From the Louisiana Legislative Auditor
On July 17, 2024, the Louisiana Legislative Auditor (LLA) released the findings of its audit assessing the Louisiana Department of Health’s (LDH) efforts to tackle abuse and neglect in Intermediate Care Facilities for Individuals with Developmental Disabilities (ICF/DDs or ICFs).
LLA conducted this audit as a response to legislative interest, concerns raised by parents, and the vulnerable nature of the population being served.
A developmental disability is a severe, chronic disability attributable to cerebral palsy, autism, epilepsy, or other condition, other than mental illness, that results in an impairment of general intellectual functioning or adaptive behavior and requires treatment and services; manifested before the person reaches age 22 and is likely to continue indefinitely.
A summary of LLA’s audit findings:
LDH improved the timeliness of its recertification surveys from 362 (95.8%) of 378 recertification surveys conducted timely in fiscal year 2020 to 100% of 413 recertification surveys conducted timely in fiscal year 2023. LDH monitors ICFs’ compliance with requirements through inspections, called surveys. LDH conducts an initial survey when an ICF opens, then conducts a recertification survey of each ICF at least once every 15 months.
LDH received 718 complaints related to ICFs during fiscal years 2019 through 2023 and conducted all 193 complaint investigations with an Immediate Jeopardy priority timely. However, LDH is not able to easily identify which of these complaints are related to abuse and neglect. In addition, parents and stakeholders feel that LDH could improve its communication with complainants and the timeliness of investigations. The exhibit at right summarizes the total number of complaints LDH received each fiscal year during fiscal years 2019 through 2023. The exhibit on the following page summarizes the complaint allegations related to abuse and neglect received by LDH during fiscal years 2019 through 2023.
ICFs reported more than 4,000 incidents of actual or alleged abuse and neglect during fiscal years 2019 through 2023. However, LDH does not ensure that ICFs report incidents timely as 1,103 (23.5%) of 4,698 Facility Reported Incidents (FRIs) were not reported within 24 hours of discovery as required by state regulations. In addition, as of May 2024, 25 (39.1%) of 64 sheriffs’ offices did not have access to the Statewide Incident Management System to respond to allegations of abuse and neglect that occur within their jurisdictions.
LDH cited ICFs with 4,948 deficiencies during fiscal years 2019 through 2023. Of those, 614 (12.4%) were related to client protections, which include deficiencies related to abuse and neglect. LDH could increase transparency and assist the public with making more informed decisions about care by posting information about deficiencies, complaints, and FRIs on its website. Making this type of information available to the public may help families and stakeholders make more informed choices when making decisions about care.
LDH assessed fines totaling $450,250 to ICFs for deficiencies identified during surveys and investigations conducted during fiscal years 2019 through 2023. However, fine amounts may not be adequate to deter non-compliance. Fine maximums established in state law have not increased since they were set in 1997.
LDH could use Medicaid data to monitor ICFs for compliance with Medicaid requirements. For example, we identified ICF residents who potentially did not receive annual doctor visits as required by Medicaid. ICFs are required to arrange an annual physical examination of all residents. We reviewed Medicaid data for medical services provided during fiscal year 2022 and found that 135 (4.3%) of 3,165 ICF residents potentially did not receive an annual doctor visit.
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