MedicaidAdministrativeMedium impact
Provider Bulletin 01-08-2025 Reminder Community Based Adult Services and Long-Term Care Facilities Critical Incidents Reporting LA
Molina Healthcare·CA · Geriatrics·Medicaid
Effective date
Jan 8, 2025
We identified it
Jun 19, 2026
Summary
Molina Healthcare of California reminds Community-Based Adult Services (CBAS) and Long-Term Care facilities of their obligation to report Critical Incidents within 24-48 hours, triggered by the recent state of emergency in Los Angeles and Ventura counties. Providers must complete CDA 4009 forms and submit them to CBAS@molinahealthcare.com for incidents including epidemic outbreaks, fires, deaths from unnatural causes, suspected abuse, and other unusual occurrences threatening patient safety.
Action Required
Immediately: CBAS and Long-Term Care facilities must establish incident reporting procedures. Review CDA Incident Report Instructions, complete CDA 4009 forms for all critical incidents, and submit to CBAS@molinahealthcare.com within 24 hours for unusual occurrences and 48 hours for deaths/serious injuries. Failure to report may result in regulatory non-compliance.