Audit 332958

2024-001 – ALN 93.958 – Block Grant for Community Mental Health Services – Activities Allowed/Allowable Costs: Completion of Comprehensive Assessment (Repeat Comment) Criteria: The Block Grant for Community Mental Health Services provides for a set of documentation requirements for clients in the covered programs, including the completion of a Financial Assessment Form (FAF) to document financial eligibility over allowable costs. Based on the client’s income and number of dependents, this form is used to determine a “discount class”, and calculate a sliding scale discount percentage and/or dollar amount of SMA’s fees that the client would be responsible for paying. This form is required to be completed when clients are discharged after being provided mental health services. FAF are to be updated yearly for patients with active billable services, noting all service dates with a billed service should fall within one year of the FAF completion date. Condition: 7 of the 60 clients tested did not have the discount fee that was used shown on their Financial Assessment Form. Additionally, 8 of the 60 clients tested had service dates that did not fall within one year of the FAF completion date. Cause: The requirement to perform these control elements were not followed by the case managers. Effect: The Financial Assessment Forms that were not properly completed or not completed within the required timeframe could result in noncompliance with the grant agreement or noncompliance with established controls. Recommendation: We recommend that the process be changed so that all Financial Assessment Forms required be completed fully and accurately for all patients within one year of service, and that additional controls be put in place to ensure the discount rate applied is documented and proper.

2024-002 – ALN 93.959 – Block Grant for Prevention and Treatment of Substance Abuse – Activities Allowed/Allowable Costs: Completion of Financial Assessment Form (Repeat Comment) Criteria: The Block Grant for Prevention and Treatment of Substance Abuse provides for a set of documentation requirements for clients in the covered programs, including the completion of a Financial Assessment Form (FAF) to document financial eligibility over allowable costs. Based on the client's income and number of dependents, this form is used to determine a "discount class", and calculate a sliding scale discount percentage and/or dollar amount of SMA's fees that the client would be responsible for paying. This form is required to be completed when clients are discharged after being provided mental health services. FAF are to be updated yearly for patients with active billable services, noting all service dates with a billed service should fall within one year of the FAF completion date. Condition: 1 of the 60 clients tested did not have the Financial Assessment Form properly signed by the client. Additionally, 2 of the 60 clients tested had service dates that did not fall within one year of the FAF completion date. Cause: The requirements to perform these control elements were not followed by the case managers. Effect: The Financial Assessment Forms that were not properly completed or not completed within the required timeframe could result in noncompliance with the grant agreement or noncompliance with established controls. Recommendation: We recommend that the process be reviewed and staff be trained and have regular training updates to ensure that the required Financial Assessment Forms are completed fully and signed for all clients, and that additional controls be put in place to ensure the discount rate applied is documented and proper.

2024-004 – ALN 93.558 – Temporary Assistance to Needy Families Grant – Activities Allowed/Allowable Costs: Timeframe for Completion of Master Treatment Plan (New Comment) Criteria: The Temporary Assistance to Needy Families Grant provides for a set of documentation requirements for clients in the covered programs, including the completion of a Master Treatment Plan within established timeframe (30 days and 15 days from the date of admission for Outpatient and Residential II, respectively) to document allowable costs. Condition: 5 of the 40 clients tested did not have the Master Treatment Plan completed within the established timeframe. Cause: The requirements to perform these control elements were not followed by the clinical staff. Effect: The Master Treatment Plans that were not completed within the required timeframe could result in noncompliance with the grant agreement or noncompliance with established controls. Recommendation: We recommend that the process be reviewed and staff be trained and have regular training updates to ensure that the required Master Treatment Plans are completed within established timeframe.

2024-001 – ALN 93.958 – Block Grant for Community Mental Health Services – Activities Allowed/Allowable Costs: Completion of Comprehensive Assessment (Repeat Comment) Criteria: The Block Grant for Community Mental Health Services provides for a set of documentation requirements for clients in the covered programs, including the completion of a Financial Assessment Form (FAF) to document financial eligibility over allowable costs. Based on the client’s income and number of dependents, this form is used to determine a “discount class”, and calculate a sliding scale discount percentage and/or dollar amount of SMA’s fees that the client would be responsible for paying. This form is required to be completed when clients are discharged after being provided mental health services. FAF are to be updated yearly for patients with active billable services, noting all service dates with a billed service should fall within one year of the FAF completion date. Condition: 7 of the 60 clients tested did not have the discount fee that was used shown on their Financial Assessment Form. Additionally, 8 of the 60 clients tested had service dates that did not fall within one year of the FAF completion date. Cause: The requirement to perform these control elements were not followed by the case managers. Effect: The Financial Assessment Forms that were not properly completed or not completed within the required timeframe could result in noncompliance with the grant agreement or noncompliance with established controls. Recommendation: We recommend that the process be changed so that all Financial Assessment Forms required be completed fully and accurately for all patients within one year of service, and that additional controls be put in place to ensure the discount rate applied is documented and proper.

2024-002 – ALN 93.959 – Block Grant for Prevention and Treatment of Substance Abuse – Activities Allowed/Allowable Costs: Completion of Financial Assessment Form (Repeat Comment) Criteria: The Block Grant for Prevention and Treatment of Substance Abuse provides for a set of documentation requirements for clients in the covered programs, including the completion of a Financial Assessment Form (FAF) to document financial eligibility over allowable costs. Based on the client's income and number of dependents, this form is used to determine a "discount class", and calculate a sliding scale discount percentage and/or dollar amount of SMA's fees that the client would be responsible for paying. This form is required to be completed when clients are discharged after being provided mental health services. FAF are to be updated yearly for patients with active billable services, noting all service dates with a billed service should fall within one year of the FAF completion date. Condition: 1 of the 60 clients tested did not have the Financial Assessment Form properly signed by the client. Additionally, 2 of the 60 clients tested had service dates that did not fall within one year of the FAF completion date. Cause: The requirements to perform these control elements were not followed by the case managers. Effect: The Financial Assessment Forms that were not properly completed or not completed within the required timeframe could result in noncompliance with the grant agreement or noncompliance with established controls. Recommendation: We recommend that the process be reviewed and staff be trained and have regular training updates to ensure that the required Financial Assessment Forms are completed fully and signed for all clients, and that additional controls be put in place to ensure the discount rate applied is documented and proper.

2024-004 – ALN 93.558 – Temporary Assistance to Needy Families Grant – Activities Allowed/Allowable Costs: Timeframe for Completion of Master Treatment Plan (New Comment) Criteria: The Temporary Assistance to Needy Families Grant provides for a set of documentation requirements for clients in the covered programs, including the completion of a Master Treatment Plan within established timeframe (30 days and 15 days from the date of admission for Outpatient and Residential II, respectively) to document allowable costs. Condition: 5 of the 40 clients tested did not have the Master Treatment Plan completed within the established timeframe. Cause: The requirements to perform these control elements were not followed by the clinical staff. Effect: The Master Treatment Plans that were not completed within the required timeframe could result in noncompliance with the grant agreement or noncompliance with established controls. Recommendation: We recommend that the process be reviewed and staff be trained and have regular training updates to ensure that the required Master Treatment Plans are completed within established timeframe.