Recurring Findings

Health Care: Recurring Most severe Noncompliance
Federal Program Issue First Year Reported
Department's Assertion Page Number
Medical Assistance Program Health Care Services has not completed re-enrollment of Medicaid providers prior to 1999 and does not have the required re-enrollment package, including the required provider agreement, on file with the Provider Enrollment Division. 2006-07
Partially Corrected. Provider Enrollment Division is currently planning the implementation of the 2010 Affordable Care Act (ACA) requirement to revalidate provider enrollment information every five years. Implementation is scheduled to begin on January 1, 2013. 106
Medical Assistance Program Health Care Services lacks adequate internal controls over its redetermination requirements for MediCal beneficiaries to ensure benefits are discontinued when annual redetermination forms are not provided. Also, Health Care Services' Medicaid Eligibility Quality Control process has a 5.5 percent error rate which indicates there is a material risk of noncompliance related to eligibility. 2008-09
Fully Corrected. Health Care Services will discuss each of the audit findings with the affected counties. These discussions will include a review of the specific findings with each affected county, possible corrective actions, and best practices referrals. If warranted, Health Care Services will conduct focused reviews in specific counties to address potential Medi-Cal redetermination performance issues. Health Care Services will continue to reinforce expectations that the counties must complete Medi-Cal redeterminations on a timely basis and reiterate to the counties the pertinent documentation must be available for review in county case files and automated systems as required by state policies. 100
Medical Assistance Program Health Care Services did not conduct site visits of local government agencies (LGAs) and local education consortiums (LECs) as required. Specifically, there were 18 LGAs/LECs that had not had a site visit within the last three or four years. 2009-10
Partially Corrected. It was the initial intent of the Countybased and School-based Medi-Cal Administrative Activities Units (CMAA and SMAA) to conduct the 18 site visits during 2010-11 and 2011-12 to comply with Medicaid funding requirements, which indicates site visits must be conducted at least once every four years. However, due to the delayed passage of the State Budgets in 2010 and 2011 and a Governor?s order restricting non-essential travel in May 2011, the CMAA and SMAA Units were unable to reach compliance. Without the ability to travel, the CMAA and SMAA Units developed a desk review process to meet the Medicaid funding requirements without requiring travel. Through the desk review process, the Units have conducted and completed the oversight responsibilities for a major portion of the non-compliance during 2011-12. However, due to the aforementioned non-essential travel restriction, the remainder of the issues will not be resolved until the end of the 2012. The CMAA and SMAA Units have received exemptions from the travel restriction and began conducting on-site reviews as of July 1, 2012. As a result of this exemption, the CMAA and SMAA Units will complete all outstanding site visits issues by December 31, 2012. 102
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