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Health and Safety Incident: An incident that poses an immediate threat to the welfare of the member up to an and including, loss of life, physical harm, and/or physical, sexual, psychological abuse or exploitation.
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Significant injuries related to seclusion or restraints, requiring urgent care or Emergency Room visit.
Injuries or emergency services occurring in a facility or Provider’s office that are unanticipated and require urgent care or Emergency Room visit.
Serious adverse reactions to treatment including medication errors that results result in the need for Emergency Room visitvisits.
Incident reports of sexual behaviors with other consumers, staff, or a third party whether consensual or not, that occur while in any treatment setting. (i.e. sexual contact of any type, sexual abuse, sexual assault, rape, attempted rape, touching, or indecent exposure).
Incident reports of physical/psychological abuse or neglect by staff or other consumers that jeopardizes jeopardize the life or health of consumers or could result in physical/psychological harm while receiving services in any treatment setting.
Unexpected death, occurring in any setting that is not related to the natural course of the patient’s medical illness or underlying condition.
Attempted suicide or attempted homicide occurring in any treatment setting
Major infectious disease occurrences or outbreaks in a facility -described as potentially communicable through common social or sexual contact, and poses a significant health risk if contracted i.e. diseases such as but not limited to TB, Hepatitis A, B, or C, or serious sexually transmitted diseases as tracked by the Center for Disease Control but which only need to be reported if there is a threat of transmission of the disease to staff or other residents.
Fire setting Firesetting or property damage that results in life-threatening danger to self or others..
Other occurrences representing actual serious harm to a member not listed above, e.g., staff misconduct, unexpected closure of a facility, environmental hazard, inadequate SE CCM follow-up. (Discretionary – the SE may contact an Oversight Team staff member to discuss any particular situation , if it is questionable).
For additional information please refer to the below Incident Reporting Regulations document:
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