North Dakota Could Better Ensure That Providers Fully Comply With Federal Waiver and State Health, Safety, and Administrative Requirements at 44 Residential Settings

Why OIG Did This Audit

• OIG conducts health and safety audits of supported living services, adult day care, foster care homes, and regulated child care facilities.
• Previous audits identified multiple health and safety issues that put children and people with special health care needs at risk.
• This audit examined whether North Dakota: (1) exercised adequate oversight of Home and Community-Based Services (HCBS) providers to ensure the health and safety of Medicaid enrollees with intellectual and developmental disabilities residing in residential habilitation settings and (2) established infection control and prevention standards.

What OIG Found

North Dakota could improve its oversight to better ensure residential providers meet some health and safety standards for Medicaid waiver enrollees with intellectual and developmental disabilities, including oversight of infection control and prevention standards.

Of the 16 providers and 51 residential settings we reviewed, we found 182 instances of provider noncompliance with administrative, health, safety, and residential records requirements; and 1 provider that did not have sufficient evidence of a written policy for infection control and prevention. Specifically, we identified:

• 8 providers that did not comply with 1 or more administrative requirements, resulting in 108 instances of provider noncompliance
• 44 residential settings that were not in compliance with 1 or more health, safety, and residential records requirements, totaling 74 instances of provider noncompliance

What OIG Recommends

We made three recommendations, including that North Dakota follow up with residential providers that had the 182 instances of provider noncompliance identified in this report to ensure that corrective actions have been taken; improve its oversight and monitoring of residential providers; and work with residential habilitation services providers to improve internal controls for health and safety at residential habilitation settings, maintenance of records, and training.

North Dakota concurred with two recommendations and detailed steps it has taken and plans to take in response to our recommendations. North Dakota did not concur with one recommendation.

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