YELLOW SHEET Office of the State Auditor of Missouri Claire McCaskill

June 3, 2002

Report No. 2002-42

The following areas of concern were discovered as a result of an audit conducted by our office of the Department of Mental Health, St. Louis Regional Center.

The St. Louis Regional Center (SLRC) is one of eleven regional centers established by the Department of Mental Health.� The Department of Mental Health allocates portions of its department-wide appropriations to the St. Louis Regional Center to pay for the costs of services provided to Regional Center clients.� The Regional Center purchases services for clients who live in personal residences and pays a portion of the costs for eligible clients who live in Community Placement facilities.� Allocations are also used to fund specialized programs such as First Steps, Autism, and Choices for Families. 

There is a lack of control over the spending of allocations.� Regional Center management indicated they compare the total allocations to the total costs of authorized services on a monthly basis.� Since the Regional Center overspent program allocations by more than $2 million during the years ended June 30, 2001 and 2000, it does not appear that adequate steps were taken to control spending. 

The Choices for Families program provides financial assistance to eligible families so they can better met the special needs of any developmentally disabled individuals which reside within their home. �During our review of Choices for Families expenditures, we noted numerous instances where clients' monies were inappropriately borrowed for Choices for Families expenditures. �In addition, several families received funding in excess of the maximum amount allowed.� Program guidelines clearly state that no family shall receive more than $3,600 annually, unless approved by the District Deputy Director. Furthermore, instances were noted where the costs of goods and services for the Choices for Families program were not bid. 

Client monies, such as income and benefits, are received by Regional Center personnel and transmitted to personnel at the Bellefontaine Habilitation Center to be deposited into a fiduciary checking account.� These monies are used to pay for such things as care, treatment, and personal items for Regional Center clients.� Adequate steps are not always taken to safeguard client monies.� Eighteen client accounts had negative balances, totaling $6,632, as of November 3, 2001.� Additionally, inactive client accounts totaled more than $17,000, and numerous client accounts exceeded the maximum allowable balance, which can jeopardize future client benefits. 

Procedures for documenting employees' actual time worked are inadequate.� Employees do not always document time worked.� There is a lack of supervisory review of time worked.� Employees� supervisors do not sign attendance sheets in at least two of the five Regional Center buildings, and payroll and timekeeping personnel do not compare attendance sheets to exception sheets.� The lack of this comparison has resulted in at least some errors.

Regional Center service coordinators provide Targeted Case Management (TCM) services to numerous clients.� If eligible, the state�s Medicaid program currently reimburses the Regional Center $6.36 for every unit, or five minutes, spent on TCM services. �During the year ended June 30, 2001, the Regional Center received approximately $4.9 million in reimbursements from the state's Medicaid program for TCM services. 

Ten clients were selected from TCM billings during the months of May and October 2001.� On 30 percent of the invoices reviewed, the number of units billed did not agree to the amount of time spent providing TCM services to clients.� After bringing the discrepancies to the attention of Regional Center personnel, a member of the Information Technology department determined that the discrepancies occurred due to an error in the computer billing system. 

Regional Center management has placed most of the responsibility of monitoring the quality of services on its clients and their families.� During the year ended June 30, 2001, the Regional Center contracted with approximately 379 different providers.� Regional Center personnel do not review any documentation that supports the amounts billed for services provided to clients. �Some vendors reviewed could not provide adequate documentation to support amounts billed on behalf of Regional Center clients.� In two different instances, we noted that one vendor billed the Regional Center twice the actual cost of equipment purchased for clients.  

Procedures for monitoring credit card purchases are inadequate.� A credit card is assigned to each Regional Center vehicle to be used for fuel purchases and emergency repair costs.� During the years ended June 30, 2001 and 2000, total credit card purchases totaled $13,531 and $8,539 respectively.� We noted credit card receipt slips are not reconciled to the credit card invoice before payment is made.� Additionally, all credit cards are not adequately safeguarded.�  

Regional Center management has not adopted a formal cellular telephone policy to address the usage and monitoring of cellular telephones.� As of June 30, 2001, the Regional Center owned 17 cellular telephones with total cellular telephone expenditures of $11,550 and $9,521 for the years ended ��June 30, 2001 and 2000, respectively.� Numerous cellular telephone invoices are not reviewed for �personal calls and accounts payable personnel do not request reimbursement for personal calls in a timely manner.� One employee used the cellular telephone 2,813 minutes, or more than 47 hours, during one month, and the invoice was paid without any review. 

Also included in the audit are recommendations to improve policies and procedures regarding general fixed assets.

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