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Recognizing and Reporting Critical Incidents and Abuse, Neglect and Exploitation

Date: 10/16/23

Long-term Services and Supports (LTSS) providers 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 Commission (HHSC), or a law enforcement agency is a state violation that can lead to a criminal offense.

In addition to state-required reporting, LTSS providers who work directly with Superior HealthPlan 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 Critical Incident and/or ANE report.

LTSS providers must ensure that their staff have been trained on recognizing and reporting critical incidents and acts or suspected acts of ANE. HHSC provides a computer-based ANE training. Providers should access the HHSC Learning Portal to complete the ANE Competency Training and Exam. 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.

Recognizing Critical Incidents and Abuse, Neglect, and Exploitation

  • Critical Incidents:
    • Medication error
    • Serious physical injury
    • Unauthorized use of restraints, seclusion, or restrictive interventions
    • Criminal victimization
    • Unexplained death
    • An allegation or confirmation of abuse, neglect, or exploitation
    • 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:

If the provider determines that a member is in immediate danger and in an emergency/life threatening situation, call 911 before reporting to DFPS or HHSC.

How to report a Critical Incident and Abuse, Neglect, and Exploitation to HHSC, DFPS, and Superior:

  • Providers enrolled in the following programs are required to submit Critical Incidents online using HHSC’s Critical Incident Management System (CIMS™).
    • Deaf Blind with Multiple Disabilities (DBMD)
    • Home and Community-based Services (HCS)
    • Texas Home Living (TxHmL)
    • Community Living Assistance and Support Services (CLASS)
    • Medically Dependent Children Program (MDCP)
    • STAR Kids MDCP / STAR Health MDCP
    • STAR+PLUS Home and Community Based Services (HCBS)
    • LIDDA General Revenue (GR) services

Please Note: Providers are still required to report ANE allegations to DFPS per current reporting guidelines.

  • If a Home and Community Support Services Agencies (HCSSA) has cause to believe that the alleged ANE was committed by an employee, volunteer, contractor, or subcontractor of the HCSSA including family members employed by the HCSSA report to the HHSC new incidents submission portal under Texas Unified Licensure Information Portal. HHSCA’s programs include the following:
    • Home and community support service agencies (home health and hospice)
    • Day activity and health services
    • Assisted living facilities
    • Licensed and skilled nursing facilities
    • Licensed intermediate care facilities for persons with an intellectual disability
    • Non-licensed ICF/IDs

Please Note: HCSSA should report to DFPS only if they believe the abuse, neglect or exploitation was committed by someone other than an HCSSA staff member or if the member is in a state of self-neglect.

  • All critical incidents and ANE’s should be reported to Superior’s secure fax line at 1-833-856-6863:
    • Within one Business Day of submission to DFPS and/or HHSC
    • Providers must also submit a copy of the ANE findings within one Business Day of receipt of the findings from HHSC/DFPS and the individual remediation, on confirmed allegations.
  • 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.

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