Loading...
HomeMy WebLinkAboutMINUTES - 08172004 - C80 TO: BOARD OF SUPERVISORS 'r' Contra FR011r1: JOHN SWEETEN, County Administrator Caste DATE: AUGUST 2, 2004 " County SUBJECT: RESPONSE TO GRAND JURY REPORT NO.0405, ENTITLED"IN-HOME OF SUPPORTIVE SERVICES—A VITAL PROGRAM" SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATION: APPROVE response to Grand Jury Report No. 0405, entitled "In-Home Supportive Services—A Vital Program", and DIRECT the Clerk of the Board to forward the response to the Superior Court no later than August 4, 2004, BACKGROUND: The 200312004 Grand Jury filed the above-referenced report on June 10, 2004, which was reviewed by the Board of Supervisors and subsequently referred to the County Administrator and the Employment and Human Services Director, who jointly prepared the attached response that clearly specifies: A. Whether the finding or recommendation is accepted or will be implemented; B. If a recommendation is accepted, a statement as to who will be responsible for implementation and a definite target date; C. A delineation of the constraints if a recommendation is accepted but cannot be implemented within a six-month period; and D. The reason for not accepting or adopting a finding or recommendation. CONTINUED ON ATTACHMENT: YES SIC-NATURE--- --- - -- -- f------------------- ;,-'RECOMMENDATION OF COUNTY ADMINISTRATOR RECOXM4M NDATION OF BOARD COMMITTEE ,a...-APPROVE OTHER 1 SIGNATURE (S): -- ----- - -—------------------------------------------------------------------- -------------------------------------------- -------------------- ACTION OF BOA C3N s f _APPROVE AS RECOMMENCED OTHER 5� t VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT COPY OF AN ACTION TAKEN UNANIMOUS{ABSENT ) AND ENTERED ON THE MINUTES OF THE BOARD OF SUPERVISORS ON THE DATE AYES: Z4 NOES: 0 SHOWN. ABSENT: ABSTAIN: ATTESTED: AUGUST 17,2004 CONTACT: JULIE ENEA(925)335-1077 JOHN SWEETEN,CLERK OF THE BOARD OF CC: BOARD OF SUPERVISORS MEMBERS SUPERVISORS AND COUNTY ADMINISTRATOR PRESIDING JUDGE OF THE GRAND JURY GRAND JURY FOREMAN COUNTY ADMINISTRATOR EMPLOYMENT AND HUMAN SERVICES DIRECTOR > HUMAN RESOURCES DIRECTOR BY ^L DEPUTY BOARD OF SUPERVISORS RESPONSE TO GRAND JURY REPORT NO. 0405: IN-HOME SUPPORTIVE SERVICES - A VITAL PROGRAM The Grand Jury is concerned that the In Home Supportive Services (IHSS) program provides an unreasonable opportunity for and risk of misconduct, including fraud, by care-givers and those requiring services, acting either separately or in concert. Such misconduct can result in added costs to the County, victimization of the program's clients or both. FINDINGS 1. IHSS provides non-medical domestic and personal care to qualified elderly and disabled persons (Consumers) in their homes. Response: Agree. 2. The IHSS program permits Consumers to remain at home, with appropriate care, as an alternative to living in a nursing home. Response: Agree, with the clarification that not all consumers served by the IHSS program are disabled to the extent that they need nursing home care. 3. Consumers of IHSS services must have limited income and assets to qualify. Approximately 90% of Consumers are recipients of federal SSI (Supplemental Security Income) payments, which automatically qualifies them for the IHSS program. Response: Partially disagree. Receipt of SSI benefits confers automatic financial eligibility for the IHSS Program, but there also must be a demonstrated functional need for IHSS services to qualify for the Program. 4. There are approximately 6000 Consumers receiving IHSS services in Contra Costa County(County). Response; Agree. 5. The IHSS care-givers (Providers) are of two general types: 1) relatives, friends or acquaintances of the Consumer; and 2)persons hired from a list(Registry) established by the responsible County agency. Approximately 85% of Providers fall within the first category, and within that group the majority of the Providers are adult children of the Consumers for whom they work. Response: Partially disagree. There is also a third category of providers who are neither relatives, nor friends, nor acquaintances of the consumer and are not hired from the registry. Also, of the 85% of the providers who fall in the category of relatives, friends, or acquaintances of the consumer, the majority are either adult children or other relatives (not just adult children). 6. IHSS is a state program. County agencies perform many of the administrative functions necessary to provide delivery of the services. (See Findings 14 and 15). County agencies function under general guidelines established by the California Department of Social Services. In-Home Supportive Services—A Vital Program August 2, 20014 Board of Supervisors Response to grand Jury Report No. 00405 Page 2 Response: Partially disagree. IHSS is a State and Federal program administered locally by county agencies. 7. The state pays a substantial share of the costs. The County also pays a part, including costs of County administration and a portion of the direct labor costs of the program. The anticipated cost to the County in FY 2003-04 will exceed $18 million dollars. Response: Partially disagree. The costs of the IHSS program are shared by the federal, state, and county governments. 8. The County offers training classes to Providers, but since February 2003, when payments to Providers to attend classes were discontinued, very few Providers have participated. Response: Partially disagree. The IHSS Public Authority offers the training classes. 9. Providers are paid by the hour. The County pays the portion of the hourly wage rate which exceeds the part paid by the state. Providers in the County are paid $9.50 per hour. The County also pays a part of the costs of certain fringe benefits for Providers. Response: Partially disagree. The costs of provider wages and benefits are shared by the federal, state, and county governments. Under the funding arrangements in place for the 2003104 Fiscal Year in Contra Costa County, the federal government covered approximately 401, the State approximately 40016 and the County approximately 201. The sharing ratio for wages and specific benefit items varies depending upon whether the particular care provided qualifies for federal funding and depending upon whether the State has chosen to participate in that particular benefit or level of funding. It is anticipated that the overall federal, State, and County sharing percentages will change in the 2004105 Fiscal Year because of recent State Budget action and a pending waiver request that the State has submitted to the federal government. 10. All Providers who work more than twelve hours per month must join (or pay an equivalent to union dues to) Service Employees International Union Health Care Workers Union Local 250, which has negotiated a Memorandum of Understanding (IMOU)governing the terms and conditions of the Providers' employment. The MOU provides for wage rates and medical, dental and pension coverage for Providers. Eligibility for such fringe benefits depends upon working a minimum number of hours per month. Response: Partially disagree. Providers must both work and be paid for 12 hours in a given month in order to contribute union dues. 11. The state is the paymaster for IHSS, disbursing checks to Providers based upon payroll information forwarded by the County. Response: Agree. In-Home Supportive Services —A Vital Program August 2, 2004 Board of Supervisors Response to Grand Jury Report No. 0405 Page 3 12. At least one county in California is testing an automated time records system, which enables a Provider to call a telephone number at the beginning and end of work. The system eliminates the written time sheets and the cost of processing them. Response: Partially disagree. The testing of this automated time record system has not yet begun because the State has not yet given its approval for the test to proceed. 13. The state uses the Case Management and Information Payroll System (CMIPS), an automated system, to standardize and centralize the payroll function. CMIPS provides standardized reports to the County. Some of the reports include information to alert officials to possible fraud or other irregularities in the administration of IHSS. (See Findings 17-19). Response: Agree. 14, The County has established the IHSS Public Authority(PA)to assume some of the responsibilities of a typical employer in the relationship between the Consumer and the Provider. Among the PA's major functions: a. It assists Consumers in selecting providers, if requested, both in the first instance and to replace Providers who leave employment for any reason. b. It signs the MOU with the union representing the Providers. C. It establishes and maintains the Registry of potential providers seeking employment. This Registry is not for persons who are already known to and have been selected by a Consumer. No Provider has applied to be on the Registry after first being employed by a relative or friend. PA has a procedure for screening Registry applicants. The 2002-2003 Contra Costa County Grand Jury Report 0304 recommended a background check for all Providers, whether or not they become employed from the Registry. That recommendation was rejected by the Board of Supervisors. The PA's current screening procedure for the Registry does not include fingerprinting, although PA gives that option to Consumers, who must bear the cost. Response. Partially disagree. In addition to the tasks outlined, the IHSS Public Authority completes the paperwork for enrollment of all providers and consumers into the payroll system, and offers and provides training to providers. 15. Only Consumers have the right to hire, supervise and terminate Providers. Response: Agree. 16. The Aging and Adult Services Bureau (ARSB) of the County Employment and Human Services Department(or the Administrative Bureau of that Department) are also active in the administration of IHSS. Their responsibilities include the following. a. It directs the social workers who determine the nature and level of services for which the Consumer is eligible. The AASB social workers authorize the maximum In-Horne Supportive Services —A Vitai Program August 2, 2004 Board of Supervisors Response to Grand Jury Report No. 0405 Page 4 number of service hours per month that each Consumer may receive under the IHSS program. b. ARSB social workers maintain contact with Consumers. In practice, without notification of a particular problem, the social worker's monitoring activity consists of one visit each year to each Consumer's home. One visit is the minimum required by the state. C. It employs the only county staff members with specific responsibility for investigating welfare fraud. d. It processes handwritten time sheets submitted by Providers and signed by the Consumers and forwards payroll information to the state. Response: Partially disagree. Both the Aging and Adult Services Bureau(AASB) and the Administrative Bureau of EHSD participate in the administration of the IHSS Program. The ARSB directs the social work staff responsible for authorizing hours of service by assessing client needs on at least an annual basis. The Administrative Bureau directs the IHSS payroll staff who process time sheets and transmit payroll data to the State's vendor. The Administrative Bureau is also responsible for fraud investigation activities for all EHSD programs including IHSS. The district Attorney's office also plays a role in fraud investigation. 17. The County receives monthly data assembled in the CMIPS system and organized into approximately 20 standardized reports. Several of these reports are used by the County to identify possible fraudulent activity in the IHSS program. Examples of these reports are: a. Listing of Providers who requested payment for more than 300 hours in the month. b. Listing of Consumers whose SSI eligibility has been terminated. Response: Agree. 18. County agencies are concerned with overpayments for IHSS services occurring after a Consumer or Provider has died. The County receives from the State Controller a report of deaths of Providers and Consumers based on matching vital statistics records with IHSS and CMIPS payroll records. This report is only received quarterly, however. In addition, GASB social workers reportedly check newspaper obituaries to identify Consumers or Providers known to them who may have died. Response: Agree. 19. The County has used CMIPS data to create customized reports, which may identify possible fraudulent activity. These reports contain lists such as duplicate addresses for Consumers, names of Providers with addresses outside the County, Social Security Number matches and information on letters sent to Providers billing over 300 hours. These reports are not created on a regular, scheduled basis. Response: Partially disagree. Monthly lists of providers being paid for 300+ hours are reviewed for possible fraud referrals. Lists of out-of-County provider mailing In-Home Supportive Services —A Vital Program August 2, 2004 Board of Supervisors Response to Grand Jury Report No. 0405 Page 5 addresses and client/provider duplicate social security numbers are reviewed quarterly for potential fraud investigation. The State provides quarterly lists of deceased providers and consumers that are reviewed for potential fraud investigation. 20. There are no procedural/instructional policy manuals, which specify regular and systematic procedures for PA or AASB (or the Employment and Human Services Department)to review existing reports from the CMIPS system on a timely basis. Response: Partially disagree. There are procedures in place to review available CMIPS data on a periodic basis but there is no formal manual specifying these procedures with specific timelines. RECOMMENDATIONS The 2003-04 Grand Jury mares the following recommendations: 1. County develop a time table to expand its use of CMIPS data to obtain information useful to identify possible fraudulent activity. Response: See County's response to Recommendation No. 3. 2. County prepare written procedures governing the timing and use of all such data to assure that it is obtained and reviewed in a timely and uniform manner. The procedures should include steps to assure that investigations are undertaken when warranted. Response: See County's response to Recommendation No. 3. 3. County adopt its own procedure to check, at least monthly, County death records to identify deceased Consumers and Providers. Response: Recommendations 1, Z, and 3 require further analysis in the context of the recently adopted IHSS Quality Assurance Initiative in the Fiscal Year 2004105 State Budget. The State has recently approved and will be implementing new Quality Assurance procedures and requirements for the IHSS Program at both the State and county levels. We anticipate that additional programmatic, data, and fiscal resources may be made available in the new fiscal year at both the State and county levels that should enhance the data analysis capabilities for fraud prevention and investigation. However, we will not know the full extent of the new resources for several months yet. The Employment and Human Services Department will prepare a report by December 1, 2004 analyzing the feasibility of implementing Grand Jury Recommendations 1, 2, and 3 in the context of the new IHSS Quality Assurance initiative when implemented by the State, or absent the initiative. In-Home Supportive Services—A Vital Program August 2, 2004 Board of Supervisors Response to Grand Jury Report No. 0405 Page 0 4. County investigate using an automated, telephone based system for Providers to report working time. Response: Will not be implemented as it is not reasonable for counties to implement individual time-keeping systems for a coordinated statewide program. State approval for such a system would be required, and the State's requirements or standards for such a system are unknown at this time. Also, a change in the work-hour reporting system would likely involve meeting and conferring with the labor union representing IHSS providers. County staff will participate in any state-sponsored exploratory or planning meetings to develop such a system. 5. County investigate incentives (including stipends)to encourage Providers to attend training classes such as basic first aid and CPR. Response: Requires further analysis. There are statewide efforts underway to develop and standardize IHSS provider training. As the County is not in a financial position to afford enhancements to the IHSS Program, training incentives that involve any new casts would require identification of supplemental funding. IHSS Public Authority staff will prepare a report by December 1, 2004 analyzing this recommendation, taking into consideration any alternatives for creating andlor funding incentives for providers to attend training classes, and other related issues that may come to fore.