CMS Releases Group Home Guidance Based on OIG Critical Incidents Reports

On June 28, 2018 the Centers for Medicare and Medicaid Services (CMS) issued guidance on the health and welfare of individuals receiving Home and Community Based Services (HCBS). This guidance is in response to a January 2018 report by the Office of the Inspector General (OIG), Administration for Community Living (ACL), and Office of Civil Rights (OCR) all under the Department of Health and Human Services (HHS) on critical incident reporting in group homes, on which ANCOR reported. Specifically, the June 2018 CMS guidance focuses on incident management, and promises to be the first of a series on the topics of health and welfare.

The guidance addresses the following issues:

• Incident management and investigation.
• Incident management audits.
• Mortality reviews.
• Quality assurance.
• Next steps.

CMS specifically addresses one of the three suggestions the Joint Report made to CMS: encourage

states to implement compliance oversight programs for group homes, such as the Model

Practices, and regularly report to CMS. In addition to recommending systems change for better and more accurate reporting of critical incidents, CMS also encourages states to ensure they are creating systems that encourage not discourage providers from reporting incidents.  In next steps, CMS reminds states that there is a potential for increased federal funding for states that implement the model practices recommended by the full joint report.

ANCOR recently met with OIG, ACL, and OCR to request more inclusion of the workforce crisis to draw attention to the vacancies and turnover that can contribute to issues in critical incident reporting.