Enhanced Education and Promotion of Silent Call Feature Needed in State 911 System, Audit Shows
BOSTON (June 30, 2021) - Today, the Office of State Auditor Suzanne M. Bump released an audit of the State 911 Department that found it did not effectively promote and educate the public about the statewide 911 emergency call system's silent call feature. The silent call feature is used to communicate with individuals who are not able to speak because they are deaf or hard of hearing, or for other reasons such as experiencing a medical emergency, or if it's unsafe to speak. The audit examined the period of July 1, 2017 through June 30, 2019.
The audit recommends the State 911 Department improve its promotional outreach of services through the distribution of materials, including brochures, telephone stickers, and children's educational materials. This outreach should also be directed at state entities as well as non-profit groups that serve vulnerable populations that would benefit from being educated on how to use the silent call feature. Specifically, state agencies such as the Massachusetts Commission for the Deaf and Hard of Hearing, Office for Victim Assistance, the Department of Developmental Services, as well as nonprofit groups such as DEAF, Inc., Jane Doe, Inc., and the SafeLink Domestic Violence Hotline where advocates are bilingual in English and Spanish to help victims of domestic violence.
"The 911 emergency system is a lifeline for people in moments of crisis and it is essential that it be available to every person, with every need, at every hour of the day. Our audit makes clear that although the system is working effectively, its services and features, including silent emergency calls, could be better promoted in our communities," Bump said. "The department should continue to work with municipalities to ensure every single resident knows the protective tools at their disposal when making an emergency call."
The silent call feature was originally established in 1998. To initiate a silent call, the telecommunicator asks the caller to press one for police assistance, two for fire assistance, or three for an ambulance. The telecommunicator can ask yes-or-no questions, and the caller can respond by pressing four for yes and five for no. Landline calls indicate addresses automatically; cellphones indicate the nearest cell tower.
The State 911 Department is responsible for the coordination, administration and implementation of 911 services throughout the Commonwealth. It is also responsible for overseeing the statewide 911 emergency call system provided by municipalities and private companies through PSAP call centers for emergency services and ensuring 911 access for people with disabilities. In 2019, there were 3,475,240 calls to 911. The Department's annual budget is funded by the Enhanced 911 Fund which is supported by a surcharge assessed on subscribers to wireline and wireless services, including prepaid mobile phones and voice over Internet protocol phones.
The full audit report is available here.
Audit Provides Recommendations to Improve Safety and Care for Individuals with Disabilities
BOSTON (June 29, 2021) - Today, State Auditor Suzanne M. Bump's Office released an audit of the Department of Developmental Services (DDS) that provided recommendations to improve the safety and care for individuals with disabilities throughout the Commonwealth. The audit found DDS was missing timeframes in abuse investigations, for follow-up protective planning for alleged victims of mistreatment, as well as for oversight of incident reports from group homes. In addition, the audit showed DDS was not properly monitoring medication reporting for clients. The audit, which examined July 1, 2017 through June 30, 2019, notes that missed timeframes can put individuals who are disabled at risk of further harm. In its response, DDS stated that it has begun to institute new oversight policies and procedures to address the audit's findings.
"Protecting individuals with disabilities is one of the most critical missions and responsibilities of state government. Every instance where an abuse investigation deadline or timeframe is missed, the gaps in safety and care increase. It's clear the Department of Developmental Services must work with urgency to close those gaps," Bump said of the audit. "I'm encouraged by the initial steps DDS has taken and hope the agency continues to use our audit as a tool towards enhanced safety protocols for abuse, medical mistreatment, and neglect of individuals with disabilities."
Administering Abuse Investigations
DDS receives complaints and referrals of abuse allegations from the Disabled Persons Protection Commission (DPPC). During the audit period, DPPC referred 10,833 complaints to DDS. Under state regulations, when DDS launches an investigation of abuse, a report and decision letter, which signifies the completion of an investigation, must be issued within 45 business days from the date it is assigned to an investigator. Of the investigations reviewed, 38 percent of decision letters were not issued within the prescribed timeframe and on average were finished 42 days past the 45 days allowed. DDS was also not properly managing the conduct of administrative reviews which are designed to address situations that do not include serious physical or emotional harm. In its response to the audit, DDS stated that it will collaborate with DPPC on ways it can expedite the investigation process to meet the required timelines to ensure clients with disabilities are as safe as possible. The Office of the State Auditor recently released an audit of DPPC that also showed it has been missing required state deadlines for abuse investigations.
Oversight of Provider-operated Group Homes
During the audit, DDS contracted with 116 state-licensed providers of group homes. The audit found DDS was not ensuring that these providers were submitting and finalizing required incident reports within mandated timeframes. For major incidents, reports are required to be submitted to DDS one business day and finalized within 7 calendar days, after an event is discovered by provider staff. The audit notes that 52 percent of major incident reports reviewed were sent to DDS late (1 to 202 business days after the 1 business day allowed). This same group of reports were also finalized by the group homes 1 to 546 business days after the established 7 calendar day timeframe. In response to the audit's recommendations, DDS noted it will work with its contracted providers to establish effective guidelines and controls to ensure reports are finalized and filed on time.
Protective Services
The audit pointed to deficiencies in DDS' protective services after an abuse investigation has ended. During the audit period, the agency did not develop protective action plans on time for victims who have suffered from abuse or mistreatment, missing the required 30 business day timeframe. Auditors determined that 28 percent of completed investigations did not have action plans developed within the required 30 business day timeframe to prevent continued harm. To address the audit's concerns in this area, DDS stated that it will form a working group with the goal of creating policies that improve protective services.
The audit also found deficiencies in client medication reporting by DDS staff. The agency did not ensure that medication occurrence reports (MORs), which are used to monitor client medication routines, were always reviewed on time by the provider or by DDS staff. The audit found that 23 percent of the MORs reviewed were created by provider-operated group homes an average of 37 calendar days beyond the established 7 calendar day timeframe. Further, the audit revealed DDS did not ensure that its employees received security awareness training.
DDS operates within the Executive Office of Health and Human Services. DDS serves approximately 32,000 adults and more than 9,000 children who have intellectual and developmental disabilities. During the audit period, the agency provided these services through two state-operated facilities, 287 community-based state-operated programs, and contracted with 116 providers operating 2,144 group homes. DDS employed 7,977 individuals at its 23 area offices throughout the Commonwealth during the audit period.
The full audit report is available here.
Audit Calls on MassHealth to Enhance Measures to Prevent Unnecessary Financial Hardship in its Estate Recovery Process
MassHealth initiates policy reforms to address issues raised in audit
BOSTON (June 28, 2021) - In an audit released today, the Office of State Auditor Suzanne M. Bump (OSA) called on MassHealth to enhance measures to prevent individuals and families from incurring unnecessary financial hardship during its estate recovery process, which is used to recoup funds from the deceased for Medicaid expenses paid on their behalf. The audit shows that although MassHealth allows undue-hardship waivers to exempt possessions and holdings from the recoupment process, only a small number of members' survivors petition for them, and even fewer are approved. In addition, unlike 20 other states, Massachusetts did not have an established threshold to automatically exempt estates with minimal assets from the recovery process. The audit, which examined July 1, 2016 through December 31, 2018, recommends MassHealth establish a cost-effectiveness threshold and improve promotion of its waiver process for members' survivors in order to prevent financial hardship.
During the audit period, MassHealth recovered $96,618,866 for Medicaid expenses paid by 3,440 estates. The average estate recovery was approximately $28,087. Federal law allows states to waive recovery when it is not cost effective to pursue. The cost effectiveness threshold is made public through the state's official Medicaid plans. For example, the state of Georgia does not pursue estate recovery amounts under $25,000. In Massachusetts, however, a cost-effectiveness threshold from estates with minimal assets was not established during the time of the audit period. As such, 46% of MassHealth's recoupments were for amounts of $25,000 or less, and the total of these recoveries ($3,430,026) represented only 4% of the total cash receipts for the audit period. On May 14, 2021, MassHealth took steps to establish a cost-effectiveness threshold that exempts estates with a total value of $25,000 or less from the recovery process.
"The pain that comes with losing a loved one should never be compounded by the added stress of enduring financial hardship when settling matters of an estate," said Auditor Bump. "I am proud that this audit has led to reforms at MassHealth to become more sensitive to the individual financial circumstances of each family going through this process, while also putting in place practical exemptions that have the potential to be more cost effective for the Commonwealth."
MassHealth recovers funds by filing claims in probate court against deceased members' estates for Medicaid expenses paid on their behalf, and to limit the tax burden on the citizens of the Commonwealth. The process is used to supplement funds available for medical assistance programs. Recouped funds are returned to state and federal medical programs to help provide assistance to those in need. MassHealth may waive estate recovery if it determines that moving forward with a claim would cause undue hardship on the member's survivors. The audit determined that only 152 undue-hardship waivers were applied for during the audit period and only 20% were granted, with the others either pending, rejected or withdrawn. In its response, MassHealth reported it has expanded its criteria for undue hardship waivers, has streamlined the waiver process and created new waiver request forms, which are available online. The agency estimates that these expanded waivers will return approximately $17,200,000 to Massachusetts families each year.
MassHealth is the state's Medicaid program that provides access to healthcare for approximately 1.9 million low- and moderate-income children, families, seniors, and people with disabilities annually. In fiscal year 2018, MassHealth paid healthcare providers more than $15 billion, of which approximately 50% was funded by the Commonwealth. Medicaid expenditures represented approximately 39% of the Commonwealth's total fiscal year 2018 budget of approximately $40 billion. The MassHealth program falls under the jurisdiction of the Executive Office of Health and Human Services, through the Division of Medical Assistance.
The full audit report is available here.