NHTD Medicaid Waiver Draft Audit Protocols

This week, LeadingAge NY collaborated with the provider associations to comment on the proposed Nursing Home Transition and Diversion (NHTD) Medicaid waiver audit protocols. I want to thank HCBS members who shared their suggestions and concerns regarding the draft protocols.

The following comments were submitted to the NYS Office of the Medicaid Inspector General (OMIG).

We provided general comments that included:

• changing “recipient” to “participant” throughout the protocols;
• including language about “extenuating circumstances” (OMIG will review and consider any relevant contemporaneous documentation maintained and available in the provider’s records to substantiate a claim, as in paragraph three of the cover page), and;
• clarifying the meaning of the Note section that stated: "this finding only applies to sample claims for Service Coordination and this finding only applies to sample claims for Nursing Supervision."

The specific comments included:

• “Missing Service Plan/Revised Service Plan” – we suggested language to account for situations when the agency, despite its efforts, cannot obtain certain documentation from the responsible party;
• “Failure to Meet Service Coordination Requirements” – we suggested clarification that included language like “claims for services delivered after seven months that don’t meet this protocol will be denied. OMIG will review and consider any relevant contemporaneous documentation maintained and available in the provider’s records to substantiate a claim.”
• “Service Coordination Caseload Exceeds Limit” – we suggested clarity to provide flexibility (e.g., if an agency exceeds the 20-participant threshold due to a participant dying or leaving the waiver and a new participant begins, then the agency should not be deemed out of compliance);
• "Service Performed by Unqualified Structured Day Program Staff" – we suggested new language in keeping with the 2008 NHTD waiver manual: “Structured Day Program staff must meet the standards and qualifications as outlined in the NHTD Program Manual and if services are provided by staff that did not meet these standards, then the claims provided by the unqualified staff will be disallowed.”; and 
• "Annual HCSS in-service training" – we requested clarification on the timeframe for completing the required annual HCSS in-service training. We proposed that it be based on the HCSS staff initial date of employment.

Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871