Federal Reports

The Medicaid Management Information Systems (MMIS) is an integrated group of procedures and computer processing operations designed to meet principal objectives, such as processing medical claims. States report costs related to private MMIS contract services as administrative costs.Generally, the Federal Government reimburses States 50 percent of their administrative costs; however, for certain approved MMIS costs, the Federal Government reimburses 90 percent or 75 percent. States are required to obtain prior approval in an Advanced Planning Document (APD) to receive the higher reimbursement rates.For Federal fiscal years 2013 through 2017, 10 States claimed more than 50 percent of the total costs related to private MMIS contract services. Arkansas ranked 8th highest.

We investigated whether a BIA employee improperly received gifts, influenced a nonprofit’s operations, and awarded funds to a university.

This Office of Inspector General (OIG) Comprehensive Healthcare Inspection Program report provides a focused evaluation of the quality of care delivered in the inpatient and outpatient settings of the VA Puget Sound Health Care System, which includes the Seattle and American Lake (Tacoma) divisions and multiple outpatient clinics in Washington. The inspection covers key clinical and administrative processes associated with promoting quality care. This inspection focused on Leadership and Organizational Risks; COVID-19 Pandemic Readiness and Response; Quality, Safety, and Value; Medical Staff Privileging; Medication Management: Long-Term Opioid Therapy for Pain; Mental Health: Suicide Prevention Program; Care Coordination: Life-Sustaining Treatment Decisions; Women’s Health: Comprehensive Care; and High-Risk Processes: Reusable Medical Equipment.At the time of the OIG virtual review, the executive team had worked together for 16 months. The Director and the Chief of Staff had served since 2017, the Deputy Director for Patient Care Services and Associate Director had been in their positions since 2018, and the Deputy Director had served since 2019. Survey data indicated opportunities to improve employee satisfaction and reduce feelings of moral distress. Patient survey results showed that individuals were generally less satisfied with their care compared to VHA averages. Leaders were knowledgeable about selected data used in Strategic Analytics for Improvement and Learning models and actions taken during the previous 12 months to maintain and improve performance.The OIG issued 21 recommendations for improvement in six areas:(1) Quality, Safety, and Value• Committee processes• Protected peer review• Patient safety• Root cause analyses(2) Medical Staff Privileging• Focused and ongoing professional practice evaluations• Provider exit reviews(3) Medication Management• Aberrant behavior risk assessment• Urine drug testing• Informed consent• Patient follow-up(4) Care Coordination• Goals of care conversations• Life sustaining treatment decisions progress notes(5) High-Risk Processes• Climate control• Staff training and competencies• Monthly continuing education

The U.S. Department of Housing and Urban Development (HUD), Office of Inspector General, audited HUD’s Office of Multifamily Housing Programs’ health and safety complaint process. We conducted this audit due to a July 2019 explosion that occurred at the Calloway Cove Apartments, a Multifamily housing property in Jacksonville, FL, which resulted in a fire that injured several people. HUD’s Real Estate Assessment Center had identified life-threatening health and safety deficiencies at the property for several years, and there had been separate concerns related to health and safety issues at this complex, which appear to have gone unaddressed and may have led to the fire. Our audit objective was to determine whether HUD ensured that health and safety complaints associated with Multifamily Section 8-assisted housing were resolved in a timely manner.HUD’s complaint process did not ensure that health and safety complaints were resolved in a timely manner. On average, it took 2.5 days to resolve the life-threatening health and safety issues reviewed, including 3 days to resolve a gas leak issue. It took an average of 17 days to resolve the non-life-threatening health and safety issues, including 175 days to resolve an infestation problem. For the purpose of this audit, we determined reasonable benchmark resolution times to be 24 hours for resolving life-threatening health and safety issues and 72 hours for non-life-threatening health and safety issues. This condition occurred because HUD did not have a standardized, effective process for monitoring, tracking, and resolving complaints in a timely manner. As a result, Multifamily housing tenants were, in some instances, faced with unhealthy and dangerous living environments for extended periods.We recommend that the Deputy Assistant Secretary for the Office of Multifamily Housing Programs (1) develop a comprehensive process to ensure that complaints received by the Multifamily Housing Clearinghouse are resolved in a timely manner; (2) develop agencywide policies and procedures for the intake, monitoring, and tracking of health and safety complaints; (3) develop an automated real-time system for receiving, tracking, and resolving health and safety issues; and (4) revise the annual contributions contract to more clearly define contractor and property management responsibilities and deadlines for resolving health and safety issues.

Without the required testing and an effective system of internal controls, the EPA cannot make measurable progress toward complying with statutory requirements or safeguarding human health and the environment against risks from endocrine-disrupting chemicals.