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Risk & Quality Management Team

Ret: Annual Medicaid compliance score from External Quality Review Organization

Current Value

81%

2022

Definition

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Story Behind the Curve

This performance measure is important because it shows our commitment to improving issues of non-compliance in our Medicaid program.

This measure shows the frequency and percentage of repeat findings during any of the three annual EQRO audits. Repeat findings occur when we fail to fully correct a finding from a previous year. Repeat findings are rare for these audits and typically result from technology limitations or corrective action plans that are complicated and take more than one year to complete. There are no specific penalties for repeat findings but keeping the numbers at or close to zero demonstrates our commitment to compliance with these requirements.  When findings are received, they are reviewed with the Regulatory Compliance Committee as well as the departments/units involved with the findings. Corrective action is taken on all findings and progress is reported to AHS and the auditors. 

In 2022, we changed our method for measuring network adequacy. This change caused us to drop some of the reporting we completed during the previous audit period (CY 2019). We didn’t formally adopt the new methodology until after the EQRO review period. This caused the auditors to look for reports we were no longer creating. A team of DVHA and AHS staff are working to resolve this issue, but it resulted in significant repeat findings.

Narrative last updated:  04/04/23

Partners

  • Department of Aging and Independent Living (DAIL)
  • Vermont Department of Health (VDH)
  • Department of Mental Health (DMH)
  • Department of Children and Families (DCF)
  • Agency of Human Services Central Office (AHS CO)

Strategy

In 2022, DVHA initiated a new Risk Assessment project designed to systematically identify and correct Medicaid compliance risks. The project team comprises subject matter experts in compliance, quality and oversight & monitoring. To date, the team has reviewed approximately half of the pertinent compliance standards and their goal for 2023 is to ensure that all EQRO findings are addressed and that we take action to reduce or eliminate future findings. The team’s approach will significantly reduce or remove future repeat findings as well.

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