After a highly critical federal audit found that a state agency failed to protect adults with developmental disabilities, leaders of the Legislature’s Health and Human Services Committee are pressing the agency to explain what happened – and how it can be prevented in the future.

The committee posed a series of pointed questions in a four-page letter dated Aug. 31 to Department of Health and Human Services Commissioner Ricker Hamilton, and said it expects a written response delivered no later than next Tuesday. The panel’s quest for accountability includes trying to learn why the agency failed to investigate the deaths of 133 disabled adults who were receiving services.

“We’re hoping that all of these questions are answered, because they deserve to be,” said committee co-chair Rep. Patty Hymanson, D-York. “Frankly, it’s hard to do this. No one wants to talk about it, no one wants to give answers to these hard questions. But this is an identified problem. As the committee of jurisdiction (over DHHS) we need to press hard, for the sake of people in Maine who cannot take care of themselves.”

Federal officials also are reviewing the audit for possible action. The U.S. Center for Medicare and Medicaid Services, which funds services for the disabled, could require the state to change the way it responds to reports of abuse and other critical incidents. Specifically, CMS said it would take the auditor’s recommendations into consideration when negotiating future funding for services.

The audit, released Aug. 10, was conducted by the Office of Inspector General of the federal Department of Health and Human Services. It found several critical problems with how Maine DHHS and, in some cases, service providers, carried out their responsibilities under federal law to protect and meet the needs of adults who receive Medicaid benefits for community-based services. The audit found that DHHS failed to:

• Properly monitor and hold accountable the community-based providers who care for adults with developmental disabilities.

• Investigate the deaths of 133 Mainers in the program. Law enforcement did not open investigations into any of those deaths. The auditors found that nine of the deaths were unexplained, suspicious or untimely, and that there was not enough information about another 32 deaths to determine whether they were unexplained, suspicious or untimely.

• Report potential abuse, neglect and exploitation cases to law enforcement.

• Provide reports of rights violations to the state contractor paid to investigate such allegations.

Maine DHHS did not respond to requests for comment on the committee’s letter Wednesday.

The agency issued a statement when the audit was released last month, but it has refused to answer follow-up questions. In its statement, the department said the audit report is accurate for the period it covers, but doesn’t reflect current practices. The audit was based on a review of medical records and incident reports from January 2013 to June 2015 for 2,640 adult Medicaid beneficiaries with developmental disabilities.

The legislative committee’s letter asks specific questions and seeks detailed responses. Among the questions:

• The committee notes that DHHS disagreed with some audit findings, and asks the department to cite “facts, dates and data to clarify where and on what basis DHHS disagrees with the audit findings.”

• “What reasoning does DHHS have for not investigating the deaths of 133 Mainers with developmental disabilities?”

• “Please describe how DHHS is working to collect aggregate data to assess the shortcomings of the entire system, such as staff retention, shortage of crisis beds, unmet needs, an unrecognized waiting list, critical incidents within your system, the lack of availability of mental health services for people with intellectual or developmental disabilities or autism, and a reduction of service providers.”

• Noting that former Commissioner Mary Mayhew said the audit’s findings stemmed from “explosive entitlement growth” in previous administrations, the committee asks the department to “Please clarify with specificity what obstacles had been placed in the way of DHHS’ ability to comply with its legal obligation to protect persons with developmental disabilities as a result of ‘entitlement growth.’ Please identify what specific actions DHHS took to overcome those obstacles.”

The letter was written by Hymanson and co-chair Sen. Eric Brakey, R-Auburn.

Hymanson said the committee will review Hamilton’s responses and determine whether it needs more information in person, possibly requesting a public work session to discuss the audit. The back-and-forth written exchanges, she said, are “a clumsy process.”

“We really are looking to find out what happened,” she said. “In the end, this is about adults who need every part of their life overseen, and when mistakes are made we need to know why. Not only for the safety of the adults, but for improvement in the system. If we don’t look, then we don’t find. If we don’t find, we can’t improve.”

Brakey did not respond to multiple requests for comment on the audit.

In its response to the audit, the department said the audit period included a time of “significant transition” after DHHS reorganized to incorporate two other departments and create the Office of Aging and Disability, which oversees developmentally disabled Medicaid patients in Maine. As part of that transition, the Office of Advocacy was eliminated and its duties outsourced to Disability Rights Maine.

In a letter to the auditors, DHHS said it already had taken steps to address some of the issues raised in the report. The agency has issued a notice to providers about proper reporting of incidents, started sending monthly restraint-use reports to a third-party advocate, and will hold quarterly meetings with each provider, according to a June 26 letter from the commissioner to the auditors.

Noel K. Gallagher can be contacted at 791-6387 or at:

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