For Providers

Managed Long Term Services and Supports

MLTSS Critical Incident Reporting
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Providers with suspicion or evidence of a MLTSS member Critical Incident must report them to Horizon NJ Health within one business day of discovery. Upon discovery of a critical incident, providers are to take steps to prevent further harm to members and promptly respond to these members’ needs. These steps may include reporting potential violations of criminal law to law enforcement authorities.

**The initial report of a Critical Incident may be submitted verbally, but the verbal report must be followed up by a written report within two business days. **

Examples of a Critical Incident:

  • Unexpected death of a member
  • Missing person or unable to contact
  • Suspected or evidenced physical or mental abuse (including seclusion and restraints, both physical and chemical)
  • Theft with law enforcement contact
  • Severe injury or fall resulting in the need for medical treatment
  • Medical or psychiatric emergency, including suicide attempt
  • Medication errors with serious consequences
  • Inappropriate or unprofessional conduct by a provider involving the member
  • Sexual abuse and/or suspected sexual abuse
  • Elopement/wandering from home or facility
  • Eviction/loss of home
  • Cancellation of utilities
  • Natural disasters, with direct impact to member's health and welfare
  • Neglect/Mistreatment, including self-neglect, caregiver overwhelmed, environmental
  • Exploitation, including: financial, theft, and destruction of property
  • Failure of a member's backup plan
  • Facility closure, with direct impact to member's health and welfare
  • The potential for media involvement
  • Other

Providers who have reported, or have been involved with, an MLTSS member Critical Incident are also required to independently conduct an internal investigation, and submit a summary on their findings to Horizon NJ Health. The report should be submitted no longer than 15 calendar days after the date of the incident or discovery of its occurrence. Under extenuating circumstances, but only with the approval of Horizon NJ Health, the summary may be submitted within 30 calendar days after the date of the incident.

To report a Critical Incident to HNJH:

  • Call HNJH MLTSS Provider Services at 1-855-777-0123, or
  • Fax the HNJH Critical Incident Reporting Guide, along with any supporting documentation, to HNJH to 609-583-3003