Purpose

To determine whether the Department of Health (Department) is providing sufficient oversight to ensure that Maximus is implementing the contract deliverables and meeting specified performance standards. The audit covers the period June 1, 2012 through February 3, 2016.

Background

In October 2013, the Department launched a state-based Marketplace, known as the New York State of Health, to help New Yorkers shop for and enroll in health insurance coverage. Since 2010, the Department has had a contract with Maximus to develop and operate a statewide enrollment center for the State’s public health insurance programs. Through several amendments to the contract, the Department tasked Maximus to staff and operate a Customer Service Center to assist Marketplace users. Consisting of a Contact Center and an Eligibility and Enrollment Unit, the Customer Service Center provides assistance to various consumers of the Marketplace as well as centralized eligibility and enrollment processing. Maximus is required to meet performance standards related to processing, accuracy, and reporting on its operations. The Department’s Bureau of Quality Management and Change Control monitors Maximus’ performance against contract requirements through quality assurance reviews and regular meetings with Maximus staff to discuss issues found during these reviews.

Key Findings

• The Department has an effective system to ensure that Maximus is complying with contract requirements and meeting performance standards.
• The Department can make improvements noted by actions already taken, such as requiring Maximus to provide a complete sample population for each business function the Department reviews; and to increase staffing to complete more quality assurance reviews.

Key Recommendation

None are required. At the time we completed our audit fieldwork, Department and Bureau officials had already taken actions to address the matters we identified to help ensure Maximus’ compliance with prescribed performance standards.

Other Related Audit/Report of Interest

Department of Health: Oversight of the Early Intervention Program’s State Fiscal Agent (2015-S-22)