Commonwealth of Massachusetts
MassHealth
Provider Manual Series
Subchapter Number and Title
Appendix U: DPH-Designated Serious 
Reportable Events That Are Not 
Provider Preventable Conditions

Page
U-1
All Provider Manuals
Transmittal Letter
ALL-196
Date
10/01/12


DPH-Designated Serious Reportable Events That
Are Not Provider Preventable Conditions

Appendix U is applicable to the following MassHealth providers.

-	acute inpatient and acute outpatient hospitals  
	and hospital-licensed health centers (HLHCs)
-	acute inpatient and acute outpatient hospitals and 
	HLHCs billing for acute inpatient and acute 
	outpatient hospital-based physician services
-	privately owned chronic disease and 
	rehabilitation inpatient and outpatient hospitals
-	freestanding ambulatory surgery centers (FASCs)
-	state-owned non-acute inpatient and outpatient 
	hospitals operated by the Department of Public 
	Health (DPH)
-	substance abuse treatment inpatient and 
	outpatient hospital

The following events that are designated by the Massachusetts Department of Public Health (DPH) as 
“Serious Reportable Events (SREs)” in accordance with 105 CMR 130.332 (or 105 CMR 140.308, as 
applicable) are not considered “Provider Preventable Conditions” (PPCs) under MassHealth. These SREs 
shall be subject to applicable MassHealth provisions on “Serious Reportable Events” set forth, in the case of 
DPH-licensed hospital providers, in the hospital’s agreement with MassHealth governing payment for 
services, or in the case of freestanding ambulatory surgery centers, in Transmittal Letter FAS-25.

1.	Discharge or release of a patient/resident of any age, who is unable to make decisions, to other than 
	an authorized person
2.	Any incident in which systems designated for oxygen or other gas are delivered to a patient contain 
	no gas or the wrong gas or are contaminated by toxic substances
3.	Any instance of care ordered by or provided by someone impersonating a physician, nurse, 
	pharmacist, or other licensed health care provider
4.	Abduction of a patient/resident of any age
5.	Sexual abuse/assault on a patient or staff member within or on the grounds of the health care setting

NOTE:  The above list is subject to change.




Commonwealth of Massachusetts
MassHealth
Provider Manual Series
Subchapter Number and Title
Appendix U: DPH-Designated Serious 
Reportable Events That Are Not 
Provider Preventable Conditions

Page
U-2
All Provider Manuals
Transmittal Letter
ALL-196
Date
10/01/12






















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