PAR Mail 2018-126 | July 3, 2018
CMS, OIG Issue Group Home Guidance
Feds Ask States to Have Robust Oversight in Place
As a result of an ongoing investigation of group home safety and health concerns by the Office of the Inspector General of the U.S. Department of Health and Human Services (HHS), key funding and regulatory partners have joined with the Center on Medicaid and Medicare Services (CMS) to issue a Joint Report and an Informational Bulletin with specific policy recommendations.

The Informational Bulletin is a combined effort from CMS and the U.S. Department of Health and Human Services Office of Inspector General, Administration on Community Living and Office for Civil Rights urges states to implement compliance oversight programs for group homes, such as the Model Practices (referring to a March 12, 2014 CMS Informational Bulletin), and regularly report to CMS.
The Informational Bulletin identifies four components of a robust oversight framework including:

  1. State Incident Management and Investigation: states are urged to ensure that state systems be required to define critical incidents to be reported to the state including unexpected deaths, allegations of physical, psychological, emotional, verbal and sexual abuse, neglect and exploitation.
  2. Incident Management Audits: states are urged to ensure that all information on all occurrences meeting the state's definition of a critical incident are reported. States should have a protocol in place that effectively captures all incidents relevant to the state's definition of critical incidents.
  3. Mortality Reviews: states should require a preliminary review of all beneficiary deaths; investigations should focus on deaths that are determined to be "unusual, suspicious, sudden or unexpected, or potentially preventable, including all deaths alleged or suspected to be associated with neglect, abuse or criminal acts."
  4. Quality Assurance: states should establish, with input from beneficiaries and stakeholders, a transparent, person centered quality assurance program that includes regular communication with all stakeholders including individuals waiting for service.
The Informational Bulletin also notes that states may apply to CMS for enhanced Medicaid funding to implement a more robust quality assurance, monitoring and incident management program.

The desire of the OIG, CMS and HHS to see improvement in this area came after the issuance of the highly critical OIG Report finding injuries, serious medical conditions and even deaths of those with developmental disabilities living in group homes, often overlooked by state officials. The OIG's audit and review to date has focused on four states including, Pennsylvania, Massachusetts, Maine and Connecticut, however it is expected that several more states will be reviewed as part of the ongoing study by the OIG. Specific shortcomings have been identified in Massachusetts, Maine and Connecticut. The OIG audit of Pennsylvania has yet to be completed.
ODP Deputy Secretary Nancy Thaler noted in reviewing and sharing the Joint Report and Informational Bulletin that "the OIG is still in our program conducting their audit of our incident management system." Thaler also noted that “Pennsylvania has adopted many of the recommendations cited in the OIG Report in the Medicaid Waiver program and the proposed CH 6100 regulations and will continue to look for ways to improve the quality of services and the health and safety protections for people receiving services."