Critical incident reporting

Abuse: The injury, confinement, control, intimidation, or punishment of an individual that has resulted in physical harm, pain, fear, or mental anguish. Abuse includes, but is not limited to, physical, emotional, psychological, verbal, and sexual abuse.

Behavioral support misuse: The use of unauthorized restraint, unauthorized restrictive intervention, or unauthorized seclusion.

Neglect: When there is a duty to do so, failing to provide an individual with any treatment, care goods, or services necessary to maintain the health or welfare of the individual.

Exploitation: The unlawful or improper act of using an individual’s resources through the use of manipulation, intimidation, threats, deception, or coercion for monetary or personal benefit, profit, or gain.

Misappropriation: The act of depriving, defrauding, or otherwise obtaining of any value the money or real or personal property (including prescribed medication) of an individual that could potentially impact their health and welfare of the individual.

Unnatural or accidental death: A death resulting from an accident or death that otherwise could not have been reasonably expected, including, but not limited to, death caused by abuse, neglect, suicide, medication error, and homicide.

Self-harm or suicide attempt: A physical attempt by an individual to harm themselves that results in emergency room treatment, inpatient observation, or hospital admission.

Medication error: any medication error that results in a consultation with a poison control center (including telephone calls), an emergency department or urgent care visit, hospitalization, or death involving:

• A medication prescribed to the individual.
• Any supplement, over-the-counter medication, or medication not prescribed to the individual.

Individual becomes lost or missing: The health and welfare of the individual are at risk due to the individual being lost or missing.

Natural deaths: Not due to events such as accidents, injuries, homicide, suicide, or overdoses.

Individual or family member behavior, action, or inaction that the creation of, or adjustment to, a health safety action plan (HSAP).

The health and welfare of the individual are at risk due to any of the following:

• Loss of the individual's paid or unpaid caregiver
• Prescribed medication issues not resulting in a consultation with a poison control center, a visit to an emergency department or urgent care, hospitalization, or death
• Eviction or housing crisis

Suicide attempt that does not result in emergency room treatment, inpatient observation, or hospital admission.

Unprofessional behavior or provider

• Failure to provide documentation
• Failure to comply with HIPAA or confidentiality
• Failure to maintain documentation

Failure to coordinate service delivery

• Failure to provide services as specified in PCSP
• Failure to notify when a service is not provided

Failure to report

• Failure to report an incident
• Failure to report a change in individual or services
• Failure to provide 30-day notice

Prohibited provider behavior

• Provider behaviors expressly prohibited
• Provider behaviors expressly prohibited while rendering services

Non-Medicaid fraud billing issue

Medicaid fraud