North Dakota Could Better Ensure That Providers Fully Comply With Federal Waiver and State Health, Safety, and Administrative Requirements at 44 Residential Settings
Learn how the AI-generated research projects were createdOverall Conclusion
The North Dakota State agency could improve oversight of residential providers and settings to better ensure the health and safety of participants with intellectual and developmental disabilities residing in residential habilitation settings; weaknesses in the quality management system limited the ability to detect and prevent noncompliance, necessitating strengthened oversight and internal controls.
Source Document
Audit Scope
Scope included Medicaid Traditional IID/DD HCBS waiver residential habilitation services in North Dakota, using MMIS data for the quarter ended December 31, 2023; 16 providers and 51 residential settings; on-site unannounced visits August 27–November 21, 2024; fieldwork conducted in Bismarck, Mandan, Grand Forks, and Fargo.
Key Findings Summary
The State agency could improve its oversight to ensure residential providers meet health and safety standards, including infection control and prevention standards, for Medicaid waiver participants with IID/DD.
Of the 16 providers and 51 residential settings reviewed, 182 instances of provider noncompliance with administrative, health, safety, and residential records requirements were identified; 1 provider lacked sufficient evidence of a written infection control and prevention policy.
Eight residential providers did not comply with one or more administrative requirements, resulting in 108 instances of noncompliance.
View the Findings tab to see all 7 findings
AI-Assisted
AI Scope Summary
This audit builds on the overarching objective of verifying state oversight and infection control standards for residential habilitation settings serving Medicaid IID/DD participants; findings show substantial noncompliance and suggest targeted improvements in oversight, policy implementation, and internal controls to guide future audits.
AI-Generated Insight
This audit highlights gaps between written standards and practical implementation in North Dakota's HCBS residential settings, emphasizing the need for stronger ongoing monitoring, timely provider surveys, and robust corrective-action processes to protect vulnerable participants in Medicaid-funded residential habilitation services.
Audit Objectives
Determine whether the North Dakota Department of Health and Human Service’s Developmental Disability Section (Stage agency): (1) exercised adequate oversight of HCBS providers to ensure the health and safety of Medicaid waiver enrollees with intellectual and developmental disabilities residing in residential habilitation settings and (2) established infection control and prevention standards.
Audit Findings (7)
The State agency could improve its oversight to ensure residential providers meet health and safety standards, including infection control and prevention standards, for Medicaid waiver participants with IID/DD.
Of the 16 providers and 51 residential settings reviewed, 182 instances of provider noncompliance with administrative, health, safety, and residential records requirements were identified; 1 provider lacked sufficient evidence of a written infection control and prevention policy.
Eight residential providers did not comply with one or more administrative requirements, resulting in 108 instances of noncompliance.
Forty-four residential settings were not in compliance with one or more health, safety, and residential records requirements, totaling 74 instances of noncompliance.
One provider did not have sufficient evidence of an infection control and prevention policy.
Weaknesses in the State agency’s quality management system limited the effectiveness of oversight, with staffing shortages and recent changes in administrative leadership contributing to noncompliance.
Some participant records did not consistently show evidence that the provider reported critical incidents to the protection and advocacy project within the required 24-hour timeframe.
Recommendations (3)
Follow up with residential providers that had the 182 instances of noncompliance to ensure corrective actions have been taken and verification of corrections provided.
Improve oversight and monitoring of residential providers to better identify and address health and safety risks.
Work with residential providers to improve internal controls for health and safety at residential settings, maintenance of records, and training.