Federal Reports

While New York implemented some background check requirements established under the Child Care and Development Block Grant (CCDBG) Act, it had not fully implemented all of the new criminal background check requirements as of October 1, 2018-its deadline for implementing the requirements. New York must enact supporting legislation to make the changes necessary to its current Child Care and Development Fund (CCDF) program to come into compliance with the CCDBG Act.

The audit objectives were to determine whether program funds were managed in accordance with the ARC and Federal grant requirements

Section 11(d)(9) of the Inspector General Act of 1978, as amended, requires the Council of the Inspectors General on Integrity and Efficiency to submit to Congress and the President an annual report on the activities of the Integrity Committee. For more informatoin about the Integrity Committee, please visit the link below.

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 required CMS to phase in a Competitive Bidding Program for durable medical equipment, prosthetics, orthotics, and supplies. In July 2008, mail-order diabetes test strips became part of the Competitive Bidding Program in certain limited areas, and in July 2013, this was expanded to include a National Mail-Order Program for diabetes testing supplies. The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) prohibits CMS from awarding contracts in the National Mail-Order Program to a supplier of diabetes test strips if the supplier's bid does not cover at least 50 percent, by volume, of all types of diabetes test strips provided to Medicare beneficiaries. (This is known as the "50 percent rule.") MIPPA requires OIG to determine the market shares of the types of diabetes test strips before each round of bidding to assist CMS in ensuring that bidding suppliers meet the 50-percent rule.

Rhode Island did not ensure its Medicaid managed-care organizations (MCOs) complied with Federal and State requirements prohibiting Medicaid payments to providers for inpatient hospital services related to treating certain provider-preventable conditions (PPCs). PPCs are certain reasonably preventable conditions caused by medical accidents or errors in a health care setting. For our audit period, we identified that MCOs paid providers approximately $4 million for 241 claims that contained PPCs. Rhode Island's internal controls were not adequate to ensure that its MCOs complied with Federal and State requirements. For instance, Rhode Island did not follow up with the MCOs to determine why present on admission codes were missing or whether the payments made for the related claims complied with Federal and State requirements. In addition, the MCOs did not have policies or procedures to identify PPCs on claims for inpatient hospital services or determine whether payments for claims containing PPCs should have been reduced. As a result, the unallowable portion of the $4 million identified for our audit period was included in the capitation payment rates for State fiscal years 2017 and 2018.