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Federal audit commends state’s improved Medicaid reporting

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(The Center Square) — A federal audit commended Pennsylvania for improving oversight to ensure that developmentally disabled citizens were protected in group homes.

More, however, can be done.

The federal government provides Medicaid waivers to keep disabled residents in their homes or community rather than living in institutions. A previous audit by the Department of Health and Human Services’ Office of Inspector General found a number of problems with the commonwealth’s oversight.

The oversight isn’t a minor thing, either, for the safety of disabled Pennsylvanians or for fiscal responsibility. From July 2020 to June 2021, the commonwealth claimed $3 billion – $1.7 of that being federal funds – to support almost 19,000 people in the program.

One of the leading focuses of the previous audit was ensuring that certain incidents were reported within 24 hours, such as emergency room visits, hospitalizations, and cases of neglect.

In its latest audit, the OIG noted that Pennsylvania took its recommendations to heart and reduced unreported hospital stays by 74%. To lessen the risk of missing abuse within the program, though, the auditor suggested more changes within its reporting system to catch any non-reported issues.

“Although the percentage of incidents reported improved, the State agency’s changes to implement the recommendations did not ensure that community-based providers properly reported all 24-hour reportable incidents,” the audit noted.

Of the seven recommended changes, Pennsylvania had fully implemented four to great effect.

“These corrective actions significantly improved the State agency’s compliance with Federal Medicaid waiver and State requirements for reporting hospital stays,” the audit noted.

The remaining issues, the OIG noted, were works in progress.

“Although these corrective actions have resulted in a significant improvement in the percent of acute-care hospital stays reported to the State agency, we found that 7 percent of acute-care hospital stays were not reported,” the audit noted.

The state is in the process of training providers to correctly report issues, ensure staff understand state and federal requirements, and matching Medicaid claims to reported incidents.

Emergency room visits are no longer a discrete category reported in the system; instead, they get categorized under other categories connected to ER visits – like injuries that need treatment beyond first aid or abuse.

Of the 37,000 incidents reported, 14,000 were emergency room visits, followed by 4,800 hospitalization incidents, 4,400 neglect cases, and 3,400 individual-to-individual abuse cases.

Stephanie Shell, deputy secretary for administration at DHS, concurred with the audit’s recommendations and noted the agency was in the process of implementing the changes.

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