Rule 23-208-2.5 - Quality ManagementA. 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.23 Miss. Code. R. 208-2.5
42 U.S.C. § 1396n; 42 C.F.R. § 441.302; Miss. Code Ann. §§ 37-33-157, 43-13-117, 43-13-121.