OIG audit confirms positive progress

The OIG conducted a follow-up audit regarding two audits completed in 2019 about services to members in the Medically Dependent Children Program.

• “Audit of Selected Services to STAR Kids Members in the Medically Dependent Children Program: Cook Children’s Health Plan” (August 30, 2019).
• “Audit of Selected Services to STAR Health Members in the Medically Dependent Children Program: Superior HealthPlan” (August 30, 2019).

Both audits observed STAR Kids Screening and Assessment Instruments (SK-SAIs) SK-SAIs were not always complete or aligned with medical records reviewed, and the OIG recommended creating or expanding review processes to identify and correct incomplete or inaccurate assessments.

Managed care organization (MCO) service coordinators use the SK-SAI to perform an annual comprehensive assessment of a member’s physical and functional needs. Through the assessment process, service coordinators should identity member needs and preferences, which are used to design the member’s service plan. The member and the member’s authorized representative must be present for the assessment. The SK-SAI is used to determine both MDCP eligibility and an annual cost limit for MDCP services for that member.

To follow up on whether SK-SAIs were being completed timely and thoroughly, the OIG conducted an audit of to determine whether, for newly enrolled members in MDCP, (a) the SK-SAI data entered in the Texas Medicaid and Healthcare Partnership (TMHP) online portal agrees with the information submitted by the MCO and (b) evidence shows the assessments were completed timely. The OIG concluded that SK-SAIs for members newly enrolled in MDCP are being completed correctly and timely, and no recommendations were warranted. That report, “Audit of STAR Kids Screening and Assessment Instrument New Enrollment Timeliness,” was published in April 2021.