Institutional Federal Compliance Report 2021

STATE OF NEW YORK

Schedule of Findings and Questioned Costs

Year ended March 31, 2018

(6) Are not incarcerated, other than during a period pending disposition of charges.

Lastly, 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 also states the non-Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Effective internal controls should include procedures in place to ensure eligibility and allowability determinations are performed and documented in accordance with program regulations. Condition The Department of Health (the Department) did not have effective internal controls to ensure Basic Health Plan funds were utilized for eligible individuals. For 4 out of 80 individuals selected for testwork, it was determined the individuals were ineligible for the Basic Health Program (Affordable Care Act) based on the criteria specific in 42 CFR 600.305(a). Cause The Department attributed the discrepancies between the actual eligibility determinations for these 4 individuals (all correctly determined Medicaid eligible) and the utilization of Basic Health Program (Affordable Care Act) (BHP) funds for these individuals, to improper codes and criteria being used in the system to identify certain lawfully present noncitizen individuals. Of the ineligible individuals, it was noted that all were ineligible as they were determined to be Deferred Action for Childhood Arrivals (DACA) individuals. The Department utilizes the Medicaid Management Information System (MMIS) to capture all charges for the BHP. The MMIS has flags programmed to determine eligible participates for BHP, and as their charges are submitted for reimbursement by the insurance providers, they are recorded as direct costs to the BHP trust fund. For more complex eligibility determined individuals, MMIS first defaults these individuals as 100% state Medicaid eligible claims. Department management runs a MMIS query daily of specific flagged criteria to capture and extracted BHP eligible individuals; however, the MMIS flag criteria utilized are not at a level specific enough to ensure all individuals selected are BHP eligible. As a result, certain individuals may have BHP trust funds released that are considered ineligible and unallowable. During the fiscal year, management has proposed an eMedNY Evaluation project to correct all claims in error in eMedNY, however, this correction was not implemented. Management has noted, once this correction is made, the Department’s weekly BHP number (fundable amount) for the cycle charge would be reduced by the correction amount in the applicable cycle. Possible Asserted Effect Failure to ensure only eligible individuals’ costs are charged to the Federal program could result in costs inconsistent with the laws, regulations, and terms and conditions of federal awards being claimed to Federal programs. Statistical Sampling The sample was not intended to be and was not a statistically valid sample.

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