Connecticut Did Not Comply With Federal and State Requirements for Critical Incidents Involving Developmentally Disabled Medicaid Beneficiaries

The Connecticut Department of Social Services (State agency) did not comply with Federal waiver and State requirements for critical incidents involving developmentally disabled Medicaid beneficiaries. Specifically, the State agency did not ensure that (1) group homes reported all critical incidents to the Department of Developmental Services (DDS), (2) DDS recorded all critical incidents reported by group homes, (3) group homes always reported incidents at the correct severity level, (4) DDS collected and reviewed all data on critical incidents, and (5) DDS always reported reasonable suspicions of abuse or neglect.

The State agency did not adequately safeguard 137 of 245 developmentally disabled Medicaid beneficiaries because the DDS system of reporting and monitoring critical incidents did not work as expected.

We recommended that the State agency (1) work with DDS to develop and provide training for staff of DDS and group homes on how to identify and report critical incidents and reasonable suspicions of abuse or neglect, (2) work with DDS to develop a data-exchange agreement and related analytical procedures to ensure DDS access to the Medicaid claims data in Connecticut's Medicaid Management Information System to detect unreported and unrecorded critical incidents, (3) work with DDS to update DDS policies and procedures to clearly define and provide examples of potential abuse or neglect that must be reported, and (4) coordinate with DDS and the Connecticut Office of Protection and Advocacy for Persons with Disabilities to ensure that any potential cases of abuse or neglect that are identified as a result of new analytical procedures are investigated as needed.

In written comments on our draft report, the State agency concurred with our recommendations.