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From Health Law Daily, August 11, 2017

Maine failed to report incidents involving developmentally disabled Medicaid beneficiaries

By Dietrich Knauth

The state of Maine failed to adequately report incidents involving home and community-based services for Medicaid beneficiaries with developmental disabilities according to a new report by the HHS Office of Inspector General (OIG) (OIG Report, A-01-16-00001, August 9, 2017).

The Medicaid Home and Community-Based Services Waiver program allows states to provide home and community-based services for developmentally disabled Medicaid beneficiaries who might otherwise be institutionalized, so long as the states enact necessary safeguards to protect the health and welfare of those beneficiaries. Those safeguards require providers to report critical incidents such as injury, abuse, neglect, exploitation, or death of a beneficiary, and require follow-up activity from the state, such as referring potential crimes to law enforcement and conducting studies of reported incident data to identify and address persistent problems. Maine provided 2,640 individuals with support services through the program during HHS’s audit period, according to the report.

The OIG found that Maine fell short of its responsibilities in many ways. The state failed to ensure that community-based providers reported all critical incidents to the state; failed to ensure that providers reviewed and reported on incidents involving serious injuries, dangerous situations, or suicidal acts; failed to report all incidents in which beneficiaries were restrained to disability rights watchdogs; failed to review and analyze critical incident data; failed to immediately report all incidents involving suspected abuse or exploitation to law enforcement; and failed to ensure that all beneficiary deaths were appropriately investigated by law enforcement or the state’s chief medical examiner.

Maine did not entirely agree with the OIG’s findings, disputing the auditors’ decision to treat some emergency room visits as "critical incidents" that should have been reported, and arguing that it did, in fact, ensure that critical incidents were reported by providers and referred to law enforcement authorities when necessary. The OIG recommended that Maine engage with community-based to improve identification and reporting of critical incidents, make sure that providers conduct and deliver necessary critical incident reviews, report all restraint usage and rights violations to rights organizations, better analyze incident data, improve referrals to law enforcement, and train state personnel and community-based providers’ staffs regarding the critical incident reporting requirements. Maine generally agreed to make meet those recommendations.

The OIG has been reviewing several states’ safeguards for developmentally disabled Medicaid beneficiaries in response to Congressional request and media attention surrounding deaths and cases of abuse of residents with developmental disabilities of community-based providers. OIG has previously concluded that Connecticut and Massachusetts did not comply with safeguarding and reporting requirements. It also examined New York, but didn’t recommend any changes to New York’s program.

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