Quality Management

Quality Management A. Waiver providers must meet applicable service specifications as referenced in the Traumatic Brain Injury/Spinal Cord Injury (TBI/SCI) Waiver approved by the Centers for Medicare and Medicaid Services (CMS). The Waiver is available on the Division of Medicaid’s website, www.medicaid.ms.gov. B. Providers must maintain compliance with all current waiver requirements, rules, and regulations, and administrative codes as specified by the Division of Medicaid. 1. If a TBI/SCI Waiver provider fails to maintain compliance, the Division of Medicaid may halt the acceptance of Medicaid referrals or waiver admissions until the TBI/SCI Waiver provider demonstrates compliance with the regulatory agency. 2. The decision to halt Medicaid referrals or waiver admissions is at the discretion of the Division of Medicaid. C. Waiver providers and/or contractors must report: 1. Changes in contact information, administrative staffing, ownership, and licensure within ten (10) calendar days to the Mississippi Department of Rehabilitation Services (MDRS) and the Division of Medicaid. 2. Critical incidences of abuse neglect and exploitation, (including the unauthorized use of restraints, restrictive interventions and/or seclusion) within twenty-four (24) hours of the occurrence or knowledge of the occurrence to the Division of Medicaid and other applicable agencies as required by law. 3. Any complaints not resolved within seven (7) days to MDRS and within fourteen (14) days to the Division of Medicaid. D. Quality Management Strategy for the waiver must be implemented in accordance with Appendix H of the CMS approved waiver application. E. A provider may not rely on any interpretation or exception to the Medicaid rules if it’s not provided, in writing, by the Division of Medicaid.