Community Connection Healthcare, LLC

This is a 2017 Massachusetts State Auditor performance audit of Community Connection Healthcare, a Quincy-based provider serving MassHealth members through group adult foster care.

“Community Connection Healthcare, LLC (CCH), located in Quincy, was established in 2011 as a group adult foster care (GAFC) provider under the Office of Long-Term Care within the state’s Medicaid program, MassHealth.”

Auditors reviewed CCH because it received a large amount of MassHealth money for group adult foster care, placing it among the top-billing providers in that program during the audit period.

“We selected CCH for audit because we determined that its billings (more than $11 million) were in the highest 10 billing totals of all GAFC providers during the audit period.”

The program uses public Medicaid dollars to help elderly or disabled people live outside institutions, so errors or unclear rules can affect both taxpayer costs and member care.

“Both programs are designed to provide sufficient assistance to allow members to continue to live independently and avoid the high cost of a long-term-care facility.”

If you are a taxpayer or MassHealth member, the report is about whether public money is being spent correctly and whether care could be delivered at lower cost without changing the basic goal of helping people remain in the community.

“This audit was conducted as part of OSA’s ongoing efforts to audit human-service contracting activity by state agencies and to promote accountability, transparency, and cost-effectiveness in state contracting.”

The auditor concluded CCH properly administered its program, but also said MassHealth allowed up to $1.8 million in payments the auditor considered unallowable and identified a possible medication-management savings opportunity.

“During the audit period, Community Connection Healthcare, LLC (CCH) billed, and received payments totaling as much as $1,814,810 from MassHealth, for group adult foster care (GAFC) services that were duplicative and therefore not allowable under MassHealth regulations.”

The report points to MassHealth developing clearer GAFC regulations and urges MassHealth and CCH to work together on possible cost-saving options.

“Finally, MassHealth stated that in fall 2017, it will put forth regulations governing the GAFC program and “will clarify when GAFC services do not duplicate other services a member is receiving.””

This was not a tiny program: MassHealth paid about $1.4 billion to hundreds of providers for adult foster care and group adult foster care over the five-year audit period.

“For the five-year period July 1, 2011 through June 30, 2016, MassHealth paid approximately $1.4 billion to 296 providers of home health services for GAFC and adult foster care (AFC) for a non-duplicated total of 30,889 members,1 as detailed below.”

ADLs are basic daily tasks like bathing, dressing, eating, toileting, and walking; IADLs are household tasks connected to living independently, such as laundry, shopping, meals, transportation, and medication management.

“ADLs include activities such as eating, toileting, dressing, bathing, and walking.”