Press Release  Change to Medication Management Protocols Could Save MassHealth Millions According to Audit

Boston — Auditor Suzanne M. Bump today released an audit of SafetyNet Solutions (SNS), an adult foster care (AFC) and group adult foster care (GAFC) service provider in Springfield. While the audit found no deficiencies in the administration of SNS’s GAFC program, it did highlight an opportunity for MassHealth to potentially save millions of dollars through a change to its medication management procedures in this program. The audit notes that this change could have saved as much as $2.8 million at SNS alone during the audit period, with millions of additional dollars in potential savings throughout the GAFC program.

“We owe it to the taxpayers of the Commonwealth to constantly look for ways to do our jobs better and at a lower cost,” Bump said. “By making a commonsense adjustment to its medication administration for group adult foster care participants, MassHealth could potentially save millions of dollars annually, without reducing the quality of service for members. I encourage the program to further explore this opportunity.”

GAFC programs provide assistance with activities of daily living, including eating, dressing, laundry, and meal preparation, to elderly and disabled MassHealth members, which allows those members to continue to live independently in a community-based setting, and thus avoid the high costs of paying for those members to live in a long-term-care facility, such as a rest home.

Currently, when a MassHealth member in a GAFC program cannot manage his or her own medication, the GAFC provider will typically contract with a visiting nurse association (VNA) to provide the needed services. GAFC providers use registered nurses (RNs) to manage medication because the Home Health Aides they use to provide services under the GAFC Program are not qualified to manage medication according to MassHealth regulations.  However, the audit notes that MassHealth regulation allows individuals who are trained in administering prescription medication to perform medication management, even if they are not registered nurses. If MassHealth adjusted its guidelines to allow and direct GAFC providers to use certified nursing assistants who are certified in medication management to provide these services to members who require them, it could result in millions of dollars in savings in the program, the audit found.

Previous audits found this change could have saved MassHealth up to $2.1 million at Community Connection Healthcare in Quincy, and up to $18.4 million at Nizhoni Community Care in Somerville during the periods covered by those audits.

In addition, the audit also found that MassHealth allowed SNS to bill up to $1.8 million for unallowable group adult foster care services that were duplicative of services provided through other means. MassHealth enabled this improper practice in an email to providers informing them that they could bill for these duplicative services, despite regulations to the contrary. This problem was first identified in an audit released by Bump’s office last summer.

SNS was established in 2009 as a GAFC provider for individuals living in the greater Springfield area.  During the audit period, from July 1, 2011 through June 30, 2016, it received approximately $16.9 million in GAFC payments from MassHealth for 419,951 claims for 756 members.

The audit of SafetyNet Solutions is available here. 

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