NY Manual
SHP Manual

New York Provider Manual
5.5 Disclosure Restrictions for Services Paid Out-of-Pocket | 6.1 Responsibilities of a Primary Care Provider (PCP)

5.6 Critical Incident Reporting

Effective Date: November 1, 2012

Pursuant to Special Terms & Conditions, #28, c) ii), the State, through its contracts with MCOs, shall ensure that a system is in place to identify, address, and seek to prevent instances of abuse, neglect, and exploitation of its enrollees on a continuous basis. This includes critical incident monitoring and reporting to the State and investigations of incidents.

General Definition—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 Nursing Home, LTSS, Home Health, Adult Home, and Home- and Community-Based Service participant.  

Reportable Critical Incidents Defined

·     Abuse
·     Neglect
·     Mistreatment
·     Injuries of unknown origin
·     Sexual abuse
·     Verbal abuse
·     Misappropriation of resident property has occurred
·     Medication error/drug diversion
·     Burns
·     Attempted suicide or death related to suicide, restraints, equipment
·     CPR concerns
·     Accidents related to choking or equipment hazard; resident found in nonresident area 
·     Elopement from building
·     Physical environment

Critical Incident Management and Reporting: Provider Responsibilities 

As a participating Healthfirst provider, you will be required to report all allegations of abuse, neglect, and exploitation of a member, as defined in the Critical Incident Manual. Take immediate action to assure the member is protected from further harm and respond to emergency needs of the member. 

Who is supposed to report a critical incident? Facility/staff member who becomes aware of a critical incident as defined on this form. Qualified Service Providers that are enrolled with the Department of Human Services, Transition Coordinators, and Case Managers are required to report incidents.

Incident Reporting Procedure 

How do you report a critical incident? Complete the Critical Incident Report form on the HCS Internet Portal https://commerce.health.state.ny.us within 24 hours of knowledge of the incident, any day of the week or time of day.

Using your username and password, log on to the HCS Internet Portal and proceed to the Nursing Home Surveillance and Reporting System to enter information on the electronic Incident Form. Instructions for the Incident Form can be found either by clicking on the Instruction link found on the left-hand side of the form, or through the Instruction link found within the Dear Administrator Letter section.

The Incident Reporting Line phone number, 1-888-201-4563, may be used in case of an emergency such as loss of Internet or computer service. If circumstances dictate reporting via the hotline, that contact will be sufficient and there will be no need to report online. If a provider continues to report via the hotline, they will be redirected to the website. 

PLEASE NOTE:

For purposes of facility reported incidents, long-term care facilities must report abuse, neglect, and misappropriation within 24 hours after the reasonable cause threshold is concluded.  All other reportable incidents are to be communicated to the NYSDOH by the next business day.

Detailed information and general Q&A on critical incident reporting can be found in the New York State Department of Health Nursing Home Incident Reporting Manual