OIG FY 2003 WORK PLAN

VHCA

The Office of the Inspector General (OIG) of the Department of Health and Human Services recently issued its work plan for fiscal year 2003.  The complete OIGs 2003 plan addressing the Medicare and Medicaid programs can be found at http://oig.hhs.gov/publications/docs/workplan/2003/2-CMS%20FY03.pdf

Listed below are brief descriptions of the OIGs planned studies related to nursing home Medicare and Medicaid payment:

MEDICARE PROGRAM
WORK PLAN

Medicare Beneficiary Access to Skilled Nursing Facilities Under the Prospective Payment System.  In this follow-up study, the OIG will determine if the prospective payment system (PPS) for skilled nursing facilities (SNFs) has affected Medicare beneficiaries access to care.

Nursing Home Reporting of Minimum Data Set.  The OIG will assess nursing home compliance with Minimum Data Set (MDS) reporting requirements.

Follow-up on Resource Utilization Group Assignments.  This study will examine changes in the proportion of Medicare beneficiaries assigned to each Resource Utilization Group (RUG) in light of recent legislative changes to the PPS for SNFs.

Program Integrity Safeguards.   The OIG will assess controls over the SNF PPS program integrity safeguards and determine how the results of safeguard activities can be used to identify and prevent provider noncompliance.

Three-Day Stay Requirement. The OIG will continue reviews of patient eligibility for care in SNFs.

Consolidated Billing Requirements.  This review will determine whether controls are in place to preclude duplicate billing under the SNF PPS.

Part B Payments for Beneficiaries in Nursing Homes.  The OIG will analyze Medicare Part B payments for nursing facility residents to determine if unbundling, inappropriate services, or aberrant billing patterns occurred.

Social Work Services in Skilled Nursing Facilities.  The OIG will determine if Medicare SNFs have provided the psychosocial services required by the 1987 Nursing Home Reform Act.

MEDICAID PROGRAM
WORK PLAN 

Medicaid Payments to Skilled Nursing Facilities for Medicare-Covered Services.  The OIG will determine if any Medicaid payments were made for SNF care covered and paid for by Medicare.

Payments to Public Nursing Facilities.  The OIG will determine the adequacy of Medicaid payments to public nursing facilities in states that have enhanced payment programs for such facilities.

Payments for Ancillary Services in Nursing Homes.  The OIG will determine the appropriateness of Medicaid payments to providers of ancillary services in nursing homes.

Nursing Facility Administrative Costs.  This national review will determine whether nursing facilities that participate in the Medicaid program claimed unallowable or highly questionable administrative expenses.