Reports

The COVID-19 pandemic resulted in upheaval to the economy and government services. Ulster County needed to address the questions of people and organizations during the pandemic as it related to public health concerns. To address public questions and concerns, Ulster County established a COVID hotline. Despite allocating significant resources to promotion and widening the scope of the Service Center, it still receives few calls. The call volume does not seem to align with the staffing and additional resources being allocated to operate a separate unit of government. This downtime could...

Our audit sought to determine if unemployment claims filed in the name of Ulster County employees were handled in accordance with current law and Ulster County policy. Our audit revealed that the Personnel Department properly identified fraudulent unemployment claims and challenged those claims. In addition, the Personnel Department staff appropriately notified the Sheriff’s Department and the Information Systems Department about the potential unemployment insurance fraud. However, it appears that some employees may not have been notified by the Personnel Department that they were the victims...

This report is a summary of the costs related to responding to the pandemic that the Ulster County Comptroller’s Office was able to aggregate from existing reported financial and personnel data for 2020. The County continues to incur substantial costs in the current year 2021, many of which are offset by pandemic related revenue streams, such as the cost of operating vaccination clinics. We have reviewed the 2020 expenditures to assist in both improving the accounting for these costs and potentially identifying and obtaining revenues to offset these costs.

The Comptroller’s Office surveyed Ulster residents on potential uses of the American Rescue Plan funds. The survey was promoted on social media from March 24 through May 3, 2021, and in electronic newsletters to the Comptroller’s Office distribution lists. Two hundred and twelve people responded. Respondents were provided with 14 potential options for the use of funds and asked to grade each on a score of 1 to 10.

As a result of the coronavirus disease 2019 (COVID-19) pandemic, State Medicaid programs have expanded options for telehealth services. Rapid expansion of telehealth may pose challenges for State agencies and providers, including State oversight of these services. Our objective is to determine whether State agencies and providers complied with Federal and State requirements for telehealth services under the national emergency declaration, and whether the States gave providers adequate guidance on telehealth requirements.

Title IV-E of the Social Security Act (the Act), as amended, authorizes the Federal Foster Care Program, which helps provide safe and stable out-of-home care for children until the children are safely returned home, placed permanently with adoptive families, or placed in other planned arrangements for permanency. Title IV-B of the Act authorizes Federal funding to States to promote flexibility in the development and expansion of coordinated child and family services programs. In response to COVID-19, on April 15, 2020, the Children's Bureau the operating division of the Administration for Children and Families (ACF) that administers the Title IV-B and Title IV-E programs at the Federal level—provided flexibility to State Title IV-E agencies related to (1) fingerprint-based criminal record checks requirements for prospective foster parents (allowing for name-based checks until fingerprint-based checks can safely be done), and (2) caseworker visit requirements (allowing videoconferencing visits to count toward the requirement that 50 percent of visits must occur in the child's home). On April 27, 2020, the Children's Bureau reminded States of additional flexibilities afforded by the Statute, including the authority to modify foster family licensing standards as long as the standards are applied to all of these placements in accordance with the requirements of the Statute. Additionally, States have the authority to set their own foster care maintenance payment rates including, at their own discretion, enhancing those rates for children who test positive for COVID-19.

We intend to survey all States and identify the States that adopted any new licensing regulations or policies and procedures as a result of the existing flexibilities in the Statute and the waivers provided by ACF. Based on the information gathered, we plan to identify three States and conduct separate audits to ensure foster care providers are safeguarding the health and safety of children during the COVID-19 pandemic and identify any vulnerabilities or gaps in policies or procedures that could place these children at risk. As part of these audits, we would ensure that criminal record checks for foster parents conducted via name-based checks were ultimately conducted through fingerprints whenever determined safe to do so.

The United States faces two simultaneous nationwide public health emergencies: the opioid epidemic and the coronavirus disease 2019 (COVID-19) pandemic. Recently released Centers for Disease Control and Prevention data identified that in 2018, there were nearly 47,000 opioid-related overdose deaths in the United States. In addition, as of May 28, 2020, over 100,000 U.S. citizens had died from complications related to COVID-19. Because of the widespread transmission of COVID-19, Federal, State, Tribal, and local government agencies have recommended and implemented extensive community mitigation activities, including issuing orders to residents to stay at home and practice social distancing, to help slow and contain the spread of the virus. We plan to identify the challenges that opioid treatment programs (OTPs) are encountering during the COVID-19 pandemic. In addition, we will identify the actions that OTPs are taking to address those challenges while ensuring the continuity of needed services and protecting the health and safety of their clients and staff.

The Centers for Disease Control and Prevention has indicated that individuals at high risk for severe illness from coronavirus disease 2019 (COVID-19) are people aged 65 years and older and those who live in a nursing home. Currently, more than 1.3 million residents live in approximately 15,450 Medicare- and Medicaid-certified nursing homes in the United States. As of February 2020, State Survey Agencies have cited more than 6,600 of these nursing homes (nearly 43 percent) for infection prevention and control program deficiencies, including lack of a correction plan in place for these deficiencies. To reduce the likelihood of contracting and spreading COVID-19 at these nursing homes, effective internal controls must be in place. Our objective is to determine whether selected nursing homes have programs for infection prevention and control and emergency preparedness in accordance with Federal requirements.

This work will examine the effectiveness of HHS controls over the awarding and disbursement of $50 billion in Provider Relief Fund (PRF) payments to hospitals and other providers. We will obtain data and interview program officials to gain an understanding of how PRF payments were calculated and review PRF payments for compliance with Coronavirus Aid, Relief, and Economic Security (CARES) Act requirements. Among other things, we will seek to determine whether HHS controls over PRF payments ensured that payments were correctly calculated and disbursed to eligible providers.

Onsite surveys of nursing homes are a fundamental safeguard to ensure that nursing home residents are safe and receive high-quality care. In response to the coronavirus disease 2019 (COVID-19) pandemic, CMS directed State Survey Agencies (SSAs) to suspend standard onsite surveys and most onsite surveys for complaints. CMS directed SSAs to conduct onsite surveys in response to the most serious complaints (i.e., those involving immediate jeopardy) and complaints related to infection control, and to conduct targeted infection control surveys, which are abbreviated surveys focused on infection control policies and practices within facilities. Using recent complaint and survey data for all nursing homes, this study will examine the extent to which SSAs and CMS are conducting onsite surveys in nursing homes related to serious complaints and targeted infection control, in accord with CMS's recent guidance to suspend certain onsite surveys. We will also identify any barriers that CMS and SSAs face in conducting onsite surveys, as well as potential solutions.