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YELLOW SHEET Office of the State Auditor of Missouri |
January 13, 2004
Report No. 2004-02
Systematic procedures and controls needed to help
ensure consistent authorization of personal care hours and to ensure client
safety
The
Medicaid personal care program was established to enable qualified Medicaid
recipients to remain in their own homes rather than being placed in nursing
homes; provided the monthly costs for personal care services did not exceed
monthly nursing home costs.� The
Department of Health and Senior Services, Division of Senior Services and
Regulation oversees the personal care program.�
During fiscal year 2003, the program enabled 37,000 Medicaid clients to
remain in their residences.� This audit
focused on the division�s oversight of the program to determine consistency of
authorization of personal care hours and if personal care providers are
operating in compliance with state laws and regulations, and contractual
requirements as they relate to the safety and quality of care of the clients.� The following highlights the findings:
Substantial
variances existed in personal care hours authorized by some regions
The
division has not established criteria to determine and control the number of
personal care service hours Medicaid recipients can be authorized on a
statewide basis.� Auditors discovered
substantial differences in hours authorized with no identified or documented
factors justifying the variances.� The division
director and the manager of the two St. Louis regions stated they have not
identified any factors to justify why the number of hours authorized by the St.
Louis regions was more than twice the amounts authorized by the St. Joseph and
Columbia regions for the same level of care.�
(See page 5)
Inconsistent
authorization of personal care hours resulted in higher program costs
Auditors
found the average monthly cost for St. Louis City was about twice the average
monthly cost for St. Joseph and Columbia during fiscal year 2002, and about 57
percent higher than Kansas City during the first nine months of fiscal year
2003.� If the two St. Louis regions�
monthly average hours per client were the same as the Kansas City metro
regions� average, the cost of the program would have been reduced by about
$24.7 million in fiscal year 2002 and about $15.5 million through the first
nine months of fiscal year 2003.� (See
page 8)
Timely
notification of provider compliance violations needed to ensure client safety
Upon
completing quality assurance reviews the division has taken up to 4 months to
notify providers their names would be removed from the contracted providers
list.� This removal is necessary when
providers are in noncompliance with state regulations, creating a potential
risk of injury or harm to the personal care clients.� When this situation was brought to the
attention of division officials, guidelines were implemented requiring
notification within 30 days of the conclusion of the quality assurance review.
(See page 10)
