Finding 9913 (2023-007)

Significant Deficiency Repeat Finding
Requirement
E
Questioned Costs
-
Year
2023
Accepted
2024-01-25
Audit: 13548
Organization: Edgecombe County (NC)

AI Summary

  • Core Issue: Significant deficiencies in eligibility documentation for Medicaid, leading to potential inaccuracies in assistance provided.
  • Impacted Requirements: Compliance with 42 CFR 435, which mandates proper documentation and electronic verification for eligibility determinations.
  • Recommended Follow-Up: Conduct internal reviews of files, retrain workers on documentation standards, and ensure all files include necessary verifications and clear case notes.

Finding Text

US Department of Health and Human Services Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL # 93.778 Inadequate Finding: 2023-007 Request for Information SIGNIFICANT DEFICIENCY ELIGIBILITY Recommendation: Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources of income and those amounts agree to information in NC FAST. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. Views of responsible officials and planned corrective actions: The county agrees with the finding. Please refer to the corrective action plan for details. Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Effect: For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST which could affect countable resource. Therefore, applicants could have received assistance for which they were not eligible. Context: We examined 60 from a total of 911,554 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to re-determine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2022-006. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2022-005. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Criteria: In accordance with 42 CFR 435, documentation must be obtained as needed to determine if a recipient meets specific standards, and documentation must be maintained to support eligibility determinations. Electronic matches are required at applications and redeterminations. Condition: There were 14 errors discovered during our procedures that inadequate information was requested at applications and/or redeterminations. Recommendation: Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources of income and those amounts agree to information in NC FAST. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. Views of responsible officials and planned corrective actions: The county agrees with the finding. Please refer to the corrective action plan for details. Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility.

Corrective Action Plan

Finding: 2023-007 Inadequate Request for Information Finding: 2023-008 Untimely Review of SSI Termination Section III - Federal Award Findings and Question Costs (continued) Corrective Action: MA-1000 SSI Medicaid Automated Process Section VII - SSI Terminations training will be conducted with all workers. SSI termination reports will be monitored to ensure that there is not an untimely review of terminated SSI recipients. Documentation templete will be used to ensure that all online verifications have been completed and the evidence matches the information in NCFAST. Medicaid Supervisors and Quality Control workers will review files internally to ensure that OVS is ran and AB is evaluated for all Medicaid programs when SSI is terminated. Name of contact person: Veronica Lyons, Tina Radford, Virginia Ewuell, & Angel Joyner - Medicaid Supervisors Corrective actions for finding 2023-004, 2023-005, 2023-006, 2023-007, 2023-008 also apply to the State Award findings. Edgecombe County, NC Section IV - State Award Findings and Question Costs Corrective Action: MA-2261 1/3 Reduction, MA-2280 CAP, and MA-2230 Financial Resources training completed with all workers. Caseworkers will be instructed to end date evidence and start a new evidence for the new receritification period to show the updated information. Caseworkers will be instructed to run OVS/AVS prior to working any evidence in the case. Documentation template will serve as a reminder to ensure online verifications are ran on each case. Medicaid Supervisors and Quality Control workers will review files internally to ensure policy is applied to all cases and online verifications are completed and documented. Proposed Completion Date: Training and implementation of additional reviews and procedures will be implemented by February 15, 2024.

Categories

Eligibility Significant Deficiency

Other Findings in this Audit

  • 9910 2023-004
    Significant Deficiency Repeat
  • 9911 2023-005
    Significant Deficiency Repeat
  • 9912 2023-006
    Significant Deficiency Repeat
  • 9914 2023-008
    Significant Deficiency Repeat
  • 586352 2023-004
    Significant Deficiency Repeat
  • 586353 2023-005
    Significant Deficiency Repeat
  • 586354 2023-006
    Significant Deficiency Repeat
  • 586355 2023-007
    Significant Deficiency Repeat
  • 586356 2023-008
    Significant Deficiency Repeat

Programs in Audit

ALN Program Name Expenditures
21.027 Coronavirus State and Local Fiscal Recovery Funds $5.99M
93.778 Medical Assistance Program $1.78M
93.563 Child Support Enforcement $984,140
93.558 Temporary Assistance for Needy Families $944,426
10.561 State Administrative Matching Grants for the Supplemental Nutrition Assistance Program $732,296
93.568 Low-Income Home Energy Assistance $634,693
10.760 Water and Waste Disposal Systems for Rural Communities $503,000
93.658 Foster Care_title IV-E $465,309
93.667 Social Services Block Grant $415,990
10.557 Special Supplemental Nutrition Program for Women, Infants, and Children $233,159
93.994 Maternal and Child Health Services Block Grant to the States $203,961
93.045 Special Programs for the Aging_title Iii, Part C_nutrition Services $164,484
93.044 Special Programs for the Aging_title Iii, Part B_grants for Supportive Services and Senior Centers $142,342
93.596 Child Care Mandatory and Matching Funds of the Child Care and Development Fund $119,410
20.600 State and Community Highway Safety $72,727
93.268 Immunization Cooperative Agreements $71,746
93.217 Family Planning_services $55,168
93.659 Adoption Assistance $41,632
97.042 Emergency Management Performance Grants $39,032
93.767 Children's Health Insurance Program $34,381
93.391 Activities to Support State, Tribal, Local and Territorial (stlt) Health Department Response to Public Health Or Healthcare Crises $32,961
93.069 Public Health Emergency Preparedness $31,126
93.991 Preventive Health and Health Services Block Grant $30,651
93.053 Nutrition Services Incentive Program $28,576
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $24,544
93.116 Project Grants and Cooperative Agreements for Tuberculosis Control Programs $21,061
16.001 Law Enforcement Assistance_narcotics and Dangerous Drugs_laboratory Analysis $13,500
93.674 John H. Chafee Foster Care Program for Successful Transition to Adulthood $9,896
93.645 Stephanie Tubbs Jones Child Welfare Services Program $6,630
93.556 Promoting Safe and Stable Families $2,333
93.898 Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations $1,925