Critical Incident Management System. The State Medicaid Agency or the MCO operates a critical incident management system according to the State Medicaid Agency’s established policies, procedures and regulations. On an ongoing basis the State Medicaid Agency ensures that all entities, including the MCOs, prevent, detect, report, investigate, and remediate instances of abuse, neglect and exploitation, and ensures participant rights are maintained through policies concerning seclusion, restraint, and medication management. MCOs, providers and participants are educated about this system initially at the start or at hire, and at least annually thereafter. MCO and provider obligations include specific action steps that MCOs and providers must take in the event of suspected or substantiated abuse, neglect or exploitation, including risk mitigation. If the State Medicaid Agency delegates the responsibility for the critical incident management systems to the participating MCOs, the State Medicaid Agency must collect and analyze the data collected by the MCOs on a regular, periodic basis, and ensure that individual situations are remediated in a timely manner and that system-wide issues are identified and addressed.
Critical Incident Management System. The Contractor shall establish a Critical Incident Management System consistent with all applicable laws and shall include policies and procedures for identification of incidents, reporting protocols, and oversight responsibilities. The Contractor shall increase intervention for an Enrollee when incident behavior escalates in severity or frequency. The Contractor shall designate a Critical Incident Manager responsible for administering the incident management system and ensuring compliance with the requirements of this section.
Critical Incident Management System. The state must operate a critical incident management system according to the state’s established policies, procedures and regulations (as described in Attachment D), including the requirement to report, document, and investigate incidents of abuse, neglect , and exploitation. The state must notify CMS of any changes to the policies, procedures and regulations. The MCO/state is required to analyze the critical incident data, track and trend, and make necessary changes in order to prevent reoccurrence.
