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Critical Incidents

WellCare will provide training for all Providers on Critical Incidents and will offer periodic updates to training to ensure Providers are fully aware of how they should respond to these occurrences. 

A critical incident is a distressing, traumatic event which can occur in a Nursing Facility or Skilled Care Nursing Facility (NF/SCNF) or home and community-based long-term care service (HCBS) delivery setting, community alternative residential settings, adult day care centers, other HCBS Provider sites, and a Member’s home. Events are defined as, but are not limited to; the following categories:

  • Major Incident – an occurrence involving a consumer during service provision that:
    • Results in a physical injury to or by the Member that requires a physician’s treatment or admission to a hospital
    • Results in the death of any person
    • Requires emergency mental health treatment for the consumer
    • Requires the intervention of law enforcement
    • Requires a report of child abuse pursuant to Iowa Code section 232.69 or a report of dependent adult abuse pursuant to Iowa Code section 235B.3
    • Constitutes a prescription medication error or a pattern of medication efforts
    • Involves a Member’s location being unknown by Provider staff who are assigned protective oversight

WellCare will require its staff members and contracted providers to report, respond to, and document critical incidents as specified by WellCare. WellCare’s staff and contracted providers will report critical incidents to WellCare in accordance with applicable requirements. 

WellCare will develop and implement a critical incident reporting process, including a form and/or IA database, to be used to report critical incidents and reporting timeframes. 

Information will include but not be limited to the following: 

  • Date of Occurrence; 
  • Date WellCare became aware of the incident; 
  • Type of Incident; Setting; Provider; 
  • Short description of the incident; 
  • Short description of the immediate actions taken; and
  • Date incident investigation was completed.

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Last Updated On: 11/14/2016