Incident Reporting
Reporting of Unusual Occurrence
Reporting of Reasonable Suspicion of a Crime Against a Resident
This page is intended to provide health care facilities and providers with information on the reporting of incidents to the Indiana State Department of Health (ISDH). The term “incidents” includes the following:
- Reporting by a covered individual of a reasonable suspicion of a crime against a resident pursuant to Federal regulation.
- Reporting by a health care facility of unusual occurrences pursuant to the ISDH Unusual Occurrence Policy.
- Reporting of allegations of abuse, neglect, misappropriation of resident property pursuant to State and Federal regulations
This page is not intended to be used by consumers for the submitting of complaints against a health care facility. Consumers should go to the Reporting a Complaint page at http://www.in.gov/isdh/21533.htm for information.
Background
Facilities are required by law to report unusual occurrences within 24 hours of occurrence to the Long Term Care Division. CFR 483.13(c)(2) states:
The facility must ensure that all alleged violations involving mistreatment, neglect, or abuse, including injuries of unknown source and misappropriation of resident property are reported immediately to the administrator of the facility and to other officials in accordance with State law through established procedures (including to the State Survey and Certification Agency).
Background on reporting a reasonable suspicion of a crime against a resident.
Section 6703(b)(3) of the Patient Protection and Affordable Care Act, in part, amends Title XI of the Social Security Act by adding a Section 1150B. Section 1150B requires long term care facilities that receive at least $10,000 in Federal funds under the Act during the preceding year to annually notify each covered individual of their obligation to report to the State Survey Agency and at least one local law enforcement entity “any reasonable suspicion of a crime,” as defined by local law, committed against an individual who is a resident of, or is receiving care from, the facility.
The long term care facilities included in this reporting requirement are:
• Nursing facilities (NFs)
• Skilled nursing facilities (SNFs)
• Hospices that provide services in long term care facilities
• Intermediate Care Facilities [formerly Intermediate Care Facilities for the Mentally Retarded (ICF/MR)]
Contact the ISDH
Indiana State Department of Health
Division of Long Term Care
2 North Meridian Street, 4B
Indianapolis, IN 46204
(317) 233-7442 (Long Term Care Receptionist)
(317) 233-1325 (ISDH Main Switchboard)
Map
Complaint / Incident Reporting Program Director
Karen Smith
Email: ksmith@isdh.in.gov
Phone: 317-233-7709 [direct line for general questions about reporting]
Phone: 317-233-5359 [report line voicemail]
Fax: 317-233-7494
Division Director, Division of Long Term Care
Kim Rhoades
Email: krhoades@isdh.in.gov
Phone: (317) 233-7289
Phone: (317) 233-9691 [Administrative Assistant]
Fax: (317) 233-7322
Acronyms and Definitions
Acronyms
CMS: Centers for Medicare and Medicaid Services ISDH: Indiana State Department of Health
Definitions
Covered individual: A “covered individual” is defined at Section 1150B(a)(3) as each individual who is an owner, operator, employee, manager, agent, or contractor of such long term care facility.
Forms
The Incident Report Form is to be used by facilities to notify the ISDH of an unusual occurrence pursuant to the ISDH Reportable Unusual Occurrence Policy. The Incident Report Form may also to be used by covered individuals (at nursing homes, intermediate care facilities, and hospice agencies providing services in a nursing home) to report a reasonable suspicion of a crime against a resident. This form is not to be used to file a complaint.
How to Report an Incident / Unusual Occurrence / Crime to the ISDH
There is no prescribed form for reporting a reasonable suspicion of a crime against a resident to the ISDH. While there is no required form for reporting, the ISDH requests that reports be submitted in writing via either fax or email when possible. Individuals may use the ISDH Incident Report Form or use their own form. The ISDH Incident Report Form is the same form used by facilities to report unusual occurrences or reportable incidents. The form has been updated to include reports of suspected crimes.
The following are ways to report reportable incidents, to include unusual occurrences or suspected crimes, to the ISDH:
1. Email the report to the ISDH
Email address for incident reports: unusual occurrences and reasonable suspicion of crime reports: incidents@isdh.in.gov
2. Fax the report to the ISDH
Fax number for incident / crime reports: (317) 233-7494
3. Call the ISDH
Complaint / incident report line: 1-800-246-8909 [staffed during state business hours and includes voicemail capacity]; or
Incident report line voicemail: (317) 233-5359
Regardless of the method of reporting, the following information should be included if applicable and known by the individual when reporting a reportable incident or suspected crime against a resident. The Incident Report Form may be used for this purpose.
- Facility name
- Facility address
- Facility city, state and zip
- Person making the report and their title
- Date and time of incident
- Residents involved, room number, age and diagnosis
- Staff involved, their title, and professional license or aide registry number
- Brief description of incident
- Type of injury/injuries
- Immediate action taken
- Preventative measures taken
- Type of report (choose one): Initial / Follow-up / Initial with Follow-up
Laws and Regulations
Elder Justice Act – Section 1150B of the Social Security Act as established by section 6703(b)(3) of the Patient Protection and Affordable Care Act of 2010
The provided section of the Elder Justice Act is the section requiring the reporting of a reasonable suspicion of a crime against a resident.
Program Guidance and Advisory Letters
CMS Survey and Certification Letters
CMS Survey and Certification Letter 11-30-NH: Reporting reasonable suspicion of a crime in a long term care facility (including questions and answers)
ISDH Program Advisory Letters
ISDH Program Advisory LTC-2011-01: Reporting reasonable suspicion of a crime against a long term care facility resident ISDH Program Advisory LTC-2011-01 Attachment A: Template of required notice to be posted in facility ISDH Program Advisory LTC-2011-01 Attachment B: Template of contact information for reporting notice to be posted in facility ISDH Program Advisory LTC-2011-01 Attachment C: Requirements implementation checklist ISDH Program Advisory LTC-2011-01 Attachment D: Questions and answers regarding the reporting of a reasonable suspicion of a crime against a long term care facility resident
ISDH Program Policies and Procedures
ISDH Reportable Unusual Occurrence Policy
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