Critical Incident Management. The CONTRACTOR shall adhere to all State requirements for Critical Incident management and reporting as defined in NMAC 8.308.21.13. The CONTRACTOR shall develop policies and procedures to address and respond to incidents, report incidents to the appropriate entities per required time frames, and track and analyze incidents. The CONTRACTOR shall use this information to identify trends and patterns both case-specific and systemic, identify opportunities for improvement, and develop and implement appropriate strategies to reduce the occurrence of incidents and improve the quality of care. The CONTRACTOR shall use this information and the data to conduct an annual evaluation of its Critical Incident management system. The CONTRACTOR shall include the results of its evaluation as part of the CONTRACTOR's QM/QI work plan submitted to HCA as outlined in Section 4.12.2.9 of this Agreement. The CONTRACTOR shall require its staff and Contract Providers to complete a reassessment of risk and update the CCP to address potential gaps in the Member’s care, to mitigate assessed risks and to prevent occurrence of further incidents. The CONTRACTOR shall have policies to address and respond to new PCS authorizations. The CONTRACTOR shall be responsible to verify Contract Providers have sufficient staff to provide services, assure Contract Providers assigned have initiated care and initiate procedures in place when services have not begun within five (5) calendar days. The CONTRACTOR shall require its staff and Contract Providers to collaborate with any investigation conducted by the CONTRACTOR or outside agencies (e.g., HCA, the Collaborative, the DOH, CYFD, APS, and law enforcement). The CONTRACTOR shall also require its staff and Contract Providers to report, respond to, and document Critical Incidents and the resulting follow-up activities, as specified by the CONTRACTOR. The CONTRACTOR shall require its staff and Contract Providers to document the initiated action(s) and all follow-up activities related to the intervention(s) implemented as a result of the incident and enter the information into the HCA Critical Incident Reporting Portal until the established intervention(s) demonstrate the Member’s health, safety, and welfare are no longer issues of concern. Follow-up action(s) include actions taken as a result of reviewing a Critical Incident that: Require investigation or intervention for issues of health and safety; Include a referral request for additional informa...
Critical Incident Management. 1. The SE shall develop and implement a statewide critical incident management system that identifies and tracks critical incidents, corrects case-specific issues, and addresses identified systems’ issues that place consumers at risk.
Critical Incident Management. The CONTRACTOR shall adhere to all State requirements for Critical Incident management and reporting. The CONTRACTOR shall develop policies and procedures to address and respond to incidents, report incidents to the appropriate entities per required time frames, and track and analyze incidents. The CONTRACTOR shall use this information to identify trends and patterns both case-specific and systemic, identify opportunities for improvement, and develop and implement appropriate strategies to reduce the occurrence of incidents and improve the quality of care. The CONTRACTOR shall use this information and the data to conduct an annual evaluation of its Critical Incident management system. The CONTRACTOR shall include the results of its evaluation as part of the CONTRACTOR's QM/QI work plan submitted to HSD as outlined in Section 4.12.2.9 of this Agreement. The CONTRACTOR shall require its staff and Contract Providers to complete a reassessment of risk and update the CCP to mitigate assessed risks and to prevent occurrence of further incidents. The CONTRACTOR shall require its staff and Contract Providers to collaborate with any investigation conducted by the CONTRACTOR or outside agencies (e.g., HSD, the Collaborative, the DOH, CYFD, Adult PS, and law enforcement). The CONTRACTOR shall also require its staff and Contract Providers to report, respond to, and document Critical Incidents and the resulting follow-up activities, as specified by the CONTRACTOR. The CONTRACTOR shall require its staff and Contract Providers to document the initiated action(s) and all follow-up activities related to the intervention(s) implemented as a result of the incident and enter the information into the HSD Critical Incident Reporting Portal until the established intervention(s) demonstrate the Member’s health, safety, and welfare are no longer issues of concern. Follow-up action(s) include actions taken as a result of reviewing a Critical Incident that: Require investigation or intervention for issues of health and safety; Include a referral request for additional information to internal or external staff or agencies; and Include any change in the CONTRACTOR’s activities, including but not limited to a Care Coordination visit, a Care Coordination investigation, an intervention, and/or a reassessment or change in CCP. The CONTRACTOR shall provide appropriate training and take corrective action as needed to ensure Provider compliance with Critical Incident requirements. The CONTRA...
