Page 2 C. McClain Haddow survey agency. We also recommend that HCFA conduct its own special study of survey and certification activities in the State of Oklahoma, and consider exercising the Department's authority to conduct "look behind" reviews in those facilities identified as warranting such reviews. We would appreciate being advised within 60 days of actions you plan to or have initiate(d) as a result of our report. Attachment For further information, contact: Glyndol J. Taylor Regional Inspector General for Audit, Region VI FTS 729-8414 Review of Medicare and Medicaid Oklahoma State Department of Health REGION VI NOTICE The designation of financial and/or management practices as questionable or a recommendation for the disallowance of costs incurred or claimed, as well as other conclusions and recommendations in this report, represent the findings and opinions of the HHS Office of Inspector General. Fil determination on these matters will be made by authori officials of the HHS operating divisions. Audit Control Number: 06-60151 Enclosed for your information and use is a copy of an OIG Office of Audit report titled, "Review of Medicare and Medicaid Provider Certification Activities, Oklahoma State Department of Health." Your attention is invited to the audit findings and recommendations contained in the report. The below named official will be communicating with you in the near future regarding implementation of these items. In accordance with the principles of the Freedom of Information Act (Public Law 90-23), OIG Office of Audit reports issued to the Department's grantees and contractors are made available, if requested, to members of the press and general public to the extent information contained therein is not subject to exemptions in the Act, which the Department chooses to exercise. (See Section 5.71 of the Department's Public Information Regulation, dated August 1974, as revised.) To facilitate identification, please refer to the above audit control number in all correspondence relating to this report. Sincerely yours, Glyndal J Jayla GLYNDOL J. TAYLOR Regional Inspector General for Audit Enclosure Direct reply to: Dr. Kenneth C. Schneider Associate Regional Administrator Health Care Financing Administration INTRODUCTION BACKGROUND The Social Security Act (Sections 1864 and 1902) authorizes the Secretary of HHS to contract for the services of State agencies to determine whether health facilities meet the requirements for participation in the Medicare and Medicaid programs. In Oklahoma, the State Department of Health (OSDH) is the State survey agency responsible for performing annual certification surveys of participating facilities. At the Federal level, the Health Care Financing Administration, Department of Health and Human Services (DHHS), is responsible for administering the Medicare and Medicaid provider certification program. The State and Federal participation requirements consist of a series of health and safety standards which measure the ability of an institution to render adequate and safe care. Certification surveys consist of (1) health and sanitation requirements which are evaluated by the survey agency and (2) life safety code requirements which are evaluated by the State Fire Marshal's office -- under contract with the OSHD. Facilities not in full compliance with the health and sanitation and the life safety code requirements may be certified for a limited period under both programs, but only with an approved plan for correcting deficiencies noted during the survey. Medicare and Medicaid regulations also provide for automatic cancellation of a facility's certification if deficiencies noted have not been corrected within the time period specified in the plan of correction. During the period of our review, OSDH was responsible for certifying some 360 intermediate care facilities (ICFs), 102 hospitals, 9 skilled nursing home facilities (SNPs), 84 home health agencies, 47 independent laboratories, and 34 other miscellaneous health providers. SCOPE OF AUDIT Our review was made in accordance with standards for governmental auditing and included interviews with responsible officials and a review of documentation relating to State surveys of hospitals, ICFs, SNFs, and home health agencies. The ICFS and the one SNF reviewed were selected by both judgmental and statistical sampling methods. Our revi primarily directed towards ICF certification activities because preliminary audit work indicated more of a problem with these facilities remaining in compliance with Medicaid standards. Our sample included 17 ICFs reviewed in a prior audit of State certification activities (ACN: 06-02100, issued in June 1980), 11 additional ICFs, and 1 SNF. Our review, which covered surveys performed during the four |