State & Local Reports

What Was Performed? An examination of the Kutz Rehabilitation and Nursing’s fiscal records of the Delaware Department of Health and Social Services, Division of Medicaid and Medical Assistance, Medicaid Long-Term Care Facilities’ Statement of Reimbursement Costs for Skilled and Intermediate Care Nursing Facilities – Title XIX and Nursing Wage Survey (cost report and nursing wage survey, respectively) for fiscal year ended June 30, 2018. WhyThis Engagement? This engagement was conducted in accordance with federal requirements (42 CFR 447.253 and 483 Subpart B) and state requirements (Title XIX Delaware Medicaid State Plan, Attachment 4.19D) (criteria), as applicable to the Kutz Rehabilitation and Nursing’s fiscal records. The criteria were used to prepare the Schedule of Adjustments to the Trial Balance, Patient Days, and Nursing Wage Survey for fiscal year ended June 30, 2018 found in the report. The State ofDelaware is required to ensure thatthe fiscal records atthe nursing care facilities are retained and properly supportthe cost report, or the financial report showing the cost and charges related to Medicaid activities, submitted to the Medicaid Agency. These costs must be compliantwith federal and state regulations.Under the Delaware Medicaid State Plan, the state is required to examine a sample of facilities located within the state to ensure the facilities’ cost reports and nursing wage surveys are compliant with federal and state requirements.What Was Found? It is my pleasure to report that there were no findings identified and the Kutz Rehabilitation and Nursing Long-Term Healthcare Facility complied, in all material respects, with the criteria mentioned above. The Kutz Rehabilitation and Nursing Long-Term Healthcare Facility Examination for Fiscal Year ended June 30, 2018, can be found on our website: click here.For any questions regarding the attached report, please contact State Auditor Kathleen K. McGuiness at Kathleen.Mcguiness@delaware.gov.

What Was Performed? An examination of the Delaware Hospital for the Chronically Ill’s fiscal records of the Delaware Department of Health and Social Services, Division of Medicaid and Medical Assistance, Medicaid Long-Term Care Facilities’ Statement of Reimbursement Costs for Skilled and Intermediate Care Nursing Facilities – Title XIX and Nursing Wage Survey (cost report and nursing wage survey, respectively) for fiscal year ended June 30, 2018. Why This Engagement? The State Auditor is authorized under 29 Del. C., §2906 to conduct post-audits of all financial transactions of all state agencies. This engagement was conducted in accordance with federal requirements (42 CFR 447.253 and 483 Subpart B) and state requirements (Title XIX Delaware Medicaid State Plan, Attachment 4.19D) (criteria), as applicable to the Delaware Hospital for the Chronically Ill’s fiscal records. The criteria were used to prepare the Schedule of Adjustments to the Trial Balance, Patient Days, and Nursing Wage Survey for fiscal year ended June 30, 2018 found in the report. The State of Delaware is required to ensure that the fiscal records at the nursing care facilities are retained and properly support the cost report, or the financial report showing the cost and charges related to Medicaid activities, submitted to the Medicaid Agency. These costs must be compliantwith federal and state regulations.Under the Delaware Medicaid State Plan, the state is required to examine a sample of facilities located within the state to ensure the facilities’ cost reports and nursing wage surveys are compliant with federal and state requirements.What Was Found? It is my pleasure to report that there were no findings identified and the Delaware Hospital for the Chronically Ill Long-Term Healthcare Facility complied, in all material respects, with the criteria mentioned above. The Delaware Hospital for the Chronically Ill Long-Term Healthcare Facility Examination for Fiscal Year ended June 30, 2018 can be found on our website: click here. For any questions regarding the attached report, please contact State Auditor Kathleen K. McGuiness atKathleen.Mcguiness@delaware.gov

What Was Performed? An examination of the Cadia Rehabilitation Pike Creek’s fiscal records of the Delaware Department of Health and Social Services, Division of Medicaid and Medical Assistance, Medicaid Long-Term Care Facilities’ Statement of Reimbursement Costs for Skilled and Intermediate Care Nursing Facilities – Title XIX and Nursing Wage Survey (cost report and nursing wage survey, respectively) for fiscal year ended June 30, 2018. WhyThis Engagement? This engagement was conducted in accordance with federal requirements (42 CFR 447.253 and 483 Subpart B) and state requirements (Title XIX Delaware Medicaid State Plan, Attachment 4.19D) (criteria), as applicable to the Cadia Rehabilitation Pike Creek’s fiscal records. The criteria wereused to prepare the Schedule of Adjustments to the Trial Balance, Patient Days, and Nursing Wage Surveyfor fiscal year ended June 30, 2018 found in the report. The State of Delaware is required to ensure that the fiscal records at the nursing care facilities are retained and properly support the cost report, or the financial report showing the cost and charges related to Medicaid activities, submitted to the Medicaid Agency. These costs must be compliant with federal and state regulations.Under the Delaware Medicaid State Plan, the state is required to examine a sample of facilities located within the state to ensure the facilities’ cost reports and nursing wage surveys are compliant with federal and state requirements.What Was Found? It is my pleasure to report that there were no findings identified and the CadiaRehabilitation Pike Creek Long-Term Care Facility complied, in all material respects, with the criteria mentioned above. The Cadia Rehabilitation Pike Creek Long-Term Care Facility Examination for Fiscal Year ended June 30, 2018, can be found here.For any questions regarding the attached report, please contact State Auditor Kathleen K. McGuiness atKathleen.Mcguiness@delaware.gov.

What Was Performed? An examination of the Cadia Rehabilitation Capitol’s fiscal records of the Delaware Department of Health and Social Services, Division of Medicaid and Medical Assistance, Medicaid Long-Term Care Facilities’ Statement of Reimbursement Costs for Skilled and Intermediate Care Nursing Facilities –Title XIX and Nursing Wage Survey (cost report and nursing wage survey, respectively) for fiscal year ended June 30, 2018.WhyThis Engagement? This engagement was conducted in accordance with federal requirements (42 CFR 447.253 and 483 Subpart B) and state requirements (Title XIX Delaware Medicaid State Plan, Attachment 4.19D) (criteria), as applicable to the Cadia Rehabilitation Capitol’s fiscal records. The criteria were used to prepare the Schedule of Adjustments to the Trial Balance, Patient Days, and Nursing Wage Survey for fiscal year ended June 30, 2018 found in the report. The State of Delaware is required to ensure that the fiscal records at the nursing care facilities are retained and properly support the cost report, or the financial report showing the cost and charges related to Medicaid activities, submitted to the Medicaid Agency. These costs must be compliant with federal and state regulations.Under the Delaware Medicaid State Plan, the state is required to examine a sample of facilities located within the state to ensure the facilities’ cost reports and nursing wage surveys are compliant with federal and state requirements.What Was Found? It is my pleasure to report that there were no findings identified and the CadiaRehabilitation Capitol Long-Term Care Facility complied, in all material respects, with the criteria mentioned above. The Cadia Rehabilitation Capitol Long-Term Care Facility Examination for Fiscal Year ended June 30, 2018,can be found here.For any questions regarding the attached report, please contact State Auditor Kathleen K. McGuiness atKathleen.Mcguiness@delaware.gov

What Was Performed? An examination of the Atlantic Shores Rehabilitation and Health Center’s fiscal records of the Delaware Department of Health & Social Services, Division of Medicaid and Medical Assistance, Medicaid Long-Term Care Facilities’ Statement of Reimbursement Costs for Skilled and Intermediate Care Nursing Facilities – Title XIX and Nursing Wage Survey (cost report and nursing wage survey, respectively) for fiscal year ended June 30, 2018. WhyThis Engagement? This engagement was conducted in accordance with federal requirements (42 CFR 447.253 and 483 Subpart B) and state requirements (Title XIX Delaware Medicaid State Plan, Attachment 4.19D) (criteria), as applicable to the Atlantic Shores Rehabilitation and Health Center’s fiscal records. The criteria were used to prepare the Schedule of Adjustments to the Trial Balance, Patient Days, and Nursing Wage Survey for fiscal year ended June 30, 2018.The State of Delaware is required to ensure that the fiscal records at the nursing care facilities are retained and properly support the cost report, or the financial report showing the cost and charges related to Medicaid activities, submitted to the Medicaid Agency. These costs must be compliant with federal and state regulations.Under the Delaware Medicaid State Plan, the state is required to examine a sample of facilities located within the state to ensure the facilities’ cost reports and nursing wage surveys are compliant with federal and state requirements.What Was Found? It is my pleasure to report that there were no findings identified and the Atlantic Shores Rehabilitation and Health Center Long-Term Care Facility complied, in all material respects, with the criteria mentioned above. The Atlantic Shores Rehabilitation and Health Center Long-Term Care Facility Examination for Fiscal Year ended June 30, 2018, can be found here.For any questions regarding the attached report, please contact State Auditor Kathleen K. McGuiness atKathleen.Mcguiness@delaware.gov

The Cuyahoga County Department of Internal Auditing (DIA) conducted an audit to assess the effectiveness of Division of Senior and Adult Services (DSAS) contract usage relating to DSAS programs. The purpose of this audit was to ensure that contract expenditures have controls and supporting documentation, and comply with procedures, regulations, or contract terms. The audit also reviewed fraud risk to determine if it had been mitigated during the procurement and usage of contracts. The audit found that generally, there was effective management of contract reliant programs, however, DIA's audit procedures disclosed internal control weaknesses related to monitoring contract vendors, documenting vendor selection for DSAS clients, policies and procedures not being fully developed, and lack of supporting documentation for contract expenditures.

What Was Performed? An examination of The Moorings at Lewes Nursing Home’s fiscal records of the Delaware Department of Health and Social Services, Division of Medicaid and Medical Assistance, Medicaid Long-Term Care Facilities’ Statement of Reimbursement Costs for Skilled and Intermediate Care Nursing Facilities – Title XIX and Nursing Wage Survey (cost report and nursing wage survey, respectively) for fiscal year ended June 30, 2018. WhyThis Engagement? This engagement was conducted in accordance with federal requirements (42 CFR 447.253 and 483 Subpart B) and state requirements (Title XIX Delaware Medicaid State Plan, Attachment 4.19D) (criteria), as applicable to The Moorings at Lewes Nursing Home’s fiscal records. The criteria wereused to prepare the Schedule of Adjustments to the Trial Balance, Patient Days, and Nursing Wage Surveyfor fiscal year ended June 30, 2018 found in the report. The State of Delaware is required to ensure that the fiscal records at the nursing care facilities are retained and properly support the cost report, or the financial report showing the cost and charges related to Medicaid activities, submitted to the Medicaid Agency. These costs must be compliant with federal and state regulations.Under the Delaware Medicaid State Plan, the state is required to examine a sample of facilities located within the state to ensure the facilities’ cost reports and nursing wage surveys are compliant with federal and state requirements.What Was Found? The examination identified two findings, with each finding resulting in both a material weakness in internal control and a compliance finding: ▪ The facility did not provide the general ledger and supporting documentation for the period of July 1, 2017 through September 30, 2017.▪ The facility did not provide sufficient supporting documentation for salary expense for the period ofJuly 1, 2017 through December 31, 2017.The facility was unable to provide the above detail support for certain costs, with the total amount of untested costs being approximately $2.1 million (34.3% of total costs) on the cost report and nursing wage survey. As a result, we were unable to obtain sufficient appropriate evidence about the accuracy and allowability of these costs. We were also unable to determine whether adjustments to these amounts were necessary, and whether management’s assertions related to these costs are accurate. Not being able to support the costs recorded could result in a disallowance of those costs, which would affect the facility’s reimbursement rate. The Moorings at Lewes Nursing Home Long-Term Healthcare Facility Examination for Fiscal Year ended June 30, 2018, can be found here.For any questions regarding the attached report, please contact State Auditor Kathleen K. McGuiness atKathleen.Mcguiness@delaware.gov

The Office of Inspector General (OIG) conducted an audit of the Department of Family and Support Services’ (DFSS) Strategic Contracting process for selecting delegate agencies. The objective of the audit was to determine whether DFSS’ contracting processes align with outcomes-based goals and the Department’s internal framework known as the Commitment to Outcomes, of which its Strategic Contracting process is a part. OIG concluded that DFSS’ Strategic Planning and Impact division’s involvement in developing requests for proposal (RFPs) and evaluation tools—critical steps in the Strategic Contracting process—helps align those steps with the Commitment to Outcomes. However, OIG also determined that there is room for improvement.OIG concluded that DFSS largely applies its Strategic Contracting process in accordance with the Commitment to Outcomes, but that there is room for improvement. That is, DFSS could more thoroughly apply its Commitment to Outcomes to maximize its effectiveness in improving outcomes.

In our Financial Statements and Federal Single Audit, we identified several state departments, including the Washington state Office of Management, Department of Commerce, and the Department of Social and Health Services did not have adequate internal controls over the Coronavirus Relief Fund and did not comply with certain requirements.