DRAFT

Crosswalk of Incident Reporting
NHTD, TBI, MLTC Partial Capitation, and MMC

• Crosswalk is also available in Portable Document Format (PDF)

	NHTD	TBI	MLTC Partial Capitation	MMC
Serious Reportable Incidents, Recordable Incidents, and Critical Incidents	Serious Reportable Incidents (SRI) are defined as any situation in which the participant experiences a perceived or actual threat to his/her health and welfare or to his/her ability to remain in the community. There are 10 SRI classifications, including abuse (which has 7 subcategories), neglect, unplanned hospitalization, and death. These incidents must be reported to DOH through the RRDS assigned to that region using the process outlined in Section X of the Program Manual; they must also be reviewed by the provider´s Serious Incident Review Committee, also outlined in Section X. Some of these incidents must also be reported to Adult Protective Services and/or the police. Recordable Incidents are defined as incidents that do not meet the level of severity described as SRI, but which adversely affects the participant´s life in the community. An example of these incidents is a fall that does not require medical attention. These Recordable Incidents do not need to be reported to DOH. However, Recordable Incidents must be investigated by the provider and included in the annual report prepared by the Serious Incident Review Committee provided to RRDS. DOH waiver staff reserve the right to review Recordable Incidents at any time. (NHTD Program Manual – Section X)	Serious Reportable Incidents are defined as any situation in which the participant experiences a perceived or actual threat to his/her health and welfare or to his/her ability to remain in the community. There are 9 SRI classifications, including abuse (which has 9 subcategories), neglect, unplanned hospitalization, and death. These incidents must be reported to DOH via the appropriate RRDS using the process outlined in Section X of the Program Manual; they must also be reviewed by the provider´s Serious Incident Review Committee, also outlined in Section X. Some of these incidents must also be reported to Adult Protective Services and the police. Recordable Incidents are defined as incidents that do not meet the level of severity as described as SRI, but which impact the participant´s life in the community. An example of these incidents is a fall that does not require medical attention. These Recordable Incidents do not need to be reported to DOH. However, DOH reserves the right to review these incidents at any time. (TBI Program Manual – Section X)	1. The Contractor must have policies and procedures for identifying, addressing and seeking to prevent critical incidents, which include instances of abuse, neglect and exploitation of its Enrollees, on a continuous basis. The Contractor is required to provide critical incident monitoring and investigations of critical incidents including but not limited to: a. wrongful death; b. use of restraints; c. medication errors that resulted in injury; and d. any other incidents as determined by the Department. 2. The Contractor must submit critical incident reports to the Department regarding Enrollee health and welfare pursuant to Article VIII of this Contract. (MLTC Partial Model Contract – Article V)	The Contractor must have effective mechanisms to identify, address and seek to prevent instances of abuse, neglect and exploitation of its Enrollees in receipt of Long Term Services and Supports on a continuous basis. Such mechanisms will include, at a minimum: i) A process to include information in education materials distributed to Enrollees and providers to enable reporting of such instances to the Contractor or providing available community resources for Enrollee assistance; ii) provisions in subcontracts to ensure providers of long term services and supports comply with State requirements for worker criminal background checks; iii) identification of critical incidents, including but not limited to: wrongful death, restraints, and medication errors resulting in injury, which are brought to the Contractor´s attention, and subsequent investigation or referral of the incidents to oversight agencies; and iv) reporting critical incidents to SDOH as provided by Section 18.5(a)(vi)(D) of this Agreement. (Medicaid Managed Care Model Contract – Section 10)