In consultation with state regulating agencies, including the Department of Health (DOH), Office for People With Developmental Disabilities (OPWDD), Office of Mental Health (OMH), and Office of Addiction Services and Supports (OASAS), OMIG has developed a series of audit protocols to assist the Medicaid provider community in developing programs to evaluate compliance with Medicaid requirements under federal and state statutory and regulatory law. Outlined below is the process by which OMIG reviews and updates these protocols.
Phase 1: OMIG subject matter experts research and review relevant laws, regulations and program agency guidance. After this review, subject matter experts draft the initial set of protocols.
Phase 2: Draft protocols are sent to program agency for review. OMIG and the program agency collaborate to discuss the program agency's feedback. OMIG then revises protocols as needed.
Phase 3: Internal OMIG review occurs, encompassing both quality assurance and legal review.
Phase 4: Provider associations are given the opportunity to review the drafted protocols. OMIG reviews all submitted association feedback and revisions are made as necessary. The protocols then go through a final review by OMIG. After the final review, the Audit Protocol is published on OMIG's website.
Audit protocols are applied to a specific fee-for-service provider or category of service in the course of an audit and involve OMIG's application of articulated Medicaid agency policy and the exercise of agency discretion.
These audit protocols are intended to serve solely as guidance and do not alter any statutory or regulatory requirement. In the event of a conflict between statements in the protocols and either statutory or regulatory requirements, the requirements of the statutes and regulations govern.
For reasons such as responding to a hearing decision, litigation decision, or statutory or regulatory change, an audit protocol may be amended.
To view prior published versions of these protocols, please visit Audit Protocols Archive.
View frequently asked questions
View the protocol change log, which summarizes recent updates to published protocols.
For questions relating to audit protocols, please contact the Division of Medicaid Audit at [email protected].
