Healthy Louisiana Adverse Incident Form Updated

Date: 01/04/18

The Louisiana Department of Health (LDH) recently updated the Healthy Louisiana Adverse Incident (AI) Reporting Form and the AI Reporting Form Instructions and Definitions. Effective January 1, 2018, all mandated reporters – including healthcare providers – are required to use the updated AI form to report adverse incidents to Louisiana’s Medicaid Managed Care Organizations (MCOs), including Louisiana Healthcare Connections.

What’s an adverse incident?

An adverse incident is defined as an unexpected occurrence that led to, or could have led to, serious unintended or unexpected harm, loss, or damage. Adverse incidents result in unintended harm to the patient by an act of commission or omission, rather than by the underlying disease or condition. These include, but are not limited to death, abuse and/or neglect.

Are all healthcare providers considered mandated reporters?

In Louisiana, health practitioners are mandated reporters. “Health practitioner” is defined in the Louisiana Children’s Code Title VI, Article 603, as any individual who provides health care services. This includes a physician, surgeon, physical therapist, dentist, resident, intern, hospital staff member, podiatrist, chiropractor, licensed nurse, nursing aide, dental hygienist, emergency medical technician, optometrist, medical examiner or coroner.

How is the AI Reporting Form used?

LDH requires that the Healthy Louisiana plans detect, report, remediate (when applicable) and work to prevent the future re-occurrences of adverse incidents. The AI Reporting Form is used to help the health plans identify adverse incidents for immediate member outreach and for reporting requirements to the state. Once the form is received, the health plan will review it and contact you if additional information, such as further details, medical records or the results of any internal or external investigations regarding the incident, are necessary.

Is the AI Reporting Form different for each Healthy Louisiana plan?

No. All of Louisiana’s MCOs, including Louisiana Healthcare Connections, use the same AI Reporting Form. Providers are required to complete the form and fax it to the affected member’s health plan.

How soon after the adverse incident does the form have to be submitted?

The AI Reporting Form must be completed and submitted to the affected member’s Healthy Louisiana plan (not the state) within 24 hours of discovery of the incident. For Louisiana Healthcare Connections members, the form must be submitted via fax to 1-866-704-3063.

What happens if an adverse incident is not reported?

Louisiana Healthcare Connections tracks and monitors providers to ensure compliance with the state’s adverse incident reporting requirements. Providers who are non-compliant will be notified by the health plan. If providers remain non-compliant, they will be referred to our Behavioral Health Medical Director for actions per our internal policy.

Where can providers get adverse incident training?

Louisiana Healthcare Connections, in coordination with Envolve People Care, provides regular Adverse Incident Reporting Training at no cost to providers. You can register for this training (and the other free educational opportunities we offer) by clicking here.