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Wisconsin IRIS Critical Incident Reporting, DHS P-03131 (05/2025)

Wisconsinsub-regulatoryWisconsin Department of Health Services, Division of Medicaid Services· effective 2022-01-01

What this rule requires your agency to do

  • 1The provider/agency must report and document the critical incident in DHS's centralized case management system within seven calendar days of being notified of the incident. (P-03131)(Wisconsin IRIS Critical Incident Reporting, DHS P-03131 (05/2025))
  • 2The agency must complete follow-up activities on the critical incident within 30 calendar days of the incident. (P-03131, Follow-up)(Wisconsin IRIS Critical Incident Reporting, DHS P-03131 (05/2025))
  • 3The agency must report critical incidents falling within the defined categories, including financial exploitation, treatment without consent, injuries requiring emergency attention, falls with moderate-to-severe injury, medical emergencies, participant death, missing participants, law enforcement involvement, medication errors, and unapproved restrictive measures. (P-03131, Critical Incident Definitions)(Wisconsin IRIS Critical Incident Reporting, DHS P-03131 (05/2025))
  • 4The agency must refer financial exploitation incidents to Adult Protective Services (APS) within 24 hours. (P-03131, Secondary Referrals)(Wisconsin IRIS Critical Incident Reporting, DHS P-03131 (05/2025))
  • 5The agency must refer caregiver misconduct occurring in licensed settings (CBRFs, adult family homes, day care programs, residential care apartment complexes) to the Division of Quality Assurance (DQA). (P-03131, Secondary Referrals)(Wisconsin IRIS Critical Incident Reporting, DHS P-03131 (05/2025))
  • 6The provider (or participant, guardian, or legal representative) must notify the IRIS Consulting Agency within 24 hours of discovering a critical incident. (P-03131, Critical Incident Reporting Timeframes)(Wisconsin IRIS Critical Incident Reporting, DHS P-03131 (05/2025))

Applies to: home and community based services; self-directed personal care and supports under the IRIS waiver

Wisconsin DHS sub-regulatory guidance (P-03131) governing critical incident reporting under the IRIS 1915(c) HCBS waiver. It requires participants, guardians, legal representatives, or providers to notify the IRIS Consulting Agency within 24 hours of a critical incident, requires system documentation within seven calendar days, follow-up within 30 calendar days, and mandates secondary referrals to Adult Protective Services and the Division of Quality Assurance in specified cases.

Regulatory information, not legal advice — always confirm against the cited official source. Verification reduces error; it does not certify compliance.