After a recent review from a federal watchdog agency found Alaska health care providers failed to correctly report and monitor critical incidents involving people with developmental disabilities, state health officials are making changes in an attempt to close the gaps.
“We actually feel like this report from the (Office of the Inspector General) is really an opportunity or catalyst for us to really make our providers aware that they must report all critical incidents to the state,” said Deb Etheridge, acting director of the Division of Senior and Disabilities Services.
“Critical incidents” are events in which Medicaid beneficiaries are injured and require medical attention, or situations involving medication errors, or instances where patients are restricted or restrained. They can include everything from broken bones and instances of sexual abuse to concussions, cuts and bruises.
The review from the Department of Health and Human Services’ Office of the Inspector General covered more than a year of field work and 59,000 medical claims. Auditors selected 303 claims for review, and found more than two thirds of them were not correctly reported as critical incidents, according to the OIG. Medicaid rules require providers report critical incidents to the state, said Stacy DeWeber, a senior auditor with the OIG.
“The state agency cannot investigate and take appropriate actions to protect the health and welfare of Medicaid beneficiaries with developmental disabilities when community-based providers do not report critical incidents,” she said.
The term “community-based providers” can refer to anything from group homes to family members responsible for a Medicaid beneficiary’s care, according to the OIG. The Alaska Division of Senior and Disabilities Services currently has more than 700 credentialed providers offering two dozen types of services, from meals to transportation to specialized employment, according to the division.
Deb Etheridge, the acting director, said providers may not always know when a “critical incident” has occurred, and if a provider doesn’t know something happened, they’re not required to report it. Since it can be impossible to verify, Etheridge said, the state doesn’t fully concur with federal auditors’ findings.
Still, she said, the state is taking action, making it easier to file reports and access training resources, and adding new internal staff training and reporting processes, including cross-checking Medicaid claims data and investigating events that might not have been reported.
Hopefully, Etheridge said, the new systems can help keep cases from falling through the cracks.