HCBS Waiver Critical Incident Reporting

Health First Colorado (Colorado’s Medicaid Program) is a health care program for low income Coloradans. A waiver is an extra set of Health First Colorado benefits that you can qualify for in certain cases. Home and Community Based Services (HCBS) Waiver services complement and/or supplement the services that are available through the Medicaid State plan and other Federal, state and local public programs as well as the supports that families and communities provide to individuals. These benefits can help an individual remain in your home and community and, thereby, avoid institutionalization.

A critical incident is an actual or alleged event that creates the risk of serious harm to the health or welfare of a client receiving Health First Colorado benefits. A critical incident may endanger or negatively impact the mental and/or physical well-being of a client.

Critical Incidents include, but are not limited to: Death, Mistreatment/Abuse/Neglect/Exploitation, Injury/Illness to Client, Damage to Consumer’s Property/Theft, Medication Management Issues, Criminal justice involvement/incarceration, Missing Person, Unsafe housing/displacement and others.

When a critical incident occurs involving an HCBS waiver participant, a report must be made to the case manager of the case management agency that is coordinating the care for the waiver participant. The case manager must report the critical incident within one business day of notification of the incident. The critical incident will be entered into the State Benefits Utilization System (BUS). Critical incidents can be reported to the case manager by home health agencies, caregivers, law enforcement, participants and their family.

CIRs Updates/Projects

Category	Short Description	Date Reported	Status	Additional Attachments
Critical Incident Reporting for Covid-19	HCPF OM 20-022 Operational Memo		03/19/2020	Critical Incident Reporting Covid-19 Memo

Critical Incident Forms and documents

Title	Short Description	Additional Attachments
Critical Incident Report Frequently Asked Questions	Critical Incident Report FAQ's	Critical Incident Report FAQ's
Service Provider Critical Incident Reporting form	Used to notify waiver case manager of a Critical Incident	Service Provider CIRS Form
Service Provider Critical Incident Follow-up Reporting form	Used to notify waiver case manager of a Critical Incident Follow-up	Service Provider CIRS Follow-up Form

CIRs Guides and Definitions

The following guides and definitions have been created to help you properly report critical incidents in the BUS.

Title	Short Description	Additional Attachments/Links
Critical Incident Reporting Technical Guide	Guide for entering CIRS in the BUS updated Nov 2018	CIRS Technical Guide
CIRS Agency Administrator Reporting Technical Guide	Guide for Agency Administrator BUS Reports	CIRS Agency Administrator Reporting Technical Guide
CCB Critical Incident Reporting Requirements	CCB CIRS reporting requirements	CCB Critical Incident Reporting Requirements
DD Mistreatment Definitions	DD Mistreatment terminology definitions	DD Mistreatment Definitions

CIRs Webinars

The following webinars are available for your review to help you properly report critical incidents in the BUS.

Title	Short Description	Additional Attachments
Critical Incident and Mistreatment Participant Education Reporting Webinar	Training for case managers and Case Management Agency staff on state prescribed tools for case managers to provide participant education about CIRs	Webinar link

CIRs Training Modules

The following training modules have been created to support your Agency's proper reporting of critical incidents in the BUS.

Title	Short Description	Additional Attachments/Links
Critical Incident Definition	Critical Incident Definition and examples	CIRS Definition Module
Critical Incident Timeliness	Critical Incident Notification and Follow-up Timeliness guidelines	CIRS Timeliness Module
Critical Incident Substantiated Definition	Critical Incident Substantated Definition and examples	CIRS Substantiated Definition Module
Location of Critical Incident	Location of Critical Incident details required for Critical Incident Reports and where this information is located in the BUS	CIRS Location of Incident Module
Critical Incident Details	Incident details needed to complete a Critical Incident Report	CIRS Incident Details Module
Editing and Deleting a Critical Incident Report	How and when Critical Incidents Reports can be edited or deleted in the BUS	CIRS Editing and Deleting a Critical Incident Report Module
Agency Administrator Reports	Agency Administrator guide for pulling critical incident report data from the BUS	Agency Administrator Reports Module

CIRs Participant Information

Category	Short Description	Status	Additional Attachments
Critical Incident and Mistreatment Participant Reporting QUICK Guide	Guide for critical incident and mistreatment participant reporting	08/01/2019	Critical Incident and Mistreatment Participant Reporting QUICK Guide
Critical Incident and Mistreatment Participant Reporting QUICK Guide - Audio	Audio Guide for critical incident and mistreatment participant reporting	09/04/2019	Critical Incident and Mistreatment Participant Reporting QUICK Guide - Audio
Critical Incident and Mistreatment Reporting Participant Education and Contacts	Critical incident and mistreatment partcipant education and contacts	08/01/2019	Critical Incident and Mistreatment Reporting Participant Education and Contacts

CIRs Archived Memos

The following CIRs memos have been archived for your reference after issue resolution.

Category	Short Description	Date Archived	Additional Attachments
Critical Incident Training Series	HCPF IM 19-057 Informational Memo	03/18/2020	Critical Incident Training Series Memo
CIRS Mistreatment Participant Education	HCPF OM 19-038 Operational Memo	03/18/2020	CIRS Mistreatment Participant Education Memo
Critical Incident Report BUS Email Notifications	CIRS/BUS Email Notification Issue	03/18/2020	CIRS/BUS Notification Issue Memo
CIRS Childrens Extensive Supports Waiver Timely Reporting	HCPF OM 18-019 Operational Memo	07/30/2019	CIRS CES Timely Reporting Memo
CIRS email address	HCPF IM 19-045 Informational Memo	07/29/2019	CIRS General Email Address Memo
CIRS update in the BUS	CIRS Roles and Responsibilites	07/08/2019	CIRS/BUS Memo
CIRS update in the BUS	Several CIRS updates and changes to the BUS	10/15/2018	CIRS Update Release Memo
CIRS update in the BUS	Secondary email address added to Critical Incident Follow-ups	10/09/2018	Secondary Email Address CIRS Memo
CIRS update in the BUS	DD Waiver Critical Incidents will be entered in the BUS	10/09/2018	CIRS/BUS Memo
CIRS Issues in the BUS	Print function not working, Elderly Abuse reminder and future dates	10/09/2018	CIRS/BUS Memo
CIRS Overdue Reports	CIRS Overdue Report data is invalid	10/09/2018	CIRS Memo
CIRS emails	CIRS Agency Quality person instructions	05/25/2018	CIRS Memo
CIRS update in the BUS	APS/CPS question added to the BUS	06/29/2017	CIRS Memo
CIRS update in the BUS	Edit/Delete functions added to the BUS	04/20/2016	CIRS/BUS Memo
CIRS update in the BUS	Restrictive Intervention section added to the BUS	05/05/2015	CIRS Restrictive Intervention Memo

Contact:

General CIRs email inquiries: HCPF_CIRs@state.co.us

Coronavirus Disease 2019 (COVID-19) in Colorado: State & National Resources

HCBS Waiver Critical Incident Reporting

Contact: