Audit Protocols

Overview

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: Draft Protocol and Approval. Phase 2: Program Agency Review. Phase 3: Internal Quality Review. Phase 4: Stakeholder Review.

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

Audit Protocols
Department of Health (DOH) Project TypeFor Service DatesPublished DateTargeted Next Publication
Assisted Living Program (ALP) Protocol-03/10/2017Q3 2025
Certified Home Health Agency (CHHA) Episodic Payment Protocol05/02/2012 – 07/12/201703/19/20192026
Certified Home Health Agency (CHHA) Protocol-06/26/2018 2026
Consumer Directed Personal Assistance Program Protocol -12/09/2020 2026
Dental Protocol -10/01/2014 Q3 2025
Diagnostic & Treatment Center (DTC) Services Protocol 01/01/2018 - 02/05/202311/25/20242027
Durable Medical Equipment Protocol 04/01/2013 - 03/13/202411/15/2024Pending
Early Intervention (EI) Program Protocol 04/06/2016 - 10/18/2021 03/30/2023 2026
Health Home (Adults) Protocol 01/09/2014 - 07/01/2019 05/31/2023 2026
Hospice Protocol Prior to 08/31/2016 03/14/2019 Q3 2025
Hospital Outpatient Department (OPD) Emergency Room/Clinic Protocol​09/14/2015 - 03/31/202504/11/20252027
Hospital Outpatient Department (OPD) - Laboratory Protocol09/14/2015 - 03/31/202504/11/20252027
Hospital Outpatient Department Ordered Ambulatory Services - Other Than Laboratory Protocol 09/14/2015 - 03/31/202504/11/20252027
Independent Provider for Private Duty Nursing Protocol01/01/2018 - 12/31/202310/29/20242026
Licensed Home Care Services Agency (LHCSA) for Private Duty Nursing Protocol01/01/2018 - 12/31/202310/29/20242026
Nursing Home Transition and Diversion Waiver (NHTD) Protocol-07/10/2017 Q3 2025
Personal Care Aides (PCA) Protocol -12/05/2018 2026
Pharmacy Protocol01/01/2015 - 12/31/2019 05/24/2022 2026
Transportation Ambulette ProtocolPrior to 12/31/2018 03/31/2020 Q3 2025
Transportation Taxi/Livery ProtocolPrior to 12/31/2018 06/17/2020 Q3 2025
Traumatic Brain Injury (TBI) Protocol-03/09/2018 2026
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Office of Addiction Services and Supports (OASAS) Project TypeFor Service DatesPublished DateTargeted Next Publication
Inpatient Chemical Dependence Rehabilitation Services Protocol              -                     10/12/2017 2026
Opioid Treatment Program (OTP) Protocol11/23/2015 - 06/30/20249/25/20242026
Substance Use Disorder Outpatient Programs Protocol11/23/2015 - 06/30/20249/25/20242026
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Office of Mental Health (OMH) Project TypeFor Service DatesPublished DateTargeted Next Publication
Community Rehabilitation Services for Adults Protocol-05/20/2016 Q3 2025
Comprehensive Psychiatric Emergency Programs Protocol-06/21/2016 2026
Continuing Day Treatment Services Protocol -08/12/2015 2026
Day Treatment Programs Serving Children Protocol -08/12/2015 2026
Mental Health Outpatient Treatment and Rehabilitative Services Protocol1/1/2017 - 2/28/20253/6/20252027
Partial Hospitalization Protocol -08/12/2015 2026
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Office for People With Developmental Disabilities (OPWDD) Project TypeFor Service DatesPublished DateTargeted Next Publication
Article 16 Clinic Services Protocol-04/03/2017 2027
Community Habilitation Services01/01/2018 - 01/07/202501/07/20252027
Day Habilitation Protocol-08/20/2018 2026
IRA Residential Habilitation Protocol07/01/2014 - 06/30/2018 09/17/2021 2026
Prevocational Services Protocol-03/24/2015 2027
Supported Employment Protocol07/01/2015 - 03/09/2016 02/05/2018 2027
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New Protocols in Development
Project TypeTargeted Publication Date
OMH - Personalized Recovery Oriented Services (PROS)​ Q3 2025
Physician Services2026
Medicaid in Education2027
​​Adult Day Health Care (ADHC)​ Pending
Certified Community Behavioral Health Clinic Pending
OMH - Telemental HealthPending
OPWDD - Care Coordination / Health Homes (OPWDD CCO/HH)Pending

Page last updated: April 2025