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On Feb. 21, 2024, Change Healthcare experienced a cyber security incident. Any individuals impacted by this incident will receive a letter in the mail. Learn more about this from Change Healthcare, or reach out to the contact center at 1-866-262-5342.

Reporting Requirement for Abuse, Neglect and Exploitations

Date: 08/04/22

Long-term Services and Supports (LTSS) providers who work directly with Superior HealthPlan members, have specific mandates for reporting critical incidents and suspicion of Abuse, Neglect and Exploitation (ANE). Failure to report, or false reporting, suspected ANE of a member to the Texas Department of Family and Protective Services (DFPS), Texas Health and Human Services (HHS), or a law enforcement agency is a state violation that can lead to a criminal offense.

In addition to state-required reporting, LTSS providers must report critical incidents and any allegation or suspicion of ANE that occur within the delivery of LTSS to members enrolled in Superior Medicaid (STAR Health, STAR Kids, STAR+PLUS) and STAR+PLUS Medicare Medicaid Plan (MMP) must provide Superior with a copy of ANE report findings within one Business Day of receipt of the findings from the DFPS. 

LTSS providers must ensure that their staff have been trained on recognizing and reporting critical incidents and acts or suspected acts of ANE. The provider must also show documentation regarding required actions that must be taken when, from the time they are notified, that a DFPS investigation has begun through the completion of the investigation (e.g., providing medical and psychological services as needed, restricting access by the alleged perpetrator, cooperating with the investigation, etc.). The provider must also provide the Superior member, and/or their legally authorized representative with information on how to report acts or suspected acts of ANE and the DFPS hotline at 1-800-647-7418.

What to Report:

  • Critical Incidents:
    • Medication Error
    • Serious Physical Injury
    • Unauthorized use of restraints, seclusion, or restrictive interventions
    • Criminal Victimization
    • Unexplained Death
    • Other incident or event that involved harm/risk to a member
  • Physical Abuse: Any knowing, reckless or intentional act or failure to act including unreasonable confinement, corporal punishment, inappropriate or excessive force, or intimidation which caused physical injury, death or emotional harm by a caretaker, family member, paid caretaker or other individual who has an ongoing relationship with the victim.
  • Sexual Abuse: Non-consensual sexual activity, which may include, but is not limited to, any activity that would be a sexually-oriented offense per Texas Penal Code, Chapters 21, 22 or 43 by a caretaker, family member, paid caretaker or other individual who has an ongoing relationship with the victim.
  • Emotional/Verbal Abuse: Any act or use of verbal or other communication to threaten violence that makes a reasonable person fearful of imminent physical injury. This includes communication that is used to curse, vilify, humiliate, degrade or threaten, and that results in emotional harm, or of such a serious nature that a reasonable person would consider it emotionally harmful by a caretaker, family member, paid caretaker or other individual who has an ongoing relationship with the victim.
  • Neglect: Failure to provide the protection, food, shelter and/or care necessary to avoid emotional harm or physical injury, or a negligent act or omission that caused or may have caused emotional harm, physical injury or death by a caretaker, family member, paid caretaker or other individual who has an ongoing relationship with the victim.
  • Exploitation: The illegal or improper act or process of using, or attempting to use, the resources of the alleged victim, including the alleged victim's social security number or other identifying information for monetary or personal benefit, profit or gain without the informed consent of the alleged victim by a caretaker, family member, paid caretaker, or other individual who has an ongoing relationship with the victim.
  • Emergency: Any abuse, neglect or financial exploitation, which, without immediate intervention, would result in the victim being in a state of, or at risk of, immediate and serious physical harm.

Reporting Requirements: 

Critical Incidents

  • All critical incidents should be reported to Superior by fax to 1-833-856-6863.
  • Home and Community-based Services (HCBS) providers, Texas Home Living (TxHmL) providers and Local Intellectual and Developmental Disability Authorities (LIDDA) must also enter critical incident data in the Client Assignment and Registration System (CARE) no later than 30 Calendar Days after the last day of the month being reported. To learn more, please visit the HHS Accessing CARE webpage.
  • Deaf Blind with Multiple Disabilities (DBMD) providers, Community Living Assistance and Support Services (CLASS) Case Management Agencies (CMAs) and Direct Service Agencies (DSA) must also report a critical incident to HHS by the last Calendar Day of the month following the date of becoming aware of the incident. The current process requires completion of the HHS CLASS/DBMD Notification of Critical Incidents form to be submitted to HHS electronically, or by fax to 512-206-3975.

Note: Providers should continue to follow current reporting requirements until the new Critical Incident Management System (CIMS™) is implemented.

Abuse, Neglect, and Exploitation (ANE)

  • Providers must report any types of ANE to HHS at 1-800-458-9858, if the victim is an adult or child who resides in or receives services from:
    • Nursing facilities
    • Assisted living facilities
    • Adult day care centers
    • Home and Community Support Services Agencies (HCSSAs)
      • Note: Providers are required to report allegations of ANE to both DFPS and HHS.
    • Licensed Adult Foster Care (AFC) providers.
  • Providers must report any type of ANE to the DFPS at 1-800-252-5400, within one Business Day, if the victim is one of the following:
  • An adult with a disability receiving services through the Consumer Directed Services (CDS) option
  • An adult who is elderly or has a disability, receiving services from:
    • HCSSAs
    • Unlicensed adult foster care provider with three or fewer beds
  • An adult with a disability or child residing in or receiving services from one of the following providers or their contractors:
    • Local Intellectual and Developmental Disability Authority (LIDDA), Local Mental Health Authorities (LMHAs), community center or mental health facility operated by the Department of State Health Services (DSHS)
    • A person who contracts with a Medicaid Managed Care Organization (MCO) to provide behavioral health services
    • An MCO
    • An officer, employee, agent, contractor or subcontractor of a person or entity listed above
  • Providers must submit a copy of the ANE findings within one Business Day of receipt of the findings from DFPS and the individual remediation, on confirmed allegations, to Superior’s secure fax line at 1-833-856-6863.
  • If a provider is unable to identify state agency jurisdiction, but an instance of Critical Incident or suspicion of ANE appears to have occurred, report to a local law enforcement agency and DFPS.
  • In non-emergency situations, providers can contact DFPS online at https://www.txabusehotline.org/.

For more information on provider responsibilities, please review the following resources: