Recurring Findings

Health Care: Recurring Significant Internal Control Deficiencies
Federal Program Issue First Year Reported
Department's Assertion Page Number
Medical Assistance Program Health Care Services lacks sufficient internal controls to obtain and track the enrollment presumptive eligibility identification numbers issued to prevent unauthorized use of identification numbers. Further, Health Care Services does not perform procedures to authenticate the existence of the recipient, prevent duplicate issuances, and reconcile the presumptive eligibility numbers with the recipient enrollment listing filed during the claims adjudication process. 2005-06
Remains uncorrected/agree with finding. Health Care Services is unable to reconcile the presumptive eligibility number against the enrollment listing filed with it at this time without an automated system. Health Care Services is participating in an Enterprise Enrollment Portal (EEP) Feasibility Study Report (FSR) on a web-based application process to allow individuals to apply for health care and other public assistance programs through an electronic application. The EEP FSR will include the Presumptive Eligibility program for pregnant women. The EEP will automate the enrollment process for the Presumptive Eligibility programs and eliminate the problems associated with the current paper process. The timeline for EEP includes Acquisition and Design, Development and Implementation beginning in July 2012. 247
SCHIP (State Children's Insurance Program) Health Care Services does not ensure amounts reported on its quarterly Children’s Health Insurance Program Statement of Expenditures for Title XXI (CMS-21) report are classified correctly. 2005-06
Fully corrected. This work was originally scheduled to be done under System Development Notice (SDN) 07040, but was consolidated into one project (SDN 08041). SDN 08041 - Add Federal Financial Participation (FFP) To The Claim Activity Record, was implemented on June 22, 2009. This provides the changes necessary to allow the FFP percentage to be determined for paid claims. 251
Medical Assistance Program Health Care Services does not ensure drug utilization data are provided to drug manufacturers/labelers on a timely basis. 2006-07
Fully corrected. Health Care Services implemented changes on April 1, 2009, which are expected to substantially reduce the amount of manual review time needed for all claims, including the blood factor claims which previously required significant manual review. Successful determination of these system changes will not be recognized until the second quarter. The 2009 invoices are produced and mailed to the drug manufacturer labelers at the end of August 2009. These system changes should eliminate the bulk of the manual review processes needed, especially for blood factor invoices, resulting in timely mailing of all invoices. 237
Medical Assistance Program Health Care Services does not ensure the identifying number of the federal program is included in each of its subrecipient agreements. 2006-07
Fully corrected. Language was added to each contract to address this issue. 253
Medical Assistance Program The federal expenditures noted in the quarterly CMS-64, Quarterly Statement of Expenditures for the Medical Assistance Program, are not directly traceable to individual claims. 2006-07
Fully corrected. System Development Notice 08041 - Add Federal Financial Participation (FFP) To The Claim Activity Record, was implemented on June 22, 2009. This provides the changes necessary to allow the FFP percentage to be determined for paid claims. 252
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