ABCD Welcomes Presenters in September

Published On: October 7th, 2021Categories: News

Lauri Woodward, Director of OPIA in DHS and Maria McGowan, Director of the Office of Investigation in OIPA, joined ABCD’s Quality Assurance Forum on the 17th of September for an informal discussion on OI’s process, time frames, prioritizations, identifications of related concerns and findings.  Though there have been a great many changes in OPIA over the last 10 years and all these factors have an impact on investigations, Maria emphasized the importance of sharing information and giving her division a call if agencies have any questions. Maria defined the purpose of the incident report as preventative in nature as those circumstances which could potentially rise to the level of abuse and neglect are documented, discussed, and perhaps contribute to positive internal changes from behaviors and actions to policies. During the investigatory process it is not uncommon for additional allegations to occur – most incidences are very complex, multilayered and involve multiple perpetrators and individuals.  Clearly, the State must be very thorough in its investigations.  The most complicated investigations involve medical needs which are not provided for.  At the suggestion of some forum member, OIPA will discuss the possibility of creating a public forum database so that providers can always find out the status of an investigation. Lauri and Maria were sure to make clear their appreciation for providers continued work over the last 18 months in collectively challenging times; despite being stretched thin, providers have continued to operationally at a high level of quality. And ended with, “call us on the phone and engage OI staff – it is more productive.” Will do!!

Brian Brennan, Esq, Administrator for Medicaid’s Institutional Support Services joined the CFO Forum in September to talk about Pooled Trusts. Pooled Trusts are becoming more frequent, and Brian wanted to ensure that agencies are setting them up correctly so that individual’s Medicaid eligibility will not be become an issue. Pooled Trusts cannot be created after the age of 65, cannot have money transferred into them after the individual is 65 and must be created by a non-profit.  Brain also took the time to answer questions and to discuss differences between Special Needs Trusts, ABLE Accounts and Pooled Trusts.  We thank Brian for, once again, reaching out to ABCD to educate our members so that they can prevent issues from occurring.  Thanks for thinking of us Brian!  Steven Tunney, Assistant Division Director of Medicaid answered questions during the second half of the meeting about the program application process which is seeing a severe back log across all provider types, in part, due to COVID.  He is meeting with Medicaid’s subcontractor to determine the cause as they don’t want to lose Medicaid providers and offered advice to members who find themselves in this circumstance. Steve also took the time to talk about the different provider audits. Unlike the Federal OIG, NJ State OIG/Medicaid Fraud is starting to visit with providers to find financial waste in the system. Right now, the Medicaid Fraud Unit only deals with FFS, but they may have authority over the MCOs in future.  The Office of Legislative Services audits look for improvements and develop Corrective Action Plans, but do not take money back. The audits are random, but audits which come from data mining done by the Medicaid Fraud unit are not.  Look back is 7 years even if your files are destroyed by, say, Superstorm Sandy — doesn’t matter.   If the agency goes out of business, Medicaid will ask to keep their records. Thanks for joining us, Steve!

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