, the two students in the identified case were enrolled in GSRP and issued benefits on January 28, 2022, based on the school file. These students enrolled in early childhood before the end of the school year, so they were also identified in the childcare group and were subsequently issued duplicate benefits as part of the Summer Pandemic EBT issuance on August 24, 2022. A technical solution is currently being evaluated to identify additional steps that may be implemented that cross references students across eligibility groups to ensure that duplicate payments are not issued. Anticipated Completion Date MDHHS expects to determine additional steps for a technical solution by September 30, 2023. Responsible Individual(s) Kathy Cornell, MDHHS
View Audit 20093 Questioned Costs: $1
Finding 2022-028 SNAP Cluster, ALN 10.551 and 10.561 - EBT Reconciliations Management Views MDHHS agrees with the finding. Planned Corrective Action MDHHS has been working with the vendor and DTMB data warehouse technical staff to update and correct the Benefit Issuer Food Stamp Report (BT-90) so ...
Finding 2022-028 SNAP Cluster, ALN 10.551 and 10.561 - EBT Reconciliations Management Views MDHHS agrees with the finding. Planned Corrective Action MDHHS has been working with the vendor and DTMB data warehouse technical staff to update and correct the Benefit Issuer Food Stamp Report (BT-90) so that it includes recipients who received Supplemental Nutrition Assistance Program (SNAP) benefits under the expanded COVID-19 eligibility requirements. The BT-90 is used to help ensure the client information in Bridges is accurate and does not have an impact on the federal draw. Anticipated Completion Date December 31, 2023 Responsible Individual(s) Sara Gross, MDHHS
Finding 2022-006 Income Eligibility and Verification System Management Views MDHHS and DTMB agree with parts c., d., e., and g. of the finding. MDHHS and DTMB disagree with parts a., b., and f. of the finding. For parts a. and b., MDHHS agrees with the recommendations. However, MDHHS disagrees wi...
Finding 2022-006 Income Eligibility and Verification System Management Views MDHHS and DTMB agree with parts c., d., e., and g. of the finding. MDHHS and DTMB disagree with parts a., b., and f. of the finding. For parts a. and b., MDHHS agrees with the recommendations. However, MDHHS disagrees with the exceptions identified for 1 of the 6 cited interfaces. For one interface, that impacted three cases, the interface updated appropriately, as designed, where needed. The interface did not need to update the case for citizenship and worker action was not required because citizenship was verified appropriately using another method and citizenship was not in question. For part f., MDHHS disagrees that Income Eligibility Verification System (IEVS) information is required to be requested and obtained for modified adjusted gross income (MAGI) based recipients since eligibility is verified upon determination through the MAGI eligibility determination process and then granted for a 12-month continuous eligibility period. Requesting and obtaining IEVS information throughout the eligibility period would be irrelevant since eligibility is continuous. Planned Corrective Action For parts a., b., and c., MDHHS?s ESA will continue to provide training and policy support to ensure that the local office specialists appropriately utilize the IEVS interface information in determining recipients? eligibility when applicable. ESA is developing and prioritizing a technical solution that will ensure the IEVS information is being addressed timely and used correctly in eligibility determinations. For part d., MDHHS is collaborating with other work areas to facilitate the match process for the IEVS interfaces for recipients funded by Temporary Assistance for Needy Families adoption subsidies. For part e., DTMB will review the process of how it receives the Public Assistance Reporting Information System (PARIS) file from their partners and transmits it to MDHHS Bridges. DTMB will investigate potential process improvements to limit the likelihood of the PARIS file not being transmitted. For part f., MDHHS disagrees with the finding and does not intend to take further action. For part g., MDHHS, with U.S. Department of Agriculture (USDA) Food and Nutrition Service guidance, will explore opportunities with Treasury, Tribal partners, and independent casinos to determine the feasibility of a gaming data match. Anticipated Completion Date a., b., and c. Training and policy support is ongoing. MDHHS anticipates that the technical solution will be completed by December 31, 2023. d. September 30, 2024 e. DTMB anticipates the process improvements will be implemented by September 30, 2023. f. Not applicable g. September 30 2024 Responsible Individual(s) a., b., c., and g. Dawn Sweeney, MDHHS d. Kathonya Rice, MDHHS e. Nathan Buckwalter, DTMB f. Logan Dreasky, MDHHS
View Audit 20093 Questioned Costs: $1
Finding 2022-004 Bridges Security Management and Access Controls Management Views MDHHS agrees with parts a., b., and d. through g. of the finding. MDHHS and DTMB disagree with part c. of the finding. For part c., although MDHHS and DTMB had not fully documented all database specific configuratio...
Finding 2022-004 Bridges Security Management and Access Controls Management Views MDHHS agrees with parts a., b., and d. through g. of the finding. MDHHS and DTMB disagree with part c. of the finding. For part c., although MDHHS and DTMB had not fully documented all database specific configuration standards until after the audit period, DTMB disagrees that during the audit period the system contained potentially vulnerable database configurations and disagrees that DTMB cannot ensure the security of the data. DTMB has been and continues to implement the manufacturer?s recommendations regarding security configurations. In addition, the databases reside in restricted trusted internal security zones, protected by firewalls, which are specific to each application and database, in conjunction with intrusion protection, antivirus software, and SOM standard security safeguards. Planned Corrective Action For parts a., d., and e., MDHHS will implement the Database Security Application (DSA) Bridges form which establishes a method to document user access request approval electronically and includes a semi-annual review of privileged users and an annual review of all users that is required to prevent automatic removal of access. For part b., MDHHS will prioritize updates to Bridges that will require the local office security coordinator (LOSC) to document security monitoring reports within Bridges alerts and generate a reminder to the LOSC and their manager to reconcile the report. Before the alert can be closed, the LOSC will be required to enter comments for actions taken and approve the report. For part c., DTMB developed an organization-wide framework for database security configuration management. For part f., MDHHS?s Economic Stability Administration (ESA) issued a revised memo on October 3, 2022, to Business Service Centers (BSCs) and local offices to reiterate the need for reviewing, documenting, and completing the required high-risk transaction reports timely. For part g., during February 2022, MDHHS?s Bridges Resource Center (BRC) revised their reconciliation process of high-risk transactions to comply with the changed policy requirements and ensure separate reviews are performed for each type of high-risk transaction. MDHHS?s ESA issued a revised memo on July 11, 2022, to address changes made for non-BRC Central Office staff transactions to reiterate the need for reviewing, documenting, and completing the required high-risk transactions timely. Also, an email reminder is sent out two days prior to the high-risk transaction report due date to help ensure timeliness of the reviews. Anticipated Completion Date a, d., and e. MDHHS anticipates the first phase of the DSA Bridges form will be implemented by October 2023 as a pilot and then roll out statewide with full automation by September 2024. Semi-annual and annual reviews will begin 6 months and 12 months, respectively, from the time each DSA Bridges form is implemented for each respective user. b. August 2024 c. DTMB anticipates having compliance documentation by September 30, 2023. f. Completed with ongoing monitoring. g. Completed Responsible Individual(s) a., b., d., and e. Deon Nelson, MDHHS c. Nathan Buckwalter, DTMB f. MDHHS ESA and BSC Directors g. Todd Gore and Russell Gruber, MDHHS
Finding 23648 (2022-003)
Significant Deficiency 2022
Finding 2022-003 Bridges Interface Controls Management Views DTMB disagrees with part a. of the finding. MDHHS agrees with part b. of the finding. For part a., DTMB disagrees the interface over the Bridges Integrated Automated Eligibility Determination System (Bridges) data exchanges is not operat...
Finding 2022-003 Bridges Interface Controls Management Views DTMB disagrees with part a. of the finding. MDHHS agrees with part b. of the finding. For part a., DTMB disagrees the interface over the Bridges Integrated Automated Eligibility Determination System (Bridges) data exchanges is not operating as needed. For one interface, the auditors sampled 27 different daily batches, including 9,945 records, and only four records (0.04 percent) were cited by the auditors as having inconsistencies. DTMB reviewed these four records and determined they were processed in accordance with business rules and the reporting inconsistency identified did not impact the accuracy of the reconciliation. Additionally, the auditors did not identify inconsistencies in the other eight interfaces sampled across multiple days, which totaled more than 2.95 million records. Therefore, the interface controls are effective and reasonably ensure that data transferred from a source system to a receiving system is processed accurately, completely, and timely. Planned Corrective Action For part a., DTMB disagrees with the finding and does not intend to take further action. For part b., MDHHS, in collaboration with the business program area, will work to establish all missing agreements. Anticipated Completion Date a. Not applicable b. September 30, 2023 Responsible Individual(s) a. Heather Frick and Nathan Buckwalter, DTMB b. James Bowen and Candy Calvert, MDHHS
In collaboration with DLT and its IES vendor, EOHHS has made plans to move the RI Bridges PEV data query to a later date in the month to ensure PEV occurs after the quarterly DLT SWICA refresh date. This will ensure EOHHS is capturing more delinquent wage records (reported late by employers) before...
In collaboration with DLT and its IES vendor, EOHHS has made plans to move the RI Bridges PEV data query to a later date in the month to ensure PEV occurs after the quarterly DLT SWICA refresh date. This will ensure EOHHS is capturing more delinquent wage records (reported late by employers) before the file is sent. EOHHS and DLT are also assessing an option to add a monthly SWICA update file in addition to the existing quarterly file. Furthermore, EOHHS is pursuing system enhancements to integrate state wage data provided by Equifax?s The Work Number (TWN) to RI Bridges. Adding TWN data, which is provided by pay period, to quarterly SWICA files would enable RI Bridges to process renewals and validate post-eligibility income with more frequently available wage data. Anticipated Completion Date: To Be Determined. EOHHS and DLT continue to discuss technical aspects of a monthly update file exchange. System requirements to integrate Equifax TWN data is included in Medicaid?s SFY24 Annual Planning process and will be scheduled for deployment later in CY2024. Contact Person: Brian Tichenor, RIBridges Medicaid Administrator Executive Office of Health and Human Services brian.tichenor@ohhs.ri.gov
2022-069a ? There are ongoing projects efforts with the Gainwell Technologies (the MMIS Fiscal Agent) to clean up the gaps in the TPL process that leads to inaccurate TPL data within the MMIS, those projects include: ? Changing the logic in the MMIS to end date members active TPL segments when Medic...
2022-069a ? There are ongoing projects efforts with the Gainwell Technologies (the MMIS Fiscal Agent) to clean up the gaps in the TPL process that leads to inaccurate TPL data within the MMIS, those projects include: ? Changing the logic in the MMIS to end date members active TPL segments when Medicaid eligibility is lost ? Cleaning up active TPL segments for members with dates of death in the MMIS ? Project request to clean up inaccurate Policy begin dates that are being changed by incoming ?MMA file? (From CMS) data ? Project to update coverage type codes for Medicare Advantage plans to have their own distinct code ? Expanding logic on MMA file to include more Medicaid members so more Medicare information can be taken in by the MMIS Additionally, there is work with Deloitte and Gainwell to ensure we have accurate TPL information within the RIBridges system. 2022-069b ? EOHHS has worked with Gainwell Technologies (the MMIS Fiscal Agent) to supply the MCOs with monthly files that include their enrolled members who have active TPL information within MMIS. These files have been generated and QCd by the systems team. We are currently in process with the MCO team to determine how these files will be delivered to the MCOs and define the expectations of how the MCOs use these files. Anticipated Completion Date: December 2024 Contact Person: Jeffrey Schmeltz, Chief of Family Health Systems Executive Office of Health and Human Services jeffrey.schmeltz@ohhs.ri.gov
View Audit 23102 Questioned Costs: $1
Finding 23521 (2022-068)
Significant Deficiency 2022
2022-068a ? EOHHS addressed issues with the TPL loopback file between MMIS and RI Bridges with a permanent system fix. 2022-068b ? EOHHS will assess the current process of Medicaid Administration claiming and develop a revised process to require HHS agencies to submit the reconciliations of their q...
2022-068a ? EOHHS addressed issues with the TPL loopback file between MMIS and RI Bridges with a permanent system fix. 2022-068b ? EOHHS will assess the current process of Medicaid Administration claiming and develop a revised process to require HHS agencies to submit the reconciliations of their quarterly reports to reported expenditures in RIFANS. In addition, the RIFANS documentation will be reviewed and approved prior to submission of the federal report. 2022-068c ? EOHHS will conduct this analysis and create a process to report the MCO tax on the CMS 64.11A. Anticipated Completion Date: December 2023; TPL loopback deployed into RI Bridges production on 5/19/2022. Contact Persons: Brian Tichenor, RIBridges Medicaid Administrator Executive Office of Health and Human Services brian.tichenor@ohhs.ri.gov Allison Shartrand, Assistant Director Financial and Contract Management Executive Office of Health and Human Services allison.shartrand@ohhs.ri.gov Chaz Plungis, Chief of Strategic Planning, Monitoring and Evaluation Executive Office of Health and Human Services charles.plungis@ohhs.ri.gov
2022-067a ? In amendment 5 with the health plans, signed in the fall of 2021, EOHHS strengthened its contractual requirements with the health plans by requiring the plans to reconcile differences between claims submitted and accepted via the encounter submission process to encounterable claims as re...
2022-067a ? In amendment 5 with the health plans, signed in the fall of 2021, EOHHS strengthened its contractual requirements with the health plans by requiring the plans to reconcile differences between claims submitted and accepted via the encounter submission process to encounterable claims as reported in the quarterly financial data cost reports within 0.1%. The contract at section 2.13.02.04 includes the following language: ?Contractor is responsible to reconcile Financial Data Cost Report (FDCR) cost allocations and the File Submission Report (FSR), which contains the encounter data reporting outlined above. The reported Incurred Expenditures submitted in the File Submission Report must align with the sum of the Direct Paid, Non-State Plan Paid, and Subcapitated Proxy Paid expenditures submitted in the Financial Data Cost Report for each state fiscal year within the point one percent (.1%) threshold. The FSR and FDCR used for this comparison will include the same paid run-out period. Failure to meet threshold will result in financial penalty and/or corrective action by EOHHS as outlined in ?Rhode Island Medicaid Managed Care Encounter Data Methodology, Thresholds and Penalties for Non-Compliance.?? Achieving this level of compliance has proven more difficult than anticipated. To date, EOHHS has not imposed any financial penalties as a result of this new requirement. We have, however, worked proactively with the health plans to resolve outstanding issues and reconcile differences. EOHHS staff meet with managed care staff regularly throughout the month to resolve issues that arise during the claims submission process and to determine the root cause for claim rejections. This work is ongoing. EOHHS plans to further strengthen its oversight and improve plan compliance with the procurement of the managed care contracts. That revised encounter data quality plan, which is subject to further modification into the fall as we prepare the revised procurement documentation, is available on EOHHS?s website, here: https://eohhs.ri.gov/sites/g/files/xkgbur226/files/2021-10/4.1-rhode-island-medicaid-managed-care-encounter-data-quality-measurement-20210826.pdf Anticipated Completion Date: Ongoing Contact Person: Bill McQuade, Chief of Program Analytics Executive Office of Health and Human Services bill.mcquade@ohhs.ri.gov 2022-067b ? Over the course of the last two FY audits, EOHHS continued to make improvements to automatically identify and terminate Medicaid eligibility for deceased individuals. EOHHS has completed root cause analysis and has submitted business requirements for SFY24 Annual Planning to resolve downstream issues in the MMIS when Date of Death (DoD) is not received from RI Bridges or associated interface. EOHHS has submitted both an interim business plan (IBP) and permanent system interface modification to align date of death data between RI Bridges and MMIS. Anticipated Completion Date: Ongoing. IBP is scheduled for implementation in June 2023, while the permanent system modification will be scheduled later in CY2024 post SFY24 annual planning decisions. Contact Person: Brian Tichenor, RIBridges Medicaid Administrator Executive Office of Health and Human Services brian.tichenor@ohhs.ri.gov
View Audit 23102 Questioned Costs: $1
EOHHS in partnership with is Fiscal Agent who manages our provider enrollment unit, have engaged in a project with our Managed Care Organizations to appropriately enroll and screen providers who are enrolled and credentialed in managed care networks. There have been four (4) mailing waves in which ...
EOHHS in partnership with is Fiscal Agent who manages our provider enrollment unit, have engaged in a project with our Managed Care Organizations to appropriately enroll and screen providers who are enrolled and credentialed in managed care networks. There have been four (4) mailing waves in which approximately ~24,000 letters were sent to providers by the MCOs requesting their providers to enroll. Currently, MCOs are reporting an in-network RI Medicaid screened compliance percentage of seventy-eight percent (78%). Additionally, EOHHS and the Fiscal agent have developed encounter edits to reject encounters if an MCO submits and encounter for an in-network provider, that has enrolled with an MCO but has not been screen by RI Medicaid after one-hundred twenty (120) days from enrollment with said MCO. Additional edits were put in place to reject encounters for out of network providers who provide more than one (1) instance of care to an individual and have not been screened by RI Medicaid. EOHHS has updated MCO contracts to reflect compliance with this requirement and requested the MCOs being reviewing networks and network adequacy requirements to comply with Cures Act requirements. Anticipated Completion Date: June 30, 2023 Contact Persons: Matt Kiehnle, Administrator for Medical Services Executive Office of Health and Human Services matthew.kiehnle@ohhs.ri.gov Chantele Rotolo, Managed Care Special Project Coordinator Executive Office of Health and Human Services chantele.rotolo@ohhs.ri.gov
2022-064a ? Over the course of the last two FY audits, EOHHS continued to make system improvements for controls over CHIP eligibility determinations. In response to the OAG finding two individuals out of the 40 tested covered by existing health coverage at the time of the claim, EOHHS assessed that...
2022-064a ? Over the course of the last two FY audits, EOHHS continued to make system improvements for controls over CHIP eligibility determinations. In response to the OAG finding two individuals out of the 40 tested covered by existing health coverage at the time of the claim, EOHHS assessed that one case didn?t have TPL data in Bridges due to HMO loopback file not being operational at time of OAG?s audit. The other case had eligibility run prior to the deployment of the TPL system fix on 5/19/2022. With regard to the lack of documentation for citizenship of one individual considered ineligible, EOHHS determined that this was an older case converted from InRhodes and never had eligibility run by a worker/member in RI Bridges. All eligibility runs were from mass update, which doesn?t hit the SSA composite to verify citizenship; therefore when OAG reviewed this case, auditor was not able to view that citizenship had been verified. The case has since had their eligibility run by a worker and citizenship has been verified. 2022-064b ? EOHHS will return the federal funds to the feds in June 2023. Anticipated Completion Date: EOHHS addressed issues with the TPL loopback file between MMIS and RI Bridges with a permanent system fix ? deployed into RI Bridges production on 5/19/2022. Contact Person: Brian Tichenor, RIBridges Medicaid Administrator Executive Office of Health and Human Services brian.tichenor@ohhs.ri.gov
View Audit 23102 Questioned Costs: $1
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