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:

1905NY5MAP , 1805NY5MAP, 1705NY5MAP, 51605NY5MAP, 1905NYINCT, and 1805NYINCT

Federal Award Years:

2016, 2017, 2018, and 2019

State Agency:

Department of Health

Reference:

2019-022

Criteria 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 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. Additionally, Title 42 U.S. Code of Federal Regulations Part 438 (42 CFR 438), Continued services to beneficiaries and Monitoring procedures , section 438.62(a) states The State agency must arrange for Medicaid services to be provided without delay to any Medicaid enrollee of an MCO, PIHP, PAHP, PCCM or PCCM entity the contract of which is terminated and for any Medicaid enrollee who is disenrolled from an MCO, PIHP, PAHP, PCCM or PCCM entity for any reason other than ineligibility for Medicaid. Further, Title 42 U.S. Code of Federal Regulations Part 456 (42 CFR 438), Monitoring procedures , section and 438.66(b) states The State’s system must address all aspects of the managed care program, including the performance of each MCO, PIHP, PAHP, and PCCM entity (if applicable) in at least the following areas: (1) Administration and management, (2) Appeal and grievance systems, (3) Claims management, (4) Enrollee materials and customer services, including the activities of the beneficiary support system, (5) Finance, including medical loss ratio reporting, (6) Information systems, including encounter data reporting, (7) Marketing, (8) Medical management, including utilization management and case management, (9) Program integrity, (10) Provider network management, including provider directory standards, (11) Availability and accessibility of services, including network adequacy standards, (12) Quality improvement, (13) Areas related to the delivery of LTSS not otherwise included in paragraphs (b)(1) through (12) of this section as applicable to the managed care program, and (14) All other provisions of the contract, as appropriate. Lastly, in accordance with the New York State Plan Under Title XIX of the Social Security Act, Medicaid Assistance Program (OMB No. 0938-0193) attachment 3.1-K, Amount, Duration and Scope of Medical and Remedial Care and Services Provided to the Categorically Needy, Section iv. Support System Activities , The following steps will be taken to support an individual in both a fee-for-service model and a managed care model. Fee-for-service: services provided by a local district or a regional office of OPWDD or its delegates. Managed Care (MC) or Managed Long Term Care (MLTC) plans conduct these activities on their own. The State ensures that these activities take place through its model contracts, MOUs, Administrative Agreements, and quality assurance efforts. Support activities will include the following: (a) Functional needs assessment and counseling prior to enrollment in CFCO;(b) Information, counseling, training and assistance to ensure that an

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