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Office of Inspector General Incident Management Report

The Office of Inspector General (OIG) has released their report after conducting a review of ODP’s Incident Management for individuals served in waiver programs. The report, entitled Pennsylvania Did Not Fully Comply With Federal and State Requirements for Reporting and Monitoring Critical Incidents Involving Medicaid Beneficiaries With Developmental Disabilities, outlines findings from the review as well as PA Department of Human Services’ response to the report.

The data that was reviewed is from 2015–2016. Since that time, DHS has made many advances in incident management oversight. These improvements include the development and implementation of a more sophisticated IM system, implementation of mortality reviews for all participant deaths, clarification of the types of incidents to be reported, strengthened collaboration with law enforcement, and strengthened protocols for referrals to law enforcement.

The following are excerpts from the report:

What OIG Found
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 their audit.

What OIG Recommends and Pennsylvania Comments
OIG recommends 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. Specific recommendations were made for these controls. Pennsylvania concurred with six of the seven recommendations and described corrective actions that it plans to take or has already taken, but it did not concur with the recommendation that it record the 24-hour reportable incidents noted in the 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. OIG agrees that Pennsylvania should prioritize recording unreported incidents that contain diagnoses indicative of high risk for suspected abuse or neglect but maintains that all unreported 24-hour reportable incidents must be reported.

The full report can be found here, including the response from DHS.