FINDINGS, CONCLUSIONS, AND RECOMMENDATIONS
REPORT CONCLUSIONS
The universal screening program was mandated by Public Act
89-21 and requires that all individuals seeking admission to a nursing facility be
screened prior to admission regardless of income, assets, or funding source (210 ILCS
45/2-201.5). Before July 1, 1996, only individuals seeking Medicaid assistance were
required to be screened, and private pay individuals could enter a nursing facility
without being screened. Screenings for those not seeking Medicaid are advisory; the
individual still makes the decision to go to a nursing facility or remain in the
community.
As a result of the universal screening requirement, the
Department on Aging did 332 percent more nursing facility prescreenings during Fiscal Year
1997 than in the prior year. In Fiscal Year 1997, Aging paid for 62,747 screenings
performed for individuals 60 years of age or older for a total cost of $3.6 million. Of
the 62,747 screenings performed, 51,189 resulted in the person being placed in a nursing
facility.
The universal screening program has been cost effective even
though only a small proportion of individuals screened were deflected from nursing
facility care to less expensive community based care. We estimate that during Fiscal Year
1997, an average of 741 additional people were in the State Community Care Program each
month because of universal screening with an estimated State cost savings of approximately
$2.8 million for the year.
There are other cost saving aspects of the program, including
federal savings from delayed nursing facility care. Some other cost savings aspects are
difficult to quantify. For example, individuals who are deflected to less expensive
private pay home care may delay nursing facility admission and thus delay the time when
they will need the State's assistance to pay for nursing facility care.
The universal screening requirement also applied to
individuals under age 60 seeking nursing facility admission. The requirement had little
impact on this portion of the program which is administered by the Department of Human
Services. These clients are screened by Human Services' division of rehabilitation
services or its division of mental health and developmental disabilities.
Not all individuals admitted to nursing facilities were
screened prior to admission as required by Public Act 89-21. Although an exact match of
data was not available, there were nearly twice as many admissions to nursing homes in the
12 month period of calendar year 1996 as there were screenings resulting in a nursing home
placement during Fiscal Year 1997 (July 1, 1996 to June 30, 1997). The Department of
Public Health has the authority to enforce this provision but had not taken steps to do
so.
Some weaknesses were identified in Aging's management controls
over payments for screenings. We identified over $16,000 of duplicate bills submitted by
one community agency that did screenings. After we identified these questionable billings,
Aging notified the agency, the agency acknowledged the problem and returned the amount in
error. Errors we identified at screening entities resulted in total recoveries of $19,896.
Although the percentage of inappropriate bills was small, changes in the control system
could help to guard against future errors or inappropriate bills.
Few significant delays in providing service were noted in the
first year of the universal screening program. One delay noted by a nursing home
association was for Medicaid clients who were discharged from a hospital and clearly
needed nursing home services. In a few cases, the screening was not conducted until
several days after the patient had been admitted to a nursing home. When the screening is
delayed, Public Aid rules require that payment cannot be made for services provided before
the screening was performed.
The data for the first half of Fiscal Year 1998 show that the
number of screenings is comparable to Fiscal Year 1997 and the number of Community Care
Program clients is also staying constant. If the number of people deflected to community
care decreases, the continued cost effectiveness of the screening program may become
questionable.
BACKGROUND
On May 23, 1996 the Illinois Senate adopted Senate Resolution
Number 207 directing the Auditor General's Office to conduct a program audit of the
universal screening program. The Resolution required that the audit commence on July 1,
1997, and report to the General Assembly no later than June 30, 1998. The Resolution asked
us to determine the cost effectiveness of the universal screening mandate including but
not limited to:
- Administrative Costs,
- Cost to the State,
- Operating Efficiency of the Program, and
- Delays Incurred in Providing Services to Individuals. (page 2)
AGENCIES INVOLVED IN UNIVERSAL SCREENING
The universal screening program was mandated by Public Act
89-21 and requires that all individuals seeking admission to a nursing facility be
screened prior to admission. Before July 1, 1996, only individuals seeking Medicaid
assistance were required to be screened, and private pay individuals could enter a nursing
facility without being screened. |
