Massachusetts Did Not Comply With Federal and State Requirements for Critical Incidents Involving Developmentally Disabled Medicaid Beneficiaries

The Massachusetts Executive Office of Health and Human Services, Office of Medicaid (State agency), did not comply with Federal waiver and State requirements for critical incidents involving developmentally disabled Medicaid beneficiaries. Specifically, the State agency did not ensure that (1) group homes reported all critical incidents to the Department of Developmental Services (DDS), (2) DDS obtained and analyzed data on all critical incidents, (3) appropriate action steps were identified in all incident reports that could prevent similar critical incidents, and (4) DDS always reported all reasonable suspicions of abuse or neglect to the Disabled Persons Protection Commission (DPPC).

The State agency did not adequately safeguard 146 out of 334 developmentally disabled Medicaid beneficiaries because the DDS system of reporting and monitoring critical incidents did not work as expected.

We recommended that the State agency (1) work with DDS to develop and provide training for staff of DDS and group homes on how to identify and report critical incidents and reasonable suspicions of abuse or neglect, (2) work with DDS to develop a data-exchange agreement and related analytical procedures to ensure DDS access to the Medicaid claims data contained in Massachusetts' Medicaid Management Information System so it can detect unreported critical incidents, (3) work with DDS to develop and provide training for staff of DDS and group homes to ensure that action steps are identified in the incident reports to prevent similar critical incidents, (4) work with DDS to update DDS policies and procedures so they clearly define and provide examples of potential abuse or neglect that must be reported, and (5) coordinate with DDS and DPPC to ensure that any potential cases of abuse or neglect that are identified as a result of new analytical procedures are investigated as needed.

In written comments on our draft report, the State agency agreed with our second finding and all five of the report's recommendations. However, it disagreed with our first, third, and fourth findings. We maintain the validity of our findings, recommendations, and conclusion.