Social Security Online
www.socialsecurity.gov| Home | Questions? | How to Contact Us | Search | Español |
| Jump
to content Social Security Online |
Office of the Inspector General | |||||
| www.socialsecurity.gov |
|
|||||
| OIG Home |
|
|
Office of Audit Review of the Social Security Administration Procedures to Ensure State Compliance with Section 1616(e) of the Social Security Act - A-01-96-62001 - 3/31/97 This report presents the results of our review of the Social Security Administration (SSA) procedures to ensure State compliance with section 1616(e) of the Social Security Act. Section 1616(e) requires each State to certify annually to the Commissioner of Social Security that it is in compliance. Accordingly, the objective of our review was to determine whether SSA could rely on the compliance statements made by States. To meet our objective, we reviewed the Commonwealth of Massachusetts to determine if the State: (1) has established and enforces health and safety standards for institutions, foster homes, and group living arrangements in which a significant number of Supplemental Security Income (SSI) recipients reside; and (2) reports identified shortcomings to SSA and takes corrective actions timely. SSA has established a reporting system whereby it tracks whether States certify compliance with section 1616(e). Follow-up letters are sent to those States that do not comply with the certification requirement. SSA currently has certifications on file for all States. Our review of the licensing process in Massachusetts showed that, through its licensing authorities, Massachusetts has generally established and enforces health and safety standards for various types of facilities that are required to be reviewed for licensing under the provisions of the Social Security Act. However, the Executive Office of Health and Human Services (EOHHS), responsible for overseeing the administration of the licensure programs in Massachusetts, had not established procedures to ensure that all facilities, required to meet State standards, were identified. While our tests of facilities included in our statistically selected sample did not identify any facilities which have not been properly licensed, EOHHS has no assurance that all facilities in which three or more SSI recipients reside are identified. EOHHS does not use information contained in SSA`s State Data Exchange (SDX) file, which is particularly suited for use in identifying potential candidates for licensing. More significantly, however, SSA relies on the State`s certification and was not aware that the State system may not identify all potential facilities. EOHHS does not have a system for maintaining records of information concerning enforcement proceedings and where applicable, waivers of standards and violations of standards by specific facilities. Accordingly, EOHHS officials were not aware that State licensing officials revoked three facilities` licenses between October 1, 1994 and September 30, 1996 due to noncompliance with State standards. SSA`s records indicate that five SSI recipients reside in two of the three facilities. In addition, the State has cited a fourth facility for deficiencies that seriously limit the capacity to provide care and anticipates revoking the facilities` license. SSA`s records indicate that 13 SSI recipients reside in this facility. Without a system for maintaining records, EOHHS cannot determine whether the various Departments within the State, which issue licenses, have revoked licenses or notify SSA when licenses are revoked due to noncompliance with State standards. We are recommending that SSA:
In response to our draft report, we received comments from SSA and from EOHHS. In its comments to our report, SSA stated it will correspond with all States to highlight the problems our audit identified and encourage States to report to SSA when group residential facilities lose their licenses to operate. In EOHHS` comments, the Secretary stated that he has directed all EOHHS agencies to notify SSA, EOHHS, and each other whenever an agency revokes the license of a residential facility. While both agencies` comments proposed actions to address our second recommendation, SSA did not address our first recommendation. We continue to believe that SSA should periodically review attestations made by States in their certifications of compliance to ensure that States identify all facilities required to be reviewed for licensing. BACKGROUND In recent years, considerable attention has been given to the conditions afforded to individuals living in residential settings that provide some degree of care or protective oversight. Ordinarily, residents of such facilities are aged, disabled, or mentally impaired and quite often, are eligible to receive benefits provided under the SSI program. The Congress passed section 1616(e) of the Social Security Act to protect SSI recipients who live in specified residential facilities from being subjected to unsatisfactory conditions. Under section 1616(e) of the Social Security Act, States are required to establish or designate one or more State or local authorities that must establish, maintain and ensure the enforcement of standards for any category of institution, foster home, or group living arrangement in which (as determined by the State) a significant number of SSI recipients are residing or are likely to reside. Standards shall be appropriate to the needs of the recipient and the character of the facilities involved and shall govern such matters as admission policies, safety, sanitation, and protection of civil rights. Further, each State is required to maintain records of information concerning standards, procedures available to ensure enforcement of the standards, and a list of waivers of standards and violations of standards by specific facilities. These records must be made available annually to the public. To ensure compliance with the requirements of section 1616 (e) of the Social Security Act, each State must certify annually to SSA`s Office of the Commissioner that designated licensing authorities have implemented all aspects of the program. In Massachusetts, EOHHS has been designated to implement the provisions of the Social Security Act for certifying to SSA that effective standards and enforcement procedures have been established. In turn, EOHHS delegates to Departments within the State the actual licensing of the various categories of facilities. These include the Massachusetts Departments of Health, Mental Retardation, Public Health, and the Office for Children. The Social Security Act does not provide for Federal financial participation in a State`s cost to administer the licensing. It does provide for a reduced SSI payment to recipients who continue to reside in facilities that do not meet the appropriate State or local standards. SCOPE OF REVIEW Our audit was conducted in accordance with generally accepted government auditing standards. Section 1616(e) requires each State to certify annually to the Commissioner of Social Security that it is in compliance. Accordingly, the objective of our review was to determine whether SSA could rely on the compliance statements made by States. We reviewed the Commonwealth of Massachusetts to determine if the State: (1) has established and enforces health and safety standards for institutions, foster homes, and group living arrangements in which a significant number of SSI recipients reside; and (2) reports identified shortcomings to SSA and takes corrective actions timely. To meet our objectives, we:
We reviewed those internal control procedures necessary to meet our audit objectives. The significant procedures performed by SSA were related to obtaining certifications of compliance with the Social Security Act. The significant procedures performed by State personnel were related to ensuring that all residential facilities that were identified as subject to the requirements of the Social Security Act were licensed in accordance with State licensing standards. We reviewed each of the significant areas identified for compliance with applicable laws and regulations. Except as noted in the RESULTS OF REVIEW section of this report, we found no instances of noncompliance. We conducted our audit between March 1996 and October 1996 at the State Departments and offices located in Boston, Massachusetts and at licensed residential facilities located throughout the State. We also held teleconferences with SSA officials located in Baltimore, Maryland. RESULTS OF REVIEW SSA has established a reporting system whereby it tracks whether States certify compliance with section 1616(e) of the Social Security Act. Follow-up letters are sent to those States that do not comply with the certification requirement. SSA currently has certifications on file for all States. However, SSA is not required by law to verify the State`s compliance statements to ensure that they are true. The licensing process in Massachusetts showed that, through its licensing authorities, Massachusetts has generally established and enforces health and safety standards for various types of facilities that are required to be reviewed for licensing under the provisions of the Social Security Act. However, EOHHS, responsible for overseeing the administration of the licensure programs in Massachusetts, has not established procedures to ensure that all facilities, required to meet State standards, were identified. While our tests of facilities included in our statistically selected sample did not identify any facilities which have not been properly licensed, EOHHS has no assurance that all facilities in which three or more SSI recipients reside are identified. EOHHS does not use information contained in SSA`s SDX file, which is particularly suited for use in identifying potential candidates for licensing. More significantly, however, SSA relies on the State`s certification and was not aware that the State system could not identify all potential facilities. We extracted from SSA`s SDX file all addresses in which three or more SSI recipients resided. From this listing, we eliminated duplicate records of addresses and records of addresses for facilities which had been licensed. From the remaining file of 5,669 records, we selected records where at least 6 SSI recipients were residing. The selection of six or more SSI recipients at the same address was used to eliminate living arrangements in which several family members shared the same apartment and small apartment units. From the resulting 1,618 record addresses, we selected a sample of 150 addresses for review and found that none of the selected facilities should have been licensed. EOHHS does not have a system for maintaining records of information concerning enforcement proceedings and where applicable, waivers of standards and violations of standards by specific facilities. In accordance with the Social Security Act, States must maintain such records and provide them to SSA. EOHHS was not aware of this requirement. Accordingly, EOHHS officials were not aware that State licensing officials revoked three facilities` licenses between October 1, 1994 and September 30, 1996 due to noncompliance with State standards. SSA`s records indicate that five SSI recipients reside in two of the three facilities. In addition, the State has cited a fourth facility for deficiencies that seriously limit the capacity to provide care and anticipates revoking this facility`s license. SSA`s records indicate that 13 SSI recipients reside in this facility. Because EOHHS does not maintain information concerning enforcement proceedings, it cannot determine whether the various Departments within the State, which issue licenses, have revoked licenses. Further, it cannot notify SSA when licenses are revoked due to noncompliance with State standards. In turn, SSA cannot ensure that SSI recipients, many of whom are elderly, disabled, or mentally impaired, are provided the quality of care in residential settings prescribed by State standards. RECOMMENDATIONS We are recommending that SSA:
AUDITEE COMMENTS In response to our draft report, we received comments from SSA and from EOHHS. In it`s comments to our report, SSA stated that it will correspond with all States to highlight the problems our audit identified. In addition, SSA will emphasize with the States the manner in which they can use the SDX files that SSA shares with all States to identify group homes that may not be licensed. Also, SSA will encourage States to report to SSA when group residential facilities lose their licenses to operate. In EOHHS` comments, the Secretary stated that he has directed all EOHHS agencies to notify SSA, EOHHS, and each other whenever an agency revokes the license of a residential facility. In addition, EOHHS officials will also contact SSA to obtain access to SSA`s SDX files which identify residential facilities with three or more SSI recipients since SSA`s data base will provide an additional safeguard to assure continued compliance with section 1616(e) of the Social Security Act. OIG RESPONSE TO AUDITEE COMMENTS While both agencies` comments addressed our second recommendation, SSA did not address our first recommendation. We continue to believe that SSA should periodically review attestations made by States in their certifications of compliance. This review will ensure that States identify all facilities required to be reviewed for licensing under section 1616(e) of the Social Security Act. David C. Williams APPENDICES APPENDIX C MAJOR CONTRIBUTORS TO THIS REPORT Office of the Inspector General Roger Normand, Director, Program Audits |
 |
Privacy Policy | Accessibility Policy | Linking Policy | Site Map |  |