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WILKES-BARRE — The Pennsylvania Department of Human Services on Thursday responded to the findings of a report of the federal Office of Inspector General that found fault with the monitoring of people with developmental disabilities and reporting of incidents in community-based setttings.
The report, “Pennsylvania Did Not Fully Comply With Federal and State Requirements for Reporting and Monitoring Critical Incidents Involving Medicaid Beneficiaries With Developmental Disabilities,” is available online at https://oig.hhs.gov/oas/reports/region3/31700202.pdf.
On Wednesday, state Rep. Gerald Mullery, D-Newport Township, expressed deep concern and anger over the report’s findings, saying they comes as DHS is planning to shutter two state centers — White Haven in Luzerne County and Polk in Venango County.
State officials have said residents of the facilities may be moved to community-based settings following the proposed closures, which are being fought by legislators, including Mullery.
In an emailed statement from DHS Press Secretary Erin James, the DHS said it “has made many advances in incident-management oversight in the 4 to 5 years that have elapsed between the OIG’s evaluation period and the present day.”
James said those improvements include new regulations to help the department enforce reporting requirements and impose penalties; new reviews of Medicaid ER and hospital claims to find incidents that were unreported or inaccurately reported; strengthening policies related to death investigations; and improving the system for reporting possible abuse to local police.
The DHS full response follows:
“The Department of Human Services (DHS) is committed to continuous improvement in our oversight responsibility to ensure that people served by these programs are receiving the care they need and deserve.
“Over a period of several years, DHS has worked closely with the OIG on its multi-state review of systems for monitoring and reporting critical incidents involving Medicaid beneficiaries with developmental disabilities.
“The audit was of 2015-2016 data, and DHS has made many advances in incident-management oversight in the 4 to 5 years that have elapsed between the OIG’s evaluation period and the present day.
“At a high level, these improvements include the development and implementation of a more sophisticated incident management 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.
“We look forward to continuing to work with our partners at the county level and providers throughout this system so we may work together to ensure that people we all serve are receiving the care they need safely and any incidents that occur are reported in a timely manner so DHS and our partners are able to investigate thoroughly and mitigate future risk.
“As noted in the OIG Report, DHS has also taken action to improve its incident-management practices both independently and as a result of the report’s findings. More details on these improvement activities include:
• Promulgation of new regulations that significantly enhance incident reporting and investigation requirements: On Feb. 2, 2020, new regulations will go into effect that will strengthen the department’s ability to enforce incident reporting requirements and implement sanctions for noncompliance; expand the types of incidents that require investigation by a department-certified investigator; and require review and analyses of incidents and conduct and document a trend analyses at least quarterly.
• Developing systems to use Medicaid claims for incident oversight: The department has begun reviewing emergency room and hospital claims to identify individuals with certain high-risk diagnosis codes, such as those associated with pressure ulcers and choking events. Findings will be used to identify unreported incidents or incidents that were inaccurately categorized. The department is also working on obtaining and including Medicare claims data in its analysis given that many individuals with intellectual disabilities or autism have both Medicare and Medicaid. Finally, the department has partnered with the University of Pittsburgh on a multi-year predictive analytics project to identify trends in incident-reporting practices and to identify providers with potentially noncompliant incident-management practices.
• Strengthening mortality review and death investigation practices: In May 2017, the department modified policies and the incident-reporting system to require investigations for all HCBS waiver beneficiary deaths. Prior to this change, only deaths that occurred in a provider-operated setting were required to be investigated. Most participants in ODP waivers live in family homes, not provider-operated settings, so this is an important change.
• Streamlining and expediting referrals of suspected abuse and neglect to law enforcement: In 2018, the department enhanced its incident-reporting system to prompt incident reviewers to better collect and track follow-up actions planned or being conducted (e.g. notifying law enforcement, licensing entities, Department of State, etc.) when abuse or neglect is confirmed as well as when a death is determined to be suspicious. The department also collaborated with the Pennsylvania Office of Attorney General’s Medicaid Fraud Control Unit (OAG) to develop protocols ensuring immediate notification to the OAG when there is reasonable suspicion of abuse or neglect or when a death is determined to be suspicious. This practice has significantly expedited and increased referrals to law enforcement relating to abuse, neglect, or suspicious deaths.
“As noted in the report, the Department of Human Services concurred with all but one of the OIG’s recommendations for quality improvement. At the same time, the department recommends that caution be used when drawing conclusions from the report for the following reasons:
“The use of claims data to identify unreported incidents is a relatively new practice. The department did not possess the necessary technology or comprehensive understanding of this method in 2015-2016.
“The report is limited to providers of community-based services that are funded by the department’s consolidated waiver. The report’s findings cannot be compared to other types of services, i.e. one cannot conclude that another type of service such as that provided in intermediate care facilities for individuals with an intellectual disability is “better” or “safer” than community-based services. It is likely that a similar evaluation of incident reporting in such settings would be similar to those found as a result of the OIG’s evaluation of consolidated waiver-funded community-based services.
“The report is limited to one component of the department’s quality assurance and oversight practices. Incident management is only one of the ways that the department protects individual health, safety, and rights and ensures the highest quality provision of community-based services.“
Reach Bill O’Boyle at 570-991-6118 or on Twitter @TLBillOBoyle