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Medicaid and information Blocking Discussion

Part 1: Critical Analysis of the Law

  1. Medicaid is a joint federal-state plan with funding from the federal government and state implementation.
    • Evaluate the role of state waivers in Medicaid. Compare and contrast two chosen different types of waivers. What are the state consequences of not meeting waiver requirements?
    • How could these waivers impact a long-term care organization?
  2. Discuss the COSO framework for internal controls and evaluate how it could be used to meet Medicaid waiver requirements. Be specific and demonstrate understanding of the risks and how the compliance tool can be used specifically to control the risks.

Part 2: Strategic Compliance with the Law

You work for a small managed care organization (MCO) “Splendid Healthcare” that owns a hospital and two provider clinics in. Your MCO just received notice that it will be subject to an HHS OIG evaluation of your electronic health information (EHI) practices because there was a complaint that your organization was engaged in information blocking because you did not release information to the state Medicaid office when they requested it. Honestly, your technology is out of date and you can’t transfer encrypted EHI to meet the state’s request.

  1. Name and describe and give the code section that gives Medicaid have the right to access your EHI. Name and describe and give the code section that gives the HHS OIG have the right to access your medical records to evaluate information blocking. (Give the legal source of the right)
  2. How could you have “worked around” your technology limits to provide Medicaid with the information they requested?
  3. Discuss information blocking. What could you do to bring your EHI up to date so that you don’t face an information blocking complaint in the future? Describe the steps you would take to update your EHI system.
  4. Discuss information blocking exceptions. Does your organization fall within any of the information blocking exceptions? Why or why not? If it does, how would you communicate your views on this to the HHS OIG?

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