Medicaid Audit Intelligence

Evidence record

Office Of Medicaid (MassHealth)—Massachusetts Delivery System Reform Incentive Payment Program

Jurisdiction
Massachusetts
Publishing agency
Massachusetts Office of the State Auditor
Publication date
June 29, 2022
Source record
Original document linked
Open original reportOriginal source available

Findings

1

Recommendations

1

Overall conclusion

MassHealth did not ensure that DSRIP funding was allocated to ACOs in accordance with the Massachusetts Delivery System Reform Incentive Payment Protocol (Attachment M).

Scope

Performance audit of MassHealth's Delivery System Reform Incentive Payment (DSRIP) Program payments to accountable care organizations (ACOs) during January 1, 2018 through December 31, 2020, conducted under the Massachusetts Office of the State Auditor's purview. The audit evaluated MassHealth's administration of the DSRIP Program in accordance with the Massachusetts Delivery System Reform Incentive Payment (DSRIP) Protocol (Attachment M), specifically Sections 3.3 and 3.4.4.1, including the process for ACO budget proposals submission and approval by the independent assessor prior to budget period start dates (calendar years 2018–2020), the role of the independent assessor in reviewing budgets, the timing of quarterly DSRIP payments disbursed through MMIS, and data reliability of MMIS transaction data. The scope encompasses the period, the transition to an ACO care model under the 1115 waiver from July 1, 2017 through June 30, 2022, and notes that MassHealth provided approximately $500,176,599 to its ACOs during the audit period.

Findings (1)

Each finding has a stable link.

  1. F-630

    MassHealth did not ensure that accountable care organizations submitted their budget proposals before the beginning of the budget period. In 2020, none of the 17 ACOs that received DSRIP Program funding submitted a budget proposal to MassHealth until after the beginning of the budget period. In 2018, 1 ACO did not submit its budget proposal until after the beginning of the budget period.

Recommendations (1)

  1. R-563

    MassHealth should establish monitoring activities to ensure that every ACO submits its budget proposal before the beginning of each budget period.

    Related finding F-630