12VAC35-105-20

“Level II serious incidents include:….

3. An emergency room visit.

Guidance states “All emergency room visits shall be reported as Level II serious incidents.”

Please clarify if emergency room visits for the sole purpose of accessing psychiatric care (no medical needs or concerns) are required to be reported? There appears to be some discrepancy in interpretation as unplanned psychiatric admissions during the provision of service are required to be reported. Many clients access emergency psychiatric care through the local emergency department, but are not necessarily admitted.  Ex: If a case manager advises individual with crisis symptoms to access local emergency department and individual is not admitted to psychiatric facility but is released on safety plan, is this required to be reported on CHRIS as Level II?

4. An unplanned psychiatric admission of an individual receiving services other than licensed emergency services, except that a psychiatric admission in accordance with the individual’s Wellness Recovery Action Plan (WRAP) shall not constitute an unplanned admission for the purposes of this Chapter;

Guidance states “If an individual is admitted to the hospital for psychiatric services, and the individual’s admission is in accordance with the individual’s Wellness Recovery Action Plan (WRAP), then the admission is not an unplanned admission and does not need to be reported.

Please clarify the definition of an “unplanned psychiatric admission” versus a “planned psychiatric admission”? Are voluntary psychiatric admissions considered a planned psychiatric admission and therefore, do not require reporting?  

Thank you for the addition of exceptions related to WRAP. Official WRAP facilitation and implementation can be an expensive and a time-consuming process. Many CSBs have alternate versions of WRAP plans. Is there any flexibility if other crisis plan tools are in place or is a psychiatric admission in accordance with specifically WRAP the only acceptable exception?