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Managed Care Annual Program Integrity Report

In January 2018, Managed Long Term Care (MLTC) plans will be required to complete and upload the Annual Program Integrity Report for calendar year 2017 through the Health Commerce System (HCS). The report form and instructions were recently posted to the HCS and can be accessed as follows:

To get to the form, log in to HCS. In the top toolbar on the homepage, click the drop-down menu arrow next to My Content, and click on All Applications. Click on the “M” and then MCO Reports to DOH/OMIG Submission Page.

On the MCO Reports to DOH/OMIG Submission Page, you will see a section titled "Managed Care Annual Program Integrity Report." Within that section is a link to the form and an upload button to submit the form.

The requirement for MLTC plans to conduct an assessment of their conformity with all regulatory and contractual Medicaid program integrity obligations and to submit a report to the Office of the Medicaid Inspector General (OMIG) in connection with their annual assessment is reflected in the MLTC Partial Capitation Contract.

Consistent with the Centers for Medicare and Medicaid Services (CMS) Medicaid Integrity Program Manual definition of Medicaid integrity, the New York State Department of Health (DOH) and OMIG have determined that the following areas should be assessed in accordance with the contract: planning, prevention, detection, and investigation/recovery activities, as they relate to the prevention or detection of Medicaid fraud, waste, and abuse. The Annual Program Integrity Report form addresses activities related to these four areas.

Questions regarding the report and/or submission process should be addressed to mcopireport@omig.ny.gov.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841