OIG Work Plan Includes Medicaid Adult Day Health Payment Review

Members | December 04, 2017 | by Peter Notarstefano

The OIG Monthly Work Plan Includes a Medicaid Adult Day Health Payment Review. Providers should ensure that enrollees meet eligibility requirements for the specific programs in which they are enrolled and that each enrollee has a plan of care that is updated as care progresses.

The United States Department of Health and Human Services, Office of Inspector General (the "OIG") has decided to update its Work Plan monthly, instead of an Annual update in order for providers to use these monthly updates to review and update policies and procedures based on the OIG's areas of interest and enforcement priorities.

The OIG Monthly Work Plan Includes a Medicaid Adult Day Health Payment Review. Adult day health care programs provide in-home and community-based health, therapeutic, and social services to program enrollees, which are reimbursable under Medicaid. The OIG will review Medicaid payments by states for adult day health care services to determine whether providers complied with federal and state requirements. Providers should ensure that enrollees meet eligibility requirements for the specific programs in which they are enrolled and that each enrollee has a plan of care that is updated as care progresses.

The OIG considers the following factors when determining areas of interest:

  • Mandatory requirements for OIG reviews, as set forth in laws, regulations, or other directives
  • Requests made or concerns raised by Congress, HHS management, or the Office of Management and Budget
  • Top management and performance challenges facing HHS
  • Work performed by other oversight organizations (GAO)
  • Management's actions to implement OIG recommendations from previous reviews
  • Potential for positive impact
  • Investigations of fraud, waste, and abuse
  • Facilitating compliance
  • Excluding bad actors from participating in Federal Health programs

In 2011, the OIG had released a report on the lack of documented skilled services in adult day programs that receive payment through the Medicaid state plan. LeadingAge met with officials at that time to discuss the results in the report. In 2015, the OIG also included a review of services in adult day programs in multiple states, not only the few states that offer adult day health in the state plan. No report on the 2015 review was released by the OIG.