The Oversight & Monitoring Unit (OMU) consists of two teams; Audit & Internal Control and Healthcare Quality Control. The OMU is responsible for ensuring the effectiveness and efficiency of departmental control environments, operational processes, regulatory compliance, and financial and performance reporting in line with applicable laws and regulations.

The OMU also partners with the Compliance and Quality Improvement units as part of the larger Risk & Quality Management Team. The over-arching goals of that team include:

• create a culture of pro-active regulatory compliance and continuous quality improvement;
• identify, analyze, prioritize and correct compliance risks across all departments and programs responsible for Medicaid service delivery;
• take advantage of opportunities to move beyond compliance and identify ways to improve the services we deliver to Vermonters;
• coordinate the production and/or analysis of standard performance measures pertaining to all Medicaid enrollees, including the special health care needs populations (service provision delegated to IGA partners).

The OMU serves DVHA Senior Leadership and all DVHA departments and units.

The OMU facilitates and consults on numerous exams, reviews and audits to establish professional working relationships between the DVHA units, examiners, regulators and auditors resulting in a better understanding of what is truly an issue versus a miscommunication, which results in reduced of findings.

The Health Care Quality Control Unit reviews beneficiary enrollment and eligibility determinations consistent with guidelines set forth in the Federal Payment Error Rate Measurement (PERM) regulations. This process requires a separate and distinct business area to conduct quality control reviews of eligibility determinations, based on CMS defined scopes, quantities and time frames. 

SFY22 priorities are:

• Zero repeat findings through successful closure of current open CAPs for prior audits.
• Development and maintenance of Standard Operating Procedures reinforced by internal control testing of the DVHA control environment and establishment of a Medicaid Risk Assessment Program.
• Timely submission of the 2023 CMS MEQC Plan due to CMS for approval November 1, 2022.
• Track Covid related regulation changes for impact on future audits and track “unwinding process” after PHE is declared over.
• Successful facilitation and coordination of the ongoing PERM audit (7/1/21-6/30/2022) educating state staff and the CMS Review Contractors, timely resolution of PERM findings, determination of what can be overturned with difference resolution or preparing fixes and corrective actions for any findings we cannot.