Assurance 4 - Health and Welfare
Participants are protected from abuse, neglect and exploitation and get help when things go wrong or bad things happen.
This assurance emphasizes the role of HCBS waivers in reporting, investigating, and resolving serious incidents which include, at a minimum, cases of abuse, neglect and exploitation. (click here for more information about abuse, neglect and exploitation)
- intentional actions that cause harm or create a serious risk of harm (whether or not harm is intended) to a person by a caregiver or someone who stands in a trust relationship) or
- failure by a caregiver or someone who stands in a trust relationship to satisfy a person’s basic needs or to protect a person from harm.
An example of a more specific definition –
Abuse means the infliction of injury, unreasonable confinement (physical or chemical restraints, seclusion, and restrictive interventions), intimidation or cruel punishment that causes or is likely to cause physical harm or pain or mental anguish; sexual abuse or sexual exploitation; or the intentional, knowing or reckless acts of omission or deprivation of essential needs (including medication management).
Neglect means a threat to a person’s health or welfare by physical or mental injury or impairment, deprivation of essential needs or lack of protection from these.
Exploitation means the illegal or improper use of an incapacitated or dependent person or that person’s resources for another's profit or advantage. Neglect may also include adults in need of protection who fail to provide for their own basic needs when the failure is the result of the person's mental or physical inability.
What are the requirements of this HCBS waiver assurance?
A state must have a system for reporting and investigating critical events including, at a minimum, cases of abuse, neglect, and exploitation. The system must describe:
The definition of critical events that must be reported.
The identification of individuals/entities that must report critical incidents.
The timeframes within which the critical event must be reported.
The method of reporting (e.g., phone, written form, web-based reporting system).
The entity (or entities) that receives reports of each type of critical event or incident.
The entity that is responsible for evaluating reports and how reports are evaluated.
The entity that is responsible for conducting investigations and how investigations are conducted.
The timeframes for conducting an investigation and completing an investigation.
The process and timeframes for informing the participant (or the participant’s family or legal representative as appropriate) and other relevant parties (e.g., the HCBS waiver providers, licensing and regulatory authorities, the HCBS waiver operating agency) of investigation results.