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Reporting Abuse, Neglect and Exploitation

Date: 06/10/21

Texas law requires that Superior HealthPlan report any allegation or suspicion of Abuse, Neglect and Exploitation (ANE) to the appropriate entity. Failure to report, or false reporting, is a state violation that can lead to a criminal offense. This law is applicable to Superior HealthPlan Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, STAR+PLUS Medicare-Medicaid (MMP), Allwell from Superior HealthPlan (HMO and HMO SNP) and Ambetter from Superior HealthPlan providers.

In addition to state-required reporting, providers delivering Long-Term Services and Supports (LTSS) to members enrolled in STAR, STAR Health, STAR Kids, STAR+PLUS and MMP must provide Superior with a copy of ANE report findings within one business day of receipt of the findings from the Department of Family and Protective Services (DFPS). Providers are responsible for submitting the individual remediation on confirmed allegations to Superior through the secure fax line at 1-833-856-6863.

In order to avoid any liabilities, providers should be aware of what types of offenses to report and where to report them. Please reference the information below for the types of abuse that should be reported if noticed among our members.

What to Report: An allegation, suspicion or witnessed event of ANE.

  • 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: Providers should report any types of ANE to Texas Health and Human Services (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 providers.

Providers should 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.
    • A MCO.
    • An officer, employee, agent, contractor or subcontractor of a person or entity listed above.

Providers should 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 or by mail to:

Superior HealthPlan
ATTN: Quality Improvement
5900 E. Ben White Blvd.
Austin, Texas 78741

If a provider is unable to identify state agency jurisdiction, but an instance of ANE appears to have occurred, report to a local law enforcement agency and DFPS.

Please note: In non-emergency situations, providers can contact DFPS online at https://www.txabusehotline.org/.

For more information on ANE, please review the following state codes: