Adverse & Critical Incident Report
Network providers shall participate in and cooperate with Community Care Plan (CCP) Risk Management Program. Note that provider submission of adverse incident reports from the following providers: health maintenance organizations and health care clinics reporting in accordance with s. 641.55, F.S.; ambulatory surgical centers and hospitals reporting in accordance with s. 395.0197, F.S.; assisted living facilities reporting in accordance with s. 429.23, F.S.; nursing facilities reporting in accordance with s. 400.147, F.S.; and crisis stabilization units, residential treatment centers for children and adolescents, and residential treatment facilities reporting in accordance with s. 394.459, F.S. are not contractually required. Adverse incidents occurring in these licensed settings shall be reported in accordance with the facility’s licensure requirements.
Adverse Incident: An injury of an enrollee occurring during delivery of CCP’s covered services that:
Critical Incident: Critical events that negatively impact the health, safety, or welfare of a Long-term Care Plan enrollee, including death by suicide, homicide, abuse/neglect or that is otherwise unexpected; adverse incident or major illness; sexual battery; medication errors; suicide attempts; altercations requiring medical intervention; or elopement.
After Hours: The hours between five PM (5pm) and eight AM (8am) local time, Monday through Friday inclusive, and all-day Saturday and Sunday. State holidays are included.
ADVERSE OR CRITICAL INCIDENT REPORT INSTRUCTIONS
If an Adverse or Critical Incident occurs to an enrollee, the Provider needs to report the incident, as required by CCP Risk Manager within twenty-four (24) hours after the incident, the provider must:
When an Adverse or Critical Incident Occurs
For assistance, if needed, in completing the Potential Quality Issue form, please contact CCP’s Risk Manager at 954-622-3336.
Note: Adverse or Critical Incident Reports (PQI) are part of risk management files only and copies of the Adverse or Critical Incident (PQI) Reports must be maintained separately from Enrollee’s medical record. Appropriate action will be initiated when indicated. Adverse or Critical Incident Reports (PQI) will not be used to penalize Providers; however, failure to report an Adverse or Critical Incident may result in further action by CCP.