Evidence record
Texas Did Not Fully Comply With Federal Waiver And State Health, Safety, And Administrative Requirements At All 20 Adult Day Activity And Health Service Facilities Audited
- Jurisdiction
- Texas
- Publication date
- March 2025
- Source record
- Original document linked
Findings
8
Recommendations
3
Overall conclusion
The State agency did not fully comply with Federal waiver and State requirements in overseeing DAHS facilities serving people with special health care needs, and its inspections were not sufficient to ensure a safe and nonhazardous environment, leaving program participants at risk.
Scope
Scope: Of the 422 DAHS providers in Texas during calendar year 2022, 20 providers were selected for audit based on geographic location and number of participants. Unannounced site visits were conducted August 21–24, 2023 in Texas cities including Dallas, Garland, Desoto, Houston, El Paso, Socorro, San Antonio, Brownsville, Harlingen, and Edinburg. The objective was to evaluate whether the Texas Health and Human Services Commission (state agency) complied with Federal waiver and State requirements in overseeing DAHS facilities that serve people with special health care needs who receive services through the 1915(c) Home and Community-Based Services waiver program. The audit did not review the State agency's overall internal control structure or the entire Medicaid program, but focused on internal controls related to the audit objective.
Findings (8)
Each finding has a stable link.
- F-356
Texas did not fully comply with Federal waiver and State requirements in overseeing DAHS facilities that serve people with special health care needs receiving DAHS services through the program.
- F-357
Of the 20 providers audited, 19 did not comply with one or more health and safety requirements.
- F-358
Of the 20 providers audited, 19 did not comply with one or more administrative requirements.
- F-359
A total of 253 instances of provider noncompliance with health, safety, and administrative requirements were identified across the 20 providers.
- F-360
Health and safety deficiencies included unsafe outside areas, insufficient building maintenance, lack of non-slip surfaces for bathing amenities, clutter, water stains on ceilings, unsafe extension cords, inadequate smoke detection systems, and fly tapes.
- F-361
Administrative deficiencies included lack of licensed or certified medical personnel on staff or not present during primary hours, lack of required monthly dietician consultations, failure to post the most recent fire inspection report, incomplete Emergency and Preparedness Plans, insufficient tuberculosis screening for staff, and training deficiencies.
- F-362
Inspections were not always sufficient to detect noncompliance, with some facilities lacking background checks and tuberculin skin tests, or lacking licensed medical personnel on staff.
- F-363
Inspections between 2019 and 2023 identified compliance citations and investigations for most providers.
Recommendations (3)
- R-321
1. ensure that providers correct the 253 instances of provider noncompliance identified in this report;
Related finding F-359 - R-322
2. improve its oversight and monitoring of providers;
Related finding F-356 - R-323
3. work with providers to improve their facilities, staffing, and training.
Related finding F-361