5 Things You Need to Know About the 2016 OIG Mid-Year Work Plan

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The U.S. Department of Health and Human Services (DHHS) Office of Inspector General (OIG) recently released an updated Mid-Year Work Plan for fiscal year 2016. The updated Work Plan summarizes new and ongoing reviews and activities that OIG plans to pursue in the current year and beyond. This edition of the Work Plan describes OIG audits and evaluations that are underway or planned, and certain ongoing legal and investigative initiatives.

Here’s what you need to know about the 2016 OIG Mid-Year Work Plan.

1. National Background Checks for Long-Term-Care Employees

The OIG will review the procedures implemented by participating states for long-term-care facilities or providers to conduct background checks on prospective employees and providers who would have direct access to patients and determine the costs of conducting background checks. Their analysis will determine the outcomes of the states’ programs and determine whether the background checks led to any unforeseen consequences. This mandated work is expected to be issued in fiscal year 2019, in accordance with section 6201 of the Affordable Care Act.

2. Oversight and Effectiveness of Medicaid Waivers

The OIG will determine the extent to which selected states made use of Medicaid waivers and if costs associated with the waivers are efficient, economic, and do not inflate federal costs. Oversight of state Medicaid waivers will also be assessed. More states are using waivers to alter their Medicaid program in significant ways, and oversight of these programs presents challenges to ensure that payments made under the waivers are consistent with efficiency, economy, and quality of care. This initiative is expected to be issued in 2017.

3. Performance Improvement in Indian Health Service Hospitals

The OIG will evaluate Indian Health Service (IHS) hospitals’ use of root cause analysis (RCA) in response to adverse events, given that RCAs are critical to hospital quality assessment and performance improvement. Additionally, the OIG will identify management breakdowns, gaps, and lessons learned by IHS from its facilities’ failures to meet the care needs of American Indians/Alaska Natives, e.g., evidenced by failure to operate some facilities in compliance with Centers for Medicare & Medicaid Services (CMS) conditions of operation.

4. SAMHSA Controls Over Opioid Treatment Programs

The OIG will review State agencies’ controls over Opioid Treatment Programs (OTP) funded under the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Substance Abuse Prevention and Treatment Block Grant. Specifically, they will determine whether state agencies effectively monitor OTP services and medications in accordance with the Federal Guidelines for Opioid Treatment Programs established under 42 CFR Part 8.

5. Implementation of Recommendations Regarding HHS’ National Security Program

The OIG will assess whether applicable classification policies have been adopted, effectively administered, and followed, based on a 2013 report. The Reducing Over-Classification Act of 2010 requires that the Inspector General of each Federal department or agency with an officer or employee who is authorized to make original classification decisions conduct two evaluations. This mandatory review is expected to be issued in 2016.

These are just a few of the additions to the OIG’s 2016 Mid-Year Work Plan. The updated Work Plan contains over 30 additions and revisions and is available to download from the OIG’s website.