describes the process of managing complaints and incidents, including the types of complaints, the processing flow, and the priority of complaints
Chapter 5 of the State Operations Manual details the protocols for handling complaints and incidents involving various healthcare provider types. It covers the general intake process, regional office responsibilities, and specific procedures for different facility categories such as deemed providers, non-deemed suppliers, and nursing homes.
The manual also addresses specialized investigations, including those related to EMTALA violations, CLIA laboratory compliance, and hospital restraint/seclusion death reporting. Priority assignment systems are defined based on the severity of potential harm to patients.
The mission is to protect Medicare/Medicaid beneficiaries from abuse, neglect, exploitation, inadequate care or supervision.
Complaints alleging an immediate threat to the health, safety or welfare of individuals are investigated immediately.