Verbal abuse, defined as using words to threaten, coerce, intimidate, degrade, demean, harass, or humiliate a Participant; Neglect, which includes the failure to provide a Participant the reasonable care that he/she requires, including, but not limited to, food, clothing, shelter, medical care, personal hygiene, and protection from harm; Seclusion, which is the involuntary confinement of an individual alone in a room or an area from which the individual is physically prevented from having contact with others or leaving, is a form of neglect; Exploitation, which includes the act of depriving, defrauding, or otherwise obtaining the personal property from a participant in an unjust, or cruel manner, against one’s will, or without one’s consent, or knowledge for the benefit of self or others; Restraint, which includes any physical, chemical or mechanical intervention that is used to control acute, episodic behavior that restricts the movement or function of the individual or a portion of the individual’s body. Use of restraints and seclusion are both restrictive interventions, which are actions or procedures that limit an individual’s movement, a person’s access to other individuals, locations or activities, or restricts Participant rights; Service interruption, which includes any event that results in the Participant’s inability to receive services that places his or her health and or safety at risk. This includes involuntary termination by the provider agency, and failure of the Participant’s back-up plan. If these events occur, the provider agency must have a plan for temporary stabilization; and Medication errors that result in hospitalization, an emergency room visit or other medical intervention.
111 What are Provider Preventable Serious Adverse Events (PSAEs)? PA Health & Wellness requires all Providers to identify Provider Preventable Conditions as defined in 42 C.F.R. § 447.26 and may not pay for services related to Provider Preventable Conditions unless the condition existed prior to the initiation of treatment for the Participant. An event is a PSAE if ALL of the following criteria are present: • • • • The event was preventable The event was serious The event was within the control of the Provider or contracted service entity The event occurred as a result of an error or other system failure Please contact PA Health & Wellness or refer to the Department’s website for additional information regarding Critical Incidents and PSAE: MEDICAL RECORDS REVIEW PA Health & Wellness Providers must keep accurate and complete medical records. Such records will enable Providers to render the highest quality healthcare service to Participants. They will also enable PA Health & Wellness to review the quality and appropriateness of the services rendered. To ensure the Participant’s privacy, medical records should be kept in a secure location.
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