Oversight and Monitoring Unit

# of overall DVHA audit findings that are repeat audit findings

2SFY 2019

Line Bar
Notes on Methodology

Please note that in the chart above:

  • The solid trendline represents the total # of findings for the SFY
  • The dotted trendline represents the # of repeat finding for the SFY

Goal:  The goal for this measure is no repeat findings. However, it is understandable if there are repeat findings related to known or discovered system problems that require ADS project assessment. 

Partners
  • DVHA staff
  • DVHA Unit Directors
  • DVHA Leadership
Story Behind the Curve

This measure shows the total number of audit findings in audits that closed during a state fiscal year (SFY) and the percent that are repeat findings from previous audits.

The expectation of regulators, auditors and examiners is that findings and recommendations are resolved before the next exam or audit. The State provides corrective action plans (CAPs) to these entities at the close of each audit, as well as periodic progress reports as necessary. Findings and recommendations not adequately addressed before the next audit are reported as repeat findings. The criticality of these findings increases the longer the finding remains open. Special consideration is given for findings and recommendations that are system related which may need project planning and cannot be completed in the period between audits.

DVHA is required to be compliant with all Federal and State policies regarding the administration of the Medicaid Program and the Qualified Health Plans. When an audit identifies findings, DVHA will work to correct the issue in the approved time frames to ensure there are no repeat findings when that auditor or regulator returns.

Federal and State policies define the regulations for which DVHA must follow to be compliant with the administration of the Medicaid Program, including the Qualified Health Plans. When repeat findings exist, it brings to light that deficiencies and/or material weaknesses remain and that the programs are not compliant with the requirements. A compliant program will help to strengthen the economy, make Vermont more affordable, and protect the most vulnerable.

Oversight and Monitoring Unit (OMU) tracks all findings and monitors open items. Historical data is retained for all closed items. Repeat findings are noted as part of the tracking process.

Since 2016, The total number of findings and number of repeat findings have both decreased significantly. As we reduce the number of findings through new controls, system related findings make up a larger part of the finding totals as these take longer to close.

Finding Levels:

Deficiency - A deficiency in operation exists when a properly designed control does not operate as designed, or when the person performing the control does not possess the necessary authority or competence to perform the control effectively.

Significant Deficiency - A deficiency, or a combination of deficiencies, in internal control over financial reporting that is less severe than a material weakness, yet important enough to merit attention by those responsible for oversight of the company's financial reporting.

Material Weakness - A deficiency, or a combination of deficiencies, in internal control over financial reporting, such that there is a reasonable possibility that a material misstatement of the company's annual or interim financial statements will not be prevented or detected on a timely basis.

Audits:

45 CFR is an annual audit of the Vermont State Exchange "VHC" by an independent qualified auditing entity which, follows generally accepted governmental auditing standards (GAGAS) to perform an annual independent external financial and programmatic audit and must make such information available to HHS for review by CMS/CCIIO/HHS. The Centers for Medicare & Medicaid Services (CMS) is part of the Department of Health and Human Services (HHS). CMS administers Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and the Health Insurance Marketplace. The Center for Consumer Information and Insurance Oversight (CCIIO) has direct enforcement authority over non-Federal governmental health plans and is charged with ensuring adequate implementation of the provisions of the Affordable Care Act.

The Comprehensive Annual Financial Report (CAFR) is a thorough and detailed annual presentation of the state's financial condition. It reports on the state's activities and balances for each fiscal year. The State’s external accounting firm works with the State of Vermont to review prepared modified accrual financial statements for compliance with GAAS and GAAP guidelines.

The Single Audit is an annual review by the State’s external audit firm to ensure a recipient of federal funds is in compliance with the federal program's requirements for how the money can be used. Each federal agency that gives out grants outlines specific items it feels are important for recipients to meet to ensure the successful management of the program and alignment with the legislative intent of the program. These items are laid out in the A-133 Compliance Supplement.

CMS PI Review is a periodic audit. On a rotating cycle, the Centers for Medicare & Medicaid Services (CMS) conduct a focused review to determine the extent of program integrity oversight of the managed care program at the state level.

Payment Error Rate Measurement (PERM) is a cyclical audit performed every three years by CMS. The purpose of PERM is to comply with the Improper Payments Information Act (IPIA) by reviewing programs that are susceptible to improper payments.

Medicaid Disproportionate Share Hospital Share (DSH) is an annual audit conducted by CMS to ensure the appropriate use of Medicaid DSH payments and compliance with the statutorily imposed hospital-specific limits. Statute requires that states submit an annual report and an independent certified audit in order to receive Federal Financial Participation (FFP).

Last updated:  07/15/19

Strategy
  • Continue to work with DVHA departments to strengthen documented Standard Operations Procedures "SOPs". Through the 2018 SOP project, DVHA departments learned how to capture the risks and controls in each area and to have documentation for leadership and the regulators to support our self-assessment that we have a strong control environment. Being able to document a strong control environment that stands up to audit testing results in reduced testing and findings.
  • Continue to work with DVHA departments to assess and prepare for audits, exams and reviews to ensure consistent messaging and accurate exchange of requested documentation and answers from one exam/audit to the next.
Scorecard Result Container Indicator Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy