DSL Memo Series
2003-02
January 8, 2003
STATE OF WISCONSIN
Department of Health and Family Services
Division of Supportive Living
To:
Area Administrators/Assistant Area Administrators
Bureau Directors
County Departments of Community Programs Directors
County Departments of Developmental Disabilities Services Directors
County Departments of Human Services Directors
County Departments of Social Services Directors
Licensing Chiefs/Section Chiefs
Tribal Chairpersons/Human Services Facilitators
From:
Sinikka McCabe,
Administrator
Re: RESPONDING TO AND REPORTING CRITICAL INCIDENTS IN CIP 1A/B, CSLA
AND BRAIN INJURY WAIVERS
Document Summary
This memo defines the content and format for critical incident
reporting in BDDS-administered MA Waivers. It communicates the Division's
policy requiring County Agencies to report critical incidents, defines
these incidents and describes the way counties make these reports. This
policy will come into effect 30 days after the date of this memo but will
apply to all 2003 incidents.
The assurance of health, safety and welfare of program participants is
a condition of approval of all Medicaid (MA) Waivers by the federal
Centers for Medicare and Medicaid Services (CMS). County agencies are
required to address this pursuant to conditions in the state/county
contract and the Medicaid Waivers Manual. One of the ways both counties
and the Department assure health, safety and welfare in MA Waivers
administered by the Bureau of Developmental Disabilities Services (BDDS)
is by reporting, monitoring and resolving critical incidents. Since 1997,
Chapter 9, section 9.06 of the MA Waivers Manual has included an explicit
requirement for counties to report critical incidents involving
individuals served on waivers administered by BDDS to the regionally based
Community Integration Specialist (CIS). A standard definition of these
events or prescribed reporting format was not included in the Manual. This
has made it difficult to document the frequency and nature of all critical
incidents. CMS in their recent review of the Brain Injury Waiver program
recommended standardization of the reporting process in the format
supplied in this memo. This DSL memo contains a definition of critical
incidents and establishes a prescribed format for counties to use in
reporting these incidents.
The definitions used come from either statutes or administrative rules.
The reporting format in this memo has been in use for a number of years
with state staff completing the critical incident report based on verbal
and written communications with county staff. The original internal BDDS
system was developed with informal advice from a number of counties that
already had incident management systems in place. In fact, Winnebago
County's system was used as the model for the system described below.
CRITICAL INCIDENTS DEFINED
A "critical incident" is any actual or alleged event or
situation that creates a significant risk of substantial or serious harm
to the physical or mental health, safety, or well being of a waiver
participant. The critical incidents covered by this memo that must be
reported include:
Any death of a waiver participant including those by natural causes.
(This does not replace any other death reporting requirements); All suspected or confirmed suicide attempts by a waiver participant; A fire in the home or facility in which the participant lives or
where the participant was receiving services if the fire required the
response of a fire department and created a significant risk to the
participant’s health or safety; Significant damage to property including but not limited to the
property of the waiver participant, service providers, to the
participant’s residence, place of employment or other place the
participant frequents if such property damage poses or posed a threat
to the person’s health, safety or welfare. Includes damages that are
the result of acts of nature such as storms.
Use of isolation, seclusion, or restraint (physical or chemical) by
a service provider in violation of S. 51.61 WI Stats. , HFS 94.10
without county and the Department’s prior approval;
*County staff should take special note that reporting critical
incidents on this system does not eliminate any other reporting
requirements. All other required reporting procedures such as child abuse
or caregiver reporting or notifying BQA of possible code violations and
the timelines of these other required reporting systems remain in force
and are not replaced or superseded by this process.
APPLICATION
The subjects to whom this memo applies are Medicaid Waiver participants
with a developmental disability or acquired brain injury who participate
in one of the MA Waivers administered by the Bureau of Developmental
Disabilities Services (BDDS). Responsibility
for responding to such incidents is with the county agency operating the
Medicaid Waiver. Counties are encouraged to make the responsibility for
reporting and the procedures recommended in the attached instructions a
condition of their contracts or agreements with all service providers.
THE CRITICAL INCIDENT REPORTING AND RESPONSE PROCESS
Counties are expected to have an effective response process in which
county staff or their agents address and resolve the situations and
implement systems to decrease the likelihood of a recurrence. The report
documents the occurrence of the incident and describes the county’s
response by their staff or contract agencies. Reports must contain
accurate and timely information. BDDS will use the Critical Incident
Reports to identify statewide or regional trends, which will then allow
the development of interventions to decrease the likelihood of
reoccurrence.
The critical incident response process begins with local staff learning
of the situation. They determine what has occurred and determine the
response needed. Critical incidents that have been confirmed to have
occurred or exist as well as alleged critical incidents that have not yet
been determined to be founded or unfounded should be reported. If the
reported critical incident is determined to be unfounded the report will
be withdrawn. The response by county staff is intended to remove the
waiver participant from danger and resolve the situation to remove the
risk. The event and the response are to be reported to the assigned CIS
for the county within five days of learning of the event. Often these
reports initially are done by phone and might result in a collaborative
effort by state and local staff. Such efforts often attempt to
constructively resolve problem situations. State CIS serve as consultants,
often serve a liaison function with other units in the Department such as
the Bureau of Quality Assurance (BQA) or may get involved by assisting
with increased on-site monitoring of some situations. Critical incident
follow up may be completed in as short of time as a day or may involve a
number of corrective actions that may occur over a longer period of time.
The incident investigation may also lead to follow up monitoring by both
county and state staff and plans of correction for the county or the
provider involved.
THE CRITICAL INCIDENT REPORT (CIR)
Reportable incidents must be reported using the prescribed format
provided in this memo. The attached Critical Incident Report must be sent
to the Bureau of Developmental Disabilities Services’ Central Office
within five working days of the county learning of the situation. For
active and urgent situations, County staff should also report the incident
by phone to their assigned CIS. (Phone numbers are in the Medicaid Waivers
Manual, Appendix L.) County staff may also make other arrangements with
the CIS concerning the due date for submission of the form. Additional
reporting concerning the progress and disposition of the event that occurs
after initial reports shall be done in a timely way. All CIRs must include
information necessary for BDDS to close the incident record.
Reports shall be mailed or faxed to:
Critical Incident Report Contact
Waiver Program Assistant
Bureau of Development Disabilities Services
P. O. Box 7851
Madison, WI 53708
FAX (608) 261-6752
County staff are strongly encouraged to report serious and active
incidents to their CIS by phone immediately on learning of the situation.
Department staff must often respond to inquiries from police, legislators,
advocacy organizations, the press and others. Accurate and up to date
information helps us assure these groups that events are being handled
appropriately. In serious and active situations, make sure you talk to
someone from BDDS in person and not just leave a message on
someone's voice mail. The first point of contact is the county assigned
CIS. If the CIS is not available, please call the central phone number at
BDDS 608-266-0805 and ask to speak with a manager.
The paper form is attached to this memo. In the future, the form will
be available in a format that counties can use with word processing
programs. It is also our intent to expand the use of data collected on
this form to further analyze the nature and extent of CIRs to identify
patterns. Specifically, we hope to identify trends and clusters of
critical incidents including providers with persistent incidents to make
adjustments and improvements as needed. The results of such efforts will
be shared with counties to assist future state and local quality
improvement efforts. It is our hope and belief that this process will
improve the quality of care in our Medicaid Waiver programs.
IMPLEMENTATION
Counties are required to implement the requirements of this memo as
quickly as possible. Counties have a 90-day implementation period from the
date of this memo to work out the procedures and inform affected providers
and staff. All critical incidents that occur on or after January 1, 2003
shall be reported. This will permit the department to have and analyze a
full years worth of data. Since critical incident reporting was previously
required by Chapter 9 of the Medicaid Waivers Manual, and this new
requirement including the form and instructions will be added to Chapter 9
of the revised Manual.
We ask and thank you for your cooperation in this effort.
REGIONAL OFFICE CONTACT:
Community Integration Specialist
CENTRAL OFFICE CONTACT:
Ken Golden
DSL/BDDS
(608) 266-1520
Attachments:
Instructions
for Completing Critical Incident Reports
DDE-2558 (PDF)
Return
to Numbered Memos Index
|
