OIG Audit Prompts ASPR to Improve Its Oversight of HPP
- By Lee Fifield
- In Audit
- February 8, 2023
- No Comments
Audit reveals crisis standards of care fell short during pandemic.
The COVID-19 pandemic and nationwide shutdown that started in March 2020 placed a spotlight on crisis preparedness within the U.S. healthcare system. Nursing homes, hospitals, and other care facilities all faced challenges and scrutiny. It was during the height of the pandemic that individuals with disabilities and their advocates filed complaints with the Department of Health and Human Services’ (HHS’s) Office for Civil Rights (OCR), asserting that six states had language in their Crisis Standards of Care (CSCs) that could result in individuals being denied treatment because of their disabilities. To address these complaints, the Office of Inspector General (OIG) performed an audit to determine whether the Administration for Strategic Preparedness and Response’s (ASPR’s) oversight of the Hospital Preparedness Program (HPP) could be improved with respect to program recipients adopting CSCs that comply with federal nondiscrimination laws.
How the Audit Was Conducted
OIG reviewed the complaints filed with OCR and their resolutions. Officials from ASPR and 11 states were also interviewed, with a focus on their development of CSC planning documents, as well as their considerations of and compliance with federal civil rights laws from July 2019 through June 2021. OIG reviewed the HPP cooperative agreements and federal nondiscrimination laws and regulations, as well. Of the states included in the OIG interviews, six had complaints that had been filed and resolved with OCR during the COVID-19 pandemic. The other five states were included to round out a nationwide perspective. These states were asked to provide input because they did not have complaints filed with OCR due to their CSC documents and they represented various regions in different stages of CSC planning.
OIG’s audit discovered that “although ASPR has taken steps to improve its oversight of the HPP by promoting the adoption of nondiscriminatory CSCs that comply with federal nondiscrimination laws, it can take additional steps. The HPP cooperative agreement did not previously specify that States should consider Federal nondiscrimination laws when developing CSCs because prior to the COVID-19 pandemic, ASPR did not identify CSC compliance with Federal nondiscrimination laws as a high-risk area. Additionally, ASPR stated that it is not required to review CSCs for legal and regulatory compliance. CSCs that do not comply with Federal nondiscrimination laws increase the risk that individuals could be denied access to lifesaving care during a public health emergency.”
Even though ASPR had taken some steps previously to promote compliance with federal nondiscrimination laws, OIG thinks that ASPR could use the HPP to better promote nondiscrimination. OIG recommended additional updates to the current HPP cooperative agreement to promote that HPP recipients adopt CSCs that comply with federal nondiscrimination laws. These updates would encourage program recipients to partner with advocacy groups to make more informed, beneficial decisions surrounding crisis care planning. ASPR accepted OIG’s recommendations and agreed to immediate action.
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