Pago Pago, AMERICAN SAMOA — The American Samoa Medicaid State Agency director, Sandra King-Young, who was accompanied by staff members last week, informed LBJ Medical Center officials of the stringent process for approving participants in the Off-island Medicaid Referral Program (OMRP), according to an agency statement posted on its Facebook page regarding the presentation.

 “OMRP is unique as it covers generally 100% of the medical costs, air and ground transportation and accommodations to a certain duration,” the statement says. “There is a stringent process for the OMRP and it starts at LBJ Hospital that must initiate the medical referral.”

The presentation explained that there are four key steps to the Medicaid referral process designed to protect against Fraud, Waste and Abuse (FWA).

And the four steps were explained during the presentation with the first-one, initiated by a physician at LBJ through a request to the OMRP, which approves or denies a request.

“A key principle of the OMRP is that no one entity can make a referral without having been approved through all four steps of the referral process,” Medicaid said.

Samoa News points out that the OMRP process is very important as there have been complaints and concerns raised by some lawmakers and others in the community over the selection of patients to be sent off island for medical treatment.

In its statement, the agency said that since Medicaid reinstated the off-island medical referrals in fiscal year 2018, nearly 2,000 American Samoa residents have been referred under the OMRP. Medicaid also covers MedEvacs and patient referrals from Manu'a to LBJ hospital.

The presentation to LBJ also included data of MedEvacs as well as the number of patients referred to New Zealand — totaling 257 between FY 2022 to now; and 16 of them to Hawaii during the same period.

Meanwhile, King-Young and two senior Medicaid Office staff recently returned to the territory after attending the National Association for Medicaid Program Integrity (NAMPI) on the U.S mainland.

Medicaid explained that Program Integrity (PI) is a critical mission of the Medicaid state agency. It focuses on principles of sound policies, auditable procedures and accountable administration that protects against Fraud, Waste and Abuse (FWA).

King-Young, along with Medicaid Office Program Integrity Division Head, Matilda Kruse and Program Improvement (PI) Analyst, Manino Reed, attend the NAMPI annual conference where they work with other Medicaid state leaders and U.S Centers for Disease Control and Prevention (CDC) to analyze, update and develop new PI strategies to strengthen checks and controls across the local Medicaid program. 

"As our program continues to evolve and expand, our need to automate our operations has become more urgent and we must look to systems that can help ensure accountability and promote fairness while protecting our patients' rights to access,” said King-Young.

“This is part of the PI work we must engage in in moving forward as part of our compliance with federal laws,” she added.