A recent state audit found that Allied Community Resources, Connecticut’s fiscal intermediary in charge of administering in-home healthcare, took over three months to get a client trained and authorized to hire a personal care assistant (PCA).
Under the Community First Choice program, the person receiving services (the client) acts as the employer instead of the state, and Allied Community Resources issues payment to the PCA based on time sheets submitted by the client. So, the client must first be referred to Allied by the Department of Social Services (DSS), receive training in how to manage time sheets and budgets, and then receive authorization to hire a PCA.
Although Connecticut’s contract with Allied requires 30 days between referral by DSS and client training, the average length of time was 61 days, double the contractual time limit. By the time an elderly or disabled person was authorized to hire a PCA and receive services, several more weeks were added to the process.
“It took an average of 102 and median 71 days between the DSS referral to Allied to the date that a client may hire a personal care assistant,” the auditors wrote, although they cautioned some of the data may not be entirely accurate due to some time periods that ranged into multiple years.
The state’s home healthcare system overseen by DSS is part of Connecticut’s push to keep more people who qualify for Medicaid living at home with the assistance of a PCA rather than in a long-term care facility. The program, called Community First Choice has grown significantly since it was launched in 2015 as part of the Affordable Care Act.
According to the audit report, between 2016 and 2020, the number of clients receiving services grew from 1,683 clients to 3,952. Medicaid expenses grew along with it, rising from $36.4 million in 2016 to $125.1 million in 2020. Those figures represent both the state and the federal government’s payments.
And while the report notes that the CFC program has been a success based on those numbers, Allied Community Resources has come under scrutiny over the past several years as PCAs claimed Allied was not paying them on time, prompting union protests outside their facility.
According to SEIU 1199, which represents PCAs, there were 6,000 timesheet errors “admitted by Allied,” and the union was calling for a new fiscal intermediary to be contracted following the expiration of Allied’s contract with the state in June of 2021.
“Payroll mistakes by Allied are harmful to workers and the people they care for every day,” SEIU wrote on their website. “Workers have been forced to pay thousands of dollars in overdraft bank penalties.”
However, the audit shows that payroll errors may have grown worse for a period of time. According to auditors, the average weekly unresolved payroll errors rose from 11 percent in May of 2020 to 20 percent by May of 2021, prompting DSS to urge Allied to get the rate back down to 11 percent or less by June 2021.
“DSS appears to have selected an 11% error rate for unresolved errors based on Allied’s historical experience,” the auditors wrote. “We would suggest that DSS reexamine this 11% goal and the persistent error rate. Both rates may be considered too high, particularly for payroll expenses.”
Other findings in the audit include long phone call wait times for Allied, exceeding the 15 minutes expected of the company. The auditors also noted a suspiciously low number of fraud investigations by the Office of Quality Assurance.
The auditors issued a number of recommendations to which DSS agreed, noting they are “currently in the procurement process for a Fiscal Intermediary and has incorporated additional measurable performance targets as outcomes and service level agreements that will be contractual requirements for the resultant contractor.”
While the state issued a request for proposals to pick a new fiscal intermediary in December of 2021, the state ultimately delayed any action and extended Allied’s contract until the end of 2022.