Common use of MCO Duty to Immediately Report Clause in Contracts

MCO Duty to Immediately Report. Certain Member Incidents 1. The MCO is required to report immediately to its DHS Member Care Quality Specialist any of the following: a. Upon learning a member’s whereabouts are not known for 24 hours or more, under any of the following circumstances: i. The member is under guardianship/protective placement; ii. The member has been identified as a vulnerable/high risk member as defined under Article I.127; iii. The MCO has reason to believe that the member’s health or safety is at risk; iv. The member is a potential threat to the community or self; v. The member has a significant medical condition that would deteriorate without medications/care; vi. The member lives in a residential facility; or vii. The area is experiencing potentially life-threatening weather conditions. b. Upon learning a member has died under any of the following circumstances: i. Death involving unexplained, unusual, or suspicious circumstances; ii. Death involving apparent abuse or neglect; iii. Apparent homicide; iv. Apparent suicide; v. Apparent poisoning; vi. Apparent accident, whether the resulting injury is or is not the primary cause of death; or vii. When a physician refuses to sign the death certificate. c. Upon learning a member has suffered an injury or accident related to any of the following circumstances: i. When unexplained, unusual, or suspicious circumstances exist; ii. When law enforcement or a court of law have investigated and/or are involved; iii. When the member was the victim of physical abuse, sexual abuse, or neglect by a caregiver; or iv. When the member has been poisoned. d. Upon learning a member has been admitted to a state IMD or to an Intensive Treatment Program (ITP). 2. In addition to the immediate reporting requirements provided by Article V.O. 1., MCOs shall also comply with all other reporting requirements in this contract, including, but not limited to, those provided in Addendum II.A.2.

MCO Duty to Immediately Report. Certain Member Incidents 1. The MCO is required to report immediately to its DHS Member Care Quality Specialist Contract Coordinator any of the following: a. Upon learning a member’s whereabouts are not known for 24 hours or more, under any of the following circumstances: i. The member is under guardianship/protective placement; ii. The member has been identified as a vulnerable/high risk member as defined under Article I.127; iii. The MCO has reason to believe that the member’s health or safety is at risk; iv. The member is a potential threat to the community or self; v. iii. The member has a significant medical condition that would deteriorate without medications/care; viiv. The member lives in a residential facility; or vii. v. The area is experiencing potentially life-threatening weather conditions. b. Upon learning a member has died under any of the following circumstances: i. Death involving unexplained, unusual, or suspicious circumstances; ii. Death involving apparent abuse or neglect; iii. Apparent homicide; iv. Apparent suicide; v. Apparent poisoning; vi. Apparent accident, whether the resulting injury is or is not the primary cause of death; or vii. When a physician refuses to sign the death certificate. c. Upon learning a member has suffered an injury or accident related to any of the following circumstances: i. When unexplained, unusual, or suspicious circumstances exist; ii. When law enforcement or a court of law have investigated and/or are involved; iii. When the member was the victim of physical abuse, sexual abuse, or neglect by a caregiver; or iv. When the member has been poisoned. d. Upon learning a member has been admitted to a state IMD or to an Intensive Treatment Program (ITP). 2. In addition to the immediate reporting requirements provided by Article V.O. 1V.O.1., MCOs shall also comply with all other reporting requirements in this contract, including, but not limited to, those provided in Addendum II.A.2.

MCO Duty to Immediately Report. Certain Member Incidents 1. The MCO is required to report immediately to its DHS Member Care Quality Specialist any of the following: a. Upon learning a member’s whereabouts are not known for 24 hours or more, under any of the following circumstances: i. The member is under guardianship/protective placement; ii. The member has been identified as a vulnerable/high risk member as defined under Article I.127I.136; iii. The MCO has reason to believe that the member’s health or safety is at risk; iv. The member is a potential threat to the community or self; v. The member has a significant medical condition that would deteriorate without medications/care; vi. The member lives in a residential facility; or vii. The area is experiencing potentially life-threatening weather conditions. b. Upon learning a member has died under any of the following circumstances: i. Death involving unexplained, unusual, or suspicious circumstances; ii. Death involving apparent abuse or neglect; iii. Apparent homicide; iv. Apparent suicide; v. Apparent poisoning; vi. Apparent accident, whether the resulting injury is or is not the primary cause of death; or vii. When a physician refuses to sign the death certificate. c. Upon learning a member has suffered or caused an injury or accident related to any of the following circumstances: i. When unexplained, unusual, or suspicious circumstances exist; ii. When physical abuse, sexual abuse, or neglect exist; iii. When the member has been poisoned; or iv. When law enforcement or a court of law have investigated and/or are involved; iii. When the member was the victim of physical abuse, sexual abuse, or neglect by a caregiver; or iv. When the member has been poisoned. d. Upon learning a member has been admitted to a state or private IMD or to an Intensive Treatment Program (ITP). 2. In addition to the immediate reporting requirements provided by Article V.O. 1., MCOs shall also comply with all other reporting requirements A list of both county and privately operated IMDs in this contract, including, but not limited to, those provided Wisconsin can be found in Addendum II.A.2.section 27.11