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Appendix XIII, Critical Incident Reporting - CLASS Provider Manual (HHSC); death reporting per 40 TAC 42.401(c)

Texassub-regulatoryTexas Health and Human Services Commission (HHSC)

What this rule requires your agency to do

  • 1The provider must report a critical incident using the HHSC CLASS/DBMD Notification of Critical Incidents form, submitted electronically or faxed to 512-206-3975. (CLASS Provider Manual, Appendix XIII)(Appendix XIII, Critical Incident Reporting - CLASS Provider Manual (HHSC); death reporting per 40 TAC 42.401(c))
  • 2The provider must report a critical incident to HHSC by the last calendar day of the month following the date of becoming aware of the incident. (CLASS Provider Manual, Appendix XIII)(Appendix XIII, Critical Incident Reporting - CLASS Provider Manual (HHSC); death reporting per 40 TAC 42.401(c))
  • 3The CLASS DSA must send a copy of the critical incident report and Form 2067 to the CMA within five calendar days (and the CMA must reciprocally send to the DSA). (CLASS Provider Manual, Appendix XIII)(Appendix XIII, Critical Incident Reporting - CLASS Provider Manual (HHSC); death reporting per 40 TAC 42.401(c))
  • 4The provider must complete a separate Notification of Critical Incidents form for each individual, though multiple incidents for that individual may be listed on one form. (CLASS Provider Manual, Appendix XIII)(Appendix XIII, Critical Incident Reporting - CLASS Provider Manual (HHSC); death reporting per 40 TAC 42.401(c))
  • 5The provider must report the death of an individual, from any cause, within 24 hours after learning of the death. (CLASS Provider Manual, Appendix XIII; 40 TAC 42.401(c))(Appendix XIII, Critical Incident Reporting - CLASS Provider Manual (HHSC); death reporting per 40 TAC 42.401(c))
  • 6The provider must report reportable critical incidents including choking requiring medical attention, criminal conduct, elopement of at-risk individuals, emergency room visits, medication errors, physical altercations, authorized restraints, and seclusion. (CLASS Provider Manual, Appendix XIII)(Appendix XIII, Critical Incident Reporting - CLASS Provider Manual (HHSC); death reporting per 40 TAC 42.401(c))

Applies to: Home and community-based services waiver providers (CLASS Direct Services Agency, Case Management Agency, and DBMD program providers)

HHSC's CLASS/DBMD provider manual (Appendix XIII) requires HCBS waiver providers to report defined critical incidents (choking, criminal conduct, death, elopement, ER visits, emergencies, medication errors, physical altercations, restraint, seclusion, theft/property damage, and other harm) to HHSC using the CLASS/DBMD Notification of Critical Incidents form, with monthly reporting for most incidents and expedited 24-hour reporting for deaths.

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