In 2008, the U.S. Government Accountability Office (GAO) recommended that CMS encourage states to conduct mortality reviews in 1915(c) HCBS waivers.16 The mortality review process typically involves screening a death to ascertain whether it meets a pre-determined criteria for an in-depth review, investigation by a mortality review committee of circumstances that led to the death, a systems-level review to examine any commonalities across deaths to identify and recommend changes to reduce future risk of death.
The GAO was silent on the advisability of mortality reviews for 1915(c) waivers serving other populations and for MLTSS programs. However, good practice in community-based LTSS suggests that mortality reviews are an important oversight in LTSS program.17 Among the programs reviewed, we found evidence that seven conduct mortality reviews. Six delegate this responsibility to the MCO. The Michigan program which enrolls members with severe mental illness and IDD requires investigation of unexpected deaths only. Arizona requires MCOs to conduct mortality review for deaths among members with IDD only. The Tennessee Choices program, serving the Aged/Disabled population, does not require mortality reviews.
|EXHIBIT 5. Member Feedback Surveys|
|State||Entity Conducting Survey||Survey Type||Notes|
|MI||X||MHSIP1||Mail survey to members with mental illness.|
|X||Core Indicators||In-person survey with IDD members; 1 year grant from ACL2 to cover costs of data collection; uncertain about sustainability due to cost.|
|MN||X||Satisfaction||Managed Care Public Programs Satisfaction Survey.|
|NC||X||Satisfaction||MCO must contract with external vendor; MCO surveys must be approved by the state.|
|X||Core Indicators||In-person survey with IDD members.|
|Based on items from the PES & MFP Quality of Life Survey items.|
|X|| HCBS Experience
|Participating in pilot study for CMS-funded HCBS Experience of Care Survey (external survey vendor).|
|FEA||Satisfaction||Survey of consumer-directed members.|
|LTSS-focused items added to CAHPS survey.|
|X||Satisfaction||Nature of survey at MCO discretion.|