YELLOW SHEET Office of the State Auditor of Missouri Claire McCaskill

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)

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