Category: MAOTD (Medicaid Acronym of the Day)

U.S. Department of Health & Human Services, Office of Inspector General’s (OIG) mission is to protect the integrity of Department of Health & Human Services (HHS) programs as well as the health and welfare of program beneficiaries. Since its 1976 establishment, OIG has been at the forefront of the Nation’s efforts to fight waste, fraud and abuse in Medicare, Medicaid and more than 100 other HHS programs.

HHS OIG is the largest inspector general’s office in the Federal Government, with approximately 1,600 dedicated to combating fraud, waste and abuse and to improving the efficiency of HHS programs. A majority of OIG’s resources goes toward the oversight of Medicare and Medicaid — programs that represent a significant part of the Federal budget and that affect this country’s most vulnerable citizens. OIG’s oversight extends to programs under other HHS institutions, including the Centers for Disease Control and Prevention, National Institutes of Health, and the Food and Drug Administration.

Further reading –

https://oig.hhs.gov/

The Federal Medical Assistance Percentages (FMAPs) are used in determining the amount of Federal matching funds for State expenditures for assistance payments for certain social services, and State medical and medical insurance expenditures. The Social Security Act requires the Secretary of Health and Human Services to calculate and publish the FMAPs each year.

The “Federal Medical Assistance Percentages” are for Medicaid. Section 1905(b) of the Act specifies the formula for calculating Federal Medical Assistance Percentages.

Further reading –

https://www.medicaid.gov/medicaid/financing-and-reimbursement/

The Administration for Children & Families (ACF), a division of the U.S. Department of Health & Human Services (HHS), promotes the economic and social well-being of families, children, individuals and communities with funding, strategic partnerships, guidance, training and technical assistance. ACF promotes the economic and social well-being of families, children, individuals and communities who are resilient, safe, healthy, and economically secure. Learn more about ACF’s vision, mission and values.

Further reading –

https://www.acf.hhs.gov/

The Medicaid Information Technology Architecture (MITA) is an initiative of the Center for Medicaid & State Operations (CMSO), and it is aligned with the National Health Infrastructure Initiative (NHII) (http://aspe.hhs.gov/sp/nhii/).NHII is a voluntary network comprising clinical, public health and personal health knowledge-based information systems that make health information available as needed to improve decision-making. MITA is intended to foster integrated business and IT transformation across the Medicaid enterprise to improve the administration of the Medicaid program.

Further reading –

https://www.cms.gov/Research-Statistics-Data-and-Systems/Computer-Data-and-Systems/MedicaidInfoTechArch/downloads/mitaoverview.pdf

A Qualified Intellectual Disabilities Professional (QIDP) must have at least one year of experience working directly with people with intellectual and developmental disabilities, meet the minimum federal educational requirements for a QIDP outlined in 42 CFR 483.430, and must provide documentation of both education and experience.

Direct work experience may include, but is not limited to:
• Case management or activities that include involvement with individuals in daily, work or social activities
• Interactions with consumers in the implementation of individual service plans, education plans or behavior programs
• Gathering behavior program data by interacting with or observing consumers to determine appropriate program implementation
• Involvement with consumers in programming at residential, work sites and other venues.

Persons, who would meet QIDP requirements within a reasonable time, may gain QIDP experience under the direct supervision of a trained QIDP by assisting them in collecting or collating data, drafting paperwork, organizing or recording team meetings, etc. However, only QIDPs on the Department’s QIDP database can be assigned full QIDP responsibilities (e.g., preparing ISPs, conducting meetings, assessing consumer progress, completing paperwork and signing documents that require QIDP approval). QIDPs cannot sign off on QIDP paperwork prepared by staff not approved as a QIDP, even if that staff meets QIDP requirements.

QIDPs are responsible for many things, not least of which includes ensuring that the individuals we support receive appropriate, effective, and individualized person-centered services. This training is designed to give you an overview of what your position will likely involve, as well as a
wealth of tools, tips, and resources that you can utilize in provision of those services.

Further reading –

http://www.dhs.state.il.us/OneNetLibrary/27896/documents/By_Division/Division%20of%20DD/QIDP/QIDPModule1.pdf

Home and community-based services (HCBS) provide opportunities for Medicaid beneficiaries to receive services in their own home or community rather than institutions or other isolated settings. These programs serve a variety of targeted populations groups, such as people with intellectual or developmental disabilities, physical disabilities, and/or mental illnesses.

Further reading –

https://www.medicaid.gov/medicaid/hcbs/index.html

The United States Department of Health and Human Services (HHS), also known as the Health Department, is a cabinet-level department of the U.S. federal government with the goal of protecting the health of all Americans and providing essential human services. Its motto is “Improving the health, safety, and well-being of America”.[2] Before the separate federal Department of Education was created in 1979, it was called the Department of Health, Education, and Welfare (HEW).

Further reading –

https://www.hhs.gov/

Since inception in 1997, the Health Care Fraud and Abuse Control (HCFAC) Program has been at the forefront of the fight against health care fraud, waste, and abuse. Since 2010, the U.S. Department of Health & Human Services, Office of Inspector General (HHS OIG), the Centers for Medicare & Medicaid Services (CMS), and the U.S. Department of Justice (DOJ) have been able to expand their capacity to fight fraud and abuse by using powerful, new anti-fraud tools to protect Medicare and Medicaid by shifting from a “pay and chase” approach toward fraud prevention. Through the groundbreaking Healthcare Fraud Prevention Partnership, stronger relationships have been built between the government and the private sector to help protect all consumers.

Further reading –

https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-01-18-2.html

Medicaid Fraud Control Units (MFCUs) investigate and prosecute Medicaid provider fraud as well as patient abuse or neglect in health care facilities and board and care facilities. MFCUs operate in 49 States and the District of Columbia. The MFCUs, usually a part of the State Attorney General’s office, employ teams of investigators, attorneys, and auditors; are constituted as single, identifiable entities; and must be separate and distinct from the State Medicaid agency. OIG, in exercising oversight for the MFCUs, annually recertifies each MFCU, assesses each MFCU’s performance and compliance with Federal requirements, and administers a Federal grant award to fund a portion of each MFCU’s operational costs.

Further reading –

https://oig.hhs.gov/fraud/medicaid-fraud-control-units-mfcu/index.asp

Center for Program Integrity – In April 2010, Secretary Sebelius aligned the Medicare and Medicaid program integrity functions with the creation of the Center for Program Integrity (CPI).  This newly-established Center brought together oversight of Medicare and Medicaid program integrity to coordinate resources and best practices for overall program improvement. The Affordable Care Act and the Small Business Jobs Act of 2010 provided additional opportunities to strategically combat fraud, waste and abuse with a coordinated approach in Medicare and Medicaid.

Further reading –

https://www.cms.gov/About-CMS/Components/CPI/Center-for-program-integrity.html