Critical Incidents (CIs) are defined by the Division of Medicaid and Medical Assistance (DMMA). They include but are not limited to:
Highmark Health Options will report to the state if any staff or the staff of a subcontractor has reason to believe that a member has been abused, mistreated, neglected, or financially exploited, or has knowledge of the occurrence of other critical incidents.
Critical incidents must be reported the same business day of the occurance or knowledge of the incident. Report critical incidents to Highmark Health Options by calling 1-844-325-6251.
A report should also be made to the appropriate investigative state agency:
For suspected abuse, neglect, disruptive behavior, or exploitation.
For adult members in a long-term facility and for child members in a pediatric nursing facility.
For residents in long-term care facilities who have a complaint about their rights.