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HomeMy WebLinkAboutMINUTES - 06222004 - C130 R CONTRA. TO: BOARD OF SUPERVISORS �,, . ....: .. COSTA COUNT'" FROM: Jahn Sweeten, County Administrator 1 DATE; June 22, 2004 SUBJECT: Grand Jury Report No. 0405 — In Home Supportive Services — A Vital program SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION RECOMMENDATION(S): RECEIVE the Grand Jury Report No. 0405 entitled "in Home Supportive Services — A Vital Program" and REFER it to the County Administrator's Office for response. CONTINUED ON ATTACHMENT. —YES SIGNATURE: RECOMMENDATION OF COUNTY ADMINISTRATOR_RECOMMENDATION OF BOARD COMMITTEE—APPROVE®OTHER SIGNATURE(S): ACTION OF BOARD ON APPROVED AS RECOMMENDED OTHER VOTE OF SUPERVISORS 1 HEREBY CERTIFY THAT THIS IS A UNANIMOUS{ABSENT a j TRUE AND CORRECT COPY OF AN AYES: NOES: ACTION TAKEN AND ENTERED ABSENT: ABSTAIN: ON MINUTES OF THE BOARD OF SUPERVISORS ON THE DATE SHOWN. Contact:Julie Enea,Sr.Deputy CAO ATTES7Ep "g JOHN SWEETEN,CLERK OF THE BOARD OF SUPERVISORS cc: CAOAND COUNTY ADMINISTRATOR BY s DEPUTY 729 Cour.Street Or ad Jury Contra PD.BOX 911 'Marbriey,CA 04553-0091 Uosta A00% uountiff 1 June 10, 2004 - s s^s_C73 la,. .r Board of Supervisors 651 Pine Street Martinez, CA 94553 Dear Board of Supervisors: Attached is a copy of Grand Jury Deport No. 0405, "In Home Supportive Services A Vital Program" prepared by the 2003-2004 Contra Costa County Grand Jury. In accordance with California Penal Code Section 933.05, this report is being provided to you at least two working days before it is released publicly. Section 933.5(x) of the California Government Code requires that (the responding person or entity shall report one of the following actions) in respect to each finding: (1) "The respondent agrees with the finding." (2) "The respondent disagrees with the finding." (3) -rhe respondent partially disagrees with the finding." In the cases of both (2) and (3) above, the respondent shall specify the portion of the finding that is disputed, and shall include an explanation of the reasons therefor. In addition, Section 933.05(b) requires that the respondent reply to each recommendation by stating one of the following actions: 1. The recommendation has been implemented, with a summary describing the implemented action. 2. The recommendation has not yet been implemented, but will be implemented in the future, with a time frame for implementation. 3. The recommendation requires further analysis. This response should explain the scope and parameters of the analysis or study, and a time frame for the matter to be prepared for discussion. This time frame shall not exceed six months from the date of the publication of the Grand Jury Report. Board of Supervisors June 10, 2004 Page. 2 4. The recommendation will not be implemented because it is not warranted or is not reasonable, with an explanation thereof. Please be reminded that Section.933.05 specifies that no officer, agency, department or governing body of a public agency shall disclose any contents of the report prior to its public release. Please insure that your response to the above noted Grand Jury report includes the mandated items. We will expect your response, using the form described by the quoted Government Code, no later than September 8, 2004. Sincerely, A. W. Ronat, Foreman 2003-2004 Contra Costa County Civil Grand Jury cc: John Sweeten, County Administrator A REPORT BY THE 2003-04 CONTRA COSTA COUNTY GRAND JURY 725 Court Strut Martinez, California 94553 Report No. 0405 "IN HOME SUPPORTIVE SERVICES —A VITAL PROGRAM" APPROVED BY THE GRANTS JURY: ARTHUR W. RONI AT GRAND JURY FOREMAN ACCEPTED FOR FILING: Tate: RICHARD S. FLIER JUDGE OF THE SUPERIOR COURT CONTRA COSTA COUNTY GRAND JURY REPORT NO. 0405 In Hone Supportive Services - A Vital Program TO: Contra Costa County Burd of Supervisors BACKGROUND 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 rewiring 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 I. IHSS provides non-medical domestic and personal care to qualified elderly and disabled.persons(Consumers) in their hones. 2. The IHSS program permits Consumers to remain at home,with appropriate care, as an alternative to living in a nursing home. 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. 4. There are approximately 6000 Consumers receiving IHSS services in Contra Costa County(County). 5. The IHSS caregivers (Providers) are of two general types: l)relatives, friends or acquaintances of the Consumer; and 2)persons hired from a list(Registry) established by the responsible County agency. Approximately85% of Providers fall within the first category, and within that group the majority of the Providers are adult children of the Consumers for whore they work. 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 ander general guidelines established by the California Department of Social Services. 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 l the program. The anticipated cost to the County in FY 2003-04 will exceed$18 million dollars. 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. 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. 10, All Providers who work more than twelve hours per month must join(or pay an equivalent to union clues to) Service Employees International Union health Care Workers Union Local 254,which has negotiated.a Memorandum of Understanding(MOU) governing the terns 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. 11. The state is the paymaster for IHSS, disbursing checks to Providers based upon. payroll information forwarded by the County. 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 thea.. 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). 14, The County has established the IHSS Public Authority(PAA.) 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, bath 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. 2 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 2002-2033 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. 15. Only Consumers have the right to hire,supervise and terminate Providers, 16. The Aging and Adult Services Bureau(AASB)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 AAS$ social workers authorize the maximum number of service hours per month that each Consumer may receive under the IHSS program. b. ARSB social workers maintain contact with Consumers. Io 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, 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 IEISS program. Examples of these reports are: a. Listing of Providers who requested payment for more than 300 hours in the month. 3 b. Listing of Consumers whose SSI eligibility has been terminated. IS. 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, ARSB social workers reportedly check newspaper obituaries to identify Consumers or Providers known to them who may have died.. 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. 20. There are no procedural/instructional policy manuals,which specify regular and systematic procedures for PA.or AASB (or the Employment and I-wnan Services Department)to review existing reports from the CMIPS system on a timely basis. RECOMMENDATIONS The 200304 Grand Jury makes 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. 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 mangier. The procedures should include steps to assure that investigations are undertaken when warranted. 3. County adopt its own procedure to check, at least monthly, County death records to identify deceased Consumers and Providers, 4. County investigate using an automated, telephone based system for Providers to report working time. 5. County investigate incentives (including stipends)to encourage Providers to attend training classes such as basic first aid and CPP.. 4