Federal Reports

Without clear and enforceable limitations in synthetic-minor-source permits, facilities may emit excess pollution that would otherwise subject them to the more stringent requirements of the Clean Air Act major-source permitting programs.

Federal RequirementsPhysicians who bill for TCM services are restricted from billing for restricted overlapping care management services (77 Fed. Reg. 68985 and 68990 (Nov. 16, 2012)). Therefore, these overlapping care management services may not be billed for services provided during the same 30-day TCM service period for the same beneficiary.According to CMS officials, in these instances the first claim submitted should be paid and the second claim submitted should be denied.Physicians who bill for TCM services are restricted from billing for restricted overlapping care management services (77 Fed. Reg. 68985 and 68990 (Nov. 16, 2012)). Therefore, these restricted overlapping care management services may not be billed for services provided during the same 30-day TCM service period for the same beneficiary.According to CMS officials, in these instances the first claim submitted should be paid and the second claim submitted should be denied.

BACKGROUNDMedicaid Health Home ServicesThe Medicaid program provides medical assistance to low-income individuals and individuals with disabilities. The Federal and State Governments jointly fund and administer the Medicaid program. At the Federal level, the Centers for Medicare & Medicaid Services (CMS) administers the program. Each State administers its Medicaid program in accordance with a CMS-approved State plan. In New York, the New York State Department of Health (State agency) administers the Medicaid program.Effective January 2011, section 1945 of the Social Security Act (the Act) was amended to include an option for States to establish a health home program through a Medicaid State plan amendment (SPA) approved by CMS. Under a SPA, States can establish a health home program through a care management service model in which all parties involved in a beneficiary’s care communicate with one another so that medical, behavioral health, and social needs are addressed in a comprehensive manner. While States have flexibility to define the core health home services, they must provide all core services required in the Act. Specifically, the Act requires that health home services include comprehensive care management, care coordination, health promotion, comprehensive transitional care/follow-up, patient and family support, and referral to community and social support services. Beneficiaries enrolled in a health home program receive services through provider networks, health plans, and community-based organizations.New York’s Medicaid Health Home ProgramNew York operates a Medicaid health home program which provides comprehensive care management for beneficiaries with at least two chronic conditions or a single qualifying condition (e.g., serious mental illness). Health home providers directly provide, or contract for the provision of, health home services to eligible beneficiaries. Core health home services provided include engaging and retaining beneficiaries enrolled in the program, coordinating and arranging for the provision of services, supporting adherence to treatment recommendations, and monitoring and evaluating beneficiaries’ needs. New York relies on its health home providers to locate and enroll potentially eligible beneficiaries identified by the State agency or through community-based referrals (case-finding). Beneficiaries enrolled with a health home provider are assigned a dedicated care manager to assist them with obtaining medical, behavioral, and social services (referred to by the State agency as active care management). New York’s health home program provides for a per member per month (PMPM) payment for beneficiaries in case-finding or active care management status.The State agency is primarily responsible for monitoring and overseeing the health home program and works with its interagency partners to monitor the program and review providers’ performance.The State agency claimed Medicaid reimbursement totaling $341,936,568 ($193,238,148 Federal share) for payments made to health home providers for services provided to beneficiaries diagnosed with serious mental illness and/or substance use disorder (SUD) during the period January 2016 through December 2018 (audit period).OBJECTIVEOur objective was to determine whether the State agency’s claims for Federal Medicaid reimbursement for payments made to health home providers on behalf of beneficiaries diagnosed with serious mental illness and/or SUD complied with Federal and State requirements.

The Electronic Health Record Modernization program manages VA’s transition to a new electronic health record system interoperable with the Department of Defense’s system, allowing care providers to access more comprehensive medical histories for the nine million-plus veterans enrolled in VA health care.The VA Office of Inspector General (OIG) conducted this audit because of the importance of the modernization program and its extensive costs. The audit assesses whether the Office of Electronic Health Record Modernization (OEHRM) estimated information technology (IT) infrastructure upgrade costs in accordance with VA standards and Government Accountability Office guidance. The OIG also examined whether OEHRM reported to Congress all costs needed to support the program, including future technology refreshment. This is the second OIG report this year examining VA’s development and reporting of cost estimates for infrastructure upgrades needed to support the program (See VA OIG, Deficiencies in Reporting Reliable Physical Infrastructure Cost Estimates for the Electronic Health Record Modernization Program, Report No. 20-03178-116, May 25, 2021).In this report, the OIG found weaknesses in how OEHRM developed and reported cost estimates. The two $4.3 billion infrastructure upgrade estimates reported to Congress were not reliable and, because of incomplete documentation, determining the accuracy of the estimates was not possible. The OIG also found VA did not report to Congress other IT upgrade costs of about $2.5 billion because OEHRM did not include costs other VA agencies would bear. OEHRM also did not update the cost estimates it provided to Congress.The OIG made six recommendations to help VA ensure an independent cost estimate is performed, reassess and refine the estimate to comply with standards, develop procedures consistent with guidance, disclose to Congress all costs for all IT infrastructure upgrades and updates, and formalize agreements with OIT and VHA to identify expected funding contributions from each entity.

This Office of Inspector General (OIG) Comprehensive Healthcare Inspection Program (CHIP) report provides a focused evaluation of Veterans Integrated Service Network (VISN) 19 facilities’ COVID-19 pandemic readiness and response. This evaluation focused on emergency preparedness; supplies, equipment, and infrastructure; staffing; access to care; community living center patient care and operations; facility staff feedback; and VA and VISN 19 vaccination efforts.The OIG has aggregated findings on COVID-19 preparedness and responsiveness from routine inspections to ensure prompt dissemination of information given the quickly changing landscape as infection rates and demands on facilities continually shift. Findings of inspected medical facilities are grouped by VISN, which are regional offices that provide oversight of medical centers in their area.This report, the second in a series, describes findings on COVID-19 practices from healthcare inspections performed within VISN 19 during the weeks of November 30 and December 7, 2020. It also provides a more recent snapshot of the pandemic’s demands on these facilities’ operations based on data compiled as of April 2021. Interviews and survey results provide additional context on lessons learned and perceptions of both preparedness and response. This report also provides data that illustrates the tremendous COVID-19-related demands on VA healthcare services. It describes leader and staff experiences, assessments, shared sentiments, and best practices to help improve operations and clinical care during public health crises.At the time of the inspections, the Veterans Health Administration and the VISN were experiencing the highest number of cases since the beginning of the pandemic and had valuable information to share about their experiences.

OIG data analytics identified this site as having large retail floor stamp inventory count shortages and one overage from October 1, 2019 through April 30, 2021. Retail associates who work at window services are not assigned a stamp stock inventory and instead work from a shared retail floor stamp inventory. The objective of this audit was to determine whether the James Brown Jr. Station properly accounted for stamps, money orders, and cash.

The Postal Service uses a vast network of systems to collect, process, transport, and deliver nearly half of the world’s mail. The majority of these systems are classified as business applications because they support essential business functions, such as mail processing and delivery. To improve business operations and reduce cyber risk, the Postal Service invests in new and innovative applications and retires those that are outdated and no longer supported. Our objective was to assess the effectiveness of the Postal Service’s business application retirement process.

The Office of the Inspector General conducted a review of the John Sevier Combined Cycle (JSCC) Plant to identify factors that could impact JSCC’s organizational effectiveness. During the course of our evaluation, we identified behaviors that had a positive impact on JSCC. These included positive relationships between team members and management; however, we also identified minimal behavioral risks associated with communication and accountability. In addition, we identified minimal risks to operations that, if unaddressed, could hinder JSCC’s effectiveness. These were related to resource needs, such as problems obtaining parts and materials needed to perform jobs, as well as a desire for additional training, including instrument mechanic and instrumentation training.