Reports

This report describes the functions and components of PBMs in delivering pharmacy services, responsibilities for related performance and oversight, and how the components interact with each other to delivery pharmacy services. Issued November 17, 2017; revised September 30, 2019.

The audit evaluated HALO-Flight fee-for-service claims for air ambulance services were billed in accordance with state laws, regulations, and the Texas Medicaid Provider Procedures Manual.  Results indicated no exceptions for the claims tested.  Issued November 15, 2017.

The audit objective was to evaluate activities designed to analyze eligibility determination errors for benefit programs managed by the Texas Health and Human Services (HHS) System. Issued November 13, 2017.

The Annual Report of State Hospital Investigations for fiscal year 2017.

The Annual Report on Certain Fraud and Abuse recoveries for fiscal year 2017.

The Annual Report of State Supported Living Center Investigations for fiscal year 2017.

The audit objective was to determine whether the amounts in the capitalization and moveable equipment cost centers reported on the Providence Memorial Hospital cost report were accurate, allowable, and adequately supported according to CMS and state requirements. Issued October 31, 2017.

The audit objective was to determine whether therapy services at Sunny Springs were provided consistent with physician orders and in accordance with resident assessments and evaluations. Issued October 25, 2017.

This report details the inspection of procedures to maximize recovery of Supplemental Nutrition Assistance Program overpayments through the Treasury Offset Program. Issued October 20, 2017.

This issue brief provides an overview of value-based payments, which are structured to incentivize providers to delivery quality care in the most cost-effective manner.

The annual PARIS-VA Match Report for fiscal year 2017.

The Consolidated Senate Bill 30 Annual Report for fiscal year 2017.

This report details the inspection of Texas Medicaid providers to examine MCO controls for prior authorization, best practices to strengthen controls, medical necessity for authorization, and speech therapy utilization rates across managed care service areas. Issued October 2, 2017.

The IG Annual Report for fiscal year 2017, including the report from the fourth quarter.

This issue brief provides an overview of new state and federal guidelines for Medicaid managed care organizations about the recovery of improper payments and how other states distribute recovered Medicaid funds.