Rule 511-7-1-.08 - ContractsA Health Care Provider must execute a Contract with the Department prior to delivering Health Care to Patients which shall include, but not be limited to, the following provisions:
(1) Access to Records. As governed by applicable state and federal laws, the Health Care Providers shall make all Patient Records and other documents related to the Health Care provided under the Program available to the Department and state and/or federal entities that are legally entitled to request and examine them.(2) Termination. The Department is authorized to terminate the Health Care Provider from participating in the Program for the following reasons: (a) Failure of the Health Care Provider to perform responsibilities identified in the Contract within a time period prescribed by DPH after receipt of written notice of default by DPH.(b) Convenience of DPH or the Health Care Provider, upon thirty (30) calendar days notice.(c) The performance of an Experimental/Clinically Unproven procedure.(d) Health Care Provider's failure to be deemed acceptable under a credentialing process wherein the termination shall be immediate.(e) Suspension, probation, conditional restriction, debarment, or revocation of any license, certificate, or permit required for the Health Care Provider to perform the full scope of services pursuant to the terms and conditions of this Agreement.(f) A determination by the appropriate department, agency, or board that the Health Care Provider has failed to provide Health Care in accordance with applicable standards of care.(g) The amendment or repeal of O.C.G.A. 31-8-190et seq. wherein the Health Care Provider is not considered a state officer or employee for purposes of Article 2 of Chapter 21 of Title 50 of the Official Code of Georgia Annotated. If termination occurs as a result of a reason set forth in subsection (2)(e) or (f), the Department remay in its discretion reinstate the Health Care Provider if the determination upon which the termination is based is reversed.
(3) Adverse Incidents. (a) Health Care Providers must report to the Department within twenty-four hours of such occurrence following the Adverse Incidents: 1. Any unanticipated Patient death not related to the natural course of the Patient's illness or underlying condition;2. A rape, as defined pursuant to O.C.G.A. § 16-6-1, that occurs on the premise at which the Health Care is provided;3. Any surgery on the wrong Patient or on the wrong body part of the Patient;4. Any Patient injury which is unrelated to the Patient's illness or underlying condition and results in a permanent loss of limb or function;5. Second or third degree burns involving twenty percent or more of the body surface of an adult patient or fifteen percent or more of the body surface of a child which burns were acquired by the Patient while in the care of the Health Care Provider;6. Serious injury to a Patient resulting from the malfunction or intentional or accidental misuse of patient care equipment;7. Any assault, committed pursuant to O.C.G.A. § 16-5-21et seq. or any other applicable law, on a Patient, which results in an injury requiring treatment;8. Discharge of an infant to the wrong family;9. Any circumstances involving a patient under observation who cannot be located where circumstances reasonably indicate that the health, safety, or welfare of the Patient or others are at risk and the Patient has been missing for more than eight hours; and10. To the extent that the Health Care Provider determines that the following events caused a significant disruption to a Patient's care, labor strikes, walk-outs or sick-outs, or interruption of service. The Adverse Incidents set forth in this Paragraph are not intended to be an exhaustive list.
(b) The Department shall report adverse incidents provided in subsection (3)(a) of this Rule to the appropriate department, agency, or board for further action. Notwithstanding, the Department may conduct its own investigation and terminate the Health Care Provider if the Department deems such action necessary and appropriate.(4) Patient Number Modifications. The Department and a Health Care Provider may mutually agree in writing to modify the number of Patients referred to the Health Care Provider.Ga. Comp. R. & Regs. R. 511-7-1-.08
O.C.G.A. Secs. 31-2A-6, 31-8-200.
Original Rule entitled "Contracts" adopted. F. Sep. 20, 2013; eff. Oct. 10, 2013.