Re: Single County Audit Finding 2022-006, Significant Deficiency over Eligibility Cause: Caseworkers did not take proper steps ensuring what was used for eligibility determination was complete and accurate per program guidelines. Auditors Recommendation: Caseworkers should review eligibility deter...
Re: Single County Audit Finding 2022-006, Significant Deficiency over Eligibility Cause: Caseworkers did not take proper steps ensuring what was used for eligibility determination was complete and accurate per program guidelines. Auditors Recommendation: Caseworkers should review eligibility determinations and ensure all documentation is included and accurate. Corrective Action Plan: Agency realigned Medicaid to be under one Program Manager to ensure consistency with quality control and review. ? Program Manager, Supervisors, and Lead Workers created a Medicaid Quality Control plan to be followed by all units that includes pulling a random sample from each caseworker every month to include at least 2 approvals and 1 denial. ? The DHB 7078, Second Party Review Worksheet, is completed for each application or case pulled to ensure that policy and procedure is followed. The Explanation of Errors section is completed for any errors discovered and the completed DHB 7078 is then attached to an email and sent to the individual caseworker along with a detailed explanation providing policy and training materials, OST guidance, or emails that reinforce the decision to cite the error. As it relates specifically to the cited error above, the DHB 7078 section B. Documentation is used to review that all required documents are placed in the case record. ? Checklists have been created and are being utilized to prevent errors and all caseworkers have a copy of the DHB 7078 and are required to review prior to authorizing. ? When an error is discovered, the caseworker?s name, case number, and specific error are logged on a Quality Control spreadsheet. This spreadsheet is used to identify training issues and/or repetitive errors. The spreadsheet will be reviewed monthly by Supervisors and Lead Workers for their own unit and reviewed quarterly with all Medicaid Supervisors and Program Manager. ? Along with one-on-one emails that address the individual caseworker errors, group trainings will be held based on repetitive errors and knowledge checks will be utilized at the end of group trainings. ? If an individual caseworker has repeat findings after an error has been addressed there will be a meeting between the caseworker and the supervisor to discuss the issue. During this meeting, training, to include policy sections, training materials, OST guidance, and/or emails will be provided. The caseworker will be asked to sign a training acknowledgement form stating that they have received the training, understand the policy, have no questions, and understand that a full coaching will be implemented if the errors continue. The caseworker will have additional work reviewed for the next 30 days. Proposed Completion Date: Ongoing Name/ Position Contact Person: Kimberli Sholar, Medicaid Program Manager