23 Miss. Code. R. 208-2.5 - Quality Management
A. Waiver providers
must meet applicable service specifications as referenced in the Independent
Living Waiver document approved by the Centers for Medicare and Medicaid
Services (CMS).
B. Waiver
providers and/or contractors must report changes in contact information,
staffing, and licensure within ten (10) calendar days to the Mississippi
Department of Rehabilitative Services (MDRS) and the Division of Medicaid.
C. All reports of abuse, neglect
or exploitation, as defined below, must be reported by phone and written report
immediately by the appropriate case manager to their supervisor at MDRS and the
Department of Human Services (DHS). The potential abuse, neglect, or
exploitation must be reported to the Division of Medicaid/Long Term Care within
twenty-four (24) hours.
1. Abuse (A) is
defined as willful or non-accidental infliction of a single or more incidents
of physical pain, injury, mental anguish, unreasonable confinement, willful
deprivation of services necessary to maintain mental and physical health, and
sexual abuse.
2. Neglect (N)
includes, but is not limited to, a single incident of the inability of a
vulnerable person living alone to provide for himself and/or failure of a
caretaker to provide what a reasonably prudent person would do.
3. Exploitation (E) is the illegal or
improper use of a vulnerable person or his resources for another's profit or
advantage with or without the consent of the vulnerable person and includes
acts committed pursuant to a power of attorney and can include but is not
limited to a single incident.
D. The Department of Human Services (DHS),
Division of Aging and Adult Services is responsible for investigating
allegations of Abuse, Neglect and Exploitation. The Division of Medicaid and
DHS have a Memorandum of Understanding (MOU) allowing a free flow of
information between the two (2) agencies to ensure the health and welfare of
waiver participants.
E. Quality
Management Strategy for the waiver includes the following:
1. Level of care determination consistent
with the need for institutionalization,
2. Plan of Services and Supports (PSS)
consistent with the participant's needs,
3. Providers must meet the provider
specifications of the CMS approved waiver, including licensure/certification
requirements,
4. Critical
event/incident reporting mechanism for participants and caregivers to report
concerns/incidents of abuse, neglect, and exploitation,
5. Division of Medicaid retention of
administrative authority over the waiver program,
6. Division of Medicaid retention of
financial accountability for the waiver program.
F. When change in the Quality Improvement
Strategy is necessary, a collaborative effort between the Division of Medicaid
and MDRS is made to meet waiver reporting requirements.
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