Presentation of the Consumer-Directed Attendant Support Serv. Audit
COMMITTEE ON JOINT HEALTH AND HUMAN SERVICES
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01:35 PM -- Presentation of the Consumer-Directed Attendant Support Serv. Audit
Trey Standley, Office of the State Auditor (OSA), gave an overview of the OSA's role related to the SMART Act. He explained that the OSA is required to annually conduct audits on one or more specific programs or services in at least two departments. He described the analysis that the Office uses when auditing the programs. He discussed the audit report of the Consumer-Directed Attendant Support Services (CDASS) program in the Colorado Department of Health Care Policy and Financing (HCPF), and provided an OSA briefing document to the committee (Attachment J). Mr. Standley gave background information on the CDASS program and reported that the program served 3,124 clients and cost $82.3 million for FY 2014.
Mr. Standley reported on the program's performance plan. He told the committee that there were no performance measures in HCPF's FY 2015 Performance Plan that directly related to CDASS; however, it did include measures related to the Home- and Community-Based Service (HCBS) waivers. He described the performance measures for HCBS waiver programs set by HCPF. He stated that the audit found that the measures generally comply with SMART Act requirements; however, the audit recommends that HCPF do more to measure the cost effectiveness of the CDASS program. Mr. Standley discussed a HCPF 2013 study that compared the costs and outcomes of clients enrolled in CDASS to the costs and outcomes of clients who receive services through alternative delivery options. He stated that the study did not accurately reflect the cost effectiveness of the program. Overall, the program complies with client flexibility intended by statute and is line with program goals.
Mr. Standley responded to legislator concerns about the small sample size of clients used for the audit. He noted that audits do not typically focus on clients or members of the public, but rather the focus is on case management and administration of the program. He told the committee that a client survey was ruled out due to the nature of the sensitive information, and that 30 client files were examined during the audit. He stated that two clients were interviewed for the audit due to their involvement with many aspects of the program and could speak generally.
In response to legislator questions, Mr. Standley discussed the different cost comparisons for the programs. Mr. Standley explained that the savings from lower hourly rates for attendants in the program is recouped in other area of the program.
02:02 PM -- Jose Torres-Vega, Colorado Cross-Disability Coalition, testified in support of CDASS. He noted that the program requires a large amount of funding and expressed concern over the limited number of clients that were interviewed for the audit. He told the committee that he received training on how to manage funds he receives through CDASS. He also suggested that quality of life analysis to be included in the audit.
02:05 PM -- Christina Johnson,, stated that she has been in the CDASS program since 2008 and explained that she prefers CDASS to the agency home program due to quality of life issues. She expressed concern that the audit did not take into account the experiences of the clients. Ms. Johnson responded to questions from committee members.
02:10 PM -- Katherine Carol, self, explained that she is the mother of a child with a disability, and expressed support of the program. She told the committee that home health care was not a good experience for her and her daughter. She noted that her daughter has a social life and is able to work using CDASS. She stated that the program liberates individuals and families.
02:13 PM -- Angela Nevin, self, told the committee about her experiences as a care attendant employed by CDASS and expressed support for the program.
02:16 PM -- Linda Andre, self, testified in support of the program. She told the committee that she has been in the CDASS since the program inception. She explained that due to the services she receives through CDASS, she is able to have a job.
02:21 PM -- Debbie Miller, self. testified in support of the bill and discussed her families experience with the program. She noted that her son is in the program. She testified in support of the program, and explained negative experiences with agencies in the past.
02:27 PM -- Julie Farrar, self, testified in support of the CDASS program. She explained the Centers for Medicare and Medicaid Services requirements for long-term care, and talked about Colorado's long-term care system. Ms. Farrar responded to questions from members. She noted that CDASS client allocation is based on the needs of the individual.
02:36 PM -- Mark Simon, self, testified in support of the CDASS program. He explained that the program was created with the input of the clients. He noted difficulties with receiving agency care in his rural area, and explained how he receives services with CDASS. He explained the process of receiving allocations for CDASS and noted that he does not always use his full client allocation. He talked about the lack of fraud allegations for the CDASS program.
Mr. Standley returned to the table. He responded to additional questions from members. He reiterated that collecting the data to compare CDASS to other programs would be very labor intensive. He confirmed that the content of the audit is typical for an OSA performance audit. Mr. Standley noted that HCPF agrees with all recommendations expect the cost effectiveness analysis, to which it partially agreed. It was noted that the program exists in other states.