Meeting CMS proposed rule critical incident reporting and investigation requirements.
Medicaid home- and community-based services (HCBS) participants are among those most vulnerable to abuse, neglect and exploitation. Yet, a standard definition of what classifies as a critical incident in need of investigation and resolution does not exist across, or even within, states.
In fact, despite states having incident management regulations for health and human services programs for the protection of program participants, “there have been notable and high-profile instances of abuse and neglect in recent years that highlight the risks associated with poor quality care and with inadequate oversight of HCBS in Medicaid,” according to the Centers for Medicare & Medicaid Services (CMS).
Despite the programmatic need, according to CMS, a lack of standardization for incident reporting across states has meant critical incident definitions vary from state to state, or even within various state agencies. Further, the agency notes, manual, paper-based incident management remains a reality in many states today. And a lack of communication between state agencies remains a barrier to incident resolution for many.
A recently proposed rule, CMS-2442-P: Medicaid Program; Ensuring Access to Medicaid Services, seeks to change this. With new standards around critical incident management – including how incidents are defined and reported – the agency is seeking to find ways to better protect participants of HCBS waiver programs. The new rule requires states to operate and maintain an “incident management system that identifies, reports, triages, investigates, resolves, tracks and trends critical incidents. The proposal is intended to ensure standardized requirements for states regarding incidents that harm or place a beneficiary at risk of harm.”
According to the proposed rule, states must have incident management solutions that fulfill a series of requirements moving forward, including:
- Electronic submission of incident reports from a variety of entities, including Medicaid fraud control units, adult protective services, child protective services and law enforcement.
- Electronic tracking of incident investigation status.
- Streamlined data sharing between incident reporting entities to aid in investigations.
According to the proposed rule, states must also report the results of an assessment of their incident management system to CMS every two years.
The CMS proposed rule was published in March and the agency accepted commentary until July 3, 2023. The more than 300-page proposed rule received hundreds of comments. Among the comments on incident management, was a request from the National Association of Medicaid Directors (NAMD), ADvancing States and the National Association for State Directors of Developmental Disabilities Services (NASDDDS) among others, that for a requirement of this magnitude – implementing an electronic incident management system – states be given at least five years to do all that is required to comply with the new regulations; CMS had proposed three years.
While the new CMS proposed rule is applicable to HCBS waiver programs, protecting and ensuring the health and safety of program participants remains a high priority for county, state and federal agencies serving vulnerable and at-risk populations. At FEI we share in that commitment and have designed an incident management solution that not only meets the needs of HCBS waiver programs, but a variety of other health and human services programs.
Our team of experts have developed a solution that collects and reports on incident data to facilitate the timely investigation and resolution of reported incidents. Further, our incident management solution offers trend analysis and predictive analytics to help identify patterns in behaviors or activities that can be tracked and used to prevent further events from occurring and causing harm.
As CMS seeks to increase access to Medicaid, improve quality measures and standardize incident management – as demonstrated in a series of recently proposed rules – we have aligned our technology solutions to assist our state partners in meeting these goals. We recognize the magnitude of these proposed rules and can accommodate new federal reporting and program management requirements without major impacts on day-to-day operations or a state agency’s bottom line.
