DHHS officials tell committee they repaid improper grant payments and tightened controlled-substance controls; timely visit rates improved but remain below goal

Department of Health and Human Services officials responded on Jan. 9, 2025, to audit findings presented to the Legislative Audit and Fiscal Review Committee, describing corrective actions on controlled-substance controls, repayment of improper workforce-retention grant payments, and ongoing efforts to improve timeliness of face-to-face contacts in suspected child-abuse cases.

Dr. Eduardo Yabut, medical director at the North Dakota State Hospital, told the committee the hospital has implemented automated dispensing cabinets, required dual signatures for controlled substances, and eliminated the use of half tablets since the audit period, actions intended to strengthen internal controls over medications.

Jessica Thomasson, executive director of the Human Services Division at DHHS, reported that the audit identified instances in which workforce retention grants had been issued to noneligible employees and some payments exceeded the program's stated $2,100 maximum award. DHHS reviewed payments to the three largest providers cited and other suspect payments; all overpayments and payments to ineligible employees were repaid, totaling $4,418.

On the audit finding that staff did not timely contact suspected victims of child abuse and neglect, Thomasson said the State Auditor's office could not fully review case-specific exceptions because departmental policy permits documented exceptions under the child welfare practice model. Kirsten Hansen, DHHS Prevention and Protection Administrator, told the committee several factors affect timeliness: difficulty locating children who are transient, families not responding, unknown child identities, and coordination needs with law enforcement or children's advocacy centers when criminal investigations are ongoing. Hansen said that when face-to-face visits cannot occur, DHHS implements safety plans and verifies safety through non-offending caregivers when appropriate.

Thomasson and other DHHS speakers said timeliness rates have been a focus since a federal performance improvement plan in 2019; the department reported timely visit rates rose from 40 percent in 2021 to 68 percent in 2024, with a target of 90 percent. Rhonda Allery, Mountain Lakes Human Service Zone Director, told the committee the State Auditor's office review did not adequately consider written case narratives explaining delays. State Auditor Josh Gallion said the auditor reviewed samples of narratives, notes, and exceptions during the audit and emphasized the office's intent to collaborate with clients to ensure accurate reporting.

Committee members asked questions about operational constraints and verification steps; DHHS described both process improvements and remaining challenges. No formal committee action on DHHS responses was recorded at the meeting.