What are some of the most significant changes to the new RoP Interpretive Guidance for Abuse, Neglect & Exploitation?


Some of the most significant changes to the new RoP Interpretive Guidance (IG) for Abuse, Neglect & Exploitation include the following:

      • The IG now states that surveyors should not automatically determine that every resident-to-resident altercation be cited as abuse.  CMS states that “Infrequent arguments or disagreements during the course of normal social interactions would not constitute abuse”.
      • Facilities must evaluate whether residents have the capacity to consent to sexual activity as part of their steps to protect residents from abuse.
      • There is new guidance regarding bed rails for F 604, Right to be Free from Physical Restraints.  A bed rail is considered to be a restraint if it keeps a resident from voluntarily getting out of bed in a safe manner due to their physical or cognitive inability to lower the bed rail independently.
      • Under F607 facilities must post a conspicuous notice of employee rights, including the right to file a complaint with the State Survey Agency if they believe the facility has retaliated against an employee or individual who has reported a suspected crime and how to file such a complaint.  Also, facility abuse policies must address how staff will communicate and coordinate situations of abuse/neglect with their QAPI program.
      • F 608 Reporting Reasonable Suspicion of a Crime has been deleted and the information combined with F609.  There are many items that must be included in the facility policies including:  examples of crimes that would be reported (i.e., assault & battery, sexual abuse, drug diversion, etc.), along with how staff will be trained in orientation and annually, and how the facility will provide ‘periodic drills’.
      • There is a new CMS ‘Sample Form for Initial Reporting’ (Exhibit 358) and ‘Sample Follow-up Investigation Report’ (Exhibit 359) that can be used for reporting of alleged violations under F609.
      • There are new examples of Alleged Violations of Staff to Resident Abuse for Mental/Verbal Conflict and Sexual Contact, as well as for Injuries of Unknown Source, Neglect and Misappropriation under F609.
      • There is a new Psychosocial Outcome Severity Guide that notes the specific F tags where the psychosocial impact of the cited deficiency on the resident will be assessed at https://www.cms.gov/files/zip/survey-resources-staff-vaccine-documents-06072022.zip

See the newly revised Appendix PP State Operations Manual  at: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations/Downloads/Appendix-PP-State-Operations-Manual.pdf


Janine Lehman, RN, RAC-CT, CLNC
Director of Regulatory Services

Learn more about the rest of the Proactive team.