Summary of Report 10-014

November 2009

Report Number 10-014

The Department of Aging and Disability Services (Department) regularly inspects service providers for its Home and Community-based Services (HCS) program, and it consistently sanctions providers that do not comply with program requirements. The Department also routinely reviews its payments to HCS program service providers and recoups funds paid for services that were not authorized or for which insufficient documentation exists to show that the services were delivered.

The Department should strengthen its processes for HCS program complaint and consultation intake to ensure that it appropriately records, investigates, and disposes of all complaints and consultations. The database that the Department uses to document HCS program complaints and consultations does not contain records of all complaints and consultations, and the Department improperly classified complaints as consultations in 14 (47 percent) of 30 cases sampled. Additionally, complaints and consultations do not go through a standard intake process to ensure that the Department collects all necessary information from callers, and the Department does not monitor calls to ensure that staff who receive the calls appropriately handle and document the calls.

The Department also should strengthen its process for reviewing HCS program plans of care to ensure that providers plan appropriate levels of service for consumers. The Department has internal guidelines indicating when staff should review these plans, but Department staff followed these guidelines in only 4 (15 percent) of 27 cases sampled. In those 4 cases, the reviews resulted in the Department's staff reducing supported home living services by an average of 64 percent per consumer, which translates to a cost reduction of approximately $24,325 per review. This indicates that consistently conducting reviews in accordance with the guidelines could enable the Department to serve additional individuals who are currently waiting for HCS program services.

The Department administers the HCS program waiting list fairly and in compliance with its rules and statutes, but it should restrict access to the automated system that contains the waiting list. More than 200 state employees and contractors have access to fields in the database where waiting list dates may be changed and from which HCS program enrollment offers are extended. The Department also should strengthen its monitoring of local mental retardation authorities (MRA) that administer the waiting list locally in 39 regions across the state. MRAs do not consistently record individuals' first expressions of interest in HCS program services, and they inappropriately removed some individuals from the waiting list. The Department should strengthen its processes for correcting these mistakes to ensure that MRAs maintain the appropriate chronological order of individuals who are waiting for HCS program services. As of August 31, 2009, there were 42,360 individuals on the HCS waiting list. Individuals enrolling in the HCS program at that time had waited on the list for an average of nearly nine years. This audit report refers to the list as a "waiting list," but the Department refers to that list as an "interest list" because an individual's eligibility for HCS program services is not determined until program resources become available for that individual.

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