Institutional Federal Compliance Report 2021

STATE OF NEW YORK

Schedule of Findings and Questioned Costs

March 31, 2019

Federal Agency:

United States Department of Health and Human Services

Federal Program:

Medicaid Cluster (93.775, 93.777, and 93.778)

Federal Award Numbers:

1805NY5MAP and 1905NY5MAP

Federal Award Years:

2018 and 2019

State Agency:

Department of Health

Reference:

2019-021

Criteria Title 42 U.S. Code of Federal Regulations Part 447 (42 CFR 447), Payments for Services , section 447.253(g) states the Medicaid agency must provide for periodic audits of the financial and statistical records of providers. Additionally, Title 45 U.S. Code of Federal Regulations Part 75 (45 CFR 75), Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards , section 75.303(a) states the nonfederal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the nonfederal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. In accordance with the New York State Plan Under Title XIX of the Social Security Act (the Act), Medicaid Assistance Program (OMB No. 0938-0193) citation 4.19, Payment for Services , the Medicaid agency meets the requirements of 42 CFR Part 447, Subpart C, and sections 1902(a)(13) and 1923 of the Act with respect to payment for inpatient hospital services. 42 CFR Part 447, Subpart C, and section 1902(a)(13)(A) of the Act requires that the State Plan provide for payment for hospital and long-term care facility services through the use of rates that the State finds, and makes assurances satisfactory to the Secretary, are reasonable and adequate to meet the costs that must be incurred by efficiently and economically operated facilities to provide services in conformity with State and Federal laws, regulations, and quality and safety standards. Section 1923 sets forth the methodology for determining the costs for individuals who have no health insurance or other source of third party coverage for services furnished during the year for purposes of calculating the hospital-specific disproportionate share hospital payment limit under section 1923(g) of the Act. Under citation 4.19(g) of the New York State Plan, the Medicaid agency assures appropriate audits of records when payment is based on costs of services or on the fee plus cost of materials. Condition During the fiscal year ended March 31, 2019, annual audits were not performed by the Department of Health (the Department) for institutional cost reporting periods ended December 31, 2016 and 2017. However, the audits of long-term care facilities were performed during the fiscal year March 31, 2019. The long-term care facility audits are performed internally within the Department by the Bureau of Residential Health Care Reimbursement.

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