Feb 20 2025 | Reporting of Crimes — F607 and F609

4An often overlooked or misunderstood federal requirement is the result of section 1150B of the Social Security Act (SSA). On March 23, 2011, federal laws went into effect that require covered individuals in federally funded long-term care (LTC) facilities (including assisted living and skilled nursing facilities) to report any reasonable suspicion of a crime committed against a resident of that facility. The SSA and the Center for Medicare & Medicaid Services (CMS) use the term “covered individuals.” Covered individuals include all Medicare/Medicaid facility owners, operators, employees, managers, agents, or contractors.

The requirements state that a Medicare or Medicaid-participating LTC facility must:

• Notify “covered individuals” annually of their reporting requirements
• Prevent retaliation if an employee makes a report
• Post information about employee rights, including the right to file a complaint if a long term care facility retaliates against anyone who files a report

The facility must also develop and implement written policies and procedures that ensure the reporting of crimes in accordance with section 1150B of the Act. The policies and procedures must include but are not limited to the following elements:

• Annually notifying covered individuals of that individual’s obligation to comply with the reporting requirements.
• Each covered individual shall report to the State Agency and one or more law enforcement entities for the area in which the facility is located any reasonable suspicion of a crime against any individual who is a resident of or is receiving care from the facility.
• Each covered individual shall report immediately, but not later than 2 hours after forming the suspicion, if the events that cause the suspicion result in serious bodily injury to the resident or not later than 24 hours if the events that cause the suspicion do not result in serious bodily injury.

According to CMS, a facility’s policies and procedures for reporting should at least specify the following components:

• Identification of whom in the facility is considered a covered individual
• Identification of crimes that must be reported
• Identification of what constitutes “serious bodily injury”
• The timeframe for which the reports must be made
• Which entities must be contacted, for example, specifically the State Survey Agency and local law enforcement.

CMS directs surveyors to review whether the facility has included in their policies and procedures examples of which crimes would be reported. CMS goes on to say that each state and local jurisdiction may vary in what is considered a crime and may have different definitions for each type of crime.

Facilities should consult with local law enforcement to determine what is considered a crime in their area. However, because all reasonable suspicions of crimes must be reported, regardless of whether it is perpetrated by facility staff, residents, or visitors, it would be especially beneficial for the facility to work with local law enforcement in determining what would not be reported (e.g., all cases of resident to resident conflict may not rise to the level of abuse and may not be appropriate to report to local law enforcement).

Each facility’s implementation of policies and procedures must ensure the reporting of a reasonable suspicion of a crime by addressing, at a minimum, the following actions:

• Orienting new and temporary/agency/contracted staff to the reporting requirements
• Assuring that covered individuals are annually notified of their responsibilities in a language that they understand
• Identifying barriers to reporting such as fear of retaliation or causing trouble for someone, and implementing interventions to remove barriers and promote a culture of transparency and reporting
• Identifying which cases of abuse, neglect, and exploitation may rise to the level of a reasonable suspicion of crime and recognizing the physical and psychosocial indicators of abuse/neglect/exploitation
• Working with law enforcement annually to determine which crimes are reported
• Assuring that covered individuals can identify what is reportable as a reasonable suspicion of a crime, with competency testing or knowledge checks
• Providing in-service training when covered individuals indicate that they do not understand their reporting responsibilities
• Providing periodic drills across all levels of staff across all shifts to assure that covered individuals understand the reporting requirements

More information to ensure facility compliance with these requirements can be found in the Guidance for F607 and F609 in the State Operations Manual, Appendix PP and the Critical Element Pathway for Abuse. If you have questions, please contact Elena Madrid, Executive Vice President of Education and Regulatory Affairs.