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e) Mtt/DD/SA programs are subject to strict operating regulations <br /> from the state and federal governments and can and do suffer <br /> monetary sanctions. <br /> · As an example, Medicaid audits of clinical records involve <br /> 17 areas of compliance. Deficiency in only one area results <br /> in a disallowance and payback. <br />J) The program and Medicaid implications apply not only to those <br /> services provided directly by Piedmont but also to the 120 <br /> independent providers under contract with Piedmont. <br /> <br />3. The Olmstead Decision: <br /> <br />a) A United States Supreme Court decision affecting state MH/DD/SA <br /> programs has determined that individuals capable of functioning <br /> in community settings cannot be retained in institutions because of <br /> insufficient community ~ervices and programs. <br /> · The upshot is that unknown numbers of individuals residing <br /> in institutions will need to be released into communities if <br /> the state is to avoid lawsuits; that community programs will <br /> need to expand with no likelihood of new state and federal <br /> dollars at a time when North Carolina is facing a billion <br /> dollar deficit. These populations will be high risk and very <br /> expensive to care for. <br />b) HIPPA regulations will add unknown new costs to Piedmont's <br /> operations at a time of a major state budget deficit. <br /> <br /> <br />