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SUMMARY
The
Office of the Auditor General has conducted a performance audit of the
Department of Economic Security’s Division of Developmental Disabilities
(Division) in response to a June 16, 1999, resolution of the Joint Legislative
Audit Committee. This audit was conducted in response to the requirements of
Laws 1996, Chapter 290 §3. Additionally, the audit considered concerns raised
by the Joint Legislative Developmental Disabilities Oversight Committee in a
letter to the Auditor General dated February 24, 2000.
The
Division provides services to about 18,000 persons who have mental
retardation, autism, cerebral palsy, and epilepsy, as well as to the families
that care for them. These services include therapies, day care, respite, and
other services and supports to help clients attain and keep a maximum
functional level. The Division determines eligibility for services, develops
plans for addressing client needs and monitoring outcomes, and contracts with
agencies and individual providers for the provision of services. While most
services are provided under contracts, Division staff also directly provide
services in state-operated facilities, such as group homes.
Coordination
Between the
Division and CPS
Can Be Improved
(See pages 13 through 19)
The Division can better
coordinate its efforts with Child Protective Services (CPS) in serving foster
care children who have developmental disabilities. In June 2000, the Division
and CPS shared responsibility for 524 such children. The two staffs each have
their own responsibilities: CPS staff conduct abuse and neglect investigations
and work with the courts, while Division staff assess service needs for
children with developmental disabilities and locate service providers.
However, the Division and CPS do not have up-to-date policies on sharing and
transferring
cases,
resulting in delays in obtaining services. Further, staff in the two units do
not receive comprehensive cross-training to enable them to better
understand—or, if needed, carry out—the other’s duties and ensure
children receive services promptly.
The
need for better coordination is heightened by a recent state law requiring
more timely services for abused, neglected, and abandoned children, and by an
increasing number of such children in foster care. To improve services to
these clients, the Department of Economic Security (DES) could transfer some
CPS case managers to the Division’s existing foster care unit and provide
cross-training to the unit’s staff.
Inadequate
Information Systems
Hamper Efforts to Meet Clients’
Needs and Manage
Business Operations
(See pages 21 through 27)
The Division’s
current information systems do not meet its needs. For example, the
Division’s main information system, ASSISTS, does not capture key client
information, cannot be used to manage the client waiting list for services,
and cannot provide up-to-date reports to help support coordinators authorize
services. Even the limited information already contained on ASSISTS is not
available to many staff, because they do not have adequate computer equipment
to access it.
The
systems also provide limited help in coordinating the Department’s various
business functions, such as licensing providers, authorizing services, and
bill payments. As a result, the systems cannot generate critical
decision-making information for Division managers or the Legislature. In 1995,
consultants determined that ASSISTS could not be sufficiently upgraded due to
numerous deficiencies and estimated that replacing the system would cost $25
million. However, the Division has not yet prepared replacement proposals in
sufficient detail for legislative review. To address this critical need, the
Division and DES need to work with the State’s Government Information
Technology Agency in building a better and fuller justification for the
project.
The
Division Does Not
Adequately Maintain and
Manage Its Waiting List
(See pages 29 through 34)
One specific management
system issue that needs to be addressed is the list of clients waiting for
services, which does not contain complete or reliable information. For
example, when the Division recently attempted to measure the service needs for
children who were eligible for state-funded services, it could document only
75 percent of the children on the official waiting list as waiting for
services. The waiting list also lacks accurate information on how long clients
wait for services, in part because the ASSISTS system cannot capture
historical data. Due to these problems, Division managers cannot effectively
ensure that clients receive services as soon as possible, determine whether
the highest priority needs are met first, or tell the Legislature how much
money would be needed to meet clients’ needs.
Division
managers acknowledge the list’s deficiencies. They stated that some clients
are not included because the clients become discouraged with the wait and ask
to have their names removed. In other cases, errors or omissions occur because
staff are not adequately trained. However, because waiting list problems
significantly affect clients, the Division needs to improve the accuracy and
reliability of the information on the list. The Division should revise its
policies, improve training, and establish an alternative procedure for
tracking service needs until ASSISTS can be replaced.
The
Division Needs to
Further Improve Its Management
of Unusual Incident Reports
(See pages 35 through 40)
The
Division can further improve its management of Unusual Incident Reports (UIRs),
which record incidents of client abuse and neglect. The Division has taken
steps to improve the UIR system since a 1993 Auditor General’s report
(Report No. 93-2), which identified several problems. The Division has
established UIR Quality Assurance units in three of the Division’s largest
districts, improved reporting procedures, developed a database to track UIRs,
and established program monitors who receive special investigative training.
Despite these
improvements, management problems remain. Central Office still provides poor
oversight and duplicates districts’ decisions on whether to investigate
incidents. Understaffing at Central Office, combined with numerous UIRs,
continues to hinder timely entry of UIR data. As a result, the Central Office
has a long-standing data entry backlog, which has delayed follow up on client
incidents until it was too late for meaningful action. Although the Division
has designed a pilot project that streamlines UIR practices and eliminates
Central Office duplication, the Division needs to do more, such as eliminating
the UIR backlog and ensuring district staff are properly trained on the new
process.
The
Division Has Improved Its
Contract Management Practices
(See pages 41 through 44)
The
Division has significantly improved its contract management. Previous audits
found several problems with the Division’s contracting practices, including
failure to comply with procurement code requirements, overuse of consultant
contracts, and a lack of Central Office oversight over district contracting
practices. Although the current
audit found no indication of these past problems, one recent Request for
Proposals (RFP) lacked clear language and resulted in a contract challenge. To help avoid similar problems in the future, the Division plans to
hire a consultant to review its procedures. Since Division contracts represented approximately 78 percent or $255
million in fiscal year 1999, the Division should continue its efforts to
improve contracting practices.
Other Pertinent
Information
(See pages 45 through 49)
During
the audit, other pertinent information was collected on the future expansion
of service needs and the Division’s efforts to implement a legislatively
mandated Fair and Equitable Rate Structure. First, service needs for Arizonans
with developmental disabilities will expand. The Division does not know the
full extent of service needs, since many potential clients do not request or
receive its services. However, the number of clients needing services will
expand as older parents can no longer care for their adult children with
developmental disabilities. In addition, if Arizona adopts the more liberal
federal definition of eligibility based on functional limitations,
approximately 10,685 individuals would qualify for services at an additional
cost of $95 million annually.
Second, the Division is
finally making progress in implementing a Fair and Equitable Rate Structure.
Such a rate structure will establish statewide uniform contract rates paid for
services provided to clients. Legislation adopted in 1994 mandated that the
Division implement a “rate structure that ensures an equitable funding
basis.” Subsequent legislation in 1998 and 1999 provided a new
implementation date of December 31, 1999, and required a field test of
provider rates. The Division and its Design Team have completed a review of
current rates and the proposed rates for its pilot project. By February 2001,
the Division anticipates beginning the rate structure pilot test, with
providers selected under a Request for Proposal.
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