The U.S. Center for Medicare and Medicaid Services will review and consider action in response to a federal audit that faulted Maine health officials for failing to adequately protect disabled Medicaid clients in Maine.
A CMS official said Friday that Medicaid officials will analyze the Office of Inspector General report detailing Maine’s flawed system of reporting cases of abuse against people with developmental disabilities.
Some of the Medicaid clients with developmental disabilities receive services under a CMS waiver that allows people to live in small group home settings instead of institutions like Pineland Center in New Gloucester. Pineland Center closed in 1996, when Maine de-institutionalized services for adults with intellectual and developmental disabilities.
“Depending on the nature of the state-based report, CMS engages with the state to address any recommendations outlined in the report, if any,” CMS said in a statement. “If a state’s waiver is implicated in a report and recommendations are suggested in the report, CMS takes these into consideration in discussions with the state when negotiating the conditions of the extension of the waiver.”
Medicaid is a federal program operated by the states under federal rules and oversight.
The OIG report found that 2,600 Medicaid recipients with developmental disabilities – including those with conditions such as autism, brain damage and Down syndrome – were not being protected because some abuse complaints were not being reported and investigated. In addition to abuse complaints, the state also is required to investigate reports of serious injuries, suicide attempts, medication errors and other problems.
The review of medical records and incident reports from January 2013 to June 2015 indicates that the Maine Department of Health and Human Services did not comply with requirements for reporting and monitoring critical incidents for the 2,640 Medicaid beneficiaries being cared for by community-based providers. Included in that population are about 1,800 adults with intellectual disabilities who live in group homes, according to the Maine Association for Community Service Providers.
The OIG auditors cross-checked the reports of 2,243 “critical incidents” – including the abuse and neglect cases – with Maine hospitals’ “paid Medicaid claims” database.
They found that more than one-third of critical incidents that should have been reported to Maine DHHS were missing. The nonprofit agencies that operate the group homes should have been reporting the incidents to the state.
Of the cases that were reported to the state, many were not investigated, the OIG report said. For instance, only 5 percent of physical and verbal abuse cases reported to the state were investigated, and only 27 percent of sexual abuse or exploitation cases were investigated.
Richard Estabrook, a Maine attorney and former chief advocate for the now-defunct Office of Advocacy within Maine DHHS, said the dismantling of the Office of Advocacy by the LePage administration in 2012 has weakened the checks and balances that were previously in place. Estabrook said when the Office of Advocacy closed, it had eight employees, including himself, who were charged with making sure that abuse and neglect cases among the developmentally disabled population were properly investigated.
Estabrook said he’s not sure where the gaps in the system are occurring now, but it’s clear from the OIG report that many abuse cases are not being investigated.
“Oversight for people in these systems of care must be maintained,” he said, explaining that people with developmental disabilities can’t advocate for themselves and many times the families also are not effective advocates for the cause. “What is absolutely certain is that in some of these reports, an investigation should have been conducted and the problems should have been addressed.”
Estabrook believes Medicaid officials will take the OIG report “very seriously” and will work with Maine to improve the system. CMS has a lot of leverage with Maine because the agency controls funding for Medicaid. Called MaineCare in Maine, Medicaid is funded with a blend of federal and state dollars according to a formula. In Maine, about two-thirds of all Medicaid funding is federal.
“The ultimate sanction by CMS would be to say, ‘We’re not paying the state of Maine for any of these services,” Estabrook said. “CMS could say to Maine that the state is not keeping up its side of the bargain.”
The waiver that Maine operates under requires that the state have effective oversight of the group homes.
The Department of Health and Human Services issued a statement Thursday saying it had already taken steps to address some of the issues raised in the report. They have issued a notice to providers about proper reporting of incidents, started sending monthly restraint use reports to a third-party advocate, and will now hold quarterly meetings with each provider, according to a June 26 letter from the commissioner to the auditors.
The restraint reports are being sent to Disability Rights Maine, a third-party advocate charged with protecting the rights of the developmentally disabled in Maine.
The audit also found that the department was not analyzing the critical incident data it received from providers. The department says it has started trend analysis and will share the results with providers at the quarterly meetings.
DHHS officials did not respond to multiple requests Thursday and Friday for details about the changes being made in response to the audit.
Todd Goodwin, president of the Maine Association of Community Service Providers, said his organization is not aware of any improvements in the system that have already been made by Maine DHHS.
The OIG conducted similar audits in Connecticut and Massachusetts and also found deficiencies. In those states, the auditors only evaluated reporting of critical incidents from group homes, not from all community-based service providers.
In Connecticut, multiple state agencies are involved in oversight. The lead agency is revising its agreements with other agencies to develop, provide and monitor new training for all involved staff. State health officials also met with the state’s protection and advocacy agency about investigating cases of abuse and neglect.
In Massachusetts, the department developed and piloted new training for providers on how to identify and report critical incidents, and new training for state agency management and staff on how to review incidents.
Noel K. Gallagher can be reached at 791-6387 or at:
Twitter: noelinmaine
Joe Lawlor can be reached at 791-6376 or at:
jlawlor@pressherald.com
Twitter: joelawlorph
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