CMS New ROP: Reporting Abuse, Neglect and Exploitation (§ 483.12)

Nancy Leveille and Lisa Volk in Clinical & Quality

NYSHFA has received questions about changes in the new Requirements of Participation (RoPs) related to reporting abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property. We have been in discussion with the NYSDOH, CMS via AHCA and sought legal guidance to clarify the new ROP on this topic. We still have questions that have not been clarified, but want to alert you to what the current regulation says at this time.

The specific regulatory language follows (emphasis added):

§ 483.12 Freedom from abuse, neglect, and exploitation.

(c) In response to allegations of abuse, neglect, exploitation, or mistreatment, the facility must:

(1) Ensure that all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property, are reported immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury, or not later than 24 hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury, to the administrator of the facility and to other officials (including to the State Survey Agency and adult protective services where state law provides for jurisdiction in long-term care facilities) in accordance with State law through established procedures.

AHCA met with CMS and they interpret this language to mean: all allegations of abuse, and injuries of unknown source that result in serious bodily injury, MUST be reported to the State Agency immediately upon awareness of the allegation of abuse or knowledge of serious bodily injury of unknown source and no longer than 2 hours after becoming aware of the allegation or injury of unknown source.

In the new ROP’s, it appears CMS is merging the requirements of when to report a suspected crime, which has a very short timeframe of reporting to the authorities, now with allegations of abuse, neglect, exploitation or mistreatment. NYSHFA is discussing with DOH our ability to continue to utilize “reasonable cause to believe” when an allegation of potential abuse has occurred as we investigate the incident.

The CMS guidance on this topic is set to be released no later than November 2017, will hopefully provide additional clarification.

NYSHFA will continue to seek clarification on this issue and will report to members when updates are available.

NYSHFA/NYSCAL CONTACTS:

Nancy Leveille, RN, MS
Sr. Director, Member Operational Support
518-462-4800 x20

Lisa Volk, RN, B.P.S., LNHA
Director, Clinical & Quality Services
518-462-4800 x15