{"ref":"MI-HH-SG-01","title":"Adult Abuse, Neglect, and Exploitation: Recognition and Mandatory Reporting","category":"Safeguarding","own":false,"summary":"Sets out how every staff member recognizes and reports suspected abuse, neglect (including self-neglect) and exploitation of an adult patient, or of another vulnerable adult met during a visit. Michigan law (MCL 400.11a) requires anyone employed to provide health care to make an immediate oral report to MDHHS, in practice through MDHHS Centralized Intake for Abuse and Neglect at 855-444-3911, and 42 CFR §484.50(e)(2) requires staff to report immediately to the Agency as well. The policy covers what the report must contain, when to call 911, the Medicaid supplemental visits MDHHS may request, reports to the Attorney General when the alleged abuser is a provider, confidentiality and immunity, the civil fine for failing to report, documentation on Form MI-HH-SG-01-A, and follow-up care.","inShort":["If you suspect abuse, neglect, self-neglect or exploitation of any adult, call MDHHS Centralized Intake at 855-444-3911 right away, day or night.","Call 911 first if anyone is in immediate danger.","Then call the clinical manager or on-call nurse at once. Telling a supervisor does not replace your own call.","You do not need proof. Do not investigate or confront anyone.","Write down the facts and the patient’s own words, and the date and time of your call.","Your name is kept confidential, and you are protected when you report in good faith. Not reporting can mean a fine."],"primaryCitation":"MCL 400.11a","citations":["MCL 400.11","MCL 400.11a","MCL 400.11c","MCL 400.11e","MCL 750.145m and 750.145n","Michigan Medicaid Provider Manual, Home Health, Section 8.1.K","Michigan Medicaid Provider Manual, General Information for Providers, Section 15.4"],"federalCitations":["42 CFR §484.50(c)(2)","42 CFR §484.50(e)(1) and (e)(2)","45 CFR §164.512(c)"],"surveyorAsks":["If your aide saw bruises on a patient and the patient said a family member hit her, what would the aide do, and how fast?","Who in your agency is a mandated reporter of adult abuse in Michigan, and how do they make the report?","Show me your records of reports made to MDHHS in the last year and how you followed up.","How do staff recognize financial exploitation and self-neglect?","How do you protect a staff member who makes a report?"],"version":"1.0","effectiveDate":"2026-10-01","reviewDate":"2027-10-01","approvedBy":"Pat Sample, Administrator","forms":[{"ref":"MI-HH-SG-01-A","title":"Adult Abuse, Neglect, or Exploitation Internal Report Record"}],"sections":[{"heading":"Terms of Reference","body":["This section sets out the standing under which this policy is issued, who owns it, who is bound by it, and how it is kept current. It is not itself a procedure. The obligations begin at Section 1."],"table":{"caption":null,"headers":[["Item"],["Detail"]],"rows":[[["Issued by"],["The governing body of ",{"k":"field","name":"agency.name","text":"Sample Agency, LLC"}]],[["Document owner"],[{"k":"field","name":"people.supervisingNurse.name","text":"Robin Sample, RN"},", ",{"k":"field","name":"people.supervisingNurse.title","text":"Supervising Nurse"}]],[["Authority"],["Adopted under the Michigan Social Welfare Act, MCL 400.11 to 400.11f (adult protective services: definitions, mandatory reporting, confidentiality, immunity and the civil fine for failure to report), which binds every person employed to provide health care in Michigan; 42 CFR §484.50(c)(2) and (e) (freedom from abuse, neglect and misappropriation; immediate reporting to the HHA and to authorities), which bind the Agency as conditions of its Medicare certification; 45 CFR §164.512(c) (disclosures about victims of abuse); and the Michigan Medicaid Provider Manual, Home Health chapter, Section 8.1.K, and General Information for Providers chapter, Section 15.4, for Michigan Medicaid. Michigan does not license home health agencies; this policy follows the federal Conditions of Participation and the Michigan laws and Medicaid rules named here."]],[["Applies to"],["Every employee, contractor furnishing services under arrangement, student and volunteer of the Agency, in the home, in the community, by phone or in the office, and for every adult they meet in the course of their work, whether or not that adult is a patient."]],[["Status"],["Mandatory. Adherence is a condition of employment and of any contract for services. No provision may be waived, shortened, or varied by any employee."]],[["Not covered here"],["Suspected abuse or neglect of a child, which is Policy MI-HH-SG-02. Investigation of an allegation against an Agency staff member, which is Policy MI-HH-SG-03 (the report under this policy is still made first). Workplace violence against staff, which is Policy MI-HH-HR-05."]],[["Review"],["Reviewed by the document owner at least every ",{"k":"field","name":"settings.reviewFrequencyMonths","text":"12"}," months, at the annual policy review in Policy MI-HH-GOV-04, and within 30 days of any amendment to a rule cited at Section 15. Each review is recorded at Section 18 whether or not the text changes."]],[["Amendment"],["Any change requires the approval of the governing body and the issue of a new version number. Superseded versions are retained for at least seven years."]],[["Distribution"],["Master copy held in the policy manual at the Agency office. Available to every staff member it applies to through the policy library and covered at orientation."]],[["Questions"],["Direct to the document owner on ",{"k":"field","name":"agency.phone","text":"(517) 555-0100"}," or ",{"k":"field","name":"agency.email","text":"office@example.com"},"."]]]},"edited":false},{"heading":"1. Purpose","body":["This policy protects adult patients of ",{"k":"field","name":"agency.name","text":"Sample Agency, LLC"}," from abuse, neglect and exploitation by making sure every staff member knows the signs, reports any suspicion at once to MDHHS and to the Agency, and acts to keep the patient safe. Michigan law requires a person employed to provide health care who \"suspects or has reasonable cause to believe that an adult has been abused, neglected, or exploited\" to \"make immediately, by telephone or otherwise, an oral report\" (MCL 400.11a(1)). Michigan does not license home health agencies; this duty comes from the Social Welfare Act, which applies to each staff member personally, and from the federal Conditions of Participation that bind the Agency."],"edited":false},{"heading":"2. Scope","body":["This policy covers definitions, who must report, recognizing abuse, neglect, self-neglect and exploitation, immediate safety, how and when to report, report content, notifying the Agency, informing the patient, Medicaid supplemental visits, reports to the Attorney General and the police, confidentiality and immunity, penalties for not reporting, documentation, and follow-up."],"edited":false},{"heading":"3. Definitions","body":["The following terms have the meanings given below when used in this policy."],"table":{"caption":null,"headers":[["Term"],["Meaning"]],"rows":[[["Agency"],[{"k":"field","name":"agency.name","text":"Sample Agency, LLC"},", a Medicare-certified home health agency serving ",{"k":"field","name":"agency.counties","text":"Ingham and Eaton Counties"},"."]],[["Patient"],["A person receiving home health services from the Agency. 42 CFR Part 484 says \"patient\". The Michigan Medicaid Provider Manual says \"beneficiary\" for a person covered by Michigan Medicaid. In this policy the two words mean the same person."]],[["Medicare-certified"],["Certified by CMS to take part in Medicare under 42 CFR Part 484 (the home health Conditions of Participation). Michigan does not license home health agencies. The Agency is surveyed for CMS by the Michigan Department of Licensing and Regulatory Affairs, Bureau of Survey and Certification, or by an accrediting organization with CMS-approved deeming authority. This manual is written for a certified Agency, so every Condition of Participation it cites binds the Agency. Michigan Medicaid enrolls only a home health agency that is Medicare-certified (Michigan Medicaid Provider Manual, Home Health, Section 1)."]],[["CMS Certification Number (CCN)"],["The Medicare provider number CMS assigns to the Agency when it is certified. Because Michigan issues no home health license, the CCN is the Agency’s identifying number in this manual and appears as ",{"k":"field","name":"agency.licenseNumber","text":"000000"},". The Agency’s National Provider Identifier (NPI) and its Michigan Medicaid (CHAMPS) provider ID are separate identifiers."]],[["Abuse (MCL 400.11(a))"],["\"harm or threatened harm to an adult's health or welfare caused by another person. Abuse includes, but is not limited to, nonaccidental physical or mental injury, sexual abuse, or maltreatment.\""]],[["Neglect (MCL 400.11(d))"],["\"harm to an adult's health or welfare caused by the inability of the adult to respond to a harmful situation or by the conduct of a person who assumes responsibility for a significant aspect of the adult's health or welfare. Neglect includes the failure to provide adequate food, clothing, shelter, or medical care.\" This includes self-neglect, where the adult cannot respond to a harmful situation. The statute adds that a person is not abused or neglected for the sole reason of receiving or relying on treatment by spiritual means through prayer alone."]],[["Exploitation (MCL 400.11(c))"],["\"an action that involves the misuse of an adult's funds, property, or personal dignity by another person.\""]],[["Vulnerable (MCL 400.11(f))"],["\"a condition in which an adult is unable to protect himself or herself from abuse, neglect, or exploitation because of a mental or physical impairment or because of advanced age.\""]],[["Adult in need of protective services (MCL 400.11(b))"],["\"a vulnerable person not less than 18 years of age who is suspected of being or believed to be abused, neglected, or exploited.\""]],[["Abuse and neglect under the Conditions of Participation"],["Each patient has the right to be free from \"verbal, mental, sexual, and physical abuse, including injuries of unknown source, neglect and misappropriation of property\" (42 CFR §484.50(c)(2)). The Agency treats each of these as reportable under this policy."]],[["Reasonable cause to believe"],["Facts that would lead a careful person to suspect abuse, neglect or exploitation. Proof is not needed, and staff do not investigate before reporting."]],[["MDHHS Centralized Intake"],["The MDHHS statewide intake for reports of abuse and neglect: ",{"k":"field","name":"fixed.abuseReportRoute","text":"Michigan Department of Health and Human Services (MDHHS) Centralized Intake for Abuse and Neglect, toll-free 855-444-3911, any time day or night"},". The statute directs the report to the county department; Centralized Intake receives reports for every county."]]]},"edited":false},{"heading":"4. Policy Statement (MCL 400.11a)","body":["Every staff member who suspects or has reasonable cause to believe that an adult (a patient, a family member, or anyone met during a visit) has been abused, neglected or exploited makes an oral report immediately to MDHHS through Centralized Intake at ",{"k":"field","name":"fixed.abuseHotline","text":"855-444-3911"},", as MCL 400.11a(1) requires. Every staff member also reports the finding immediately to the Agency, as 42 CFR §484.50(e)(2) requires: \"Any HHA staff (whether employed directly or under arrangements) in the normal course of providing services to patients, who identifies, notices, or recognizes incidences or circumstances of mistreatment, neglect, verbal, mental, sexual, and/or physical abuse, including injuries of unknown source, or misappropriation of patient property, must report these findings immediately to the HHA and other appropriate authorities in accordance with state law.\"\n\nThe duty is personal. Telling a supervisor does not take its place, and no one at the Agency may stop, delay or discourage a report. As the Agency’s own standard, every staff member is treated as a mandated reporter, including home health aides (MDHHS lists aides among health care mandated reporters) and office staff.\n\nIf a person is in immediate danger, call 911 first. Then make the report to MDHHS and tell the Agency."],"edited":false},{"heading":"5. Recognizing Abuse, Neglect and Exploitation","body":["Signs do not prove abuse, but they are reasons to report. Table 1 lists common signs in the home."],"table":{"caption":["Table 1.  Signs that should lead to a report"],"headers":[["Type"],["Examples"]],"rows":[[["Physical abuse"],["Bruises, burns, cuts, fractures or marks that do not fit the explanation; injuries in different stages of healing; grip marks on the arms; the patient flinches or is afraid of a caregiver; injuries of unknown source"]],[["Sexual abuse"],["Bruising or bleeding in the genital area or breasts; new sexually transmitted infection; the patient reports it; unusual fear of a person during personal care"]],[["Emotional or verbal abuse"],["A caregiver who yells, threatens, humiliates, isolates or ignores the patient; the patient seems withdrawn, fearful or anxious around that person"]],[["Neglect by a caregiver"],["Missing medications, food or water; untreated wounds or pressure injuries; soiled bedding or clothing; patient left alone who cannot be; unsafe home; missed medical appointments the caregiver agreed to arrange"]],[["Self-neglect"],["The patient cannot meet basic needs and refuses or cannot get help: no food or heat, hoarding that blocks exits, severe weight loss, refusing essential care while unable to understand the risk"]],[["Exploitation"],["Missing money or property; unpaid bills while someone controls the patient’s funds; sudden changes to a will, bank accounts or property titles; a new \"friend\" who controls the patient’s money; the patient lacks food or medication despite adequate income"]],[["Misappropriation by staff"],["A report that a staff member took or used the patient’s money, medications or property (also handled under Policy MI-HH-SG-03)"]]]},"edited":false},{"heading":"6. How to Report","body":[],"list":[["Make sure the patient is safe. If anyone is in immediate danger, or a crime has just happened, call 911."],["Call MDHHS Centralized Intake at ",{"k":"field","name":"fixed.abuseHotline","text":"855-444-3911"},", available any time day or night, immediately: during the visit if you can do so safely, or as soon as you are out of the home. Do not wait until the end of the day. A written report to MDHHS is optional after the oral report (MCL 400.11a(1))."],["Call the clinical manager, ",{"k":"field","name":"people.supervisingNurse.name","text":"Robin Sample, RN"},", or the on-call nurse at ",{"k":"field","name":"agency.afterHoursPhone","text":"(517) 555-0199"},", right away, and tell them you have reported or are about to report (42 CFR §484.50(e)(2))."],["Write the name of the intake worker, the date and time, and any reference number you are given on Form MI-HH-SG-01-A, and give it to the clinical manager before the end of your shift."],["Write a factual note in the clinical record the same day: what you saw and heard, the patient’s words in quotation marks, the care you gave, and that a report was made to MDHHS (date and time). Do not name the person you suspect as guilty or give opinions."]],"ordered":true,"edited":false},{"heading":"6.1 What the Report Contains","body":["MCL 400.11a(4) says the report \"shall contain the name of the adult and a description of the abuse, neglect, or exploitation.\" If possible it also gives the adult’s age and the names and addresses of the adult’s guardian or next of kin and of the persons the adult lives with, including their relationship to the adult, and any other information available that may establish the cause and the manner of the abuse, neglect or exploitation. Give what you know; do not delay the report to find missing details."],"edited":false},{"heading":"6.2 Telling the Patient","body":["Where it is safe, the clinician or clinical manager tells the patient that a report has been or will be made, unless professional judgment says this would put the patient at risk of serious harm, or the person who would be told is a personal representative believed to be responsible for the abuse (45 CFR §164.512(c)(2)). A competent adult may refuse protective services, but that does not remove the duty to report."],"edited":false},{"heading":"7. Other Reports","body":[],"table":{"caption":["Table 2.  Reports in addition to MDHHS"],"headers":[["Situation"],["Also report to"],["Who reports"]],"rows":[[["Immediate danger, assault, sexual assault, serious injury or theft in progress"],["911 or local police"],["The staff member, at once"]],[["The person suspected is an Agency employee or contractor"],["The Administrator, who starts Policy MI-HH-SG-03"],["The staff member and the clinical manager, at once"]],[["Suspected patient abuse by a provider that receives Medicaid funds (including Agency staff)"],["Michigan Department of Attorney General, Health Care Fraud Division: ",{"k":"field","name":"fixed.healthCareFraudUnit","text":"Michigan Department of Attorney General, Health Care Fraud Division (Medicaid Fraud Control Unit), P.O. Box 30218, Lansing, Michigan 48909; toll-free 800-242-2873; email HCF@michigan.gov"},". The Michigan Medicaid Provider Manual says the Attorney General \"is also empowered to investigate and prosecute any complaint involving patient abuse by a provider that receives Medicaid funds\" (General Information for Providers, Section 15.4)."],["The Administrator, the same day"]],[["The patient lives in a nursing home, adult foster care home or home for the aged"],["The facility’s administrator, and the ",{"k":"field","name":"fixed.ombudsmanProgram","text":"Michigan Long Term Care Ombudsman Program (advocates for residents in nursing homes, adult foster care homes, and homes for the aged)"}," at ",{"k":"field","name":"fixed.ombudsmanPhone","text":"866-485-9393"}," if the patient wishes"],["The clinical manager"]],[["A licensed or registered health professional (for example a nurse) may have committed a violation of the Public Health Code"],["LARA, as MCL 333.16222 requires (Policy MI-HH-HR-04)"],["The licensee who has knowledge, with the Administrator’s help"]]]},"note":["Some acts against vulnerable adults are crimes. Under MCL 750.145n a caregiver or other person with authority over a vulnerable adult commits vulnerable adult abuse when the caregiver intentionally causes physical or mental harm, or when a reckless act or failure to act causes harm or poses an unreasonable risk of harm; \"vulnerable adult\" is defined in MCL 750.145m(u). Staff report the facts and leave decisions about crimes to MDHHS and the police."],"edited":false},{"heading":"8. Michigan Medicaid Patients: Supplemental Visits","body":["For Michigan Medicaid patients, the Michigan Medicaid Provider Manual requires that \"If there is reasonable cause to suspect that a beneficiary may be in danger of abuse, neglect, exploitation, cruelty, or other hazards, the HHA must report the suspected abuse to the Adult or Child Protective Services Unit of the local MDHHS office\" (Home Health, Section 8.1.K). After the report:"],"list":[["The local MDHHS office can ask the Agency for supplemental home health visits to complement protective services. \"Medicaid covers up to two home health visits for this purpose.\""],["The Agency documents in the patient’s record \"the county and the name of the individual MDHHS staff member who approved the request.\""],["Approved visits must be ordered by the attending physician or non-physician practitioner and documented in the record (Policy MI-HH-ORD-01)."],["Billing staff follow the Manual’s billing limits for these visits (Policy MI-HH-BUS-02)."]],"ordered":false,"edited":false},{"heading":"9. Confidentiality, Immunity and Protection From Retaliation","body":[],"list":[["The identity of a person who makes a report \"shall be confidential, subject only to disclosure with the consent of that person or by judicial process\" (MCL 400.11c(1))."],["A person acting in good faith who makes a report, or helps make it, is immune from civil liability that might otherwise result, and is presumed to have acted in good faith. The immunity does not cover a negligent act that causes personal injury or death (MCL 400.11c(1))."],["A report made by a physician or other licensed health professional is not a violation of privileged communication or of the confidentiality provisions of the Public Health Code (MCL 400.11a(2)). HIPAA permits the disclosure because it is required by law (45 CFR §164.512(c); Policy MI-HH-PRV-01)."],["No staff member is disciplined, threatened or treated unfairly for making a report in good faith or for cooperating with an investigation. Retaliation is itself a violation of Agency policy and is handled under Policy MI-HH-SG-03."]],"ordered":false,"edited":false},{"heading":"10. Failure to Report","body":["A person required to report under MCL 400.11a \"who fails to do so is liable civilly for the damages proximately caused by the failure to report, and a civil fine of not more than $500.00 for each failure to report\" (MCL 400.11e(1)). A staff member who fails to report suspected abuse, neglect or exploitation, or who discourages another person from reporting, is also disciplined up to termination."],"edited":false},{"heading":"11. Follow-Up Care and Coordination","body":[],"list":[["The clinical manager reviews every report the same day, confirms that MDHHS and any other required authority have been told, and records the follow-up on Form MI-HH-SG-01-A."],["The clinical manager tells the patient’s physician or allowed practitioner, and updates the plan of care for safety (for example more frequent visits, a safety plan, community resources, a change in caregiver) (Policy MI-HH-CP-01)."],["The Agency cooperates with the MDHHS adult protective services worker and with law enforcement, giving the information they need as the law allows (Policy MI-HH-PRV-01), and records each contact."],["If the patient lives in the home of the person suspected, the clinical manager plans visits so that staff are safe (Policy MI-HH-HR-05)."],["Reports are tracked and reviewed by the QAPI program each quarter without names (Policy MI-HH-QA-01)."]],"ordered":false,"edited":false},{"heading":"12. Responsibilities","body":["Accountability under this policy is allocated as follows."],"table":{"caption":["Who is accountable for what"],"headers":[["Role"],["Responsibility under this policy"]],"rows":[[["Every staff member"],["Recognizes signs; calls 911 for immediate danger; reports immediately to MDHHS Centralized Intake; tells the clinical manager at once; documents facts; never investigates alone or confronts the person suspected."]],[[{"k":"field","name":"people.supervisingNurse.name","text":"Robin Sample, RN"},", ",{"k":"field","name":"people.supervisingNurse.title","text":"Supervising Nurse"}],["Owns this policy; supports staff to report; confirms each report was made; tells the practitioner; updates the plan of care; coordinates with MDHHS; keeps Form MI-HH-SG-01-A in the safeguarding file."]],[[{"k":"field","name":"people.alternateSupervisingNurse.name","text":"Casey Sample, RN"},", ",{"k":"field","name":"people.alternateSupervisingNurse.title","text":"Alternate Supervising Nurse"}],["Carries out the clinical manager’s duties when the clinical manager is not available."]],[[{"k":"field","name":"people.administrator.name","text":"Pat Sample"},", ",{"k":"field","name":"people.administrator.title","text":"Administrator"}],["Reports to the Attorney General Health Care Fraud Division where a provider is suspected; starts Policy MI-HH-SG-03 when Agency staff are involved; makes sure no one is penalized for reporting."]],[[{"k":"field","name":"people.alternate.name","text":"Jo Sample"},", ",{"k":"field","name":"people.alternate.title","text":"Alternate Administrator"}],["Acts for the Administrator when the Administrator is not available."]],[[{"k":"field","name":"people.privacyOfficial.name","text":"Lee Sample"},", ",{"k":"field","name":"people.privacyOfficial.title","text":"HIPAA privacy official"}],["Advises on what information may be shared with investigators; makes sure the reporter’s identity is protected."]]]},"edited":false},{"heading":"13. Records and Compliance Monitoring","body":["Form MI-HH-SG-01-A and related notes are kept by the clinical manager in a confidential safeguarding file, separate from the clinical record and the personnel file, for at least seven years as the Agency’s own standard. The clinical record holds the factual visit note, the date and time a report was made, and, for Michigan Medicaid supplemental visits, the county and the MDHHS staff member who approved them. The clinical manager reports the number of reports made, the time from finding to report, and follow-up actions to the QAPI program each quarter."],"edited":false},{"heading":"14. Staff Training","body":["All staff are trained at orientation, before their first visit, on this policy: the Michigan definitions, the signs, how to call Centralized Intake, the duty to tell the Agency, confidentiality and immunity, and the penalty for not reporting (Policy MI-HH-HR-01). Every staff member completes a refresher each year as the Agency’s own standard. Each staff member carries the Centralized Intake number on the Agency’s badge card or phone."],"edited":false},{"heading":"15. References","body":["This policy implements the following authorities."],"list":[["MCL 400.11 (definitions), 400.11a (reporting), 400.11c (confidentiality and immunity) and 400.11e (failure to report), Social Welfare Act"],["MCL 750.145m and 750.145n, Vulnerable adult abuse (Michigan Penal Code)"],["42 CFR §484.50(c)(2) and (e), Patient rights: freedom from abuse; investigation and reporting"],["45 CFR §164.512(c), Disclosures about victims of abuse, neglect or domestic violence"],["Michigan Medicaid Provider Manual, Home Health chapter, Section 8.1.K, and General Information for Providers chapter, Section 15.4 (version October 1, 2026)"]],"ordered":false,"edited":false},{"heading":"16. Related Policies and Forms","body":["The following documents are read together with this policy."],"table":{"caption":null,"headers":[["Reference"],["Title"]],"rows":[[["Policy MI-HH-SG-02"],["Child Abuse and Neglect: Mandated Reporting"]],[["Policy MI-HH-SG-03"],["Allegations Against Staff: Protection, Investigation, and Corrective Action"]],[["Policy MI-HH-QA-02"],["Incident Reporting, Adverse Events, and Investigations"]],[["Policy MI-HH-PR-01"],["Patient Rights and Responsibilities"]],[["Policy MI-HH-PRV-01"],["HIPAA Privacy and Michigan Confidentiality Laws"]],[["Policy MI-HH-CP-01"],["Individualized Plan of Care"]],[["Policy MI-HH-CC-01"],["Coordination of Care, Case Conferences, Summary Reports, and Coordination With Home Help and MI Choice"]],[["Policy MI-HH-REC-01"],["Clinical Records: Content, Authentication, Timeliness, and Retention"]],[["Policy MI-HH-HR-01"],["Personnel Qualifications, Job Descriptions, Orientation, In-Service Training, and Evaluation"]],[["Policy MI-HH-CMP-01"],["Complaints and Grievances"]],[["Form MI-HH-SG-01-A"],["Adult Abuse, Neglect, or Exploitation Internal Report Record"]]]},"edited":false},{"heading":"17. Approval","body":["This policy is adopted by the governing body of ",{"k":"field","name":"agency.name","text":"Sample Agency, LLC"},". The effective date, the person who approved it, and the date of approval are shown in the header block and recorded in the signature lines below."],"edited":false},{"heading":"18. Revision History","body":["Every version of this policy, the date it took effect, a summary of what changed, and who approved it is recorded below. Where a rule cited in Section 15 is amended, the amendment is recorded in this table and a new version of this policy is issued."],"edited":false}],"missing":[],"editedCount":0,"pack":"mi-hha","state":"Michigan","service":"Home health","guides":[{"path":"/guides/abuse-neglect-exploitation-reporting/","h1":"Abuse, neglect and exploitation policies: what each state requires"},{"path":"/guides/home-health-agency-policies/","h1":"What policies and procedures are required for home health agencies?"},{"path":"/guides/home-health-conditions-of-participation/","h1":"Home health Conditions of Participation: which policies each one needs"}],"sample":true,"agency":{"name":"Sample Agency","legalName":"Sample Agency, LLC","logo":null}}