Nursing Facility Emergency Preparedness: Mystic Park Nursing and Rehabilitation Center
Executive Summary

The inspection objective was to determine whether Mystic Park Nursing and Rehabilitation Center followed select state and federal requirements for emergency preparedness. Issued August 25, 2022. OIG Report No. INS-22-010.

Clinical Laboratory Improvement Amendments (CLIA) Certification: Texas Medicaid and Healthcare Partnership (TMHP)
Executive Summary

The inspection objective was to determine whether TMHP has controls to ensure payments made to laboratories are only for services covered under the laboratory's CLIA certification level. Issued August 19, 2022. OIG Report No. INS-22-009.

Nursing Facility Staffing Hours Verification: Mira Vista Court
Executive Summary

The inspection objective was to determine whether the direct care licensed nursing hours recorded at Mira Vista Court supported the hours submitted to the U.S. Centers for Medicare and Medicaid Services in compliance with federal requirements. Issued August 16, 2022. OIG Report No. INS-22-008.

Nursing Facility Staffing Hours Verification: Westchase Health and Rehabilitation Center
Executive Summary

The inspection objective was to determine whether the direct care licensed nursing hours recorded at Westchase Health and Rehabilitation Center supported the hours submitted to the U.S. Centers for Medicare and Medicaid Services in compliance with federal requirements. Issued August 9, 2022. OIG Report No. INS-22-006.

Nursing Facility Staffing Hours Verification: Winchester Lodge Healthcare Center
Executive Summary

The inspection objective was to determine whether the direct care licensed nursing hours recorded at Winchester Lodge Healthcare Center supported the hours submitted to the U.S. Centers for Medicare and Medicaid Services in compliance with federal requirements. Issued August 9, 2022. OIG Report No. INS-22-007.

Clinical Laboratory Improvement Amendments (CLIA) Certification Series 4
Executive Summary

This inspection examined the processes Cook Children’s Health Plan, El Paso Health, and Superior HealthPlan have for ensuring laboratory service providers have the appropriate CLIA certification prior to paying submitted claims. Issued July 12, 2022. OIG Report No. INS-22-005.

Clinical Laboratory Improvement Amendments (CLIA) Certification Series 3
Executive Summary

This inspection examined the processes Amerigroup, Blue Cross and Blue Shield of Texas, Dell Children’s Health Plan, Molina Healthcare of Texas, and United Healthcare Community Plan have for ensuring laboratory service providers have the appropriate CLIA certification prior to paying submitted claims. Issued July 12, 2022. OIG Report No. INS-22-004.

Clinical Laboratory Improvement Amendments (CLIA) Certification Series 2
Executive Summary

This inspection examined the processes Aetna Better Health of Texas, Community First Health Plans, Driscoll Health Plan, and Parkland Community Health Plan have for ensuring laboratory service providers have the appropriate CLIA certification prior to paying submitted claims. Issued July 11, 2022. OIG Report No. INS-22-003.

Clinical Laboratory Improvement Amendments (CLIA) Certification Series 1
Executive Summary

This inspection examined the processes Community Health Choice, FirstCare HealthPlans, Scott & White Health Plan, and Texas Children’s Health Plan have for ensuring laboratory service providers have the appropriate CLIA certification prior to paying submitted claims. Issued July 11, 2022. OIG Report No. INS-22-002.

Nursing Facility Staffing Hours Verification: The Villa at Mountain View
The inspection objective was to determine whether the licensed nursing hours recorded at the Villa at Mountain View supported the hours submitted to the U.S. Centers for Medicare and Medicaid Services (CMS) in compliance with federal requirements. The inspection did not result in any recommendations to the Villa at Mountain View. Issued February 17, 2022. OIG Report No. INS-22-001.

Delivery Supplemental Payments (DSP): Medicaid CHIP Services—Financial Reporting and Audit Coordination (FRAC)
The inspection focused on whether FRAC periodically verifies that DSP claims are valid and adequately supported, conducts retrospective reviews of DSP claims, and implemented policies and procedures to ensure delivery supplemental payment claims are processed timely and accurately. Issued August 31, 2021.

Mental Health Targeted Case Management and Mental Health Rehabilitative Services in Managed Care: Local Mental Health Authorities and Local Behavioral Health Authorities in Texas Medicaid
The inspection focused on mental health targeted case management and mental health rehabilitative services provided by local mental health authorities (LMHAs) and local behavioral health authority (LBHA) contracted providers. Issued August 30, 2021.

Supplemental Nutrition Assistance Program: Second Level Review Process
This inspection determined the second level review process is operating effectively to detect errors and prevent distribution of ineligible SNAP benefits. As a result, no observations were identified for this inspection. Issued August 25, 2021.

The National Correct Coding Initiative in Texas Medicaid: Informational Report on Use of NCCI Edits by Managed Care Organizations
The objective was to understand whether MCOs have processes in place for deployment of current NCCI edits and how often those edits are updated. Issued August 12, 2021.

Documentation of Reductions to Authorized Levels of Care: Local Mental Health Authorities in Texas
This inspection assessed whether the reduction of Medicaid members' mental health services by LMHAs was documented and in compliance with Texas Administrative Code and Texas Resilience and Recovery Utilization Management Guidelines: Adult Mental Health Services. Issued July 28, 2021.