Behavioral Health - Reporting Adverse Incidents

When reporting an adverse incident, you'll need the following information:

• Hospital name
• Date of incident
• Gender
• Age group
• MassHealth Member ID
• Type of incident 

For a complete list of the information you'll need, please see the Adverse Incident Form.

When to report

Submit the Adverse Incident Form. on the day of the adverse incident, or the next business day if the adverse incident occurs on a holiday or weekend.

Date range for report  

Include only reportable adverse incidents that have occurred since the last submission.

What is an "adverse incident"

Behavioral Health reportable adverse incidents include, but are not limited to, the following:

• Any death (include cause of death if known)
• Any absence without authorization (AWA)
• Any serious injury resulting in hospitalization
• Any sexual assault or alleged sexual assault
• Any sexual activity in a 24-hour level of care facility
• Any violation or alleged violation of the Department of Mental Health physicalrestraint and/or seclusion regulations
• Any physical assault or alleged physical assault on or by a covered individual, or by staff
• Any contraband found prohibited by provider policy
• Any injury or illness requiring transportation to an acute care hospital for treatment while in a 24-hour program
• Any unscheduled event that results in the evacuation of a program or facility