Current through Register Vol. 56, No. 18, September 16, 2024
(a) In the event of any serious occurrence,
all PRTF providers shall report the occurrence to the appropriate authorities
in accordance with
42 CFR 483.374(b) and (b)
through (d) below.
(b) All reports of serious occurrences shall
include, at a minimum, the following information:
1. The name of the resident;
2. A detailed description of the
occurrence;
3. The name, street
address and telephone number of the facility; and
4. Any other information the PRTF is able to
provide regarding the occurrence.
(c) In-State PRTF providers who are licensed
by, and under contract with, DCF/DCSOC shall report all serious occurrences as
follows:
1. All serious occurrences shall be
reported to the provider's respective licensing and contracting agency in
accordance with agreed upon reporting procedures between the provider and the
agency.
2. All serious occurrences
shall be reported to Disability Rights New Jersey no later than the next
business day after the incident. Reports shall be mailed to: Disability Rights
New Jersey
210 South Broad Street, 3rd Floor
Trenton, NJ 08608
3. If the resident is a minor (under age 18),
the parents or legal guardians shall be notified as soon as reasonably
possible, but no later than 24 hours after the incident.
4. If the resident dies as a result of the
serious occurrence, the incident shall additionally be reported to the Centers
for Medicare & Medicaid Services as soon as reasonably possible, but the
report should be mailed no later than the next business day after the incident.
Reports shall be mailed to: Regional Administrator
Division of Medicaid and State Operations
Centers for Medicare & Medicaid Services
Room 3800
26 Federal Plaza
New York, NY 10278
(d) In-State PRTF providers who are licensed
by, and under contract with, agencies other than DCF/DCSOC shall report all
serious occurrences as follows:
1. All
serious occurrences must be reported to DMAHS via phone call and by completing
and filing (Fax and hard copy) an "Initial Serious Occurrence Incident Report
Form" (FD-400).
i. The report must be filed
by telephone and Fax as soon as reasonably possible, but no later than 24 hours
after the incident.
ii. The report
must be mailed no later than the close of business on the next regular business
day. Providers shall mail the report to: DMAHS Incident Report Coordinator
PO Box 712
Mail Code #18
Trenton, NJ 08625-0712
2. All serious occurrences shall be reported
to Disability Rights New Jersey no later than the next business day after the
incident. Reports shall be mailed to: Disability Rights New Jersey
210 South Broad Street, 3rd Floor
Trenton, NJ 08608
3. If the resident is a minor (under age 18),
the parents or legal guardians shall be notified as soon as reasonably
possible, but no later than 24 hours after the incident.
4. If the resident dies as a result of the
serious occurrence, the incident shall additionally be reported to the Centers
for Medicare & Medicaid Services as soon as reasonably possible, but the
report should be mailed no later than the next business day after the incident.
Reports shall be mailed to the CMS Regional Office at the address in (c)4
above.
(e) Out-of-State
PRTF providers licensed by, and under contract with, NJ DCF/DCSOC shall report
all serious occurrences as follows:
1. In
addition to any other procedures required by the State in which the provider is
located, all serious occurrences shall be reported to the New Jersey agency
that licenses and contracts with the provider, in accordance with the
agreed-upon reporting procedures between the provider and the agency;
2. All serious occurrences shall be reported
to the designated Protection and Advocacy agency in the State in which the
provider is located;
3. If the
resident is a minor (under age 18), the parents or legal guardians shall be
notified as soon as reasonably possible, but no later than 24 hours after the
incident; and
4. If the resident
dies, the provider shall also notify the Centers for Medicare & Medicaid
Services Regional Office serving the state in which the provider is located.
The incident shall be reported as soon as reasonably possible, but the report
should be mailed no later than the next business day after the
incident.
(f)
Out-of-State PRTF providers who are not licensed by and under contract with NJ
DCF/DCSOC shall report all serious occurrences as follows:
1. All serious occurrences must be reported
to DMAHS via phone call and by completing and filing (Fax and hard copy) an
"Initial Serious Occurrences Incident Report Form" (FD-400).
i. The report must be made by telephone and
Fax as soon as reasonably possible, but no later than 24 hours after the
incident, to the DMAHS Incident Report Coordinator at the phone and Fax numbers
in (c) above.
ii. The report must
be mailed no later than the close of business on the next regular business day.
Providers shall mail the report to the DMAHS Incident Report Coordinator at the
address in (d)1 above.
2. All serious occurrences must be reported
to the designated Protection and Advocacy agency in the state in which the
provider is located.
3. If the
resident is a minor (under age 18), the parents or legal guardians shall be
notified as soon as reasonably possible, but no later than 24 hours after the
incident.
4. If the resident dies,
the provider shall also notify the Centers for Medicare & Medicaid Services
Regional Office serving the state in which the provider is located. The
incident shall be reported as soon as reasonably possible, but the report shall
be mailed no later than the next business day after the incident.
(g) All PRTF providers, both
in-State and out-of-State, who are licensed by and under contract with New
Jersey agencies other than DCF/DCSOC, shall conduct an internal review of the
serious occurrence. The provider shall submit a written follow-up report to the
DMAHS Incident Report Coordinator at the address in (d)1 above. This report
shall be filed no later than 45 working days following the incident. A complete
follow-up report shall include, at a minimum:
1. A description of methods used to gather
information during the agency's internal review;
2. A more extensive description of the
incident, including the date and any and all additional information obtained
during the internal review process;
3. Copies of all reports prepared by outside
agencies regarding the incident, such as police reports and emergency room
reports;
4. A summary of the review
of the incident and actions taken by staff during and immediately after the
incident, including, but not limited to, any actions that could have been taken
to avoid the incident;
5. A
description of any and all actions taken by the agency including, but not
limited to: staff education, review and revision of policies and procedures,
staff debriefing and quality improvement initiatives; and
6. Pertinent findings/conclusions.
(h) The names of all individuals
or entities notified of the serious occurrence shall be documented in the
resident's record as soon as possible, but no later than 24 hours after the
incident occurs. This documentation shall include, at a minimum, the name(s)
and agency affiliation of the person making the report, the name(s) and agency
affiliation of the individuals who received the report and the time and date
the report was made.
For example: "John Doe, child care worker, notified Jane
Smith, of Region II CMS, of the serious occurrence that occurred on 02/01/03 at
9:00 P.M., which involved resident Bill Jones."
(i) All entries into the record shall be
legible and the person entering the information shall print and sign their name
in ink, including their title and the date that the entry was
made.
