Office of the State Auditor of Missouri
Report No. 2006-21
The following findings were included in our audit report on the Department of Mental Health, Springfield Regional Center.
The Springfield Regional Center (SRC) has not taken adequate steps to ensure clients receive the best care possible. Unsatisfactory living conditions were observed during a November 30, 2005, visit to one group home. We found it quite disturbing that service coordinators' case notes from visits to the home on November 10 and 16, 2005, contained very little mention of any concerns. The Auditor's Office notified the SRC of some of our concerns in a letter dated December 6, 2005. The SRC subsequently met with the provider to address these unsatisfactory conditions. We visited a second group home owned by this same provider and found steps had been taken the morning of our visit to ensure the appearance of the home was tidy and well maintained.
Our visits to various placement facilities also noted problems related to the facilities' management of client funds including: balances exceeding maximum limits, inadequate documentation, inaccurate reporting of fund balances, untimely deposits, commingling of clients' funds with facility operating funds, and accounts with negative balances.
Our review found that the regional center did not obtain the proper background checks for 10 of 20 personal assistants (50 percent) reviewed that had worked for regional center clients at some point between January 2003 and June 2005. Further, of the 10 files reviewed where background checks had been performed, we found that 4 were not performed on a timely basis. For example, one individual started providing personal assistant services to a regional center client on November 9, 2004, and the background check for this individual was not completed until May 17, 2005.
The SRC spent over $20 million in fiscal year 2005 to care for its clients. The SRC could better manage costs by monitoring service providers' actual and past costs of operation and by reviewing rates for consistency. Regional center personnel do not periodically review documentation to support the amounts billed by approximately 70 service providers or vendors for client services, and contracts with various day habilitation service providers were unclear. Additionally, the SRC has not established adequate procedures to ensure client budgets prepared by service coordinators are accurate.
The SRC provided funding in excess of the maximum allowed by the community support waiver and did not obtain approval from the Division of Mental Retardation and Developmental Disabilities (MRDD) Director for the additional funding. For example, day habilitation services costing $30,417 were provided to one client between May 2004 and April 2005 and approval for the additional funding was not obtained. These services are limited to $17,000 based on Department of Mental Health (DMH) guidelines. We also noted two other instances where excess funding was provided and approval was not obtained.
The SRC has not taken adequate steps to ensure Medicaid reimbursements from TCM services are maximized. The DMH has established a standard that provides that service coordinators are to log 106 direct service hours to the TCM system monthly, or 1,272 hours each year. However, we found 12 service coordinators did not meet the 106 direct hour standard when we compared the total direct hours logged by service coordinators in fiscal year 2005, and this resulted in the SRC losing an estimated $83,000 in potential reimbursements. Additionally, TCM billings are not adequately reviewed to ensure Medicaid billings include the correct number of units and are supported by adequate documentation in the case notes.
The SRC does not adequately monitor the Disabilities Advocacy and Support Network's (the Network) performance or contract compliance. The Network is a not-for-profit corporation located on the grounds of the SRC. The Network's performance is not evaluated or monitored annually as required by the contract, and documentation to support the specific clients served or the service provided is not maintained. Also, while contract terms indicated the SRC would pay the Network to provide a maximum of 1,300 hours at a cost of $14,989 for development of natural supports during the year ended June 20, 2005, we found the Network billed the regional center for 1,880 hours for development of natural supports totaling $21,676. Furthermore, the SRC subsidized some of the operating expenses of the Network, including utilities, trash service, office space, and phone service. This subsidizing practice does not appear to be appropriate and may violate provisions of the Missouri Constitution.
During our audit of the SRC, we became aware of serious weaknesses over the management and accountability of donations made to the regional center. A separate report issued by the State Auditor�s Office in December 2005, Report No. 2005-102, disclosed that donations of property with an estimated value of at least $222,313 were made to the SRC but not accounted for properly, and we noted numerous internal control weaknesses, lack of accountability over distributions of donated property, and ineffective management oversight.
The audit also includes some comments related to billing of matching funds to Senate Bill 40 Boards, Choices for Families, training services, and payroll documentation upon which the center should consider and take appropriate corrective action.
Complete Audit Report