This joint report is issued by the U.S. Department of Health and Human Services, Office of Inspector General (OIG); Administration for Community Living (ACL); and Office for Civil Rights (OCR) to help improve the health, safety, and respect for the civil rights of individuals living in group homes. The joint report provides suggested model practices to the Centers for Medicare & Medicaid Services (CMS) and States for comprehensive compliance oversight of group homes to help ensure better health and safety outcomes. In addition, the Joint Report provides suggestions for how CMS can assist States when serious health and safety issues arise that require immediate attention.
In OIG’s audits of Connecticut, Massachusetts, and Maine, the State agencies did not comply with Federal waiver and State requirements for reporting and monitoring critical incidents involving Medicaid beneficiaries with developmental disabilities. These audits found that these State agencies:
- failed to ensure that group homes reported all critical incidents,
- failed to ensure that all critical incidents reported by group homes were properly recorded,
- failed to ensure that group homes always reported incidents at the correct severity level,
- failed to ensure that all data on critical incidents were collected and reviewed, and
- failed to ensure that reasonable suspicions of abuse or neglect were properly reported.
Our suggestions for ensuring group-home beneficiary health and safety involve four key
compliance oversight components:
- reliable incident management and investigation processes;
- audit protocols that ensure compliance with reporting, review, and response requirements;
- effective mortality reviews of unexpected deaths; and
- quality assurance mechanisms that ensure the delivery and fiscal integrity of appropriate community-based services.