Maine Did Not Comply With Federal and State Requirements for Critical Incidents Involving Medicaid Beneficiaries With Developmental Disabilities 

The Maine Department of Health and Human Services (State agency) did not comply with Federal Medicaid waiver and State requirements for reporting and monitoring critical incidents involving Medicaid beneficiaries with developmental disabilities residing in community residences. The State agency did not fulfill many of the participant safeguard assurances it provided to the Centers for Medicare & Medicaid Services in its Medicaid waiver. Specifically, the State agency did not (1) ensure that community-based providers reported all critical incidents to the State agency; (2) ensure that community-based providers conducted administrative reviews of all critical incidents involving serious injuries, dangerous situations, or suicidal acts and submitted their findings within 30 days; (3) report appropriately all restraint usage and rights violations to Disability Rights Maine (DRM); (4) review and analyze data on all critical incidents; (5) investigate and report immediately to the appropriate district attorney's office or to law enforcement all critical incidents involving suspected abuse, neglect, or exploitation; and (6) ensure that community-based providers reported all beneficiary deaths to the State agency appropriately and that the State agency analyzed, investigated, and reported the deaths to law enforcement or Maine's Office of Chief Medical Examiner (OCME).