The following words and terms, when used in this subchapter,
shall have the following meanings, unless the context clearly indicates
otherwise.
(1) Present on Admission--Present at the time the order
for inpatient admission occurs. Conditions that develop during an
outpatient encounter, including emergency department, observation,
or outpatient surgery, are considered present on admission.
(2) Preventable Adverse Event--A serious, clearly identifiable
and measurable error in medical care that is of concern to both the
public and health care professionals and providers. The Health and
Human Services Commission (HHSC) will determine Medicaid preventable
adverse events, which may include the following:
(A) a health care-associated adverse condition or event
for which the Medicare program will not provide additional payment
under a policy adopted by the federal Centers for Medicare and Medicaid
Services, which may be referred to as a hospital acquired condition,
hospital acquired infection, never event, or National Coverage Determination
(NCD).
(B) any other preventable adverse event that causes
patient death or serious disability in a health care setting, including
an event on the list of adverse events identified by the National
Quality Forum.
(3) Potentially Preventable Event--One of, or any combination
of, the following events:
(A) Potentially Preventable Admission--An admission
of a person to a hospital or long-term care facility that may reasonably
have been prevented with adequate access to ambulatory care or health
care coordination.
(B) Potentially Preventable Ancillary Service--A health
care service provided or ordered by a physician or other health care
provider to supplement or support the evaluation or treatment of a
patient, including a diagnostic test, laboratory test, therapy service,
or radiology service, that may not reasonably be necessary for the
provision of quality health care or treatment.
(C) Potentially Preventable Complication--A harmful
event or negative outcome with respect to a person, including an infection
or surgical complication, that:
(i) occurs after the person's admission to a hospital
or long-term care facility; and
(ii) may have resulted from the care, lack of care,
or treatment provided during the hospital or long-term care facility
stay rather than from a natural progression of an underlying disease.
(D) Potentially Preventable Emergency Room Visit--Treatment
of a person in a hospital emergency room or freestanding emergency
medical care facility for a condition that could be, or could have
been, treated or prevented by a physician or other health care provider
in a nonemergency setting.
(E) Potentially Preventable Readmission--A return hospitalization
of a person within a period specified by HHSC that results from deficiencies
in the care or treatment provided to the person during a previous
hospital stay or from deficiencies in post-hospital discharge follow-up.
The term does not include a hospital readmission necessitated by the
occurrence of unrelated events after the discharge. The term includes
the readmission of a person to a hospital for:
(i) the same condition or procedure for which the person
was previously admitted;
(ii) an infection or other complication resulting from
care previously provided;
(iii) a condition or procedure that indicates that
a surgical intervention performed during a previous admission was
unsuccessful in achieving the anticipated outcome; or
(iv) another condition or procedure of a similar nature,
as determined by HHSC.
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