Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-43 - Specialized Recovery Services Program › Section 5160-43-06 - Specialized recovery services program incident management system

Current through all regulations passed and filed through July 1, 2024
(A)
								The Ohio department of medicaid (ODM) or its designee
			 (hereafter referred to as ODM) shall operate an incident management system that
			 includes responsibilities for reporting, responding to, investigating and
			 remediating incidents. This rule sets forth the standards and procedures for
			 operating that system. It applies to ODM, its designees, individuals and
			 providers of specialized recovery services (hereafter referred to as
			 providers). ODM may designate other agencies or entities to perform one or more
			 of the incident management functions set forth in this rule.
(B)
								When the
			 individual is a MyCare Ohio member, this rule is not applicable. Refer to rule
			 5160-58-05.3 of the Administrative Code for incident management
			 responsibilities.
(C)
								ODM shall ensure the health and welfare of individuals
			 enrolled in the program. ODM and providers are responsible for ensuring
			 individuals in the specialized recovery services program are protected from
			 abuse, neglect, exploitation and other threats to their health, safety and
			 well-being.
(D)
								Upon entering into a medicaid provider agreement, and
			 annually thereafter, all providers, including all employees who have direct
			 contact with individuals enrolled in the program, must acknowledge in writing
			 they have reviewed this rule and related procedures.
(E)
								Upon an
			 individual's enrollment in the program, and at the time of each annual
			 reassessment, the recovery manager shall provide the individual and/or the
			 individual's authorized representative or legal guardian with documentation
			 about how to report abuse, neglect, exploitation and other incidents. The
			 recovery manager shall secure from the individual, authorized representative
			 and/or legal guardian written confirmation of receipt of the documentation and
			 it shall be maintained in the individual's record.
(F)
								Incidents
			 include, but are not limited to, all of the following:
(1)
									 Abuse: the
			 injury, confinement, control, intimidation or punishment of an individual by
			 another person that has resulted in, or could reasonably be expected to result
			 in physical harm, pain, fear or mental anguish. Abuse includes, but is not
			 limited to physical, emotional, verbal and/or sexual abuse and use of
			 restraint, seclusion or restrictive intervention that results in, or could
			 reasonably be expected to result in, physical harm, pain, fear or mental
			 anguish to the individual.
(2)
									Neglect: when
			 there is a duty to do so, the failure to provide goods, services and/or
			 treatment necessary to assure the health and welfare of an
			 individual.
(3)
									Exploitation: the unlawful or improper act of using an
			 individual or an individual's resources for monetary or personal benefit,
			 profit or gain.
(4)
									Misappropriation: depriving, defrauding or otherwise
			 obtaining the money or real or personal property (including medication) of an
			 individual by any means prohibited by law.
(5)
									Death of an
			 individual that meets the criteria for a suspicious death as described in
			 paragraph (J)(2)(a) of this rule.
(6)
									Death of an
			 individual that does not meet the criteria for a suspicious death as described
			 in paragraph (J)(2)(a) of this rule.
(7)
									Hospitalization
			 or emergency department visit (including observation) as a result of:
(a)
										Accident, injury
			 or fall when someone's action or inaction may have caused or contributed to the
			 occurrence, including inadequate oversight of medication or misuse of
			 medication;
(b)
										Injury or illness of an unknown cause or origin;
			 and
(c)
										Reoccurrence of an illness or medical condition within
			 seven calendar days of the individual's discharge from a
			 hospital.
(8)
									Unauthorized use of restraint, seclusion and/or
			 restrictive intervention that does not result in, or cannot reasonably be
			 expected to result in, injury to the individual.
(9)
									An unexpected
			 crisis in the individual's family or environment that results in an inability
			 to assure the individual's health and welfare in his or her primary place of
			 residence.
(10)
									Inappropriate service delivery including, but not
			 limited to:
(a)
										
			 A provider's violation of the requirements set forth in rule
			 5160-43-04
			 of the Administrative Code and/or any other Administrative Code rules
			 referenced therein that results in an inability to assure the individual's
			 health and welfare, or could reasonably be expected to place the individual's
			 health and welfare in jeopardy;
(b)
										Services provided
			 to the individual that are beyond the provider's scope of practice;
			 and
(c)
										Medication administration errors involving the
			 individual.
(11)
									Actions on the part of the individual that place the
			 health and welfare of the individual or others at risk including, but not
			 limited to:
(a)
										Activities that involve law enforcement;
(b)
										Misuse of
			 medications;
(c)
										Use of illegal substances; and
(d)
										The individual
			 cannot be located.