AGENCIES FOR CHILDREN’S THERAPY SERVICES (ACTS) COMMENTS REGARDING OMIG AUDIT PROTOCOLS FOR THE EARLY INTERVENTION PROGRAM SERVICES FROM APRIL 6, 2016 – OCTOBER 18, 2021
Submitted by Steven Sanders, Executive Director-ACTS
December 16, 2022
ACTS is a statewide association of Early Intervention agencies whose members provide a majority of the Early Intervention services. We appreciate the opportunity to offer comments and recommendations regarding the OMIG Audit protocols.
ACTS agrees with and applauds the mission of OMIG. Created in 2006 OMIG was designed to root out corruption, abuse and waste in the New York State Medicaid Program. Ferreting out fraud is vital endeavor and necessary to both preserve confidence in Medicaid reimbursed programs as well as saving the taxpayers money. ACTS has always condemned those few providers who engage in this type of illegal behavior. It is costly to the state and it besmirches the reputation of the vast majority of honest hard working providers and service agencies.
The Early Intervention Program is vital to the state of New York because its providers and agencies deliver desperately needed services to infants and toddlers from birth to age three.
Study after study have affirmed that Early Intervention SAVES the state untold tens of millions of dollars each year in avoided and far more expensive costs that the state would need to expend to help and remediate the needs of young children and adolescents who did not receive Early Intervention services and who are now in other educational or service programs that would be much more costly. We all know that the time to help youngsters with learning or developmental deficits is at the earliest age. The older child becomes, the more difficult and the more costly. So the Early Intervention Program is so important to the state both from a human and financial standpoint.
I mention all this because the excellent Medicaid Inspector General Frank Walsh makes mention in his annual report of the need to “work collaboratively with the provider community and stakeholders.” This mutual collaboration and respect is key to a system that has the capacity to deliver high quality services to our youngest citizens. The state needs the work of Early Intervention agencies and our agencies need the oversight of OMIG to insure that fraud and corruption have no place in our program. In short this is a symbiotic relationship which benefits all.
My comments to the Audit Protocols for the Early Intervention Program agrees with the many audit protocols in place to insure integrity in the Early Intervention Program, BUT takes exception to a few of the planks that stray from the core mission of OMIG to identify fraud, abuse, and corruption but instead penalizes honest providers who may have made honest and easily correctable mistakes in their billing for services honestly rendered. As a former member of the State Assembly for 28 years I can say without qualification that it was never the intention of the Legislature which created the OMIG program 16 years ago that honest providers who may have made small and unintentional mistakes on their billing, which are easily corrected, be put upon with penalties and disallowances for such errors. We are all human and all make some mistakes. Most auditing agencies of government give the subjects of their audits exit conferences and opportunities to make technical corrections. So should OMIG in their stated spirit of “collaborative work with the provider community.”
SPECIFIC COMMENTS/ RECOMMENDATIONS
*In Item # 3 ACTS believes that it is the IFSP that is more properly the document that should identify the eligibility and covered services for enrollment into the Early Intervention Program as opposed to the MDE
*In item #4 ACTS believes that when an evaluation is properly performed and all evaluation tools are used and clearly documented, the lack of mention of a particular service which is not needed must not be cause for full disallowance. For example…if services are to be performed in the home (as most are) the omission of a transportation assessment is a rational omission and must not be cause for a full disallowance. These evaluations are customized to some extent to meet the specific needs of the child. The health assessment included in the IFSP should also be sufficient. If in the future OMIG believes that even unneeded or unused services should still be iterated that should be PRSOPECTIVE in your guidance.
*In Item # 6 ACTS believes that since the IFSP is generated as a result of a team meeting which also includes municipal representatives, evaluators and parents…but it is the municipal representatives that make the final decisions, if there is an error which nobody caught, including the provider that mistake ought not be grounds for disallowance, but rather should be corrected.
*In Item # 8 ACTS believes and observes that if the agency did not provide the service coordination in the first instance and/or once the child has passes the age of three they were not required to have or maintain such information. The Service Coordination entity is responsible for that information. This information is also contained in NYEIS, but only until the child ages out of the Early Intervention Program. At that point that information becomes in assessable in NYEIS to the provider. Consequently for closed files only the agency that provided service coordination or services (after the age of three) when they transition to CPSE as well as the municipality has that information
*In Item # 13 ACTS believes that this is amongst the most SIGNIFICANT areas of concern. I refer back to language contained in the comments offered by the New York state Alliance for Children With Special Needs To paraphrase: Municipal directives around documentation governed the field prior to the transition to State Department of Health authority. As a result some municipalities such as New York City developed comprehensive manuals and offered guidance documents and directives to assure accountability and compliance. New York City providers were directed to use specific document forms to substantiate the delivery of Early Intervention services and verified by the parent and rendering therapist. This document was captioned
“SESSION NOTE”. However its contents included data points and verification signatures which extended beyond the standard therapist session note commonly found in health care systems in other municipalities. This single record contained ALL the required elements of both therapy session notes and the related service delivery log. As such this singular document satisfies the regulatory requirements governing session notes and service logs separately reflecting each element of required information.
It is also important to note the State Department of Health and the Bureau of Early Intervention maintained local enforcement authorities with each municipality even as the state took over contracting responsibilities from the municipalities in 2013. This is also iterated in the Provider Agreement with the State Department of Health. The State was well aware of these various forms of compliance and enforcement and never disagreed with the methods that were used in New York City. NEITHER SHOULD OMIG. It also should be noted that in 2020 and 2021 as a result of COVID everything was remote and a clinician was not physically present in the home to obtain signatures from the parent. The parent was asked to provide signatures by mail or electronically in some cases. Like in every other aspect of the state nothing went smoothly during the beginning of the COVID emergency and allowances must be made for that.
ACTS takes no exception to the vast majority of protocol items provided by OMIG. And I repeat we AGREE with the importance of accountability and oversight. We deplore those who abuse the system and we condemn those who commit fraud and engage in corrupt practices. However there must be fairness and flexibility built in to the audit practices. Unintentional and easily correctible errors must not be grounds for disallowance. Such rigidity is not usually found in other audit activities and is simply not equitable, fair or part of the core mission of OMIG. If OMIG is intent on changing the methods that have been properly used and sanctioned in the past by the Department of Health and the Bureau of Early Intervention then those changes can only be fairly implemented PROSPECTIVELY in 2023, and only after sufficient notice is given.
I close by saying what I trust that OMIG knows. The overwhelming number of Early Intervention providers are honest and very hard working. They always try to the best of their abilities to comply with regulations of which they are informed by the government entity that provides oversight. Small inconsequential errors must not be grounds for full disallowance of claims. What is most important is whether the provider rendered all the services that they are responsible for according to the IFSP and in a timely matter. ACTS also believes that disallowances must only be based on specific and actual claims found to be fraudulent or that might be rife with pervasive and serious errors and not calculated by some kind of extrapolation from claims not actually examined. OMIG’s proper mission is to discover when that occurs and to punish or penalize those who abuse or corrupt the Early Intervention Program. ACTS appreciates the important role that OMIG fulfills. We stand ready and willing to help OMIG in that regard in any way that we can.