Addressing Critical Incidents in the MLTSS Environment: Research Brief. Elements of a Critical Incident System in MLTSS


Typically, the state specifies how critical incidents should be reported and addressed -- either in the MCO contract and/or in MLTSS policies and procedures. The system's requirements usually include:

  • Types of incidents that the MCO/provider must report.

  • Entity or entities with whom the MCO/provider must file reports (e.g., protective services, licensing body, law enforcement).

  • MCO/provider timelines for reporting (may vary depending on the incident).

  • Whether the MCO, provider and/or state are responsible for conducting reviews/investigations.

  • Processes and timeframes for conducting reviews/investigations.

  • Required actions pending a review/investigation to protect the member.

  • Any monitoring processes (required for the MCO and/or conducted by the state) to ensure that critical incident policies and procedures are being followed (e.g., incidents have been reported timely, investigations have been conducted).

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"CritIncidRB.pdf" (pdf, 79.42Kb)

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