CHOICES Critical Incident Reporting Form Training July 2017 TNPEC-2021-17 November 2017
Training Topics Quick review of Critical Incidents What is a Critical Incident? Immediate Actions to be Performed APS Reporting Abuse, Neglect & Exploitation Provider APS Training Requirements Updated Critical Incident Reporting Form Why did the form change? Review of Form Sections Critical Incident Reporting Timeframes Critical Incident Contact Information 2
Quick review of CHOICES Critical Incidents 3
What is a Critical Incident? 1. Incident that occurs in a home and community based long term service and support setting or 2. Occurs during the provision of covered CHOICES HCBS or 3. Any incident is discovered or witnessed by the MCO, the provider or FEA staff and 4. Meets CRA criteria to be a Critical Incident Any unexpected death regardless of whether the death occurs during the provision of HCBS Suspected physical or mental abuse Theft Financial exploitation Severe Injury Medication Error Sexual abuse and/or suspected sexual abuse Abuse and neglect and/or suspected abuse or neglect Any incident reported to APS 4
Immediate Actions to be Performed Perform the following any time a critical incident or possible critical incident occurs and submit the critical incident to the MCO: Emergency Medical Services Obtain assistance if indicated. Law Enforcement Contact if indicated (member can refuse). Alternate Placement May be offered to the member or placement in a higher level of care. Alternate Care Ensure a new worker has been assigned or that member s back up plan has been initiated. Drug Screen If medication theft, a drug screen should be performed within 24 hours of discovery for the medication in question. 5
APS Reporting-Abuse, Neglect & Exploitation All suspected incidents of abuse, neglect or exploitation of an adult must be reported to Adult Protective Services immediately (always within 24 hours): Phone: 1-888-277-8366 or Fax to 1-866-294-3961 All reports of abuse or neglect of a child must be reported to Child Protective Services at: Phone 1-877-237-0004 If member is in Imminent Danger: Involve Law Enforcement and/or EMS immediately; Use the words Imminent Danger when notifying APS or CPS when applicable. When reports conflict regarding a suspected abuse, neglect, or exploitation report, always err on the side of caution and make a report to APS or CPS. APS and CPS will evaluate each report and is responsible for making decisions. 6
Providers-APS Training Requirements Training should be completed with all staff members. Training should include: All persons are required to report suspected abuse, neglect, or exploitation to the State of Tennessee. Any incident reported to APS must be reported to CHOICES Quality as a critical incident. As a reminder, APS requires reporting of abuse, neglect and exploitation. Failure to report may result in a misdemeanor charge. APS/CPS reporting timeframe is 24 hours from first discovery. Reports to APS/CPS should be made, even if the member and/or family member requests report not be made. Education for workers on what to expect once a report is made should be clearly defined. Fear of job loss and investigation by authorities may be a deterrent for reporting if expectations are not clearly communicated. 7
Critical Incident Reporting Timeframes Initial reporting of a Critical Incident is required as soon as possible to the Health Plan no later than 24 hours of discovery. Notify Health Plan of Critical Incident via telephone or via Critical Incident Report form (BlueCare and Amerigroup Community Care only, UnitedHealthcare must be contacted via phone). Providers are required to submit a written report using the Critical Incident Form. Written reporting is required within 48 hours of discovery of the incident. 24 or 48 Hour Written Report must include full completion sections A-J of the Critical Incident Report Form. Providers must complete a thorough investigation and submit a 20 day written report using Critical Incident Reporting Form. Reminder: Reporting timeframe is calendar days, not business days 8
Updated Critical Incident Reporting Form 9
Why did the form change? Consistency across all MCOs User Friendly 10
Which report is being submitted? Select one of the following: 24 Hour Notification 48 Hour Written Report Provider or 20 Day follow-up Report 11
Select the member s MCO Select the member s MCO. Please note the contact information for each MCO 12
Section A-Member Information Enter the member information 13
Section B-Reporting Incident Information List the information of the person reporting the critical incident 14
Section C-HCBS Servicing Provider Information List the HCBS Servicing provider information 15
Section D-Critical Incident Timelines The time zone selected should be the same time zone the critical incident occurred in. 16
Section E-Critical Incident Type Select the appropriate type of critical incident. 17
Section F-Critical Incident Setting/Location Select the appropriate setting/location of the critical incident. 18
Section G-Critical Incident Notification Select the entities notified regarding the critical incident and enter the date and time of notification. 19
Section H-HCBS Worker Initial Information Enter information regarding the HCBS Worker involved in the critical incident. 20
Section I-Details of the Critical Incident and Section J Immediate Actions Taken Enter the details of the critical incident. Enter all immediate actions taken. Ensure supporting documentation is attached as applicable. 21
Section K 20 Day Follow-up The 20 day follow-up report of provider investigation, findings and conclusion of the investigation is due 20 days from the discovery date of the incident. Please include any applicable statements from the worker involved in the incident, the CHOICES member, the member s representative or their family. The 20 day follow-up report should include the details involving replacement workers or if the worker involved in the incident has been reassigned. The following should be included in Section K: Member Investigative Findings 22
Section K 20 Day Follow-up-Continued HCBS Worker Investigative Findings 23
Section K 20 Day Follow-up-Continued Corrective Actions, Investigative Findings and Conclusion 24
24 Hour Verbal Report Phone: 1-888-747-8955 24 Hour Written Report to: Fax: 1-855-292-3715 BlueCare Contact Information Email: CHOICES_CI@bcbst.com 48 Hour Written Report and 20 day follow-up report to: CHOICESQuality@bcbst.com 25
United Health Care Contact Information 24 Hour Verbal Report Phone: East TN: Bonnie Creel (877) 534 4270 Middle TN: Davine Brasher (615) 335 0688 West TN: Jennifer Travis (877) 714 0382 48 Hour Written Report and 20 Day Follow-up report to: Fax: 866-497-7780 Email: tn_quality_review@uhc.com 26
Amerigroup Contact Information 24 Hour Verbal Report Phone: 1-866-840-4991 24 Hour Written Report to: Fax: 1-877-423-9976 Email: TN02criticalincident@amerigroup.com 48 Hour Written and 20 day follow-up report to: TN02criticalincident@amerigroup.com 27
Questions? 28