2024-056a: During SFY 2024, several system fixes were deployed to address the findings noted in 2024-056. Specifically, in September 2024, a system fix was put in place to ensure children with verified SSNs were appropriately evaluated for Medicaid/CHIP coverage and excluded from Cover All Kids.
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2024-056a: During SFY 2024, several system fixes were deployed to address the findings noted in 2024-056. Specifically, in September 2024, a system fix was put in place to ensure children with verified SSNs were appropriately evaluated for Medicaid/CHIP coverage and excluded from Cover All Kids.
RI Bridges appropriately determines eligibility for CHIP when TPL data is not present. Once TPL information is known to the system, existing eligibility rules will only evaluate for Medicaid, not CHIP.
The TPL exceptions noted by the OAG show a discrepancy between TPL data in the MMIS and the information sent to RI Bridges via the TPL loopback file. EOHHS will work with their vendor to determine the root cause of the discrepancy and establish a corrective action plan if appropriate.
Rhode Island did not participate in the February 2024 PARIS interstate match due to a file issue that has since been addressed in April 2024. The May and August 2024 PARIS matches were suspended at the Federal level for all States due to an outstanding computer matching agreement between the DoD and HHS/ACF. Enhancements to existing PARIS Interstate match logic are scheduled to run as planned for fall/winter 2025.
Income/Wage Validation: EOHHS completed implementation of an interface on 3/5/24 between The Work Number (TWN) and RI Bridges. Contract and budget actions for TWN services were not completed until fall 2024. The system requirements that Equifax initially communicated to the State and our Integrated Eligibility System implementation partner were incomplete and the original integration configured in fall 2024 did not successfully pass testing. A system modification to correct the original specifications was originally scheduled for February 2025 but was delayed due to the 12/13/24 RI Bridges cyber event. Target date for TWN implementation is July 2025.
Anticipated Completion Date: July 1, 2025 for income/wage validation.
Contact Person: Anthony Salvo, Implementation Director of Policy and Programs, Executive Office of Health and Human Services
anthony.salvo@ohhs.ri.gov
2024-056b: The Center for Staff Development and Learning (CSDL) the lead for training at the Rhode Island Department of Human Services (RIDHS) will work towards correction by using a blended approach to learning using formal (classroom or virtual learning sessions) and on the job learning activities. will conduct the following:
a. The CSDL Team will continue to include in its Ex Parte Learning Series review of where the system performs an Ex Parte review to determine Medicaid eligibility for age outs ages 19, 26, and 65. In addition, included in the Medicaid Refresher, currently in development, a review will be done of updating income and verification procedures that includes end date and employment segments when household members lost employment.
b. The Operations staff supervisors will schedule processing labs that will require the participants to process live cases with guidance from a supervisor.
Anticipated Completion Date: The trainings and refresher learnings are ongoing. Processing labs are scheduled as need for this specific topic, we anticipate that processing labs will be scheduled and completed between July – September of 2025. The Medicaid Refresher Learning Series will be released in July. This training will also be ongoing.
Contact Person: Zulma Valenzuela, Assistant Director of Administrative Services, Center for Staff Development and Learning, Department of Human Services
zulma.valenzuela@dhs.ri.gov
2024-056c: As noted in prior year responses, CMS will not pursue recoveries associated with questioned costs given that recoveries based on eligibility errors can only be pursued when identified by programs operating under CMS’ Payment Error Rate Measurement program per section 1903(u) of the Social Security Act and regulations at 42 CFR Part 431, Subpart Q. This limits CMS’s ability to recover on most of the SSA eligibility findings. While CMS will pursue the internal control deficiencies noted by the SSA, CMS will not pursue recoveries associated with the questioned costs.
Anticipated Completion Date: Not Applicable
Contact Person: Anthony Salvo, Implementation Director of Policy and Programs, Executive Office of Health and Human Services
anthony.salvo@ohhs.ri.gov