Identifying and Responding to Member Incidents. The PO shall develop and maintain an incident management system, which manages incidents occurring at the member and provider levels, in order to assure member health and safety, reduce member incident risks, and enable development of strategies to prevent future incident occurrences. The incident management system shall include policies and procedures to ensure that: The PO IDT staff inform members/legal decision makers (and involved family and other unpaid caregivers, as appropriate) about abuse, neglect, and exploitation protections, at the initial assessment upon member enrollment or at the initial comprehensive assessment, and at each annual comprehensive assessment thereafter. Completion of this task shall be documented in the member record. PO members/legal decision makers (and involved family and other unpaid caregivers, as appropriate) are informed of the process used to report member incidents. PO staff and providers are trained in identifying, responding to, documenting, and reporting member incidents. Completion of training for PO staff shall be documentedand provided upon request to DHS. Completion of training for providers shall be documented in the PO’s provider file. Contracted providers must report member incidents to designated PO staff no later than one (1) business day after the incident was discovered; Effective steps are taken immediately to prevent further harm to or by the affected member(s); Incidents wherein the member is a victim of a potential violation of the law are reported to local law enforcement authorities. Incidents where the member is suspected of violating the law are reported to local law enforcement, to the extent required by law; Incidents meeting criteria in Wis. Stat. §§ 46.90(4) or 55.043(1m) are reported in accordance with the applicable statute to the appropriate authority; the PO is not responsible for or a substitute for Adult Protective Service investigations; The PO, within three (3) calendar days of learning of the incident, notifies the member/legal decision maker of the incident, unless the member/legal decision maker reported the incident to the PO, the PO has within that time determined that the report was unfounded or unsubstantiated, or unless the legal decision maker is a subject of the investigation; The PO has designated staff to conduct incident investigations who:
Identifying and Responding to Member Incidents a. The MCO shall develop and maintain an incident management system, which manages incidents occurring at the member and provider levels, in order to assure member health and safety, reduce member incident risks, and enable development of strategies to prevent future incident occurrences.
Identifying and Responding to Member Incidents. The MCO must develop and maintain an internal incident management system that manages incidents occurring at the member and provider levels, to ensure member health and safety, reduce member incident risks, and enable development of strategies to prevent future incident occurrences. This internal incident management system must integrate with the AIRS. Immediately, but not more than three (3) business days after discovering or learning of a member incident that meets the definition of a member incident type, the MCO must report a member incident to its DHS Member Care Quality Specialist through AIRS. The MCO must require its providers to report member incidents to designated MCO staff within one (1) business day after discovering or learning of a member incident that meets the definition of a member incident type. Member incidents that must be reported in AIRS include any of the following:
Identifying and Responding to Member Incidents a. The IHCP shall use the MCO’s incident management system, which manages incidents occurring at the member and provider levels, in order to assure member health and safety, reduce member incident risks, and enable development of strategies to prevent future incident occurrences.
Identifying and Responding to Member Incidents a. The PO shall develop and maintain an incident management system, which manages incidents occurring at the member and provider levels, in order to assure member health and safety, reduce member incident risks, and enable development of strategies to prevent future incident occurrences.
