November 7, 2019

The OIG has released the next audit in its series looking into service coordination for STAR+PLUS Level 1 members.

The objective of this audit was to evaluate whether HealthSpring Life and Health Insurance Co., Inc., doing business as Cigna-HealthSpring (Cigna), a Medicaid and Children’s Health Insurance Program (CHIP) managed care organization, complied with contractual requirements for performing service coordination.

The audit found that Cigna completed individual service plans (ISPs) for all 61 members in the Home and Community Based Services (HCBS) program. However, 38 percent of STAR+PLUS Level 1 members evaluated did not receive one or more of the required service coordination activities.

The OIG recommended that HHS Medicaid and CHIP Services, through its contract oversight responsibility, should ensure Cigna:

  • Provides two face-to-face visits annually for HCBS members and quarterly face-to-face visits for members residing in a nursing facility.
  • Checks on HCBS members’ receipt of approved services within four weeks of the ISP start date.
  • Assesses members within 30 days of their entry into a nursing facility.

You can read the full audit report here: https://tinyurl.com/yxalyzyz