Health Choices - CBH Independent Audit Services

2026-11-03

The HC Program audit shall include : • An annual financial statement audit of the HealthChoices Program for the applicable calendar year . • An independent auditor ’ s opinion on the HC Program financial statements . • Reporting in accordance with Government Auditing Standards ( Yellow Book ). • Compliance procedures required under the Pennsylvania DHS HealthChoices Audit Guide . • Required communications to governance . • A management letter addressing internal control matters . HC Program – Compliance and Regulatory Testing The selected firm shall perform compliance procedures for the HC Program including , at a minimum : • Testing compliance with key DHS contractual provisions affecting financial reporting . • Independent recalculation and validation of Medical Loss Ratio ( MLR ) components . • Independent recalculation and validation of risk corridor settlements . • Testing solvency and reserve requirements , including risk and contingency balances . • Testing capitation revenue recognition , including reconciliation to DHS remittance documentation . • Consideration of internal controls over claims processing and encounter data reporting . • Fraud risk assessment procedures appropriate to a Medicaid managed care environment . The scope of compliance procedures shall be sufficient to support required reporting under Government Auditing Standards . The HC Program audit shall be suitable for submission to the Pennsylvania Department of Human Services in accordance with the HealthChoices Audit Guide . CBH Audit The CBH audit shall include : • An annual financial statement audit of Community Behavioral Health ( CBH ), a 501 ( c )( 3 ) nonprofit organization . • An independent auditor ’ s opinion on the CBH financial statements . • Required communications to governance . • A management letter addressing internal control matters . The CBH audit shall be conducted in accordance with Generally Accepted Auditing Standards ( GAAS ) applicable to nonprofit organizations . The CBH audit is not required to be submitted to DHS .

Pennsylvania

2026-05-09