Crime vs Abuse Reporting in a SNF

The new Medicare SNF Requirements of Participation (ROP) revisions involving the abuse, neglect and exploitation reporting requirements have caused some confusion with the existing Crime Reporting Requirements that were enacted as part of the Elder Justice Act and incorporated into the new ROPs.

There were no changes to the Crime Reporting Requirements. Covered individuals are required to report to the State Agency and local law enforcement a reasonable suspicion of a crime against a resident. If the event that caused the suspicion results in serious bodily injury to the resident, then the reports must be made within 2 hours. All other reports may be made within 24 hours.

In an apparent effort to align the crime reporting requirements with the reporting requirements for allegations of abuse, neglect, exploitation or mistreatment, the new ROPs revised the required time frames for reporting such allegations to the Administrator and the State Agency. However, providers should note that the time frames are not the same.

The new rule states that the “facility must ensure all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown origin and misappropriation of resident property are reported immediately [to the Administrator and State Agency], but not later than 2 hours after the allegation is made, if the events that caused 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 involve serious bodily injury.”

What does this mean?

• All allegations of abuse, regardless of whether there is serious bodily injury, must be reported to the Administrator and State agency within 2 hours. Note, however, that unless the individual has a “reasonable suspicion” that a crime has been committed, law enforcement would not need to be notified of all allegations of abuse.

• Any injury of unknown origin that involves a serious bodily injury (e.g., a fractured skull or femur), would also need to be reported to the Administrator or the State agency within 2 hours.

Please note that this alert is intended to be informational only, and is not intended to be nor should it be relied upon as legal advice. Rolf Goffman Martin Lang LLP will not be responsible for any actions taken or arrangements structured based upon this alert. The receipt of this alert by an organization that is not a current client of Rolf Goffman Martin Lang LLP does not create an attorney-client relationship between the recipient and the law firm.