The Office of the Inspector General (OIG) released its fourth state-specific report on the handling of critical incidents for people with developmental disabilities in Medicaid-funded group homes. This new report focuses on the state of Alaska, following similar investigations in Connecticut, Maine and Massachusetts in 2018. In 2018, ANCOR requested a meeting with OIG to inform it of challenges stemming from the Direct Support Professional (DSP) workforce crisis to ensure OIG understood the context in which critical incident reporting errors could occur. While OIG cannot name which other states it is investigating until the investigations are concluded, ANCOR will keep members informed of reports are they are issued.
In the Alaska report, OIG found that:
“Alaska did not fully comply with Federal Medicaid waiver and State requirements for reporting and monitoring critical incidents involving Medicaid beneficiaries with developmental disabilities residing in community-based settings. Specifically, Alaska did not ensure that community-based providers reported all critical incidents to the State. For the 303 judgmentally selected claims, 68 percent (205 claims) were not reported to Alaska as critical incidents. Alaska officials provided various reasons why a community-based provider may not properly report a critical incident to the State, including that the provider is unaware of the incident, fears retaliation by the employer, or has a general misunderstanding of the reporting requirements.
Alaska did not have a process, such as performing analytical procedures on Medicaid claims data, to determine whether there were unreported critical incidents. Alaska cannot investigate and take appropriate action to protect the health and welfare of Medicaid beneficiaries with developmental disabilities when community-based providers do not report critical incidents. As a result of not ensuring that providers reported all critical incidents, Alaska did not ensure proper responses to critical incidents or events as outlined in the safeguard assurances it provided to CMS in the Federal Medicaid waivers.
What OIG Recommends and Alaska Comments:
We recommend that Alaska (1) work with community-based providers on processes to identify and report all critical incidents and (2) perform analytical procedures, such as data matches, on Medicaid claims data to identify potential critical incidents that have not been reported and investigate as needed.
Although Alaska did not concur or nonconcur with our recommendations, Alaska stated that, based on our finding, it had initiated corrective actions to (1) implement additional training to increase providers’ ability to identify and report all incidents that meet reporting requirements and (2) establish datamining processes with analytical procedures, such as data matches, using Medicaid claims data to identify potential unreported critical incidents for further investigation.”
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