Evidence record
North Dakota Could Better Ensure That Providers Fully Comply With Federal Waiver and State Health, Safety, and Administrative Requirements at 44 Residential Settings
- Jurisdiction
- North Dakota
- Audit organization
- U.S. Department of Health and Human Services Office of Inspector General
- Publication date
- June 2026
- Source record
- Original document linked
Findings
7
Recommendations
3
Overall 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.
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.
Findings (7)
Each finding has a stable link.
- F-1257
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.
- F-1258
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.
- F-1259
Eight residential providers did not comply with one or more administrative requirements, resulting in 108 instances of noncompliance.
- F-1260
Forty-four residential settings were not in compliance with one or more health, safety, and residential records requirements, totaling 74 instances of noncompliance.
- F-1261
One provider did not have sufficient evidence of an infection control and prevention policy.
- F-1262
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.
- F-1263
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)
- R-1111
Follow up with residential providers that had the 182 instances of noncompliance to ensure corrective actions have been taken and verification of corrections provided.
Related finding F-1258 - R-1112
Improve oversight and monitoring of residential providers to better identify and address health and safety risks.
Related finding F-1257 - R-1113
Work with residential providers to improve internal controls for health and safety at residential settings, maintenance of records, and training.
Related finding F-1258