AUGUSTA — Acting Health and Human Services Commissioner Ricker Hamilton acknowledged during his confirmation hearing Friday that his department’s initial response to a critical federal audit this summer was “not satisfactory.”

Hamilton said he sent a follow-up response this week to a report by the U.S. Department of Health and Human Service’s Office of Inspector General in August that found deficiencies in Maine’s system of caring for adults with developmental disabilities. That response – to the Centers for Medicare and Medicaid Services, which oversees the programs that were audited – includes detailed responses to seven different recommendations suggested by CMS.

“I am absolutely convinced that we’re on the road to correction,” he said Friday after the legislature’s Health and Human Services Committee voted 10-1 to approve his nomination as commissioner. “We’ve already put things in place that have been helpful and have addressed some of those.

“There’s more things that we have to do and we’re going to be responding to CMS on a quarterly basis. I’m absolutely confident, without a doubt, that we’ll answer all the issues they’ve identified.”


The audit, which reviewed records and incident reports for a 30-month period between January 2013 and June 2015, found that DHHS did not comply with requirements for reporting and monitoring critical incidents for more than 2,600 Medicaid beneficiaries being cared for by community-based providers during that time.


Included in that population are about 1,800 adults with intellectual disabilities who live in group homes. It also found that the state failed to investigate the deaths of 133 people in state-managed care, although Hamilton said Friday that the majority of those deaths, roughly 80 percent, were people in hospice care or in hospital settings.

Since the OIG report went public, a number of families and providers have contacted the Portland Press Herald about various issues within the state’s fractured system.

Cullen Ryan, who has a disabled son and leads an advocacy group called Maine Coalition for Housing and Quality Services, said he was pleased that DHHS was working on a better response to the audit.

“We all want the system to work well and solving issues is an important part of that,” he said.

Providers, represented by an association, said the root problem was money and that the state needed to increase the providers’ reimbursement rate and fix the system. Disability Rights Maine, which is supposed to advocate for clients, also said the state needs more money, specifically for Adult Protective Services, in order to hire more people and be more active in enforcement.

In its initial response to the audit in August, the department said in a lengthy statement that the problems cited were in the past and it took issue with some of the concerns cited. On Friday, Hamilton acknowledged the defensive tone of that response, which he attributed to assumptions by some that he or his department were uncaring.


Hamilton’s comments Friday were a bit of a departure and he said the department’s follow-up response to CMS meant to strike a far different tone.


Among the pledges made in the recent letter to CMS were:

By April 2018, the department will have a team in place to review 100 percent of MaineCare claims of emergency room visits against critical-incident reports from providers to ensure all reports are being made.

The department will require providers, beginning in May, to conduct administrative reviews of each critical-incident report to ensure that there is follow through.

Beginning in January, the department will conduct quarterly data analysis of critical-incident reports to identify trends and prevent reoccurrence.


The department will forward all reports or abuse, neglect or exploitation to the appropriate district attorney’s office.

The department will implement a procedure of cross-reference checks to make sure all deaths of adults in state-managed care are reported appropriately and forwarded to law enforcement if abuse or neglect is suspected.

“Our oversight wasn’t what it was supposed to be,” Hamilton said before acknowledging that some of the problems cited were, “systems” issues. “It wasn’t just the department.”

The state manages two complex Medicaid waiver programs that provide the bulk of care for adults with developmental and intellectual disabilities. Decades ago, such people often were warehoused in institutions, including the now-closed Pineland Center in New Gloucester.

One of the programs, known as Section 21, places adults in residential settings – often small group homes – with integrated care depending on their needs. The other, Section 29, is for families who receive services in their own home.

For years, the state has struggled to manage resources for this population. Both programs are costly – an average of $100,000 annually for Section 21 beneficiaries and $22,000 for Section 29 – and even though federal law mandates that services be provided, wait lists have been common, particularly for Section 21.


Three years ago, the state settled a lawsuit filed on behalf of dozens of clients to clear the wait list for the highest-priority clients, but that didn’t fix the larger problem.

Another issue that has emerged is the lack of crisis beds for people who are evicted from their residential placements, often for safety reasons. Those people often end up in emergency rooms.


The state budget that passed in June included additional funding for both Medicaid programs. Hamilton said he’s pleased to see that funding has finally gone through, much of which will double the amount of in-home hours available to Section 29 clients, from 20 per week to 40.

He said he hopes that will also help the 1,600 or so clients who are on a lengthy waiting list for residential services.

Hamilton spoke at length Friday about the high cost associated with residential services and pointed out, more than once, that other states don’t have Section 21 waivers. He even floated the idea of placing a hard cap on the number of people who could receive Section 21 benefits, although he didn’t say how serious he was about that proposal.


“I mean if you want bold, that’s bold,” he said.

Eric Russell can be contacted at 791-6344 or at:

Twitter: PPHEricRussell

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