Overview
In accordance with Section 12 of Chapter 11 of the Massachusetts General Laws, the Office of the State Auditor has conducted a performance audit of certain activities of the Center for Human Development (CHD) for the period July 1, 2018 through June 30, 2020.
In 2019, the Department of Developmental Services (DDS) received complaints related to CHD’s DDS-funded group homes. One of these complaints alleged that CHD staff members mismanaged resident funds. These complaints triggered investigations by DDS’s Bureau of Program Integrity and the state Office of the Inspector General. Additionally, CHD lost two DDS-funded group home contracts by the end of 2019. In response to recommendations from the Bureau of Program Integrity’s special review report stemming from the investigations, CHD updated its representative payee policies and procedures and added the Compliance Team to its Corporate Fiscal Department in late 2019. These changes went into effect on January 1, 2020. We focused our testing on the DDS representative payee process subsequent to these changes and adjusted the audit period to January 1, 2020 through September 30, 2020 for Objective 1.
We conducted this performance audit in accordance with generally accepted government auditing standards. Those standards require that we plan and perform the audit to obtain sufficient, appropriate evidence to provide a reasonable basis for our findings and conclusions based on our audit objectives. We believe that the evidence obtained provides a reasonable basis for our findings and conclusions based on our audit objectives.
Below is a list of our audit objectives, indicating each question we intended our audit to answer; the conclusion we reached regarding each objective; and, if applicable, where each objective is discussed in the audit findings.
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Objective |
Conclusion |
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No; see Finding 5 |
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No; see Finding 4 |
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No; see Findings 1 and 2 |
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No; see Finding 3 |
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Yes |
To achieve our audit objectives, we gained an understanding of the internal controls we determined to be relevant to the objectives by reviewing CHD’s policies and procedures, as well as conducting inquires with CHD’s staff and management. We evaluated the design and implementation of the relevant controls and tested their operating effectiveness for the management of CHD’s representative payee and complaint processes.
To test the effectiveness of internal controls related to the investigation and resolution of DMH person-served complaints, we selected a random sample of 36 of 188 CHD employees hired during the audit period to work at DMH-funded programs and requested each employee’s new employee orientation checklist. We inspected each new employee orientation checklist for the employee’s and supervisor’s signatures as evidence that the employees hired during the audit period received the required training about human rights complaint procedures.
To test the effectiveness of internal controls related to transactions associated with the representative payee function at DMH-funded group homes, we selected a judgmental sample of 18 of 87 DMH persons served who received representative payee services. We inspected their Personal Funds Management Sheets (PFMSes) for the required CHD staff signatures as evidence that each transaction was appropriate and correctly recorded and that the program manager conducted a monthly review of the transactions.
To test the effectiveness of internal controls related to transactions associated with the representative payee function at DDS-funded group homes, we selected a judgmental sample of 7 of 54 DDS persons served who received representative payee services. We inspected their PFMSes for the required CHD staff signatures as evidence that each transaction was appropriate and correctly recorded and that the program manager conducted a monthly review of the transactions.
Additionally, we performed the following audit procedures.
DDS Representative Payee Function
To determine whether CHD administered the DDS representative payee function in accordance with its “Individual Funds Management Policies and Procedures,” 115 CMR 3.08(5)(a), 115 CMR 3.08(7)(a), 115 CMR 3.08(8)(d), and 115 CMR 3.08(10), we obtained a list of all 72 persons served who lived in DDS-funded group homes during the test period, January 1, 2020 through September 30, 2020. We identified the 49 of these 72 people who received CHD representative payee services for all or part of the test period. For each of these 49 people, we identified each instance when CHD served as representative payee during the test period. We identified 418 instances of CHD serving as a representative payee and performing the procedures associated with this process.
We selected a nonstatistical, random sample of 40 of the 418 instances. We inspected Individual Service Plans (ISPs) to determine whether each ISP included an up-to-date Money Management Plan with all required signatures, and we inspected Representative Payee Monthly Financial Plans (RPMFPs) to determine whether they were up to date and approved. We determined whether all payments logged on the check registers matched the RPMFPs and were supported by bills, benefit letters, and bank statements. We determined whether manual disbursements, which are unplanned and not included in an RPMFP, were supported by a Representative Payee Check Request Form. We also inspected the PFMSes to determine whether all personal spending checks received from the corporate representative payee accountant were logged and purchases were supported by a receipt. For all 418 instances, we inspected the CHD Compliance Team’s Individual Funds Management Reviews to determine whether they were reviewed and signed by (1) the chief financial officer or (2) both the vice president (VP) of Fiscal Services and the VP of Disability and Elder Services.
DMH Representative Payee Function
To determine whether CHD administered the DMH representative payee function in accordance with its “Person Served Funds Management Policy,” its “Representative Payee Account Policy,” 104 CMR 30.01(4)(a), 104 CMR 30.01(8)(c), 104 CMR 30.01(9)(d), and 104 CMR 30.02(2), we obtained a list of all 160 persons served in DMH-funded group homes during our audit period. We identified the 87 of these 160 people who received CHD representative payee services for all or part of the audit period. For each of these 87 people, we identified each month within the audit period when CHD served as the person’s representative payee and identified 1,612 instances where CHD did so.
We selected a random, statistical sample of 60 of these 1,612 instances with a 95% confidence level, a 5% tolerable error rate, and a 0% expected error rate. We inspected the Adult Comprehensive Assessments and client consent forms to determine whether they were up to date and had all required signatures. We inspected the RPMFPs to determine whether they were up to date and approved. Additionally, we determined whether all payments logged on the check registers matched the RPMFP and were supported by bills, benefit letters, and bank statements. We determined whether manual disbursements were supported by a Representative Payee Check Request Form. We also inspected PFMSes or Client Spending Received Receipts to determine whether all personal spending checks received from the corporate representative payee accountant were logged and, when applicable, whether purchases were supported by a receipt.
HRC
To determine whether CHD’s HRC reviewed all DDS and DMH complaint resolutions, we obtained directly from DDS all 77 complaint disposition letters for complaints resolved during our audit period that were filed by or on behalf of persons served at DDS-funded group homes. We also obtained directly from DMH all 62 complaint decision letters for complaints resolved during our audit period that were filed by or on behalf of persons served at CHD-operated or CHD-subcontracted group homes and programs. We then obtained and inspected all of CHD’s quarterly HRC meeting minutes for the audit period to confirm that the HRC reviewed and discussed all complaints with disposition and decision letters during the meetings. We also obtained and inspected the minutes for two quarterly HRC meetings outside the audit period (in September and December 2020) because during those meetings, the HRC reviewed and discussed disposition and decision letters that were resolved during the audit period.
To determine whether the composition of the CHD HRC membership complied with the requirements of CHD’s DMH “Human Rights Policy and Complaint Procedure for Persons Served,” CHD’s Human Rights Committee By-Laws, 115 CMR 3.09(1)(c), and 104 CMR 28.11(4), we requested a list of HRC committee members who served during our audit period and examined the roles they fulfilled and, when applicable, the credentials for specific committee member roles, such as lawyer, nurse, or clinician.
DMH Group Home Complaint Resolution
Of the 62 complaint decision letters issued during our audit period and provided to us by DMH, we identified the 8 associated with administrative resolutions and the 33 associated with 10-day fact-finding investigations, for a total population of 41. We selected a nonstatistical, random sample of 10 of these 41 decision letters. Our sample included three administrative resolutions and seven 10-day fact findings conducted by CHD.
To determine whether CHD administered its administrative resolution complaint process in accordance with 104 CMR 32.04(3)(b) and (d), we reviewed all three administrative resolutions to determine whether CHD met with the person served or complainant and provided written notice within five days after the complaint was filed or two days after meeting with the person served or complainant. To determine whether CHD administered its 10-day fact-finding investigation process in accordance with 104 CMR 32.04(4)(a), (c), and (d), we reviewed the decision letters for each complaint to identify whether all seven investigations were completed within 10 days. Additionally, we inspected all 10 of the complaint decision letters from our sample to determine whether they included the resolution and action to be taken by the responsible person and informed the person served of his/her right for reconsideration or appeal.
DDS Group Home Complaint Resolution
To determine whether CHD administered its DDS complaint resolutions in accordance with 115 CMR 9.14(6), we reviewed the 77 complaint resolution letters received from DDS and obtained the corresponding action plans. We identified 45 action plans that required a written response from CHD. We then selected a nonstatistical, random sample of 10 from our population of 45. We requested from DDS, and reviewed, CHD’s written responses to DDS to determine whether CHD responded within the required timeframe for these 10 plans.
When nonstatistical sampling was used, we could not project the results to the entire population.
Data Reliability Assessment
To determine the reliability of the representative payee lists CHD gave us for its DDS- and DMH-funded group homes, we interviewed agency officials who were knowledgeable about the data, checked for duplicate records, and verified that all dates were within the audit period. Additionally, we compared the lists of persons served who received representative payee services from CHD to a list of all persons served who lived in DDS- and DMH-funded group homes under contract with CHD. Based on these procedures, we determined that the representative payee lists for DDS- and DMH-funded group homes we obtained from CHD were sufficiently reliable for the purposes of this audit.
To determine the reliability of the list of HRC members CHD gave us, we interviewed agency officials who were knowledgeable about the data, checked for duplicate records, verified that all dates were within the audit period, and compared the attendees listed to those listed in CHD’s HRC meeting minutes. Based on these procedures, we determined that the HRC member list we obtained from CHD was sufficiently reliable for the purposes of this audit.
| Date published: | December 23, 2021 |
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