OLTL Critical Incident Report Extension Request Form

OLTL Critical Incident Report Extension Request Form

The Office of Long-Term Living (OLTL) has issued additional guidance on the Enterprise Incident Management (EIM) Enhancements.

As stated in the communication sent on December 10, 2021, Critical Incident Report Extensions changes were implemented in the EIM system on December 11, 2021. With these changes, once the maximum number of allowed extensions is reached, providers and service coordinators (SC) will need to contact OLTL if additional extensions are needed.

The December 10, 2021, communication indicated that OLTL had drafted a form to use in the near future, and once approved, you would be notified. The OLTL EIM Critical Incident Report Extension Request form has been approved and is here for your use.

When requesting incident report extensions, please follow these instructions:

  • Request forms must be submitted to OLTL at least 5 business days prior to incident report due date, via email.
  • Reasons for prior extensions must be clearly documented in the incident report.
  • The reason for an extension request must be detailed, valid, and clearly documented in the incident report as well as in the Home and Community Services Information System (HCSIS) notes.
  • Incident report extensions will be approved for 30 days from previous report due date.

OLTL staff will respond to extension requests within 3 business days by replying to the requestor to let them know if the request was approved or rejected. If rejected, the reason for the rejection will be included in the response. If approved, OLTL staff will enter the extension in EIM.

Any questions regarding the information in this email should be directed here.

Fady is responsible for policy and regulatory matters related to Physical Disabilities and Aging, with primary focus on personal assistance, employment services, and service coordination. Emphasis is placed on engaging the Office of Long-Term Living and the Community HealthChoices Managed Care Organizations, coordination of care with Behavioral HealthChoices MCOs, and collaborations with other advocacy and provider associations. Fady is also the President / CEO of ProVantaCare, an RCPA-affiliated company focused on contracting with MCOs, and is the President of XtraGlobex, a consulting firm focused on Value-Based Payment contracting. He brings extensive experience in the advocacy and operations of human services providers in physical disabilities and aging, from his role at Liberty Resources, Inc., and his service with a number of nonprofit services providers. He earned an MBA in Marketing from The University of Tennessee and a PhD in Organizational Leadership from Capella University.


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