State Medicaid Inspector General Releases 2024 Work Plan and Guidance
The NYS Office of the Medicaid Inspector General (OMIG) has published its 2024 Work Plan, which will guide its activities over the coming year. The Work Plan includes the following elements of interest to LeadingAge NY members:
Compliance Program Reviews: OMIG will conduct compliance program reviews of providers to assess whether the provider’s compliance program is implemented and operating as required.
Self-Disclosure: OMIG will continue to process submissions received under the new Abbreviated Self-Disclosure Process and the Full Self-Disclosure Process. OMIG recently posted updates to its Self-Disclosure Frequently Asked Questions and Guidance document. More information about Self-Disclosure is available here. The Work Plan notes that the Self-Disclosure Program also provides a mechanism for providers to report damaged, lost, or destroyed Medicaid claiming records; such disclosures should be made no later than 30 calendar days following discovery.
Managed Care
- Enhanced Nursing Home Capitation Payments – OMIG will work to identify instances where the Medicaid Managed Care Organization (MMCO) did not qualify for enhanced reimbursement level.
- Partial Cap MLTC – Eligibility and Care Management – OMIG will seek recoveries when it identifies inappropriate capitation payments due to a lack of services, loss of eligibility, or delayed disenrollment.
- Medicaid Advantage Plus (MAP) – Eligibility and Care Management – OMIG will review these plans to evaluate the eligibility of members and whether the care management is aligned with care plans and assessments in mid-to-late 2024.
Nursing Homes
- Nursing Home Rate Audits – OMIG will continue to ensure that facilities comply with the Department of Health's (DOH) policy and reimbursement regulations and will audit submitted costs and data related to the capital calculations and ancillary services.
- Minimum Data Set (MDS) Reviews – OMIG will continue to review the accuracy of MDS submissions for selected nursing homes, completing the 2018 audit period and starting the 2019 audit period in 2024.
The Work Plan also includes plans to audit the following community-based long term care providers, posting audit protocols for some of the provider types:
- Adult Day Health (no audit protocol posted)
- Assisted Living Programs
- Home Health (Episodic Payment)
- Personal Care Services
- Consumer Directed Personal Assistance Program
- Nursing Home Transition and Diversion Waiver
Health Care Worker Bonuses
OMIG has implemented processes for the Employer Self-Disclosure of overpaid Health Care Worker Bonus (HWB) funds and will continue to process submissions received.
Contact: Karen Lipson, klipson@leadingageny.org