The Office of Long-Term Living (OLTL) released a communication that focused on the update to the Health and Welfare Performance Measure #8 (HW-8) that was included in the OBRA Waiver amendment that was approved by the Centers for Medicare and Medicaid Services (CMS) and took effect on January 1, 2025. The update includes:
Number and percent of incidents for waiver participants each month with more than three reported incidents within the past 12 months where results of trend analysis were addressed by the Service Coordinator (SC). Numerator: Total number of incidents for waiver participants each month with more than three reported incidents within the past 12 months where results of trend analysis were addressed by the SC. Denominator: Total number of incidents for waiver participants with reported incidents within the past 12 months where a trend analysis was performed.
In accordance with this requirement, for any participant with more than three critical incidents within a 12-month period, the Service Coordinator (SC) must perform an analysis (trend analysis) and take action as necessary to prevent or mitigate further incidents. The SC must commence the analysis and implement the actions to address potential issues related to the health and welfare of the Participant within the 30-day investigation period. If additional time is needed to investigate and to implement any necessary actions to address potential issues related to the health and welfare of the Participant, the SC must document an extension in Enterprise Incident Management (EIM). The trend analysis document must be provided to a Critical Incident Management Unit (CIMU) team member for review upon request and subsequently uploaded to the respective EIM entry upon completion and submission of the critical incident report’s final section. If necessary, OLTL’s CIMU staff will provide additional feedback to the SC via the State Management Review in EIM.
For any questions regarding this change, please contact the CIMU via the resource account. Additionally, questions related to critical incidents may be emailed to the CIMU team member identified in any case-specific communication.