Open Recommendations

We recommend that the Washington State Health Care Authority review all managed-care health home encounters from July 1, 2013, through March 31, 2017, to identify whether the encounters used to support claims for enhanced Federal reimbursement have since been removed from the encounter data and refund to the Federal Government any amounts that are no longer supported.

We recommend that the Washington State Health Care Authority review all managed-care health home encounters from July 1, 2013, through March 31, 2017, to identify whether the encounters exceeded the number of reportable encounters that were allowed for an enrolled beneficiary and refund to the Federal Government any amounts related to unallowable encounters.

We recommend that the Washington State Health Care Authority implement a procedure to identify whether encounters used to support journal vouchers have been removed from the encounter data and refund to the Federal Government any Federal reimbursement that was claimed and is no longer supported.

We recommend that the Washington State Health Care Authority strengthen its MMIS edits to limit the reporting of an encounter for a tier-1 health home service to only once in a beneficiary's lifetime and ensure that only one encounter per beneficiary is reported each month.

We recommend that the Washington State Health Care Authority determine the portion of the remaining $1,367,120 that should have been claimed for managed-care health home service expenditures based on the portion of the MCOs' capitation payment rate that was specifically attributable to health home services, and refund any unallowable amounts.

We recommend the DHS OCHCO designate, direct, and oversee component representatives to maintain rosters of essential employees in each category defined by existing DHS policy.

We recommend the DHS OCHCO designate, direct, and oversee component representatives to maintain rosters of essential employees in each category defined by existing DHS policy.

(U) Rec. 1: The DoD OIG recommended that the Secretary of Defense establish policy and procedures for implementing basing actions of a unified combatant command. The policy should include potential internal controls to ensure that basing action decisions are transparent and based on verified data. The policy should direct that a candidate location's ability to achieve "Full Operational Capability" within a specific timeframe or other appropriate measurement be incorporated for all future basing actions.

CMS should ensure that participating States submit accurate quarterly reports.

Update the AHTF Program application guide with the revised performance measures and implement processes to assess the outcome of its AHTF Program performance measures.

Establish procedures to enhance the review process of progress reports to analyze the completeness, accuracy, and success of the AHTF Program.

Rec. 2.b: The DoD OIG recommended that the Director of the Federal Electronic Health Record Modernization Program Office, in coordination with the Director of the Defense Health Agency; Program Executive Director for Electronic Health Record Modernization Integration; and Program Manager for DoD Healthcare Management System Modernization develop and implement a plan for migrating legacy patient health care information needed for a patient's complete electronic health record once the Federal Electronic Health Record Modernization Program Office determines the health care data domains of patient health care information that constitutes a complete patient electronic health record.

Rec. 2.c: The DoD OIG recommended that the Director of the Federal Electronic Health Record Modernization Program Office, in coordination with the Director of the Defense Health Agency; Program Executive Director for Electronic Health Record Modernization Integration; and Program Manager for DoD Healthcare Management System Modernization develop and implement a plan for creating interfaces that would allow medical devices to connect and transfer patient health care information to Cerner Millennium.

Rec. 2.d: The DoD OIG recommended that the Director of the Federal Electronic Health Record Modernization Program Office, in coordination with the Director of the Defense Health Agency; Program Executive Director for Electronic Health Record Modernization Integration; and Program Manager for DoD Healthcare Management System Modernization develop and implement a plan to modify Cerner Millennium user roles to ensure users are granted access to only the patient health care information necessary to perform their job responsibilities.

CMS should update and broaden its lists of hospital-acquired conditions to capture common, preventable, and high-cost harm events.

CMS should explore expanding the use of patient safety metrics in pilots and demonstrations for health care payment and service delivery, as appropriate.

CMS should develop and release interpretive guidance to surveyors for assessing hospital compliance with requirements to track and monitor patient harm events.

AHRQ should, with support from HHS leadership, coordinate agency efforts to update agency-specific Quality Strategic Plans.

AHRQ should optimize use of the Quality and Safety Review System (QSRS), including assessing the feasibility of automating data capture for national measurement and to facilitate local use.

AHRQ should develop an effective model to disseminate information on national clinical practice guidelines or best practices to improve patient safety.

AHRQ should continue efforts to identify and develop new strategies to prevent common patient harm events in hospitals.

Record death information on the Numident, as appropriate, for the 40 deceased beneficiaries in our sample.

Take action, as appropriate, to record death information in the Numident for the 15,714 beneficiaries identified by our current audit.

Take appropriate action to record death information to the Numident for the 595,514 beneficiaries identified by our prior audits.

Working with the Office of the Secretary and “group of four” oversight entities as appropriate, identify and implement changes to thereview and dissemination process for I&A’s election-related intelligence products to ensure they are in accordance with applicable policies andguidelines.