Texas State Auditor
SAO: Reports:
An Audit Report on the Community Based Alternatives Program at the Department of Aging and Disability Services
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John Keel, CPA Texas State Auditor SAO: Reports: An Audit Report on the Community Based Alternatives Program at the Department of Aging and Disability Services |
June 2006
Report Number 06-044
Using its current level of funding, the Department of Aging and Disability Services (Department) could provide services to significantly more clients in the Community Based Alternatives (CBA) program if it did two things.
- The Department could serve more CBA clients if it reduced regional differences in services provided to clients with similar needs. The Department has delegated decision-making for the CBA program to staff in its regional offices, but it has not sufficiently monitored those offices to ensure consistency across regions. Auditors estimated that the Department could save between $12.1 million and $41.1 million in state and federal funds annually by reducing differences in the number of personal attendant care hours that similar clients receive in different regions of the state. The amount saved could enable the Department to provide services to an additional 800 to 2,750 clients.
- The Department could serve more CBA clients if it improved its monitoring of contracted service providers. The Department has not adequately monitored contracted providers of CBA services to prevent them from overstating clients' needs or admitting clients who do not meet functional eligibility requirements for the CBA program. CBA service providers overstated the needs of 53 percent of clients in a judgmental sample auditors tested. Providers have an incentive to overstate client needs because this allows them to deliver additional services and, therefore, receive additional payments from the State.
The Department's monitoring of CBA providers does not consistently hold providers accountable for the delivery of quality services at a fair price. For example, the Department does not verify that providers deliver the authorized number of personal attendant care hours. The Department gathers CBA client satisfaction information, but it does not use that information to monitor providers and it has not taken measures to minimize the subjectivity of that information. Auditors also identified numerous problems with bidding and specifications for minor home modifications that likely result in higher costs to the State and lower quality of service. The Department's contract monitoring function did not identify those problems.
The Department also has not adequately secured information in the automated system it uses to manage the CBA interest list, which stores information regarding individuals waiting for CBA services. The system does not track changes to critical dates that are used to select individuals off the list, and system access for more than 100 terminated employees has not been removed. Because this system lacks basic automated controls, auditors cannot provide assurance about whether the Department manages the CBA interest list fairly.
The $4,400 average prescription drug cost for a CBA client is significantly higher than the $2,800 average prescription drug costs for a Medicaid client in a nursing facility. The Department does not manage the drug benefit and has not analyzed available information to identify reasons for this difference. The Department should research why CBA clients have higher average prescription drug costs than Medicaid clients in nursing facilities.
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