Risk & Quality Management Team: Medicaid Compliance Unit (MCU)

What We Do

The Medicaid Compliance Unit (MCU) collaborates with programs responsible for delivering Medicaid services to ensure that programs are run in compliance with state and federal laws, rules and policies, as well as the terms and conditions of our Global Commitment waiver.

The MCU also partners with the Quality Improvement and Oversight & Monitoring 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).
Who We Serve

The MCU coordinates with departments across AHS to ensure that Vermont Medicaid members benefit from a healthcare system that follows all required rules and policies.  Much of this work is designed ensure that the services we deliver are medically necessary and that our processes serve the medical needs of our members in accordance with statutes and rules.

How We Impact

The MCU provides consultation and assistance to Vermont Medicaid programs on compliance issues and assists these programs with compliance corrective actions as necessary.  This impacts our programs and members by ensuring the effectiveness and efficiency of our Medicaid service delivery system and limits the number of adverse findings we have during external audits.

Action Plan

SFY22 priorities are:

  • Complete first three elements of the Medicaid Risk Assessment Project.
  • Draft new departmental IGAs based on the results of the risk assessment.
  • Complete the 2021 EQRO Compliance Audit with a score above 90% and no repeat findings.
Scorecard Result Container Indicator Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy