NYS OMIG Audit Protocol for Assisted Living Programs Released

On November 22nd, 2013, the New York State Office of the Medicaid Inspector General (OMIG) released a set of audit protocols to provide Assisted Living Programs (ALPs) with evaluating their compliance with Medicaid requirements. The audit tool contains guidance on:

  • Missing Patient Record
  • Missing Medical Evaluation
  • Missing/Invalid Signature on Medical Evaluation
  • Missing Interim Assessment
  • Missing/Invalid Signature on Interim Assessment
  • Missing Plan of Care
  • Missing Date and/or Signature on Plan of Care
  • Missing Nursing/Functional/Social Assessment
  • Missing Date and/or Signature on Nursing/Functional/Social Assessment
  • Missing Patient Review Instrument (PRI)
  • Missing Date and/or Signature on Patient Review Instrument (PRI)
  • Incorrect PRI Level Claimed – Determined by PRI Certified Nurse
  • No Service Rendered
  • Missing Service Documentation
  • Incorrect Rate Code Billed
  • Billed for Services While Inpatient at Another Facility
  • Failure to Complete Minimum Training Requirements
  • Missing Certificate of Immunization
  • Failure to Complete Required Health Assessment
  • Missing Documentation of a PPD (Mantoux) Skin Test or Follow-Up
  • Missing Personnel Records
  • Failure to Complete Annual Performance Evaluation

This protocol is effective November 22, 2013.

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