Overview
During the audit period, the Office for Refugees and Immigrants (ORI) did not always perform required monitoring activities over the Refugee Health Assessment Program (RHAP). We found that ORI representatives only attended site visits for two out of seven RHAP providers in 2021, and that no ORI representatives attended any site visits in 2022. ORI also told us that it did not conduct any site visits to the Department of Public Health (DPH) to monitor DPH’s administration of the RHAP nor did ORI document any of its desk reviews of DPH’s Trimester and Annual Reports on the RHAP.
If ORI does not perform monitoring activities over the RHAP, then refugees may not receive important healthcare services or may not be screened for communicable diseases, which may place vulnerable populations at risk.
Authoritative Guidance
According to Section 207 Chapter 6 of the Massachusetts General Laws, “[ORI] shall have the following powers: . . . (c) to coordinate the commonwealth’s policies and programs for refugees and immigrants including those administered by other state agencies.”
Section B (which was the same for fiscal years 2021 and 2022) of ORI’s interdepartmental service agreement with DPH states,
ORI’s monitoring activities shall include: 1) desk reviews of Trimester and Annual Reports on the RHAP; 2) annual formal site visits of reasonable frequency and duration, with advance notice to and coordination with DPH, to Provider sites where RHAP services are provided; and 3) formal site visits to DPH to monitor RHAP.
Reasons for the Issue
ORI told us that it did not perform all of its required monitoring activities because of a staffing shortage and the COVID-19 pandemic.
Recommendations
- ORI should conduct formal site visits with all RHAP providers at least annually.
- ORI should conduct formal site visits with DPH to monitor DPH’s administration of the RHAP at least annually.
- ORI should document all its desk reviews of DPH’s Trimester and Annual Reports.
Auditee’s Response
Based on the Interdepartmental Service Agreement (ISA) between the Office for Refugees and Immigrants (ORI) and the Department of Public Health (DPH), the Department of Public Health (DPH) is responsible for providing services under the Refugee Health Assessment Program (RHAP), including leading the efforts for site monitoring visits to RHAP sites. It is imperative to note that the challenges posed by the pandemic and staff turnover significantly impacted the joint site monitoring visits between ORI and DPH during the audit period.
In response to these challenges, ORI has recognized the need to take concrete actions, and as a result, we, in partnership with DPH, plan to revise the site monitoring visits sections of the ISA. This amendment will signify a crucial shift, ensuring that site monitoring visits to RHAP sites are conducted collaboratively between ORI and DPH. The primary aim is to reduce the burden on providers, eliminate duplication of efforts, and guarantee a more efficient and effective monitoring process. Furthermore, decreasing the frequency of visits to at least once during the contract period and as needed will streamline the process, preserving adequate oversight while preventing undue disruption.
Looking forward, the ORI is fully committed to launching site monitoring visits to the DPH by the state fiscal year following. It is essential to underscore that both ORI and DPH are dedicated to working collaboratively to implement these changes and ensure that site monitoring visits are executed as planned, with minimal disruption to service providers. This commitment is a testament to our unwavering dedication to responsibility and accountability in delivering our services.
Auditor’s Reply
Based on its response, ORI is taking measures to address this matter.
| Date published: | November 14, 2024 |
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