DHS OIG SIRS Notice of Proposed Changes to Rules on Random Sample Extrapolation

By ARRM Admin posted 11-29-2020 23:00


Did I make the title above obscure and confusing enough for you by throwing together several acronyms and a term like “random sample extrapolation?” What does that mean, anyway? Well, don’t let that minimize the importance of the topic to providers that participate in Minnesota Healthcare Programs, which includes services paid for under the disability waivers. Read below for clarity and a call to action.

Minnesota Rule 9505.2220 addresses how the commissioner of the Department of Human Services (DHS) may use a statistical method known as random sample extrapolation to calculate the amount of money they may recover from a provider if there is an overpayment. The rule allows the calculation to be based on a random sample of claims when the number of recipients or claims to be examined exceeds specific thresholds. In its current form, the rule spells out detailed requirements for the method of sampling, and specifies that DHS shall tell the provider how they will conduct the sampling BEFORE the sample is drawn.

DHS recently notified providers via bulletin of their intent to make changes to this rule. In our estimation, the proposed changes dilute the rigor with which DHS shall conduct the statistical processes, and more importantly, remove the requirement that providers be notified of the sampling method before it is done. While providers would have the ability to appeal any judgements, we believe it is important that the sampling methodology be disclosed up front for full transparency.

DHS invites public comments on the proposed changes by December 31, and they have scheduled a public hearing before an administrative law judge on Thursday, January 28, 2021 at 9:30 am. But they are seeking to waive the public hearing on the changes UNLESS at least 25 people request one in writing. ARRM will make such a request, and we encourage providers to do the same to ensure that enough requests are received.

The process to request a public hearing is as follows:

“You must make your request for a public hearing in writing, which the agency contact person must receive by 4:30 p.m. on Thursday, December 31, 2020. You must include your name and address in your written request. In addition, you must identify the portion of the proposed rules that you object to or state that you oppose the entire set of rules. Any request that does not comply with these requirements is not valid and the agency cannot count it when determining whether it must hold a public hearing. You are also encouraged to state the reason for the request and any changes you want made to the proposed rules.”

Below is suggested text you may use in making a request, which should be sent via email to Vanessa Vogl in the DHS Administrative Law Office.

“On behalf of {Organization}, I request the Department of Human Services hold the scheduled public hearing on the proposed changes to MN Rule 9505.2220. I oppose the entire set of changes to the rule.”

If you want more details on any of this information, feel free to contact me.

P.S. If you are burning with curiosity about meanings of the acronyms used in the title, the full text is Department of Human Services Office, of Inspector General, Surveillance and Integrity Review Section.

Ken Bence
Director of Research, Analysis and Policy