Department for Community Based Services

Standards of Practice Online Manual

19.4 Completion of the DPP-115 Reporting Form

Cabinet for Health and Family Services

Department for Community Based Services
Division of Protection and Permanency
Standards of Practice Online Manual
Chapter:
Chapter 19-Adult Protective Services (APS)
Effective:
6/8/2018
Section:
19.4 Completion of the DPP-115 Reporting Form
Version:
5

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Legal Authority/Introduction

LEGAL AUTHORITY:

 

Procedure

  1. The SSW initiates an interagency response by completing the following tasks when a report is received and the required information is secured:
    1. Submits all intakes to the FSOS or designee for approval and assignment;
    2. Enters the report and creates the DPP-115 Confidential Suspected Abuse/Neglect, Dependency or Exploitation Reporting Form;
    3. Sends a copy of the DPP-115 to the appropriate law enforcement agency, even when they are the reporting source;
    4. Sends each DPP-115 to the commonwealth's attorney and, county attorney for prosecution;
    5. Sends a copy of the DPP-115 to the appropriate authorized agency (e.g., OIG-regional offices, DBHDID);
    6. Sends a copy of the DPP-115 to the Office of the Attorney General for possible investigation and prosecution when employees of the facility including home health agencies receiving Medicaid funding are the alleged perpetrator;
    7. Forwards the DPP-115 to the local Guardianship Office, if the SSW is aware that the alleged victim identified in the report is a state guardianship client.
  2. For alternate care settings the DPP-115 is forwarded to all authorized agencies that have a legitimate investigative interest in these facilities.
  3. If allegations involve a registered nurse or licensed practical nurse, the SSW forwards a copy of the DPP-115 to the Kentucky Board of Nursing.
  4. The DPP-115 is forwarded to the long term care ombudsman when the report involves any long term care facility excluding support for community living (SCL) homes.
  5. When the alleged victim resides in a licensed nursing facility that receives Medicaid/Medicare, the SSW forwards a copy of the DPP-115 to:
    1. Law enforcement;
    2. Office of the Inspector General-regional office
    3. Office of the long term care ombudsman; and
    4. Office of the Attorney General, Medicaid Fraud and Abuse Control Division.
  6. When the alleged victim resides in a licensed nursing facility that does not receive Medicaid/Medicare, the SSW forwards a copy of the DPP-115 to:
    1. Law enforcement;
    2. Office of the Inspector General-regional office; and
    3. Office of the long term care ombudsman.
  7. When the alleged victim resides in a licensed personal care home or licensed family care home, the SSW forwards a copy of the DPP-115 to:
    1. Law enforcement;
    2. Office of the Inspector General-regional office; and
    3. Office of the long term care ombudsman.
  8. When the alleged victim is served by a licensed home health agency, the SSW forwards a copy of the DPP-115 to:
    1. Law enforcement;
    2. Office of the Inspector General-regional office; and,
    3. Office of the Attorney General, Medicaid Fraud and Abuse Control Division.
  9. When the alleged victim is a patient in an acute care hospital, the SSW forwards a copy of the DPP-115 to:
    1. Law enforcement;
    2. Office of the Inspector General-regional office; and
    3. Office of the Attorney General, Medicaid Fraud and Abuse Control Division.
  10. When the alleged victim resides in a supports for community living (SCL) placement or receives SCL services, the SSW forwards a copy of the DPP-115 to:
    1. Law enforcement;
    2. Division of Developmental and Intellectual Disabilities; and
    3. Office of the Attorney General, Medicaid Fraud and Abuse Control Division.
  11. When the alleged victim resides in a registered boarding home, the SSW forwards a copy of the DPP-115 to:
    1. Law enforcement; and
    2. Department of Public Health, Food Safety Branch.
  12. When the alleged victim resides in a certified assisted living facility, the SSW forwards a copy of the DPP-115 to:
    1. Law enforcement; and
    2. Cabinet for Health and Family Services, Department for Aging and Independent Living, Division of Operations and Support.
  13. When the alleged victim is served by a community mental health center or resides in a psychiatric facility, the SSW forwards a copy of the DPP-115 to:
    1. Law enforcement;
    2. Division of Behavioral Health;
    3. Office of the Inspector General-regional office; and
    4. Office of the Attorney General, Medicaid Fraud and Abuse Control Division.
  14. When the alleged victim resides in an Intermediate Care Facility for Mental   Retardation (ICFMR), the SSW forwards a copy of the DPP-115 to:
    1. Law enforcement;
    2. Division of Developmental and Intellectual Disabilities;
    3. Office of the Inspector General-regional office; and
    4. Office of the Attorney General, Medicaid Fraud and Abuse Control Division.
  15. When the alleged victim is served by a Medicaid service provider (e.g.,  transportation broker), the SSW forwards a copy of the DPP-115 to:
    1. Law enforcement; and
    2. Office of the Attorney General, Medicaid Fraud and Abuse Control Division.

Practice Guidance

  • Not all alternate care facilities are regulated by the same entities, the SSW considers the type of facility when determining where to send the DPP-115.

Related Information

The following is a list of authorized agency contacts for forwarding the DPP-115:

 

 Agency Name  Contact  Address  Telephone  Fax
Office of Inspector General (OIG) Western Branch * Regional Supervisor

Western State Hospital
2400 Russellville Rd.
Hopkinsville, KY 42240

(270) 889-6052 (270) 889-6088
 OIG Northern Branch * Regional Supervisor

L&N Building, 2-W
908 W. Broadway
Louisville, KY 40203

(502) 595-4079 (502) 595-4540
 OIG Southern Branch * Regional Supervisor 116 Commerce Ave.
London, KY 40744
(606) 330-2030 (606) 330-2056
 OIG Eastern Branch * Regional Supervisor Veteran's Hospital
P.O. Box 12250
Lexington, KY 40582
(859) 246-2301 (859) 246-2307
Office of the Attorney General (OAG) Medicaid Fraud and Abuse Control Division Director 1024 Capital Center Dr.
Frankfort, KY 40601
(502) 696-5300 (502) 573-8316
Department for Behavioral Health, Developmental and Intellectual Disabilities Incident Manager

100 Fair Oaks Ln, 4W-C
Frankfort, KY 40601

 (502) 564-7702 (502) 564-2284
Department of Public Health, Food Safety Branch Branch Manager 275 East Main St. 5C-D
Frankfort, KY 40621
 (502) 564-6930 (502) 564-6533
Cabinet for Health and Family Services, Department for Aging and Independent Living Branch Manager 275 East Main St. 5C-D
Frankfort, KY 40621
(502) 564-6930 (502) 564-4595
Office of the Long Term Care Ombudsman Long Term Care Ombudsman

3138 Cluster Drive, Suite 110
Lexington, KY
40517

(859) 277-9215

(800) 372-2991

(859) 272-0060
Kentucky Board of Nursing Investigation and Discipline Branch 312 Whittington Pkwy, Suite 300
Lexington, KY 40222
(502) 429-3300

(502) 429-3311

 

 

* See the OIG Regional Map for more information.

 

 

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