Institutional Federal Compliance Report 2021

STATE OF NEW YORK

Schedule of Findings and Questioned Costs

March 31, 2019

individual is able to manage the services; (c) Information communicated to the individual in a manner and language understandable by the individual, including needed auxiliary aids and/or translation services; (d) Conducting person-centered planning; (e) Range and scope of available choices and options; (f) Process for changing the person-centered SP; (g) Grievance process; (h) Risks and responsibilities of self-direction; (i) Free Choice of Providers; (j) Individual rights and appeal rights; (k) Reassessment and review schedules; (l) Defining goals, needs and preferences; (m) Identifying and accessing services, supports and resources; (n) Development of risk management agreements; (o) Development of personalized backup plan; (p) Recognizing and reporting critical events, including abuse investigations; and (q) Information about advocates or advocacy systems and how to access advocates and advocacy systems. Condition The Department of Health (the Department) did not have controls in place to ensure continued contract terms with Mainstream Managed Care Organizations (MCO) and Managed Long Term Care (MLTC) plans. For 8 out of 52 weekly cycles, Medicaid capitation payments through the State’s Medicaid Management Information System (MMIS) were made to MCO and MLTC providers with expired contracts. For 18 of 18 MCO and 46 of 61 MLTC providers paid during the selected cycles, their contracts had expired prior to the State’s fiscal year end, and new contracts have not yet been executed. The MCO and MLTC plans continued to provide services to the enrollees under the previous contract terms and conditions. Due to the lack of active contracts, the risk exists that the MCO or MLTCs are not following the requirements of the contract and inappropriate continued services are being provided to enrollees. Additionally, per 42 CFR 438 section and 438.66(b) (13) above, the state is required to address all aspects of the managed care program including all other provisions of the contract, as appropriate. Therefore, the expired contracts that have not been revised in the appropriate time is not in compliance with the requirements. Cause The condition is due to the Department timing of the approval of approved MCO and MLTC plan contracts between the Center for Medicare and Medicaid Services (CMS) and the Department not occurring prior to the expiration of current MCO and MLTC plan contracts. As part of the Department’s prior audit finding corrective action plan, the Department has implemented a system of internal controls to track the contracting process and measures to get all model contracts updated in accordance with current CMS standards. Draft model contracts for each type of MLTC (MLTC Partial and MAP) as well as MA were submitted to CMS for approval subsequent to the expiration of those contracts and have subsequently been given approval by CMS. Failure to ensure contracts with MCO and MLTC plans are current may result in the Department not being in compliance with Federal statutes, regulations, and the terms and conditions of federal awards. Questioned Costs None Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Possible Asserted Effect

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