OIG October Work Plan Updates: Emphasis on Children's Safety, Mental Health, and More

It is probably not intentional, but it sure seems like there is a theme to many of the U.S. Department of Health and Human Services Office of Inspector General (OIG) Work Plan items added in October 2023.  

Most of the items address programs or issues dealing with some of the most vulnerable in the United States. These include children with mental health issues, minorities and COVID, childcare centers for low-income families, and the safety of children in foster care. 

Let’s take a closer look. 

Mental Health Care for Children Enrolled in Medicaid

According to the American Academy of Pediatrics, roughly 7-8% of adolescents attempt suicide each year, and roughly 17% report serious suicidal ideation.1 In addition, rates of intentional self-harm among the young are also on the rise. The OIG states that a previous suicide attempt is the most important predictor of death by suicide, and the risk of death by suicide is highest in the period immediately after a hospitalization or emergency department visit for a suicide attempt or intentional self-harm incident.  

Because of this, is it essential that children experiencing these risks receive timely mental health follow-up care to decrease the likelihood of rehospitalization and to prevent suicide. The OIG plans to evaluate whether children enrolled in Medicaid and the Children's Health Insurance Program (CHIP) who had an emergency department visit or hospitalization for a suicide attempt or intentional self-harm incident received mental health follow-up care within established timeframes.  

They also intend to examine whether certain groups of children were less likely to receive timely mental health follow-up care after a hospitalization or emergency department visit. This Work Plan item will also include interviewing subject matter experts to identify the challenges and best practices when working to ensure youth enrolled in Medicaid and CHIP receive timely mental health follow-up care. 

Mitigating the Impact of COVID-19 Initiative

Racial and ethnic minorities, rural, and socially vulnerable populations particularly suffered during the COVID-19 epidemic. An initiative called The National Infrastructure for Mitigating the Impact of COVID-19 (NIMIC) seeks to develop and coordinate efforts mitigate the impact of COVID-19 on these populations.  

The NIMIC initiative is a three-year, $40 million cooperative agreement between HHS's Office of Minority Health and the Morehouse School of Medicine to fight COVID-19 in racial and ethnic minority, rural, and socially vulnerable communities. The Morehouse School of Medicine is leading the initiative to coordinate a strategic network to deliver COVID-19-related information to communities hardest hit by the pandemic.  

This initiative is expected to result in:  

1. Improving the reach of COVID-19-related public health messaging to racial and ethnic minority, rural, and socially vulnerable populations;  
2. Increasing connections to health care and social services for racial and ethnic minority, rural, and socially vulnerable populations;  
3. Decreasing disparities in COVID-19 testing and vaccination rates among racial and ethnic minority populations in highly impacted geographic areas; and  
4. Enhancing State, Territorial, and Tribal capacities and infrastructures to support response, recovery, and resilience among racial and ethnic minority, rural, and socially vulnerable populations.  

With this work plan item, the OIG plans to determine which strategies the Morehouse School of Medicine implemented to achieve the goals of the NIMIC initiative, and whether the Morehouse School of Medicine met the project goals and complied with Federal regulations. 

Child Care Centers

Federal funding to subsidize child care expenditures of low-income families was provided as a result of the Reauthorized in the Child Care and Development Block Grant Act of 2014 and the Child Care and Development Fund (CCDF). 

Previous OIG audits identified issues with the accuracy of child care attendance records and with related billings for child care services.  

The OIG plans to perform additional audits in this area by using a risk-based approach. They have identified audits that will occur in Minnesota and possibly additional states to determine whether the states complied with Federal and State requirements related to attendance records and whether payments for services at child care centers were allowable. 

Safety of Children in Foster Care

The Federal Foster Care Program is administered at the Federal level by the Administration for Children and Families. The program is intended to help states provide safe and stable out-of-home care for children.  

The OIG plans to perform two nationwide audits in the area of state agencies’ efforts to ensure the safety of children in foster care placements.  

One audit will examine the use of temporary emergency placements not designed to house children, such as hotels or offices, when a permanent placement is unavailable.  

The second audit will determine whether critical incidents involving serious physical injury or sexual abuse to a child in foster care are being reported in accordance with Federal and State requirements. 

Conclusion

Some additional items were also added to the work plan in October. These include recent trends in the refugee resettlement program, a review of HHS government purchase, travel, and charge card programs and a review of HHS agencies' annual accounting of national drug control program funds.  

As usual, it is recommended to assess whether any of these Work Plan items could affect your organization and to consider appropriate compliance action as necessary. 

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