Reporting Requirement

Reporting Requirement A. The PRTF must keep the Division of Medicaid informed of serious occurrences involving residents of the PRTF. 1. The death of any resident or a serious incident involving any resident, regardless of whether or not those involved were Medicaid beneficiaries, must be reported to the Division of Medicaid. a) The death of any resident must be reported to the Division of Medicaid as soon as possible, but no later than close of business the same day. b) Serious incidents must be reported by fax to the Division of Medicaid by close of the next business day. 2. The Division of Medicaid defines serious incidents as: a) Serious injury of a resident, defined as any significant impairment of the physical condition of the resident as determined by qualified medical personnel. 1) This includes, but is not limited to, burns, lacerations, bone fractures, substantial hematoma, and injuries to internal organs, whether self-inflicted or inflicted by someone else. 2) All serious injuries that require medical intervention are to be reported. b) Suicide attempt by a resident. c) Elopement of a resident. d) Allegations of sexual contact between residents. e) Allegations of maltreatment, like abuse and/or neglect of a resident. f) Any injury of a resident sustained in the course of a seclusion or restraint. 3. Each report must include: a) The name of the resident, if she/he is a Medicaid beneficiary, b) A description of the occurrence, and c) The name, street address, and telephone number of the facility. B. Serious incidents must also be reported to the appropriate agencies or entities according to applicable state and federal regulations. These include, but are not limited to: 1. Department of Human Services (DHS). 2. Mississippi State Department of Health, Bureau of Health Facilities Licensure and Certification (MSDH). 3. Disability Rights Mississippi (DRM) formerly known as the State Protection and Advocacy office. 4. Regional Office of the Center for Medicare and Medicaid Services (CMS) 5. Medicaid Fraud Control Unit, Attorney General (MFCU) 6. Utilization Management and Quality Improvement Organization (UM/QIO) for the Division of Medicaid.