OIG Report on Pennsylvania Critical Incidents Now Available

Last week the Office of the Inspector General (OIG) released a new, 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 Pennsylvania, 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.

According to OIG’s summary of its findings:

“Pennsylvania did not fully comply with Federal Medicaid waiver and State requirements for reporting and monitoring 24 hour reportable incidents involving Medicaid beneficiaries with developmental disabilities who resided in community-based settings. Specifically, Pennsylvania did not (1) ensure that community-based providers reported thousands of 24 hour reportable incidents within required timeframes, (2) ensure that community-based providers and county and regional investigators analyzed and investigated all beneficiary deaths, and (3) ensure that community-based providers referred all suspicious deaths to law enforcement.

Pennsylvania did not have adequate controls to detect unreported 24 hour reportable incidents and did not have controls in place to ensure that all beneficiary deaths were investigated and that all suspicious deaths were referred to law enforcement. Therefore, Pennsylvania did not fulfill participant safeguard assurances it gave to CMS to ensure the health, welfare, and safety of the 18,770 Medicaid beneficiaries with developmental disabilities covered by the Medicaid waiver in our audit.

What OIG Recommends and Pennsylvania Comments

We recommend that Pennsylvania improve its controls regarding the reporting and monitoring of 24 hour reportable incidents involving Medicaid beneficiaries with developmental disabilities residing in community-based settings. We made specific recommendations for these controls.

Pennsylvania concurred with six of our seven recommendations and described corrective actions that it plans to take or has already taken, but it did not concur with our recommendation that it record the 24-hour reportable incidents noted in our report. Instead, Pennsylvania stated that it plans to focus on recording unreported emergency room visits and hospital stays that contain diagnoses indicative of high risk for suspected abuse or neglect and take remedial action as appropriate. We agree that Pennsylvania should prioritize recording unreported incidents that contain diagnoses indicative of high risk for suspected abuse or neglect but maintain that all unreported 24-hour reportable incidents must be reported.”