O. State Medicaid Agency Categories in this section are for complaints about Medicaid coverage, benefits and services. 111. Access to information, application Use if information is denied or delayed to resident or legal representative; case worker is unavailable, or unresponsive to requests for information or application status. 112. Denial of eligibility Use for complaint that resident is denied Medicaid. 113. Non-covered services Use for complaints about services not covered by Medicaid. 114. Personal Needs Allowance Use for complaints about the insufficiency of the personal needs allowance. 115. Services Use for complaints about the quality or quantity of services covered by Medicaid or difficulty in obtaining services. (Use 113 for non-covered services.) 116. Not Used P. System/Others Use appropriate categories in this section to document the range of complaints against or involving individuals who are not managers/staff of facilities * or of the State=s licensing and certification or Medicaid agency. (*except for 119, as specified) 117. Abuse/neglect/abandonment by family member/friend/guardian or, while on visit out of facility, any other person Use for by individuals other than facility staff, when the facility could not reasonably have been expected to observe the acts. Use A.1 or other A categories when the facility should have overseen and acted. 118. Bed shortage - placement Use when resident is unable to find a facility placement, or for a bed shortage.
O. State Medicaid Agency Categories in this section are for complaints about Medicaid coverage, benefits and services. 111. Access to information, application Use if information is denied or delayed to resident or legal representative; case worker is unavailable, or unresponsive to requests for information or application status. 112. Denial of eligibility Use for complaint that resident is denied Medicaid. 113. Non-covered services Use for complaints about services not covered by Medicaid. 114. Personal Needs Allowance Use for complaints about the insufficiency of the personal needs allowance. 115. Services Use for complaints about the quality or quantity of services covered by Medicaid or difficulty in obtaining services. (Use 113 for non-covered services.) 116. Not Used P. System/Others Use appropriate categories in this section to document the range of complaints against or involving individuals who are not managers/staff of facilities * or of the State=s licensing and certification or Medicaid agency. (*except for 119, as specified) 117. Abuse/neglect/abandonment by family member/friend/guardian or, while on visit out of facility, any other person Use for by individuals other than facility staff, when the facility could not reasonably have been expected to observe the acts. Use A.1 or other A categories when the facility should have overseen and acted. 118. Bed shortage - placement Use when resident is unable to find a facility placement, or for a bed shortage.
Complaint_Code2015_1.docx