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Massachusetts Could Better Ensure That Intermediate Care Facilities for Individuals With Intellectual Disabilities Comply With Federal Requirements for Life Safety and Emergency Preparedness

Issued on  | Posted on  | Report number: A-01-24-00001

Why OIG Did This Audit

  • Intermediate care facilities for individuals with intellectual disabilities (ICF/IIDs) that participate in Medicaid are required by CMS to comply with requirements intended to protect residents. This includes requirements related to fire safety and emergency preparedness plans. Facilities are also required to develop infection control programs.
  • In Massachusetts, the State’s Department of Public Health (State agency) conducts surveys of ICF/IIDs for compliance with Federal requirements.
  • This audit is the first in a series of audits that assesses compliance with CMS’s life safety, emergency preparedness, and infection control requirements for ICF/IIDs.

What OIG Found

We identified 44 deficiencies related to life safety and emergency preparedness at the 2 ICF/IIDs operated by Massachusetts. The State agency generally ensured that the ICF/IIDs complied with Federal requirements for infection control.

These deficiencies put the health and safety of residents, staff, and visitors at an increased risk of injury or death during a fire or other emergency.

What OIG Recommends

We recommend that the State agency:

  1. Follow up with the two ICF/IIDs to verify that they have taken corrective actions on the life safety and emergency preparedness deficiencies identified during the audit.
  2. Work with CMS to develop standardized life safety training for ICF/IID staff.

In written comments on our draft report, Massachusetts concurred with our recommendations and described the actions that it had taken or planned to take to address them.

25-A-01-004.01 to CMS - Open Unimplemented
Update expected on 04/22/2025
We recommend that the Massachusetts Department of Public Health follow up with the two ICF/IIDs to verify that they have taken corrective actions on the life safety and emergency preparedness deficiencies identified during the audit.

25-A-01-004.02 to CMS - Open Unimplemented
Update expected on 04/22/2025
We recommend that the Massachusetts Department of Public Health work with CMS to develop standardized life safety training for ICF/IID staff.

View in Recommendation Tracker