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LLA Audit: Abuse and Neglect in Home and Community Based Services for Persons with Developmental Disabilities

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LOUISIANA DEPARTMENT OF HEALTH – PERFORMANCE AUDIT SERVICES
Issued November 27, 2024

NOTE: Home and Community-Based Services (HCBS) is not nursing home care. HCBS provides persons with developmental disabilities with care and services in their home within their community.

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VIEW THE REPORT SUMMARY >>

VIEW THE FULL REPORT >>

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Letter from Michael J. “Mike” Waguespack, CPA, Louisiana Legislative Auditor, to The Honorable J. Cameron Henry, Jr., President of the Senate, and to The Honorable Phillip R. DeVillier, Speaker of the House of Representatives regarding audit of abuse and neglect of persons with developmental disabilities:

“This report provides the results of our evaluation of the Louisiana Department of Health’s (LDH) activities related to abuse and neglect of individuals with intellectual and developmental disabilities receiving home and community-based services (HCBS).

We found that LDH’s Health Standards Section (HSS) has an internal goal of conducting licensure surveys of HCBS providers once every three years to ensure compliance with regulations. Of the 546 providers that needed a licensure survey during fiscal years 2019 through 2023 to meet this goal, LDH did not survey 140 (25.6%). In addition, we found that 69 (12.6%) providers had no licensure surveys at all during this five-year period.

We found, too, that during fiscal years 2019 through 2023, LDH conducted 1,979 surveys addressing 5,420 separate allegations of noncompliance, with 2,194 (40.5%) related to abuse or neglect. LDH completed 843 (99.4%) of 848 complaint surveys during fiscal years 2022 and 2023 in accordance with required timelines, which was an improvement from the three previous fiscal years.

We also found that LDH faces numerous challenges in ensuring that critical incident reports are submitted in accordance with program requirements. Because multiple agencies have oversight responsibility for the health and safety of HCBS participants, appropriate and timely reporting is essential to ensure proper coordination of agency efforts.

We found as well that during fiscal years 2019 through 2023, LDH did not ensure that eight (22.2%) of 36 support coordination providers received all required annual monitoring reviews. In addition, LDH has not established a process to review the monitoring efforts of local government entities to ensure that corrective actions taken by support coordination agencies are timely and sufficient.

Additionally, we found that although HSS assessed $193,450 in sanctions against HCBS providers during fiscal years 2019 through 2023, the maximum fine amounts allowed by law have not increased since 1997. LDH’s Office for Citizens with Developmental Disabilities, which administers the HCBS program, also has not developed policies or processes for imposing adverse actions against support coordinators for noncompliance with regulations.

We would like to express our appreciation to the Louisiana Department of Health for its assistance during this audit.

Respectfully submitted,
Michael J. “Mike” Waguespack, CPA
Legislative Auditor

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