Use, Cost and Quality of Care in Medicaid Intermediate Care Facilities for Individuals with Developmental Disabilities

The number of occupied Louisiana Medicaid beds in intermediate care facilities for individuals with developmental disabilities has decreased during the last three years, but the state still ranks sixth in the nation for individuals cared for in such facilities, according to a report released Monday by Legislative Auditor Daryl Purpera’s office.

Performance auditors said in their report the number of occupied beds decreased from 5,082 in 2011 to 4,789 in 2014.

The report said that with 524 facilities in the state, only six are operated by public providers. Louisiana ranks fifth-highest in the nation with the number of facilities providing services to individuals with developmental disabilities, according to an October 2013 American Health Care Association report.

The 524 facilities had a total of 5,810 licensed beds, according to the report.

“Louisiana’s use of ICFs/DD exceeds national benchmarks,” the state auditor’s report said. “Louisiana exceeded the national average of people with developmental and intellectual disabilities receiving residential services in a setting other than a family home.”

As of November 2012, the state “ranked behind the rest of the nation in the use of home and community-based services,” the performance audit said.

As of May of this year, 337 of the 524 facilities (64.3 percent) were fully occupied.

The informational report from the state auditor said that Medicaid paid $1.3 billion to the facilities from fiscal years 2011 to 2013.

The report said although DHH is supposed to adjust the facilities’ daily per-resident rate every three years, the last time rates were adjusted was in fiscal year 2008, seven years ago.

For fiscal years 2011 through 2013, the facilities were cited for 2,996 deficiencies, 355 of them repeat offenses. However, during this same time period, only 39 sanctions were imposed totaling approximately $64,000 in fines, the report said. It said that the Harmony Center No.2 of Baton Rouge was cited for 54 deficiencies and received the highest single sanction amount assessed to any facility over this three-year period, $15,300.

The report said that there are no national benchmarks that address the quality of the ICFs/DD, but in external studies Louisiana’s overall performance ranking is “comparable to other states and national data,” the report said. Based on how well state Medicaid programs serve citizens with intellectual and developmental disabilities, the United Cerebral Palsy’s 2014 “The Case for Inclusion” study showed Louisiana ranked 12^th overall nationally based on five areas.

In the United Cerebral Palsy report, auditors said Louisiana was recognized as “the second most improved state” in its overall ranking, going from 44^th to 12^th in the country in a seven-year period.