HHSOIG - A-04-17-04058 - 267362

We recommended the State agency improve its oversight of the LIP program by establishing policies and procedures for: o providing additional training to its staff members on the RFMD and STCs for the waiver; o providing training to participating hospital personnel on LIP program compliance and preparing the cost-limit calculations; and o monitoring hospital LIP calculations to verify that they comply with the RFMD and STCs including: ¿- reconciling hospital cost-limit calculations to the finalized Medicare cost reports; ¿- reviewing hospital low-income data to verify that it does not include data for undocumented aliens; ¿- reviewing hospital low-income data to verify that it does not include data for prisoners in other than an inpatient setting; ¿- testing or verifying the accuracy and completeness of the data being used by hospitals in their LIP cost-limit calculations; ¿- reviewing hospital cost-limit calculations to verify that the hospitals properly incorporate observation days and charges into the calculations, as prescribed by the RFMD; ¿- reviewing organ acquisition costs to verify that hospitals use the RFMD-required methodology and to verify the accuracy of the data used in the calculations; ¿- establishing electronic edits in the cost-limit calculation template to detect distribution errors in which low-income costs exceed total costs for individual cost centers; and ¿- reviewing section 6 costs claimed by hospitals to verify allowability based on the RFMD.