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OIG releases FY 2016 Work Plan

The Office of the Inspector General (OIG) has released its FY2016 Work Plan, which includes several initiatives relevant to post-acute and long term care providers. Some of these key initiatives include:

Nursing Homes

  • National Background Check Program for long-term-care employees – This report, expected in FY 2016, will review the implementation status of early results of the National Background Check Program for long term care employees from the first 4 years of the program. This program is a nationwide initiative mandated by the ACA to conduct national and State background checks on prospective employees of nursing facilities and other LTC providers.
  • Skilled nursing facility prospective payment system requirements – This is a new initiative with a report underway and expected to be issued in FY 2016 as well. This review will look at compliance rates for SNF PPS, including claims documentation. As noted earlier this year, the OIG has found that Medicare payments for therapy were significantly higher than the cost for therapy.

Home Health Services

  • Home health prospective payment system requirements – This report will be issued in FY 2016 and reviews the level of compliance with various aspects of the home health PPS, including claims documentation.

Home Health Services and Other Community-Based Care

  • Adult day health services – This report will review Medicaid payments for adult day care services to determine if providers complied with Federal and State requirements and this report is expected to be issued in FY 2016 as well.

Quality of Care and Safety of Beneficiaries

  • Medicaid beneficiary transfers from group homes and nursing facilities to hospital emergency rooms – The OIG has found that high numbers of emergency transfers could be indicative of poor quality of care. This report will review the rates of and reasons for transfer from these types of facilities to ERs, and will be issued in FY 2016. The OIG previously reported on nursing home resident hospitalizations in 2013.
  • State agency verification of deficiency corrections – This topic has been something that the OIG has been planning to review since the FY 2013 Work Plan, but it is listed as a new part of the Work Plan. This report reviews whether State SAs are verifying the plans of correction have been implemented that were found during nursing homes recertification surveys. The expected issue date for this report is FY 2017.

State Program Integrity Activities and Compliance with Federal Requirements

  • State and CMS oversight of provider ownership information – This is a revised initiative for the OIG that will review the extent to which States collected required ownership information and describes the extent to which this information is verified, including checking exclusions databases. This report is supposed to be issued in FY 2016.

Medicaid Managed Care

  • Managed long-term-care reimbursements – This report, expected in FY 2017, is a new initiative that will review States’ reimbursements to managed long term care (MLTC) plans to determine if these requirements meet Federal and State requirements.

Read the OIG FY 2016 Work Plan.

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