RESOLUTION NO. 114

Presented by ________________

WHEREAS, a federal report which analyzed home health care agency billings to the federal Medicare program found that over 70 percent of services contained in claims sampled from Illinois did not meet reimbursement requirements. This report by the Inspector General of the Department of Health and Human Services found that services not meeting requirements included services which were not reasonable and necessary and services for clients who did not meet home health care eligibility requirements; and

WHEREAS, a separate federal report by the General Accounting Office found that becoming a Medicare-certified home health agency is easy, given the large number of problem agencies cited in various studies. It found that agencies are certified without owners having any health care experience and found that serious deficiencies at certified agencies go undetected. To provide Medicaid home health care in Illinois, an agency must be Medicare certified; and

WHEREAS, Medicaid home health care expenditures in Illinois have increased at a higher rate than total Medicaid expenditures, with $49 million of actual expenditures for fiscal year 1997, estimated expenditures of almost $62 million in fiscal year 1998, and over $76 million included in the Governor’s fiscal year 1999 budget; and

WHEREAS, the National State Auditors Association has invited the Illinois Office of the Auditor General and auditors in other states to participate in a joint audit of states’ Medicaid home health expenditures and home health care regulation; and

WHEREAS, a joint audit of Medicaid home health care offers an opportunity to not only develop recommendations to improve individual states’ controls of home health care regulation and expenditures, but also to propose changes in federal requirements which may help states to control home health care use and quality more effectively; therefore be it

RESOLVED by the Legislative Audit Commission of the State of Illinois that the Auditor General is directed to participate in the National State Auditors Association’s joint audit of the State’s Medicaid expenditures for home health care and the State’s regulatory control over home health care agencies; and be it further

RESOLVED that the audit shall include, but need not be limited to, the following determinations:

Whether the home health services billed for Medicaid clients by providers are properly authorized, approved, allowable, and provided.

Whether there are adequate management controls over the regulatory function which controls home health care agencies;

Whether the State has procedures in place to ensure that quality care is provided to Medicaid home health care clients; and be it further

RESOLVED that the Department of Public Aid, the Department of Public Health, the Department of Human Services, and all other State agencies and other entities which may have information relevant to this audit shall cooperate fully and promptly with the Office of the Auditor General in the conduct of this audit; and be it further

RESOLVED that the Auditor General shall commence this audit immediately and report his findings and recommendations as soon as possible in accordance with the provisions of the Illinois State Auditing Act.

Adopted this 16^th day of July, 1998.

_______________________________ _______________________________

Senator Thomas J. Walsh                          Representative Julie A. Curry

Cochairman                                           Cochairman