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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
DHS OCC is currently working with the Office of Internal Audits (OIA), DHS Collections, Claims and Recovery Unit (CCRU), Policy and Legal teams to review/update the existing DHS/OIA MOU and to operationalize recapture of overpayments resulting from fraudulent practices. CCAP regulations were update...
DHS OCC is currently working with the Office of Internal Audits (OIA), DHS Collections, Claims and Recovery Unit (CCRU), Policy and Legal teams to review/update the existing DHS/OIA MOU and to operationalize recapture of overpayments resulting from fraudulent practices. CCAP regulations were updated in 2018 to state that unintentional/error based overpayments to families would be reclaimed by CCRU and unintentional/error based overpayments to providers would be reclaimed by OCC Financial Management. This would require manual processing pending RIBridges functionality updates. In cases where OIA issues a determination of IPV/fraud OIA will refer the case to CCRU for collection and recoupment. Anticipated Completion Date: April 2024 Contact Person: Sharon Fitzgerald, CCAP Administrator Department of Human Services sharon.fitzgerald@dhs.ri.gov
View Audit 23102 Questioned Costs: $1
The Office of Child Care (OCC) has reviewed available training materials related to CCAP eligibility and case processing and has identified certain gaps where additional training/clarification, and more frequent communication to processing staff is needed ? specifically in income calculation/input o...
The Office of Child Care (OCC) has reviewed available training materials related to CCAP eligibility and case processing and has identified certain gaps where additional training/clarification, and more frequent communication to processing staff is needed ? specifically in income calculation/input of paystubs, confirming asset declarations and confirming need hours. OCC has requested to work with CSDL to create a CCAP specific training to provide in-depth coverage of program requirements. OCC has presented at quarterly meetings to highlight error findings and the critical importance of accurate documentation ? specifically citizenship of the child and residency. OCC works continuously with field staff and Deloitte through weekly theme meetings to identify areas where system changes can improve accuracy of eligibility determinations. OCC is currently reviewing the grace period/short-term approval policy, how it is applied to specific cases and how it is implemented in RIBridges. Anticipated Completion Date: April 2024 Contact Person: Sharon Fitzgerald, CCAP Administrator Department of Human Services sharon.fitzgerald@dhs.ri.gov
View Audit 23102 Questioned Costs: $1
DHS will complete training and review with field staff on the required documentation for RIW. This will include training with CSDL, office hours with eligibility field staff, attending supervisors meeting to verify documentation during case reviews, and utilizing new reports from MMIS. MMIS team a...
DHS will complete training and review with field staff on the required documentation for RIW. This will include training with CSDL, office hours with eligibility field staff, attending supervisors meeting to verify documentation during case reviews, and utilizing new reports from MMIS. MMIS team are developing a report for verification to be provided to RIW vendors to ensure accurate documentation is sent to DHS and is retained accurately. Anticipated Completion Date: June 30, 2024 Contact Person: Kimberly Rauch, RI Works / TANF Administrator Department of Human Services kimberly.rauch@dhs.ri.gov
View Audit 23102 Questioned Costs: $1
Due to the continuing changes to the guidance for these funds, the Department did not begin reconciliations of the funds until mid FY22. The Department has been reconciling the funds and expects to complete before FY23 close. We have not found instances where funds were reimbursed multiple times. ...
Due to the continuing changes to the guidance for these funds, the Department did not begin reconciliations of the funds until mid FY22. The Department has been reconciling the funds and expects to complete before FY23 close. We have not found instances where funds were reimbursed multiple times. Anticipated Completion Date: June 30, 2023 Contact Person: Dorothy Pascale, State Controller Department of Administration, Office of Accounts and Control dorothy.z.pascale@doa.ri.gov
This documentation will include expense reimbursements being prepared based on the Authority?s general ledger going forward. Anticipated Completion Date: Immediately Contact Person: Caroline Muldoon, Grants Specialist Rhode Island Public Transit Authority cmuldoon@ripta.com
This documentation will include expense reimbursements being prepared based on the Authority?s general ledger going forward. Anticipated Completion Date: Immediately Contact Person: Caroline Muldoon, Grants Specialist Rhode Island Public Transit Authority cmuldoon@ripta.com
2022-041a ? In April 2022, the Department implemented a new, modernized front end application. This application utilizes advanced fraud technology by partnering with Lexis Nexis. Claimant identity information is scrubbed and claimants who have a high potential for fraud are required to contact the...
2022-041a ? In April 2022, the Department implemented a new, modernized front end application. This application utilizes advanced fraud technology by partnering with Lexis Nexis. Claimant identity information is scrubbed and claimants who have a high potential for fraud are required to contact the Call Center for additional identity verification. Those not at high risk are presented identity verification quizzes before being allowed to file a claim for unemployment insurance. In April 2023, the Department is looking into additional enhancements to the existing Lexis Nexis tools as part of an ongoing effort to enhance fraud detection and prevention while also ensuring the system is accessible to claimants. In addition, the Department is discussing other technology possibilities that can assist in the identity verification process. We are hopeful to partner with DOL through TIGER TEAMS funding to achieve this. Anticipated Completion Date: December 31, 2023 2022-041b ? Regarding claw backs of ID theft overpayments, the Department has been collaborating with USDOL, other Region 1 states and Business Affairs to identify the best process for recovering ID theft fraud claw backs. Part of this work would involve enhancing the overpayment system to record these types of overpayments properly. Anticipated Completion Date: March 31, 2024 Contact Person: Dyana Bogan, Labor & Training Administrator Department of Labor & Training dyana.bogan@dlt.ri.gov
View Audit 23102 Questioned Costs: $1
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