REPORT DIGEST REVIEW OF THE DEPARTMENT ON AGING’S COMMUNITY CARE PROGRAM REFORM IMPLEMENTATION REPORT REVIEW Release Date: March 2014 State of Illinois, Office of the Auditor General WILLIAM G. HOLLAND, AUDITOR GENERAL To obtain a copy of the Report contact: Office of the Auditor General, Iles Park Plaza, 740 E. Ash Street, Springfield, IL 62703 (217) 782-6046 or TTY (888) 261-2887 This Report Digest and Full Report are also available on the worldwide web at www.auditor.illinois.gov SYNOPSIS Public Act 98-0008 made several changes to the Illinois Act on the Aging to increase the effectiveness of the Community Care Program (CCP) administered by the Department on Aging (Aging). The Act required Aging to file an implementation report with the Auditor General, the Governor, and leaders of the General Assembly by July 1, 2013 identifying actions Aging needed to take to implement the reforms mandated by Public Act 98-0008. The Act further required Aging to provide evidence to the Auditor General by February 1, 2014 that it has undertaken the actions listed in its implementation report. Finally, the Act required the Office of the Auditor General (OAG) to review the evidence submitted by Aging and issue a report to the Governor and legislative leaders no later than April 1, 2014 as to whether Aging took the actions listed in its implementation report. Aging submitted its required implementation report with the Auditor General on June 27, 2013. The June 27 Report identified 11 provisions of Public Act 98-0008 where Aging officials concluded they needed to take some action to implement. The Report noted that no amendments to the Illinois Title XIX State plan had been made or offered. As required by Public Act 98-0008, Aging submitted its February 1, 2014 report along with the evidence which it identified as documenting the actions delineated in its June 27, 2013 report. The evidence consisted of 100 documents, including new or revised policies, proposed rules, meeting attendee information and agendas, training presentations, federal approval of payment initiative, etc. The OAG reviewed the evidence provided by Aging to determine whether it was supportive of the actions that Aging said it had taken. On February 14, 18, and 28, the OAG followed up with Aging with questions concerning the evidence provided and requested additional evidence to support actions taken. Aging provided responses to the OAG’s questions, providing over 45 pieces of additional documentation. Our review concluded that the evidence submitted by Aging generally supported the actions reported by the Department. This report does not constitute an audit as that term is defined in generally accepted government auditing standards. CONCLUSIONS BACKGROUND On April 25, 2013, the General Assembly passed House Bill 2275 which was signed into law by the Governor on May 3, 2013 as Public Act 98-0008. The Act made several changes to the Illinois Act on the Aging to increase the effectiveness of the Community Care Program (CCP) administered by the Department on Aging (Aging). Public Act 98-0008 also amended the Illinois State Auditing Act adding a section titled “Certification of Community Care Program reform implementation” that required Aging to file an implementation report with the Auditor General, the Governor, and leaders of the General Assembly by July 1, 2013. The report was to list any necessary amendment to the Illinois Title XIX State plan, any federal waiver request, any State administrative rule, or any State policy changes and notifications required to implement the Act. The Act further required Aging to provide evidence to the Auditor General by February 1, 2014 that it has undertaken the actions listed in its implementation report. Finally, the Act required the Office of the Auditor General (OAG) to review the evidence submitted by Aging and issue a report to the Governor and legislative leaders no later than April 1, 2014 as to whether Aging took the actions listed in its implementation report. (pages 1-3) AGING’S JUNE 27, 2013 CCP REFORM IMPLEMENTATION REPORT Aging submitted its required implementation report with the Auditor General on June 27, 2013. The June 27 Report identified 11 provisions of Public Act 98-0008 where Aging officials concluded they needed to take some action to implement. The Report noted that no amendments to the Illinois Title XIX State plan had been made or offered. The 11 provisions in Public Act 98-0008 for which Aging determined it needed to take some action were as follows: • 20 ILCS 105/4.01(2-a): Provide data sharing and requested employment information verification for CCP providers; • 20 ILCS 105/4.02(7): Balance Incentive Payment Program (BIP) – CCP effectiveness under Medicaid waiver; • 20 ILCS 105/4.02(9): Service authorization guidelines for in-home service; • 20 ILCS 105/4.02(10): Medicaid waiver enrollment and claiming improvements; • 20 ILCS 105/4.02(11): Seven-minute rounding policy clarification; • 20 ILCS 105/4.02(12): Coordinated (i.e., managed care) enrollment; • 20 ILCS 105/4.02(13): Maintain existing (FY13) CCP rate in FY14; • 20 ILCS 105/4.02(new): Electronic visit verification (EVV); • 20 ILCS 105/4.02(new): Reporting requirements/bi-monthly reporting; • 20 ILCS 105/4.02(new): CCP providers non- compliance; and • 30 ILCS 5/2-27(new): Certification of CCP reforms. (pages 3, 4) OAG REVIEW OF AGING’S FEBRUARY 1, 2014 SUBMISSION As required by Public Act 98-0008, Aging submitted its February 1, 2014 report along with the evidence which it identified as documenting the actions delineated in its June 27, 2013 report. The evidence consisted of 100 documents, including new or revised policies, proposed rules, meeting attendee information and agendas, training presentations, federal approval of payment initiative, etc. The OAG reviewed the specific evidence provided by Aging to determine whether it was supportive of the actions that Aging said it had taken. On February 14, 18, and 28, the OAG followed up with Aging with questions concerning the evidence provided and requested additional evidence to support actions taken. Aging provided responses to the OAG’s questions on February 25 and March 5, providing over 45 pieces of additional documentation. Our review concluded that the evidence submitted by Aging generally supported the actions reported by the Department. (pages 4-16) SCOPE OF REVIEW The Office of the Auditor General conducted this review pursuant to the Illinois State Auditing Act (30 ILCS 5/2-27). This report does not constitute an audit as that term is defined in generally accepted government auditing standards. Our review of the information provided by the Department on Aging in conjunction with its February 1, 2014 Report consisted of the following: • Verified that the statutory provisions that Aging identified as requiring action in its June 27, 2013 Report were addressed in its February 1 Report; and • Determined whether the evidence provided supported the actions Aging reported taking for each of the Community Care Program reform provisions to which it was referenced. The scope of our review focused on reviewing the information submitted by the Department and not conducting direct audit tests of such information. We did not make a determination as to whether there were additional provisions in the CCP reform legislation that required further action by the Department. (page 16) Aging was provided a draft of this report for their review. WILLIAM G. HOLLAND Auditor General WGH:JS This Review was conducted by OAG staff.