Okla. Admin. Code § 317:35-17-27 - Incident reporting
(a)
Reporting requirement. Certified ADvantage provider staff should
report critical and non-critical incidents involving the health and welfare of
ADvantage Waiver members to the Oklahoma Human Services Medicaid Services Unit
(MSU).
(b)
Critical
incidents. Critical incidents are events with potential to cause
significant risk or serious harm to an ADvantage member's safety or well-being.
Critical Incidents Reports (CIR) are completed for:
(1) Suspected maltreatment including abuse,
neglect, or exploitation, per Section 10-103 of Title 43A of the Oklahoma
Statutes (43A O.S. § 10-103);
(2) Attempted suicide or suicidal ideation
exhibition;
(3) Unexpected or
questionable death;
(4) Falls or
injuries requiring medical attention;
(5) Residence loss due to disaster;
(6) An interruption of needed medical
supports;
(7) Lost or missing
members;
(8) A medication error
requiring medical attention;
(9)
Use of physical restraints; or
(10)
Allegations related to Personal Care Assistant (PCA) or Personal Service
Assistant (PSA).
(c)
Non-critical incidents. Non-critical incidents are events with
potential to cause risk to an ADvantage member's safety and well-being, but do
not rise to the critical incident level. Non-critical incidents include:
(1) Falls or injuries that do not require
medical attention;
(2) Theft
allegations;
(3) Threatening or
inappropriate behavior;
(4)
Substance abuse or use;
(5) Serious
allegations related to a provider agency; and
(6) Law enforcement involvement due to
challenging behaviors.
(d)
Incident notification
requirements. The reporting provider documents and submits to MSU
incidents included in (b) and (c) of this Section in the electronic system on
the CIR document, within one business day of becoming aware of the incident.
The reporting provider notifies other persons or entities as required by law or
regulation, including:
(1) When a service
recipient dies, per OAC
340:100-3-35;
and
(2) Investigative authorities
immediately in cases of suspected maltreatment, as applicable, including:
(A) Local law enforcement;
(B) The Office of Client Advocacy when the
alleged perpetrator is a community service worker, per OAC
340:2-3-33;
and
(C) Adult Protective Services
when the alleged perpetrator is not a community service worker per 43A O.S.
§ 10-104.
(e)
Internal Investigation. The
provider completes an internal investigation of all critical incidents, unless
directed otherwise by an authorized government entity.
(1) All provider investigative reports are
submitted to the MSU within ten (10) working days after the initial CIR is
completed.
(2) The provider
coordinates internal critical incident investigation and response efforts with
governmental investigative authorities as required by law.
(3) Provider supervisory staff run a monthly
report from the electronic system to review all critical incidents submitted to
the MSU. Doing so ensures proper handling and dispensation occurs, as required
by the Centers for Medicare and Medicaid Services.
(f)
Escalated issues. The
Escalated Issues (EI) team reviews all CIR and determines whether the
appropriate response occurred. EI coordinates their investigation and response
efforts with governmental investigative authorities as required by law. For
non-critical incident reports, EI reviews and works with the member, the
member's informal support, provider, and others to verify appropriate actions
are taken to identify barriers to service, prevent future incidents, and assure
continued member health and welfare. Investigation results are communicated to
the member, legal guardian, or next of kin as appropriate.
(g)
Members and their
representatives. Upon entry into the program and at least annually, each
member is provided with resources and contact information to self-report
complaints, abuse, neglect, exploitation, or other issues.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
(a) Reporting requirement. Certified ADvantage provider staff should report critical and non-critical incidents involving the health and welfare of ADvantage Waiver members to the Oklahoma Human Services Medicaid Services Unit (MSU).
(b) Critical incidents. Critical incidents are events with potential to cause significant risk or serious harm to an ADvantage member's safety or well-being. Critical Incidents Reports (CIR) are completed for:
(1) Suspected maltreatment including abuse, neglect, or exploitation, per Section 10-103 of Title 43A of the Oklahoma Statutes (43A O.S. § 10-103);
(2) Attempted suicide or suicidal ideation exhibition;
(3) Unexpected or questionable death;
(4) Falls or injuries requiring medical attention;
(5) Residence loss due to disaster;
(6) An interruption of needed medical supports;
(7) Lost or missing members;
(8) A medication error requiring medical attention;
(9) Use of physical restraints; or
(10) Allegations related to Personal Care Assistant (PCA) or Personal Service Assistant (PSA).
(c) Non-critical incidents. Non-critical incidents are events with potential to cause risk to an ADvantage member's safety and well-being, but do not rise to the critical incident level. Non-critical incidents include:
(1) Falls or injuries that do not require medical attention;
(2) Theft allegations;
(3) Threatening or inappropriate behavior;
(4) Substance abuse or use;
(5) Serious allegations related to a provider agency; and
(6) Law enforcement involvement due to challenging behaviors.
(d) Incident notification requirements. The reporting provider documents and submits to MSU incidents included in (b) and (c) of this Section in the electronic system on the CIR document, within one business day of becoming aware of the incident. The reporting provider notifies other persons or entities as required by law or regulation, including:
(1) When a service recipient dies, per OAC 340:100-3-35; and
(2) Investigative authorities immediately in cases of suspected maltreatment, as applicable, including:
(A) Local law enforcement;
(B) The Office of Client Advocacy when the alleged perpetrator is a community service worker , per OAC 340:2-3-33; and
(C) Adult Protective Services when the alleged perpetrator is not a community service worker per 43A O.S. § 10-104.
(e) Internal Investigation. The provider completes an internal investigation of all critical incidents, unless directed otherwise by an authorized government entity.
(1) All provider investigative reports are submitted to the MSU within ten (10) working days after the initial CIR is completed.
(2) The provider coordinates internal critical incident investigation and response efforts with governmental investigative authorities as required by law.
(3) Provider supervisory staff run a monthly report from the electronic system to review all critical incidents submitted to the MSU. Doing so ensures proper handling and dispensation occurs, as required by the Centers for Medicare and Medicaid Services.
(f) Escalated issues. The Escalated Issues (EI) team reviews all CIR and determines whether the appropriate response occurred. EI coordinates their investigation and response efforts with governmental investigative authorities as required by law. For non-critical incident reports, EI reviews and works with the member, the member's informal support, provider, and others to verify appropriate actions are taken to identify barriers to service, prevent future incidents, and assure continued member health and welfare. Investigation results are communicated to the member, legal guardian, or next of kin as appropriate.
(g) Members and their representatives. Upon entry into the program and at least annually, each member is provided with resources and contact information to self-report complaints, abuse, neglect, exploitation, or other issues.