Home Health Care Regulation and Expenditures

This audit addresses issues related to home health care regulation and expenditures in Arizona and was conducted in conjunction with the National State Auditors’ Association’s multi-state audit on this topic. Arizona and nine other states agreed to study their respective Medicaid-supported home health service delivery systems to determine whether regulation, claims payment processes, complaint investigations, and quality-of- care assurance programs are appropriate and sufficient.

The review of DHS’ responsibilities found that DHS’ licensure and complaint investigation processes are inadequate. In 1998, DHS renewed state licenses of 43 Medicare-certified home health agencies without ensuring compliance with state licensing requirements. In addition, DHS has failed to conduct timely inspections and, as of August 1998, had accumulated a backlog of 70 overdue home health Medicare inspections. DHS has also failed to conduct timely complaint investigations resulting in a backlog of 38 complaints against home health agencies. This issue was also raised in an earlier 1998 audit of DHS (Auditor General Report No. 98-17) and, as of January 1999, DHS had investigated these complaints.

The review of AHCCCS’ responsibilities identified some improvements that could be made to controls over the claims payment process as well as some improvements that could better ensure home health clients receive quality care. Specifically, AHCCCS should work with its program contractors to ensure that only properly documented claims are paid. AHCCCS should also work with program contractors to improve annual monitoring reviews and client satisfaction surveys.