The Rundown with Kansas Legislative Division of Post Audit

Follow up Audit: Reviewing Agencies’ Implementation of Selected Performance Audit Recommendations

November 30, 2020 Legislative Post Audit
The Rundown with Kansas Legislative Division of Post Audit
Follow up Audit: Reviewing Agencies’ Implementation of Selected Performance Audit Recommendations
Chapters
The Rundown with Kansas Legislative Division of Post Audit
Follow up Audit: Reviewing Agencies’ Implementation of Selected Performance Audit Recommendations
Nov 30, 2020
Legislative Post Audit

The audit reviewed 10 recommendations from 3 prior LPA audits. It involved the Kansas Department of Agriculture and the Kansas Department of Health and Environment. The 2 agencies implemented 9 of 10 recommendations we reviewed for this audit. In April 2018, we published 2 audits with several recommendations for KDHE related to improving the state’s Medicaid program. As of October 2020, KDHE fully implemented 4 of 5 recommendations we evaluated. We were unable to determine the status of the last recommendation. In December 2018, we published an audit with several recommendations for KDA related to the animal facility inspections program. As of September 2020, KDA fully implemented all 5 recommendations we evaluated. 

Show Notes Transcript

The audit reviewed 10 recommendations from 3 prior LPA audits. It involved the Kansas Department of Agriculture and the Kansas Department of Health and Environment. The 2 agencies implemented 9 of 10 recommendations we reviewed for this audit. In April 2018, we published 2 audits with several recommendations for KDHE related to improving the state’s Medicaid program. As of October 2020, KDHE fully implemented 4 of 5 recommendations we evaluated. We were unable to determine the status of the last recommendation. In December 2018, we published an audit with several recommendations for KDA related to the animal facility inspections program. As of September 2020, KDA fully implemented all 5 recommendations we evaluated. 

Speaker 1:

From the Kansas legislative division of post-doc . And this is the rundown, your source for news and updates from LPA, including performance audits recently released to the Kansas legislature. I'm Brad hall in November, 2020 legislative post audit released to follow up performance audit, reviewing agencies , implementation of selected performance audit recommendations. I'm with Mayfield Smith, auditor and legislative post audit who completed the audit report may see , welcome to the rundown. And thanks for taking the time to discuss the audit findings with me.

Speaker 2:

Thank you so much for having me

Speaker 1:

This audit report is a follow-up report where you reviewed , uh , agency's implementation of selected performance , uh , audit recommendations. Take some time , uh , to kind of talk about the three audits that you reviewed and the state agencies involved.

Speaker 2:

So we looked at the recommendations LPA made for three audits, and those audits were all from 2018. So two audits involved the Kansas department of health and environment, and they were evaluating canned care's effect on the state Medicaid program. And the second was evaluating mental health services in local jails. The third audit was evaluating the animal facilities inspection program for the Kansas department of agriculture. I do want to point out one item before moving on that I believe is important to helping understand this audit our audit work, look, to see if the agencies implemented our recommendations. So basically, did the agencies do something yes or no? And then we reported on that we did not evaluate if or how well that something was or was not working.

Speaker 1:

Okay. Thanks for clarifying that. So let's begin discussing the two performance audits involving Katie H . So both audits were reported in to April of 2018 and they included recommendations intended to improve processes within the state's Medicaid program. So explain what you found in your followup work and what K D H E O officials are doing to implement LPAs recommendations from that original audit.

Speaker 2:

Sure. There were three recommendations that address the accuracy of data submitted by the managed care organizations. And those are the private insurance companies that manage CanCare . So those are MCs for short. If I use that acronym, we look to see if Katie H G allocated new staff and providing training to their staff for looking at claims data submitted to the MCs . We also look to see if Katie H had penalties for MCs , if they submitted inaccurate data. And then finally, if Katie had developed a process to review the data submitted , we found that Katie G had implemented those first two. I talked about allocating and training staff, and then having penalties for inaccurate data on the last one, Katie H G staff told us that there were updates and improvements made to their information systems that helped enforce the data requirements, thus that improved the data accuracy. However, we could not determine if Katie AIG had implemented these things because that would have required a more comprehensive audit. Um, we also look to see if Katie H G had developed provider capacity requirements, and if they were collecting and evaluating that provider capacity information, Katie H does collect and evaluate provider capacity information, but determining if KT H E developed requirements is not applicable at this time in the original audit, developing those requirements was tied to CMS developing those requirements. Now, CMS is the centers for Medicare and Medicaid services, and that's the federal agency that oversees those programs. So Katie H E staff reported that CMS had not set those requirements yet.

Speaker 1:

Now the second audit related to providing mental health services in local jails, specifically, one of the findings of that audit was that Katie H E O officials are not regularly notified when Medicaid recipients enter jails. So why was this a problem finding , uh , and what did you find that KBH officials are doing to address this recommendation?

Speaker 2:

So not being notified when a Medicaid recipient enters or exits jails is important because of a federal law that prohibits inmates from receiving Medicaid payments, we've found that Katie AIG worked to implement a data exchange that notifies them when Medicaid beneficiaries enter or exit local jails. So Katie HG receives those daily reports and have a specialized unit to review those.

Speaker 1:

And then the third audit you followed up on involved the department of agriculture. So LPA relate, released an audit back in December of 2018, that included recommendations for the department of agriculture and its officials to improve the consistency of animal facilities, inspections, and penalty throughout the state. So take some time to explain the findings of that audit. Uh , also the recommendations that LPA made and the status of those recommendations,

Speaker 2:

These recommendations were specific to the animal facilities inspection program or AFI. They implemented all five of our recommendations. And so I'll just walk you through those first. We recommended that the AFI program update their policy and procedure manual. They did that. It now has detailed sections on conducting inspections, determining if a violation occurred. And it also contains in it a legal penalty matrix second, per our recommendation, they created three new tasks objectives for their inspectors annual performance evaluations. So you might think of those as goals that they look at, and those goals address inspection timeliness. We also recommended that the AFI program create a process to monitor that inspections and penalties are timely. Inappropriate AFI uses a weekly report that comes out of a database they use for tracking and storing a number of items for the program. So inspectors use that report to plan inspections. And then the program manager uses that report to make sure inspectors are completing inspections on time. Now that same database, not the report, but the database is also used to monitor penalties. However, we did find that part of the penalty process relies on the agency's legal department and that department, that legal department primarily uses a paper filing system to ensure those actions are completed on time. The fourth recommendation was to work with K state to provide statutorily required training. They are doing this and worked with K state to provide that training both in 2019 and 2020. Finally, we recommended that the AFI program consider adding an investigative inspector position, and that position would be to focus on non-licensed facilities, but like everything else in 2020, it was affected by the COVID pandemic , uh , KTA posted that position, but they did not fill it because of budgetary concerns caused by the pandemic.

Speaker 1:

Finally, what is the main takeaway of this follow-up report?

Speaker 2:

I think just kind of at a high level, seeing that H implemented four of the five recommendations that we had given. Um, but then that fifth recommendation we determine if it was or wasn't implemented. And then that AFI program implemented five of five recommendations.

Speaker 1:

Macy Smith is an auditor at legislative post audit. She completed a follow-up performance audit report, reviewing agency's implementation of selected performance audit recommendations. Macy , thank you for taking the time to visit the rundown studio and walking me through your findings.

Speaker 2:

Sure. Thank you so much for having me. Thank you

Speaker 3:

For listening to the rundown . To hear more podcasts, subscribe to us on Spotify or Apple podcast . For more information about legislative hope started in our water reports . Visit Ks lpa.org. Follow us on Twitter at cadence audit or visit our Facebook.