State Medicaid Mandate Forces County to Act Fast

SCHOHARIE — The Schoharie County Board of Supervisors rang in their first meeting of 2024 with an agenda packed with change and challenges. Ranging from the introduction of the newly appointed Casella Waste Division Manager to the proposed addition of metal detectors in county offices to sweeping state-mandated updates to the state-mandated Medicare Compliance Program.  

The meeting began with Solid Waste Committee Member and Town of Fulton Supervisor Phil Skowfow’s introduction of Adam Critti, who recently took over as Regional Division Manager for Casella Waste. Critti delivered a short but clear commitment to meeting the needs of the county to commence the Privilege of the Floor section of the meeting.

Also by way of Privilege of the Floor, Sara Nies, Director of Community Services of the

 Schoharie County Community Services and MH Office, introduced Paul Mayer, Executive Vice President of The Bonadio Group, a CPA and consulting firm. Mayer was on site to pitch his firm’s ability to get the county up to speed on recent updates to the state’s Medicaid Compliance Programs. As Bonadio’s Compliance Solutions Team leader, Mayer has already worked with thirty-three counties in order to ensure they meet compliance requirements.

Mayer went on to explain a host of mandated updates and explained the risk of steep financial penalties if the requirements are not met.  For instance, Law Section 363-d includes a fine in the sum of $5000/mo. for up to 12 months and increasing to $10,000/mo. if the county's compliance program was deemed ineffective.

18 NYCRR Part 521 also saw significant amendments which became effective 12/28/22 with enforcement beginning 03/28/23.  Part 521b amendments include a variety of updates to training which mandates that a Compliance Officer must be appointed and that a Compliance Committee be formed.  In addition, written policies regarding procedures and standards of conduct must be put in place and implemented. The county is also responsible for Training and Education, Discipline, and Auditing and Monitoring.  

 One of the most significant changes, and costly, if requirements are not met is the Self Disclosure Program. The Self Disclosure Program is related specifically to instances of Medicaid overpayment and dictates the way in which the county is required to pay that money back. Penalties related to self-disclosure can fetch up to $27,000 per claim. 

A topic of concern that was touched on by Bonadio and supervisors alike is the challenges posed to smaller counties that may not have the resources or funding to implement this level of oversight and planning effectively. When asked whether there were any types of grants or funding to aid with these concerns, Mayer made it clear that the program is not funded and that any available grants are supplemental at best and would only apply to very specific circumstances. That the fiscal and logistical responsibility to meet requirements falls squarely on the shoulders of counties. Mayer stated that Bonadio had submitted a 3-year contract proposal to the county at the cost of $65,000. The board went on to pass a motion to accept this proposal. 

Please see next week's edition for part two of the January Board of Supervisors Meeting for more information about new security measures affecting the county offices.