Department of Health & Human Services Centers for Medicare & Medicaid Services 31 Forsyth Street, SW, Room 4T20 Atlanta, Georgia 30303-8909 The South Carolina Department of Health and Human Services respectfully submits the following corrective action plan for the year ended June 30, 2022. The fin...
Department of Health & Human Services Centers for Medicare & Medicaid Services 31 Forsyth Street, SW, Room 4T20 Atlanta, Georgia 30303-8909 The South Carolina Department of Health and Human Services respectfully submits the following corrective action plan for the year ended June 30, 2022. The findings from the schedule of findings and questioned costs are discussed below. The findings are numbered consistently with the numbers assigned in the schedule. FINDINGS ? FEDERAL AWARD PROGRAM AUDIT DEPARTMENT OF HEALTH AND HUMAN SERVICES 2022-005 Medicaid Cluster; Children?s Health Insurance Program (CHIP) ? Assistance Listing No. 93.775, 93.777, 93.778; 93.767 Recommendation: We recommend the Department strengthen controls over eligibility determinations to ensure documentation is maintained and reviewed in accordance with its State plan and federal regulations. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The agency continues to implement an Eligibility Performance and Remediation process, which includes internal Eligibility Quality Assurance (EQA) monthly case reviews, as well as third party case reviews conducted by the University of South Carolina Core for Applied Research and Evaluation (USC CARE). Eligibility Policies and Procedures provide instructions for a worker to ensure the case file is complete for all eligibility criteria based on policy, prior to making a determination. The policy is included in staff training and is evaluated as part of quality assurance activities. Supervisors are responsible for monitoring staff daily by using data available via system of record, the electronic document management system (OnBase), workload management software, as well as through case spot reviews. Supervisors meet monthly with each staff member to review Eligibility Quality Assurance (EQA) findings to identify and address issues that impact performance, as well as to facilitate corrections to incorrect determinations identified through the EQA process. Errors are identified via error codes and descriptions. EQA reviews are conducted and housed in a state-developed tool to allow for creation of reports that can be generated based on supervisor, worker, work type, error code or overall accuracy. The state compares errors identified through audits and federal reviews such as payment error rate measurement with internal and third party EQA error trends and use this monitoring method to identify trends, develop mitigation strategies and to determine impact of those strategies on these errors. During the 4th quarter of calendar year 2022, 15,716 cases were reviewed by EQA with the following results pertaining to missing documentation: Error Description, Q1 CY2022 % Cases Reviewed, Q2 CY2022 % Cases Reviewed, Q3 CY2022 % Cases Reviewed, Q4 CY2022 % Cases Reviewed: The application was not signed, 0.03%, 0.01%, 0.02%, 0.30%; The application could not be located in the case file, 0.02%, 0.03%, 0.01%, 0.03%; Level of care was not in the case file or in Phoenix, 0.02%, 0.01%, 0.01%, 0.01%; The case record was missing SSN or proof of application for SSN, 0.25% 0.36%, 0.26%, 0.00%; In response to these findings, the Eligibility department will conduct email and face-to-face communication with managers, supervisors and staff regarding these findings and a reminder of documentation requirements in policy, as well as to ensure supervisors are assessing for this requirement in casefile spot checks. This will also be discussed on an upcoming Eligibility Supervisor call and shared in the Eligibility, Enrollment, and Member Services Newsletter. These requirements will also continue to be emphasized in new worker and staff refresher training. Name(s) of the contact person(s) responsible for corrective action: Lori Risk Planned completion date for corrective action plan: Email, face-to-face and newsletter communications: June 2023; EQA Procedures, staff training ? Ongoing.