Abuse, Neglect, and Exploitation of Patients: Mandated Reporting to the Department

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.

This policy protects patients from abuse, neglect and exploitation and makes sure that every concern reaches the Department at once. Every 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)). Missouri names the "home health agency, home health agency employee" among the persons who "shall be required to immediately report or cause a report to be made to the department" (RSMo §192.2405.1).

This policy covers every patient of the Agency. The Missouri reporting law protects "eligible adults" (Section 3); the federal duty in 42 CFR §484.50(e)(2) covers every patient. The Agency therefore reports every concern about any adult patient. It covers abuse or neglect by anyone (family, caregivers, other people in the home, Agency staff, staff of other providers), financial exploitation, bullying, self-neglect that puts the patient at risk of serious physical harm, and residents of long-term care facilities the Agency serves.

The following terms have the meanings given below when used in this policy.

Every staff member who has reasonable cause to suspect that a patient has been subjected to abuse or neglect, or observes the patient being subjected to conditions or circumstances which would reasonably result in abuse or neglect, reports immediately to the Department (RSMo §192.2405.1(2)). Every staff member, whether employed directly or under arrangement, who identifies, notices or recognizes mistreatment, neglect, verbal, mental, sexual or physical abuse, including injuries of unknown source, or misappropriation of patient property, also reports it immediately to the Agency (42 CFR §484.50(e)(2)). The report to the Department is made through the Missouri Department of Health and Senior Services Adult Abuse and Neglect Hotline at 1-800-392-0210 (seven days a week, 7:00 a.m. to 8:00 p.m.), or online at any time through the Missouri Adult Abuse and Neglect Online Reporting System at https://moapss.health.mo.gov/. If anyone is in immediate danger, call 911 first. No one in the Agency may delay, discourage, screen or prevent a report, and no one is retaliated against for making one (RSMo §192.2475.9). The Agency investigates, protects the patient from further harm and from retaliation while it investigates (42 CFR §484.50(e)(1)(iii)), cooperates with the Department, and documents everything.

1. Make sure the patient is safe. If anyone is in immediate danger, call 911.
2. Report immediately to the Department through the Missouri Department of Health and Senior Services Adult Abuse and Neglect Hotline at 1-800-392-0210 (seven days a week, 7:00 a.m. to 8:00 p.m.), or online at any time through the Missouri Adult Abuse and Neglect Online Reporting System at https://moapss.health.mo.gov/. This number, 1-800-392-0210 (seven days a week, 7:00 a.m. to 8:00 p.m.), is the Adult Abuse and Neglect Hotline and is also the Department's home health complaint hotline. Outside hotline hours use the online reporting system. Relay service is available through Relay Missouri 1-800-735-2966 (text) or 1-800-735-2466 (voice).
3. Give the information the law asks for, if known: the patient's name, age and address; the name and address of any person responsible for the patient's care; the nature and extent of the patient's condition; and other relevant information (RSMo §192.2410.1). If a home health agency employee is involved, also give the names and addresses of the Agency and the employee and what happened (RSMo §192.2475.3).
4. Tell the clinical manager, Robin Sample, RN, or the Administrator right after making the report, or ask them to stay with you while you report. You may "cause a report to be made" by another person, but you remain responsible for making sure it is made (RSMo §192.2405.1).
5. Do not investigate, interview the suspected abuser, or tell that person a report is being made. Do not disturb evidence beyond what safety requires.
6. Write down what you saw and heard, in the patient's words where possible, the date and time of the report, the hotline report or confirmation number, and the name of the person you spoke to. Complete Form MO-HH-SG-01-A the same day.
7. Document the patient's condition and the care given in the clinical record, in facts only.

• If the patient is a resident of a long-term care facility and you have reasonable cause to believe the resident has been abused or neglected, report immediately to the Department under RSMo §198.070.1, through the same hotline. If sexual assault is suspected, a report is also made to the local law enforcement agency (RSMo §198.070.2(2)).
• If the patient is 18 to 59 and does not appear to have a disability, still report to the Department; reports about persons who are not eligible adults are referred by the Department to the appropriate authorities (RSMo §192.2410.2). The 42 CFR §484.50(e)(2) duty to report immediately applies to every patient. Report crimes to local law enforcement as well.
• If the patient is under 18, or a child in the home may be abused or neglected, follow Policy MO-HH-SG-02.

1. The clinical manager confirms that the report has been made to the Department and, if not, makes it at once.
2. The clinical manager makes a plan to keep the patient safe, which may include extra visits, a change of caregiver, a call to the ordering practitioner, or emergency services.
3. If an Agency employee or contractor is alleged to be involved, the Administrator removes that person from all patient contact at once, with pay or as the employment policy allows, until the Department and the Agency investigations are complete (Agency standard). This prevents further potential violations, including retaliation, while the complaint is investigated (42 CFR §484.50(e)(1)(iii)).
4. The Agency begins its own investigation only after the report has been made, and never in a way that interferes with the Department's investigation. It documents the existence of the allegation and its resolution (42 CFR §484.50(e)(1)(ii)).
5. The Agency gives the Department full access to staff, records and information it needs. Disclosure of patient information for a report required by law is permitted by HIPAA (45 CFR §164.512(c)). The Agency promptly tells the patient that a report has been or will be made, unless doing so would place the patient at risk of serious harm, or the person to be informed is a personal representative believed to be responsible for the abuse (45 CFR §164.512(c)(2)).
6. If the Department or the Agency finds that an employee abused or neglected a patient, the Administrator takes action under Policy MO-HH-HR-01, decides any report to a licensing board (Policy MO-HH-HR-05), and corrects the causes. The Department places on the Employee Disqualification List persons finally determined to have recklessly, knowingly or purposely abused or neglected a home health patient (RSMo §192.2475.12). The Agency never employs a person on that list (Policy MO-HH-HR-04).
7. Each report is reviewed in the QAPI program for patterns and prevention (Policy MO-HH-QA-01).

At admission, every patient and representative is told, in writing and in a language they understand, that they have the right to be free from abuse, neglect and misappropriation, and how to report concerns to the Agency and to the Department, including the hotline number 1-800-392-0210, its hours (seven days a week, 7:00 a.m. to 8:00 p.m.), and that it receives complaints about home health agencies as well as reports of adult abuse and neglect (Policy MO-HH-PR-01). Anyone may report abuse or neglect of a home health patient by a home health agency employee to the Department (RSMo §192.2475.4).

Accountability under this policy is allocated as follows.

Form MO-HH-SG-01-A for each report, Department correspondence, investigation notes and outcomes are kept in a confidential safeguarding file, separate from the clinical record and the personnel file, for at least six years (Agency standard). Signed Forms MO-HH-SG-01-B are kept in personnel files. The clinical record contains the facts observed, the care given, and that a report was made to the Department, with the date. Compliance is monitored by checking each quarter that every allegation in the incident and complaint logs has a matching report record, and that all staff have a current Form MO-HH-SG-01-B and training.

Every staff member, contractor, student and volunteer is trained at orientation, before any patient contact, and at least each year (Agency standard), on: the Missouri definitions; warning signs; the duty to report immediately to the Department and to the Agency; how to use the hotline and online system; what information to give; protections and penalties; and the Agency's steps after a report. Each person signs Form MO-HH-SG-01-B at orientation and after each annual training.

This policy implements the following authorities.

• RSMo §192.2400, Definitions (as amended effective August 28, 2026)
• RSMo §192.2405, Mandatory reporters
• RSMo §192.2410, Reports, contents; statewide toll-free number
• RSMo §192.2475, Report of abuse or neglect of in-home services or home health agency client
• RSMo §192.2490, Employee Disqualification List
• RSMo §192.2500, Prohibition against disclosure of reports
• RSMo §565.188, Failure to report elder abuse or neglect
• RSMo §198.070, Abuse or neglect of residents of long-term care facilities
• 42 CFR §484.50(c)(2) and (e), Freedom from abuse; investigation of complaints; immediate reporting
• 19 CSR 30-26.010(1)(A), Incorporation of 42 CFR Part 484
• 45 CFR §164.512(c), Disclosures about victims of abuse, neglect or domestic violence

The following documents are read together with this policy.

This policy is adopted by the governing body of 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.

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 14 is amended, the amendment is recorded in this table and a new version of this policy is issued.