Finding Number 2024-048 U.S. Department of Health and Human Services Children’s Health Insurance Program (CHIP), 93.767 Summary of Finding: Amounts reported on the CMS-21 were not supported by the underlying accounting information. NVHA did not have adequate internal controls to ensure CMS-21 report...
Finding Number 2024-048 U.S. Department of Health and Human Services Children’s Health Insurance Program (CHIP), 93.767 Summary of Finding: Amounts reported on the CMS-21 were not supported by the underlying accounting information. NVHA did not have adequate internal controls to ensure CMS-21 reports were accurate or supporting documentation for reconciling items was maintained. A nonstatistical sample of two CMS-21 reports out of a population of four was selected for testing. NVHA was unable to provide Support for the following variances: December 31, 2023 CMS-21 Report Amount Reported Amount Supported Line 1a - Premiums Up to 150% of Poverty Level – Gross Premiums Paid $12,790,058 $10,620,925 Line 9 - Dental Services $603,625 $2,772,759 Line 18 – Screening Services $54,880 $57,168 March 31, 2024 CMS-21 Report Amount Reported Amount Supported Line 1a - Premiums Up to 150% of Poverty Level – Gross Premiums Paid $9,192.633 $7,629,522 Line 8 – Prescribed Drugs $295,759 $321,092 Line 9 - Dental Services $755,375 $2,318,487 We recommend NVHA enhance internal controls to ensure CMS-21 reports are accurate and supporting documentation is maintained. NVHA Response: The Nevada Health Authority agrees with this finding. Contact Person(s): Russ Steele, Audit Manager Corrective Action Planned: The Division has enhanced its internal controls to ensure the accuracy of CMS-21 reports and the proper maintenance of supporting documentation. The following measures have been implemented: 1.System of Record – DAWN: The state’s accounting system, DAWN, continues to serve as the Division’s official system of record for compiling CMS-21 reports. 2.Documentation of Transactions: The Division has transitioned to an electronic recordkeeping system for all financial transactions. This change enhances the accuracy, consistency, and accessibility of financial records while supporting improved internal controls. Electronic documentation is now maintained in accordance with established policies and is readily available for review, permitting more efficient audit processes and ensuring compliance with applicable record retention requirements. 3.Reporting Requirements for Certain Service Costs: Currently, several service costs are commingled within MMIS. To address this, the Division performs data downloads from MMIS to separate and identify these costs appropriately for CMS-21 reporting. The Federal Reporting Unit will ensure these MMIS reports are maintained to provide transparency and traceability. 4.Collaboration with Fiscal Agent: The Division is actively collaborating with its Fiscal Agent, Gainwell, to improve CMS-21 reporting. This includes the development of new “fiscal strings” designed to capture and isolate specific costs that must be reported separately. These efforts aim to enhance transparency and accuracy in federal reporting. These improvements reflect the Division’s commitment to strengthening financial reporting processes, ensuring compliance with federal requirements, and maintaining robust documentation standards. Anticipated Completion Date of Corrective Action Plan: September 2025