12/11/15: Ohio Auditor of State Audits Medicaid School Program

I had the opportunity to sit down with the Auditor of State audit team that is performing the random Medicaid audits on various school districts. This is not the annual AUP audits that are done each year by your CPA firm. These are Medicaid audits that the Ohio Department of Medicaid has asked the State Auditor’s Office to conduct. There has been a total of 5 audits completed, and I anticipate many more to come. Of the five audits, there seems to be two consistent audit findings which are in the areas of Criminal Background Checks and Supervision of Occupational Therapy Assistants and Physical Therapy Assistants. I recommend each school district to go back and verify compliance with the following two issues:

1. Ohio Administrative Code 5101:3-35-02 (C) – “An MSP provider shall ensure all employees and contractors who have in-person contact with consumers for the provision of services undergo and successfully complete criminal records checks pursuant to rules adopted under section 5111.032 of the Revised Code.”

For district employed therapists, this is not a problem, but there seems to be issues when it comes to Contracted Therapists. In the above paragraph, the term “shall ensure”, means that you are physically getting a copy of each therapist’s background check. Do not rely on the contracted agency verbally telling you that it was completed. Get a copy and keep it on file.

2. Ohio Administrative Code 5101:3-35-05(B)(1)(ii) – “licensed occupational therapy assistant shall be practicing under the general supervision of a licensed occupational therapist who is employed or contracted by the MSP provider.” This general supervision is also required for physical therapy assistants also.

Ohio Administrative Code 5101:3-35-01(A)(4) – “The supervision requires an interactive process and shall include, but is not limited to, an initial face-to-face client evaluation and periodically thereafter, routine consult with the assistant before the assistant’s initiation of any client treatment plan”.

Simply having the occupational therapist co-sign the service documentation does not constitute “general supervision”. The auditors are wanting to see any type of written documentation that shows that the OT was consulting and evaluating the OTA. I suggest keeping meeting minutes and having the OTA document OT consultation in their student case notes.

There are additional AOS Audits in process, and it is my understanding that these AOS Audits of the Medicaid School Program will be expanded. I warned everyone over a year ago that any talks of program expansion would trigger a State Audit of the program, in preparation for a Federal Audit by CMS (Centers for Medicaid and Medicare Services). My goal is to get everyone compliant and prepared for any audit of their Medicaid program. It is imperative that all districts are complying with all parts of the MSP Rules. Those rules have been renumbered and revised since the current AOS audit period, which is July 1, 2011 – June 30, 2013. The most current MSP rules are AOC 5160-35-01, 5160-35-02, 5160-35-03, 5160-35-05, and 5160-35-06. The MSP rules can also be found on our website at www.TeamHBS.com, under MSP INFO, Current MSP Rules.

Many of the 2016 “MSP Topics of the Week” will focus on compliance with specific MSP rules.