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Jul 24, 2023 7 likes •98 views

Compliance Program Presentation to the MHBE Board of Trustees Presented by Caterina Pagilinan May 18, 2020 Q3 FY2020 Privacy, Audit And Compliance Activities Independent Financial and Programmatic Audit Annual Privacy, IT Security

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Compliance Program Presentation to the MHBE Board of Trustees

Presented by Caterina Pañgilinan May 18, 2020

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Q3 FY2020 Privacy, Audit And Compliance Activities

 Independent Financial and Programmatic Audit  Annual Privacy, IT Security and Fraud, Waste and Abuse Training  Privacy Impact Assessment (PIA) - Access to Personally Identifiable Information  Secure Faxing Protocol  Transition to HIPAA IT Security Requirements for Carriers  Office of Legislation Audit (OLA) Finance, Network and General Services Triennial Audits  SOC 2 Type 2 Audit Requirement Changes  Contract Management Process  Policy and Procedure Improvement Project  Fully Implement List of Excluded Individuals and Entities Process  Revamp Privacy Notice  508 Compliance

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Internal Control Reviews

Improve IRS 1075 Safeguards – Federal Tax Information Background Check Processes
Improve traceability of verification of consultant timesheets to invoicing to payment process
Proper Invoice Payments to Connector Entities
Expand Override Process Verifications
Inventory and Reconciliation Processes
Request For Resume Conflict of Interest
Payment Error Rate Measurement (PERM) Audit Initial Findings
Procurement Bid Security Process

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Postponed

Incorporate Unemployment Compensation Data into Income Verification Process
Full Implementation of Failure to Reconcile Taxes Process
Employer-Sponsored Coverage Verification Process
Internal Revenue Service Safeguards Triennial Review
Payment Error Rate Measurement (PERM) Audit
Eligibility Improper Payment Measurement (EIPM) Pilot
State-based Marketplace Annual Reporting Tool (SMART), Minimum Acceptable Risk

Standards for Exchanges (MARSE) and Privacy Impact Assessments (PIA)

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3rd Quarter FY20 Compliance Hotline Calls 3rd Quarter YTD FY20 Fraud, Waste & Abuse Allegations

FY 2020 Compliance Hotline

14 - Allegations  7 - Not Founded  1 - Partially Founded  5 - Referred  1 - Pending Investigation

97% 1% 2% Constituent Services Compliance Hotline Civil Rights Officer

Department 3rd QTR Calls FY20 YTD Calls Constituent Services 102 263 Compliance Hotline 3 Civil Rights Officer 2 6 TOTAL 104 272

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Q3 FY20 YTD PRIVACY INCIDENTS (Non- Producer)

Rate Per 10,000 Enrollments Per 10,000 Uploads

9% Increase in Rate of Misloads

15% Increase in Rate of Privacy Incidents - 1.31 from 1.14

2.52 2.79 1.92

0.00 0.20 0.40 0.60 0.80 1.00 1.20 1.40 1.60 1.80 2.00 5 10 15 20 25 30

Jul Aug Sep Oct Nov Dec Jan Feb Mar

FY19 Raw No. FY20 Raw No. FY19 Rate FY20 Rate

2.29 2.49

0.00 1.00 2.00 3.00

FY19 FY20

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Misloaded Documents

1 2 3 4

Jul Aug Sep Oct Nov Dec Jan Feb Mar

Per 100,000 Calls

FY 19 FY 20

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Privacy Incident Mitigation

0.00 2.00 4.00 6.00 8.00 10.00 12.00

Rate of Parties Affected (per 10,000 Enrollments) Average Days to Send Breach Letter Average Days to Delete Misload Rate of Misloads requiring Notice to Consumer (per 10 Misloads)

FY20 FY19

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