The New York State Office of the Medicaid Inspector General (OMIG) released its 2025 Work Plan, which outlines key Agency program-integrity initiatives planned for 2025. Reflecting OMIG’s commitment to education, engagement and collaboration with Medicaid program stakeholders, the 2025 Work Plan provides a comprehensive roadmap for citizens, policymakers, providers and managed care organizations and other stakeholders to follow as a guide for the year’s activities. Medicaid is a principal policy driver and primary payor for long-term residential placements for the aged and disabled. Nursing homes and Assisted Living Programs (ALPs) remain an area of focus for OMIG to ensure that residents are appropriately served, that services are rendered properly and documented in accordance with Medicaid rules and regulations. OMIG activities in this area will include:
- Nursing Home Rate Audits – OMIG will maintain collaboration with the DOH’s Bureau of Nursing Home a Long-Term Care Rate Setting to ensure that facilities comply with DOH reimbursement policies and regulations. Additionally, OMIG will audit the relevant costs and data submitted concerning capital rates and ancillary services.
- Minimum Data Set (MDS) Reviews – OMIG will continue to review the accuracy of MDS submissions for selected nursing homes, completing the 2018 audit period and working on the 2019 audit period in 2025. These submissions are used by the DOH to calculate the direct cost portion of each nursing home’s Medicaid rate.
- Assisted Living Programs Audits (view Assisted Living Program Protocol).