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Minimal Evidence Found of Service Duplication for Students with Disabilities in Schools and Communities (December 2018) 2018-12

Federal and state law require individuals with disabilities be provided with a free appropriate public education. Because students with disabilities may be receiving services in multiple settings that are covered by multiple funding streams, the potential exists for duplication of services. However, the Program Evaluation Division found there is minimal evidence of duplication of Medicaid-covered services across school and community settings. PED found that North Carolina complies with the Individuals with Disabilities Education Act (IDEA) and effectively provides services to students with disabilities. PED also found that the Department of Public Instruction’s (DPI’s) Exceptional Children Division provides technical assistance to LEAs yet does not systematically measure the effectiveness of these efforts. Lastly, PED found that North Carolina’s new health information exchange, NC HealthConnex, could improve service delivery coordination, but failure to meet the statutory connectivity deadline could negatively impact LEA funding. The General Assembly should direct DPI to establish methods for soliciting feedback from LEAs' Exceptional Children Directors and direct the Department of Information Technology to determine the feasibility of and fiscal impact on LEAs in meeting mandatory NC HealthConnex connectivity requirements.

Final Report

Executive Summary

Recommendations

Modifying Criteria for North Carolina’s Medical Release Program Could Reduce Costs of Inmate Healthcare (October 2018) 2018-11

Medical release programs allow for the release of inmates for certain reasons (e.g., age, medical condition) under specific terms (e.g., parole, furlough). A primary goal of these programs is to reduce healthcare expenditures. Advocates and opponents disagree on the merits of medical release programs. Advocates contend that qualifying inmates have lower recidivism rates and that their release shows compassion and potentially reduces overall state expenditures. Opponents contend that these inmates still pose a public safety risk and that their release compromises justice and could have a damaging psychological impact on victims. Established in 2008, North Carolina’s medical release program is somewhat more stringent than programs in other states. The number of inmates approved for medical release in North Carolina is similar to other states, suggesting the State’s program is functioning well and further indicating there is limited opportunity to achieve greater cost savings. States experience similar factors that restrict the cost savings they achieve from medical release programs, but modifications to state law could lead to more inmates being approved for medical release. If the General Assembly seeks to broaden the pool of qualifying inmates, it should consider expanding eligibility to inmates convicted of Class B crimes, lowering the minimum age to 60, and expanding eligibility to those inmates diagnosed as having less than 18 months to live.

Final Report

Executive Summary

Inadequate Data Collection and Cost Recovery Practices Limit Economy of Healthcare for Safekeepers (October 2018) 2018-10

County inmates who are referred by county sheriffs to be temporarily housed at a state prison are known as Safekeepers. The Program Evaluation Division found that the Department of Public Safety (DPS) does not systematically collect, analyze, or report data on usage of healthcare services by Safekeepers, which prevents DPS Health Services from determining if their medical needs exceed the capabilities of county jail facilities, conducting analysis of the rationales for admissions, and calculating healthcare costs. The State can recoup state Safekeeper costs by withholding Statewide Misdemeanant Confinement Program (SMCP) payments for services provided by counties for state inmates; however, counties are not required to participate in SMCP. The General Assembly should (1) modify state law to change the per diem rate for counties that fail to reassume custody of their Safekeepers in a timely manner and direct DPS Health Services to collect additional data, update the rates charged for medical services, and require that all facilities bill counties for Safekeeper services and (2) modify state law to prohibit non-SMCP-participating counties with past-due balances from transferring Safekeepers to prisons for medical purposes and modify the process by which Safekeepers are admitted to prisons for medical purposes.

Final Report

Executive Summary

Recommendations

Presentation with Audio Narration

Presentation of Findings and Recommendations

Modifications to Inmate Pharmacy Purchasing and Monitoring Could Save $13.4 Million Annually (October 2018) 2018-09

Pharmaceutical-related expenditures for inmates totaled $72.7 million in Fiscal Year 2016–17, an 88% increase from five years ago. The Program Evaluation Division (PED) found North Carolina’s failure to participate in a federal discount program caused the State to pay more for inmate prescription medications than necessary. Corrections departments in 16 other states have established such arrangements, which could save North Carolina approximately $13.3 million annually. PED also found the Department of Public Safety (DPS) cannot ensure the effectiveness of expenditures for certain high-cost medications that inmates are allowed to keep on their person; does not collect sufficient data to take disciplinary action when medications are lost during inmate transfer; and does not perform adequate data collection and oversight of prescriptions filled at local pharmacies. Finally, North Carolina does not charge inmates copayments for prescriptions; establishing such charges could generate up to $1.5 million annually. The General Assembly should direct DPS and UNC to establish a 340B discount program and direct DPS to require certain high-cost medications not be kept on an inmate’s person; establish controls and collect and analyze data on medications lost during transfer; and develop statewide contracts with retail pharmacies for local medication purchases and develop an oversight mechanism.

Final Report

Executive Summary

Recommendations

Presentation with Audio Narration

Presentation of Findings and Recommendations

Follow-up Improvements to Inmate Healthcare Reimbursement and Internal Processes Could Save $5.6 Million Annually (October 2018) 2018-08

North Carolina provides health services to inmates at a cost of $322 million annually, an $89 million increase from 10 years ago. The Program Evaluation Division (PED) found the Department of Public Safety’s Health Services division (DPS Health Services), which manages and delivers inmate healthcare services, is partially funded by lapsed salaries and cannot demonstrate results from cost-containment efforts. PED also found statutory and contractual payment arrangements cause the State to reimburse community providers at rates higher than other states. Further, chronically vacant health services positions and subsequent reliance on contract staff costs $25 million annually, and the limited use of telemedicine has contributed to unnecessary costs. Finally, DPS Health Services’s methods for pursuing federal Medicaid funding for community services has been unsuccessful. The General Assembly should direct DPS Health Services to conduct a salary study of healthcare positions, seek federal reimbursement for Medicaid-related staff activities, modify data collection and submission methods for Medicaid applications, develop a plan for implementing telemedicine, and improve supply management practices and services. Further, the General Assembly should modify state law to reduce community provider reimbursement rates and consider establishing a data analysis position and realigning DPS Health Services’s base budget.

Final Report

Executive Summary

Recommendations

Presentation with Audio Narration

Presentation of Findings and Recommendations

Opportunities Exist to Enhance the Effectiveness of the Educator Preparation Program Data Reporting System (June 2018) 2018-06

An Educator Preparation Program (EPP) provides individuals with the knowledge, skills, and training to meet teacher licensure requirements and secure teaching positions. North Carolina currently has 47 approved EPPs housed within public, private, or independent colleges and universities. The Program Evaluation Division found the current approach to EPP reporting produces documents that are difficult to interpret, lacking uniformity and helpful data indicators. PED found the State has the data and advisory bodies needed to adopt a streamlined approach to reporting in the form of a performance-based, weighted model that reflects state priorities and assesses EPP performance individually and comparatively. PED built such a model to demonstrate the State’s ability to enhance reporting. PED recommends the General Assembly add an EPP employment performance standard to state law; direct adoption of a small group exception for EPP sanctioning; direct development of a plan for incorporating private EPP data into the UNC Educator Quality Dashboard and management thereof; and require the development of a performance-based, weighted model for reporting EPP data to replace current reporting efforts.

Final Report

Executive Summary

Recommendations

Presentation

Follow-up Report: Implementation of PED Recommendations Has Improved Local ABC Board Profitability and Operational Efficiency (May 2018) 2018-05

In 2008, the Program Evaluation Division issued a report entitled North Carolina’s Alcohol Beverage Control System Is Outdated and Needs Modernization. This follow-up examines how 2010 statutory additions and changes have influenced effectiveness and efficiency of North Carolina’s ABC system and the operation of local ABC boards. The General Assembly enacted legislation in 2010 to modernize the North Carolina ABC system based on PED recommendations. Providing the North Carolina ABC Commission with management tools for better oversight of local ABC boards has increased profitability and more efficient operations for most boards. However, increasing the voter registration threshold to hold a municipal ABC store election has not eliminated inefficiencies resulting from too many ABC stores operating in close proximity.

Follow-up Report

Opportunities Exist to Improve the Efficiency of the State’s Administrative Services (April 2018) 2018-04

The Department of Administration (DOA) acts as the business manager for North Carolina state government and provides internal services and programs for state departments. The Program Evaluation Division identified opportunities to improve operational efficiencies in six DOA divisions. These efficiency opportunities include transitioning employees from state-owned properties to leased properties; ensuring compliance with space standards for each state-owned and leased office facility; increased use of contracted services to perform facility management activities; enhanced monitoring and compliance with state term contracts; increased use of competitive bidding for contracted services; effective use of information from telematics; electronic scanning of incoming mail; increased use of electronic communications; increased utilization of the State’s presort mail contract; and leasing underutilized parking spaces. Additional operational efficiencies can be achieved through the establishment of legislative performance measures for these divisions. The General Assembly should require that business case analyses be performed and statutes be amended to include legislative performance measures. In addition, the Department of Administration should be directed to establish a dedicated Project Management Office.

Final Report

Executive Summary

Presentation to Joint Legislative Oversight Committee on General Government

Measurability Assessment: Department of Administration Programs (April 2018)

The Department of Administration (DOA) provides centralized administrative support for state agency operations. DOA acts as the business manager for North Carolina state government and provides internal services and programs for state agencies. Session Law 2017-57, Section 10A.5.(b) directed the Program Evaluation Division to conduct measurability assessments of DOA's 12 programs. Overall, DOA’s programs performed well in terms of having cost sharing documents and an accounting system. DOA has several efforts underway that resulted in most programs getting partial credit for having a logic model and a strategic plan and for conducting performance measurement. Although DOA complies with statewide standards regarding risk assessment, financial forecasting, and auditing, the Measurability Assessment Guidebook contains stretch standards that resulted in most programs only receiving partial credit for these indicators. Lastly, the areas in which DOA could use the most improvement pertain to quality improvement systems and staffing analysis.

Complete Measurability Assessment

Presentation to Joint Legislative Oversight Committee on General Government

VIPER and FirstNet are Vital for Public Safety Interoperability, but VIPER Requires Upgrades (April 2018) 2018-02

North Carolina’s Voice Interoperability Plan for Emergency Responders (VIPER) and FirstNet technologies share the common purpose of improving interoperability for public safety first responders, but the Program Evaluation Division found the two systems complement rather than duplicate functionality. Each system possesses important capabilities for first responders that the other system does not offer. In addition, the VIPER system is supported by equipment purchases and in-kind contributions from local agencies and PED found that charging user fees could reduce participation in the network and diminish statewide interoperability. Furthermore, approximately 70% of VIPER’s 220 sites contain infrastructure or equipment from non-state entities, and these partnerships are crucial to VIPER’s success. PED found that failure to upgrade VIPER’s base stations and related software will adversely affect VIPER’s continued reliability and interoperability. The General Assembly should direct the Department of Public Safety to increase its VIPER outreach programs and determine the value of in-kind contributions. The General Assembly should also consider appropriating funds to upgrade VIPER base stations and establish routine software updates.

Final Report

Executive Summary

Recommendations

Presentation

Measurability Assessment: Transforming Principal Preparation Program (April 2018)

Session Law 2017-57, Section 10A.5.(b) directed the Program Evaluation Division to administer a measurability assessment of the Transforming Principal Preparation Program. Pursuant to Chapter 143E, the Division contracted with an independent assessor to perform the assessment. The Division selected Vangaard Evidence-Based Consulting, LLC from our pool of assessors. The Transforming Principal Preparation Program fully meets 8 and partially meets 6 of the 14 measurability assessment indicators.

S.L. 2017-57 also directed the Program Evaluation Division to make recommendations regarding periodic reporting by the Transforming Principal Preparation Program. The General Assembly should direct the North Carolina State Education Assistance Authority to collect long-term outcome data for the Transforming Principal Preparation Program on the number of graduates who secure positions in high-need schools and amend its cooperative agreement with the North Carolina Alliance for School Leadership Development to require specific output and outcome data in annual reports on the Transforming Principal Preparation Program.

Measurability Assessment

Measurability Assessment Presentation

Reporting Recommendations

Reporting Recommendations Presentation

The System of Attorney Allocation in North Carolina State Government is Decentralized (April 2018) 2018-01

The use of attorneys and legal professionals is widespread throughout North Carolina state government. Concentrating on traditional, state-level attorney positions, the Program Evaluation Division examined 719 attorney positions with total budgeted salaries of $67.7 million at 34 state government organizations. As of September 15, 2017, the Department of Justice (DOJ) had 304 attorney positions with total budgeted salaries of $27.6 million. Because only 42% of the 719 positions examined by PED are under the control of DOJ, the State’s system of attorney allocation can be characterized as being decentralized. PED also found all of the 21 principal departments in North Carolina state government have at least one in-house general counsel or a similar attorney position; North Carolina state entities are able to use private attorneys for legal assistance in some instances; and state organizations may employ private counsel when given explicit approval from the Governor’s Office or from the General Assembly.

Final Report

Executive Summary

Reducing Off-Season Crossings, Adjusting Fares, and Using Partnerships Can Improve Ferry Division Efficiency (October 2017) 2017-09

The North Carolina Department of Transportation’s (DOT’s) Ferry Division is responsible for providing safe, cost-effective, and dependable service for local residents and visitors. The Program Evaluation Division found that the Ferry Division can save over $1.5 million annually by reducing the number of crossings on routes during periods of lower use and can increase annual fare collections on currently tolled routes by $1.7 million without adversely affecting area commuters. Additionally, using partnerships with other government entities and the private sector can reduce state funding requirements and improve the effectiveness of the ferry system. The General Assembly should amend state law to direct DOT to produce a long-range plan for the ferry transportation system, apply for a grant from the Golden LEAF Foundation for necessary support services, and evaluate the schedule of crossings for each ferry route to ensure services cost-effectively meet the needs of both area residents and tourists.

Final Report

Executive Summary

Recommendations

Public School Construction Needs Survey and Recommendations for Funding Options for Selected Districts (May 2017)

As required by Session Law 2016-94, the Program Evaluation Division contracted with an outside entity, MGT of America Consulting, LLC, to perform an independent assessment of school construction needs and determine which local school administrative units have the highest facility needs in relation to their capacity to raise revenue to meet those needs. The nine districts selected for this report represent those with limited revenue generating capacity and aging building stock. Each school in each district was evaluated using four assessments: building condition, site condition, educational suitability, and technology readiness. The needs assessment portion of the study revealed over $600 million of unmet facility needs across the nine districts. The current process administered by DPI determines overall capital need based on the self-reporting of each district and has resulted in a degree of discrepancy between district-reported needs and actual needs. To ensure the State has the most reliable data on school capital needs the General Assembly should direct a systematic review of DPI's administration of the School Facility Needs Survey. Additionally, counties depend primarily on local property tax revenue for school capital construction. This method of funding has resulted in disparity depending on the local wealth of the county along with a backlog of need across the State. Therefore, the State should consider establishing a revolving fund account, identifying alternative sources of funding, developing a consistent methodology for determining capital construction need, and developing a system of prioritizing capital need.

Final Report

Presentation

Local Education Funding Dispute Resolution Process Is Effective and Economical, but Litigation Could Be Eliminated (May 2017) 2017-05

In North Carolina, local education agencies and local boards of education are fiscally dependent on county commissioners for local appropriations to support capital and operations for public K-12 education. When local boards of education and boards of county commissioners cannot reach agreement on a budget, state law sets out a procedure for achieving resolution that is structured into two phases: pre-litigation and litigation. This process is used infrequently and seldom reaches the litigation phase; when the process has been used, the outcomes have not historically favored either party and may serve to improve future budgeting efforts. However, litigation is costly and time-consuming. North Carolina and Tennessee are the only states with elected school boards that are fiscally dependent on county commissioners, but Tennessee uses a default funding mechanism to avoid litigation. If it wants to eliminate litigation from North Carolina’s local education funding dispute process, the General Assembly should revise state law for settling disputes to preserve the benefits of the pre-litigation phase while replacing the litigation process with a default funding mechanism. The General Assembly should also direct the Local Government Commission and School of Government at the University of North Carolina at Chapel Hill to convene a working group to develop and recommend statutory parameters for fund balances maintained by local boards of education.

Final Report

Executive Summary

Recommendations

Meeting Current Standards for School Nurses Statewide May Cost Up to $79 Million Annually (May 2017) 2017-04

The need for school nurses is growing due to increased attendance by children with health issues as well as laws and policies expanding the health care responsibilities of schools. In the 2000s, the State created the Child and Family Support Teams (CFST) and the School Nurse Funding Initiative (SNFI) to address this demand. Although these programs increased the number of nurses, the Program Evaluation Division (PED) found only 46 of 115 Local Education Agencies currently meet the school nurse-to-student ratio of 1:750 recommended by the State Board of Education (SBE) in 2004. Achieving that ratio or providing one nurse in every school would cost between $45 million and $79 million annually. PED also found approximately 60% of medical procedures conducted in schools are performed by employees who are not nurses. Furthermore, few LEAs file for Medicaid reimbursement for nursing services. The General Assembly should direct SBE to formulate a new goal and strategic plan for school nurse staffing levels, and direct the Department of Health and Human Services and the Department of Public Instruction to combine CFST and SNFI into a single program and implement acuity models at state and local levels.

Final Report

Executive Summary

Recommendations

Options Exist for Increasing Lottery Proceeds for Education (May 2017) 2017-03

North Carolina is one of 44 states that operates a lottery. In its 10 years of existence, the NC Lottery has returned over $4.6 billion to the State for education purposes. The Program Evaluation Division found that annual revenues have steadily grown since the Lottery’s inception and performance is slightly above average compared with other states. However, it is essential that the NC Lottery continues to examine its operations by reviewing revenue-generating strategies and efforts to reduce costs, thereby providing the maximum benefit to the State. To that end, the Lottery could expand its retailer network, reduce the compensation paid to retailers, authorize Video Lottery Terminals and offer iLottery games online, and enhance data collection and analysis methods to more effectively measure the influence of advertising on sales. The General Assembly should require the NC Lottery to take steps to examine these options and report on their feasibility and effectiveness as applicable.

Final Report

Executive Summary

Recommendations

No Modification to North Carolina’s School Calendar Law Satisfies Multiple Competing Interests (February 2017) 2017-01

North Carolina is 1 of 14 states that currently prescribe when public schools begin the school year and 1 of 2 states that stipulates a date when public schools must end the school year. Prior to 2004 , local boards of education had authority to determine start and end dates. The Program Evaluation Division found that opinions differ on when public schools should start and end the school year, and no modification to the State’s school calendar law satisfies multiple competing interests, which include organizations representing state government, education, parents and citizens, and travel and tourism. As a result, this report makes no recommendation for changing the school calendar law. PED also found that allowing school calendar flexibility as a mechanism for low-performing schools to address summer learning loss provides an opportunity to increase student performance. To address the needs of low-performing schools, the General Assembly should provide school calendar flexibility for schools and districts identified as low-performing by the State Board of Education, and direct the Department of Public Instruction to evaluate whether a modified school calendar increases student performance in low-performing schools and districts.

Final Report

Executive Summary

Recommendation

Program Evaluation Division, North Carolina General Assembly
Legislative Office Building, Suite 100
300 North Salisbury Street , Raleigh, NC 27603-5925
919-301-1404