Following
up on her Tuesday, Jan. 14 release detailing the "mess" the Ohio
Department of Medicaid (ODM) currently faces stemming, in large measure, from
an error-ridden information technology system that has snarled eligibility
determinations and led to substantial payment errors (see The Hannah Report,
1/14/20), ODM Director Maureen Corcoran Friday released results from the
federal Centers for Medicare and Medicaid Services (CMS) FY19 Payment Error
Rate Measurement (PERM) audit and the department's corrective action plan.
In
her cover letter, CMS Deputy Director Anne Marie Costello notes her agency's
approval of the plan and acknowledges "notable progress" the state
agency has made over the last year to address many of the issues. She went on
to note, "Under your leadership and direction, we received the state's
commitment to address the longstanding eligibility and enrollment problems,
beginning with a reduction of the application backlog. Further, Ohio was
proactive in developing and submitting a plan to address the issues CMS
identified. Specifically, issues related to:
-
"Application processing. …
-
"Timely processing of eligibility redeterminations. …
-
"Time processing of beneficiary changes in circumstances."
ODM
explains in an executive summary provided with the day's release that it has
uncovered "a multitude of issues of Ohio Benefits -- the technology system
designed to manage Medicaid and CHIP [Children's Health Insurance Program]
eligibility and enrollment determination process." Those problems include
the following:
- "Flaws allowing system users
to inadvertently overwrite archived data when new or updated eligibility
information is entered.
- "Restricted access to stored
data tables prohibiting caseworkers, auditors and ODM staff from gathering
requisite eligibility determination documents to satisfy audit
requirements.
- "Erroneous, system-generated
event management triggers that altered critical dates and deadlines, resulting
in both late and voided eligibility authorizations and renewals.
- "Duplicate, system-generated
member identifications prompting dual provider payments and undetected
financial liabilities.
- "System inability to
electronically manage and track critical tax filings and reporting with the
Internal Revenue Service.
- "Technical shortfalls that
inhibit system access and navigation to those with vision and English language
deficits."
ODM goes on to explain that CMS uses
this audit to determine improper payments -- and any repayments the state may
be liable for.
Both agencies continue to work
together on timelines for improvements over the next several months.
Costello did write that, "we
believe the strategies that Oho has included in its plan will introduce
sustainable improvements to state systems and operations to ensure that the
state conducts timely and accurate determinations at application and renewal,
that only eligible individuals are enrolled, and that the state appropriately
claims federal matching dollars for state expenditures. To that end, the plan
will also address issues identified in the FY19 Payment Error Rate Measurement
(PERM) results and help to decrease improper payments. The state's work toward
compliance with the issues outlined in the [corrective action plan] supports
the work to improve future PERM results."
The department does explain that, "CMS
clarifies in its report that PERM findings do not necessarily represent
expenses that should not have occurred. Instead, it measures the agency’s
performance in meeting timely administrative deadlines, obtaining and securing
qualifying documentation and accurately managing renewals and redeterminations."
Documents including the day's
release, the Ohio Medicaid Executive Summary, the CMS letter from Costello and
the state's corrective action plan can be found in a consolidated document on
the Hannah News website at www.hannah.com>Important
Documents and Notices>Library.