Ala. Admin. Code r. 560-X-7-.13

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-7-.13 - Adverse Events, Hospital-Acquired Conditions, And Present On Admission Indicators

(1) This rule applies to inpatient hospital admissions beginning dates of admission on or after July 1, 2010.

(2) Adverse Events are the events that must be reported to Medicaid by the hospital. To be reportable, these events must meet the following criteria:

(a) The event must be reasonably preventable as determined by a root cause analysis or some other means.

(b) The event must be within the control of the hospital.

(c) The event must be clearly and unambiguously the result of a preventable mistake made and hospital procedures not followed, and not an event that could otherwise occur.

(d) The error or event must result in significant harm. The events for consideration should be limited to those that yield a serious adverse result. Serious adverse result is defined as one that results in death, a serious disability or a substantial increase in the duration and/or complexity of care that is well beyond the norm for treatment of the presenting condition. A serious disability is defined as a major loss of function that endures for more than 30 days, is not present at the time services were sought and is not related to the presenting condition.

(e) Any process for identifying non-payable events must actively incorporate some element of case-by-case review and determination. While the source and cause of some adverse events may be clear, most would require further investigation and an internal root cause analysis to determine the cause of the serious preventable event and to assign ultimate accountability.

(3) Pursuant to these guidelines, hospitals will not seek payments for additional days directly resulting from adverse events.

(4) Hospital-Acquired Conditions are conditions that are reasonably preventable and were not present or identified at the time of admission; but are either present at discharge or documented after admission. The Present on Admission (POA) Indicator is defined as a set of specified conditions that are present at the time the order for inpatient hospital admission occurs. Conditions that develop during an outpatient encounter, including the emergency room, observation, or outpatient surgery, are considered POA.

(5) Details on billing claims and reporting Adverse Events, Present on Admission and Hospital-Acquired Conditions may be obtained in the Alabama Medicaid Provider Manual (Hospital-Chapter 19).

Ala. Admin. Code r. 560-X-7-.13

Rule entitled "Friday and Saturday Admissions" effective October 1, 1982. Repealed effective May 11, 1987. New Rule: Filed May 12, 2010; effective June 16, 2010.

Author: Jerri Jackson, Associate Director, Institutional Services

Statutory Authority: Section 1862(a)(1)(A) of the Social Security Act; Inpatient Prospective Payment System (IPPS) Fiscal Year (FY) 2009 Final Rule, Section 5001(c) of the Deficit Reduction Act of 2005.