The purpose of the Imminent Harm code review process is to address concerns around safety issues identified either internally or externally, that may warrant pre-service provision oversight. This oversight will prevent harm before it can occur, maximize safety, and allow opportunities for provider education to prevent future harm. Given that Vermont Medicaid members seeking care may continue to be referred to providers associated with an imminent harm concern, it is imperative the Department of Vermont Health Access review medical codes, including HCPS and CPT codes, to ensure the safety and well-being of its members.
Prior Authorization is required for all Medicaid members, ACO and Non-ACO attributed, for codes listed on the Imminent Harm Code List.
Imminent Harm: a situation in which an action causes, or is likely to cause, serious injury, harm, impairment, or death to a member. Imminent harm is not restricted to services that are committed but can also apply to services that are omitted. The harm that results does not need to occur within a certain time frame but may occur on a pathway that can predictably and within reason result in harm to the member. The risk of imminent harm can also be cumulative over time.
Prior Authorization is required for all Medicaid members, ACO and Non-ACO attributed, for codes listed on the Imminent Harm Code List.
Imminent Harm: a situation in which an action causes, or is likely to cause, serious injury, harm, impairment, or death to a member. Imminent harm is not restricted to services that are committed but can also apply to services that are omitted. The harm that results does not need to occur within a certain time frame but may occur on a pathway that can predictably and within reason result in harm to the member. The risk of imminent harm can also be cumulative over time.
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Imminent Harm List_4.xlsx
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