Critical Incidents
A Critical Incident is defined by the State Medicaid Contract (Article 9.10) as “an occurrence involving the care, supervision, or actions involving a member that is adverse in nature or has the potential to have an adverse impact on the health, safety, and welfare of the member or others. Critical Incidents also include situations occurring with staff or individuals or affecting the operations of a facility/institution/school.”
Horizon NJ Health is required to:
- Train staff and contracted FIDE-SNP providers on identifying, reporting, investigating and monitoring Critical Incidents.
- Develop policies and implement procedures for Critical Incident reporting.
- Track, review and analyze Critical Incidents to identify and address potential and actual health and safety issues.
Report a Critical Incident
Providers are responsible for reporting Critical Incidents to Horizon NJ Health, within 1 Business Day of discovery by faxing the Critical Incident Reporting Guide to 1-609-583-3003.
Types of Critical Incidents
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Unexpected death of a member
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Media involvement or the potential for media involvement
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Physical abuse (including seclusion and restraints both physical and chemical)
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Psychological/verbal abuse
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Sexual abuse and/or suspected sexual abuse
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Fall resulting in the need for medical treatment
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Medical emergency resulting in the need for medical treatment
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Medication error resulting in serious consequences
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Psychiatric emergency resulting in need for medical treatment
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Severe injury resulting in the need for medical treatment
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Suicide attempt resulting in the need for medical attention
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Neglect/mistreatment, caregiver (paid or unpaid)
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Neglect/mistreatment, self
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Neglect/mistreatment, other
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Exploitation, financial
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Exploitation, theft
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Exploitation, destruction of property
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Exploitation, other
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Theft with law enforcement involvement
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Failure of member's Back-up Plan
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Elopement/wandering from home or facility
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Inaccessible for initial/on-site meeting
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Unable to Contact
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Inappropriate or unprofessional conduct by a provider involving member
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Cancellation of utilities
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Eviction/loss of home
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Facility closure, with direct impact to member's health and welfare
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Natural disaster, with direct impact to member's health and welfare
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Operational Breakdown
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Other