U.S. Department of Health and Human Services Pass-through Entity: North Carolina Department of Health and Human Services Program Name: Medical Assistance Federal A...
U.S. Department of Health and Human Services Pass-through Entity: North Carolina Department of Health and Human Services Program Name: Medical Assistance Federal Assistance Listing Number: 93.778 Material Weakness and Non-Material Non-Compliance - Eligibility Finding 2022-002 Corrective Action Plan: I. Training a. The Quality and Training unit within the Economic Services Division (ESD) will review the findings and create and deliver training to staff that determine Medicaid eligibility and their supervisors and managers to address the specific errors identified during this audit, including but not limited to completing exparte determinations for eligibility when SSA terminates SSI eligibility, sending the 5097 to verify self-attest wages, properly documenting and reacting to IV-D non-cooperation, correct verification and documentation, and performing the required electronic verifications to complete an application or review. This training will be delivered by the end of the third quarter of fiscal year 2023. b. NC FAST Certification for Core Functions and Level One Medicaid policy is required by NC DHHS and completed in the NC FAST Learning Gateway for all staff that determine Medicaid eligibility. This is a staggered process initiated by NC DHHS. Mecklenburg County began this process in September 2021 with all new hires obtaining NC FAST Certification within 90 days of their hire. Existing staff that determine Medicaid eligibility were enrolled in January 2022 and will complete this training within 18 months to meet all state requirements. II. Process Improvement Strategies a. The division is continuing to hire Eligibility Specialist positions that will manage Medicaid cases. These added resources will help alleviate current workload challenges faced by existing staff and allow for a more thorough review of work being completed. b. In December 2022 Sr. Quality & Training Specialists were realigned to provide direct policy support to assigned teams. The assignment of specific Sr. Quality and Training Specialists to work directly with certain teams will enhance the relationship between Q&T, Eligibility staff and their Supervisors, with the goal of improving quality and timeliness of work. This realignment will more easily enable Sr. Quality & Training staff to correct errors identified through the second party review process and share those findings with the worker and their supervisor for learning and accountability purposes. c. A new Quality Assurance team will be created to validate the second party review process across all DSS divisions. This process will involve sampling records that have gone through the second party review process at the divisional level to ensure the review was accurate and that any errors were corrected. This team will also align second party review findings to audit findings to determine if training or process improvement strategies may improve quality. The team should be hired and standard operating procedures drafted by the 4th quarter of FY23. Ill. Quality Sampling and Accountability a. The Quality and Training Unit will complete monthly quality sampling for Medicaid. Error trends will be shared with the managers and their supervisors, who will work collaboratively with Quality & Training staff to coordinate appropriate strategies to train and coach staff to mitigate errors moving forward. b. Supervisors will review specific quality sampling results with their staff. The supervisor will, when necessary and appropriate, address continued errors using an individual Corrective Action Plan with the worker to include refresher training, additional second party review and/or initiating the formal documentation process. c. Managers will review quality sampling results with supervisors quarterly to follow up on errors addressed, trainings completed and progress with individual Corrective Action Plans. Person responsible: Jim Wright, Sr. Social Services Manager Ellese Massey, Social Services Manager Estimated date of completion: June 30, 2023