Program: U.S. Department of Health and Human Services
Children’s Health Insurance Program (CHIP), 93.767
Eligibility
Material Weakness in Internal Control over Compliance
Finding Number: 22-059
Finding: Individuals were deemed eligible but were placed in an incorrect aid category or did not have sup...
Program: U.S. Department of Health and Human Services
Children’s Health Insurance Program (CHIP), 93.767
Eligibility
Material Weakness in Internal Control over Compliance
Finding Number: 22-059
Finding: Individuals were deemed eligible but were placed in an incorrect aid category or did not have supporting documentation available for review. Individuals may receive benefits that they are not entitled to or not receive benefits for which they are entitled to. The Division did not have adequate internal controls to ensure aid categories were accurate or applications for CHIP were maintained. Prior year finding 2021-056.
Corrective Action Taken: HOH UPI XXXXX2000/CHILD UPI XXXXX9100 – Worker failed to complete re-evaluation for higher aid code (REHA function) to obtain correct eligibility.
Corrective Action: REHA function was completed on 9/27/2021 to obtain correct eligibility.
HOH UPI XXXXX6100/CHILD UPI XXXXX6100 – The Division of Welfare and Supportive Services (Division) did not have adequate internal controls to maintain supporting documentation available for review.
Corrective Action: The Division has revised scanning procedures across the state, which includes routing more documents to our vendor for scanning, rather than being retained in each district office. The Division also utilizes an internal team, Records Management
Unit (RMU), that assists with Quality Assurance of all scanned documents.
HOH UPI XXXXX8000/CHILD UPI XXXXX3200 – The Division did not have adequate internal controls to maintain supporting documentation available for review.
Corrective Action: The Division has revised scanning procedures across the state, which includes routing more documents to our vendor for scanning, rather than being retained in each district office. The Division also utilizes an internal team, Records Management
Unit (RMU), that assists with Quality Assurance of all scanned documents.
Future Corrective Action:
The Division will collaborate with all appropriate parties to move from an annual mandatory REHA training to a semiannual mandatory REHA training (every 6 months), for field staff. A new Quality Assurance tip to field staff was provided on 11/10/2022 and an updated mandatory REHA training was administered with a required completion date for all field staff of 02/2023. The next REHA training is scheduled for January/February of 2024. The Division will also continue to follow the updated process for scanning of documents and utilize the RMU for increased Quality Assurance of documents.
The Eligibility and Payments (E&P) and Program Operations, Support & Targeted Outreach (POST) teams will work closely with the Internal Controls and Audit team within the Division to ensure internal controls are strengthened. The Division anticipates the internal controls to be updated within two months to reflect the release of a semi-annual REHA training, along with a new annual Quality Assurance REHA tip.
Agency Response
Does the Agency agree With the findings: Yes
If No or Partial, please explain reason(s) why: N/A
Individual Responsible for Corrective Action Plan:
Name, Title: Tonya Stevens, Social Services Chief III, Eligibility and Payments
Phone Number: 775-684-0553
Email: tstevens@dwss.nv.gov
Name, Title: Shelly Aguilar, Social Services Chief III, Program Operations, Support & Targeted Outreach
Phone Number: 702-631-2337
Email: saguilar@dwss.nv.gov
Reviewed and Approved
Tonya Stevens, Chief III, Eligibility and Payments