State of Alaska Division of Legislative Audit

Long Term Care Lowering Costs Recommendations Table

Recommendation NumberRecommendation
2.5Annual reassessments should be performed for persons that are receiving PCA services. Currently PCA reassessments have been suspended. Reassessments [should be] performed for everyone or triaged by acuity or age. It is inefficient to continue to provide services to persons who may now be different or fewer services.
2.7A new Pioneer Home should not be constructed at this time. Over the next decade construction of a Pioneer Home should be considered with the Kenai Peninsula area as a candidate area. This home would not need to be constructed right away, as the population will not significantly increase until 2022.
3.1The Department should increase their ability to monitor, track, and limit administrative costs for vendors.
3.2The Department should consider limiting administrative costs during the contracting process. Percentage guidelines constituting a reasonable administrative cost should be considered.
3.3The Department should further monitor grant and contract budgets to ensure costs are properly allocated across each of the major cost or functional areas. In reviewing bids and/or budget proposals, the Department may desire to directly compare projected costs to see which vendors potentially may be hiding their costs.
3.4The Department should change the CON application fee to a fee that covers the cost of processing the application. A maximum fee of $75,000 generates more in revenue to the state than the state incurs in costs to process the application. Please see Recommendation 5.4 for additional details.
5.2The office of private physicians loophole in the CON regulation should be closed. Amend office of private physician’s provisions to close the loophole as it is not defined as a "healthcare facility.” Language pertaining to “not otherwise a health care facility” will need to be revised. In the past, providers have registered as an office of private physicians and then proceeded to purchase other health care facilities under the guise of an office of private physicians. This license enables the providers to bypass the required CONs through this loophole. The Department should close this loophole by changing regulations surrounding office of private physicians and the acquisition of other healthcare facilities. Regardless of the license type of the purchaser, a CON should be required for all facility types.
6.4The Department should review the Veterans Needs Assessment as published by the University of Alaska, Anchorage to review potential cost shifts that may have been identified by the study.
8.1The telehealth pilot program is recommended for expansion. An increase in telehealth in reassessments is an effective and efficient use of technology that will be cost effective.
8.4The Department should consider the use of an electronic visit verification (EVV) system with the PCA and waiver programs.
10.2The Department should issue regulations specifying the responsibility of PCA agencies for monitoring fraud and abuse and build in contractual requirements for provider agencies to control fraud and abuse.
10.3The Department should create financial incentives for the provider agencies to control fraud and abuse.
10.5The Department should establish an EVV system for in-home services.
10.6Criminal penalties for Medicaid fraud should be increased.
10.7Penalties and interests should be assessed when persons are convicted of Medicaid fraud. The state could benefit by having a Medicaid False Claims Act.