Reminder
Blue Cross and Blue Shield of Texas Long-Term Services and Support Medicaid Providers are responsible for reporting critical incidents and suspicion of Abuse, Neglect, and Exploitation to the health plan and applicable state Department of Family Protective Services agency within 24 hours of identification. If you need assistance with reporting, please contact either the Members Service Coordination team, or you may contact your Medicaid provider representative. If after business hours (8 a.m. to 5 p.m.), please contact the nurse advice line.
Failure to report, or falsely reporting suspected ANE of a member to the DFPS, HHSC, or a law enforcement agency is a state violation that can lead to a criminal offense.
In addition, you should report all deaths of members receiving LTSS services to BCBSTX Service Coordination team at 1-877-301-4394 (STAR Kids) or 1-877-214-5630 (STAR/CHIP) for reporting to Texas Health and Human Services.
What is a Critical Incident?
A critical incident is an event that may harm, or create the potential for harm to, an individual. Critical incidents include but are not limited to the following:
- Abuse, Neglect, or Exploitation (ANE)
- The unauthorized use of restraint, seclusion, or restrictive interventions
- Serious injuries that require medical intervention or result in hospitalization
- Criminal victimization
- All deaths
- Medication errors
- Other incidents or events that involve harm or risk of harm to our Member
What is Abuse, Neglect, and Exploitation?
- Physical Abuse
- Sexual Abuse
- Emotional/Verbal Abuse
- Neglect
- Emergency
- Exploitation*
*Exploitation is defined as: When the alleged perpetrator is a direct provider to a person receiving services, exploitation is defined as the illegal or improper act or process of using a person receiving services or the resources of a person receiving services for monetary or personal benefit, profit or gain, and excludes. See examples of exploitation allegations in Section 2150. See related 26 TAC Section 711.21.
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 BCBSTX, HHSC, and DFPS:
- For BCBSTX contact our Service Coordination team at 1-877-301-4394 (STAR Kids) or 1-877-214-5630 (STAR/CHIP) within one day of reporting to HHSC and DFPS. Alternatively, you can securely email BCBSTX at tx_medicaid_critical_incidents@bcbstx.com with the report.
- Providers enrolled in the following programs are required to submit Critical Incidents online using HHSC’s Critical Incident Management System (CIMSTM):
- Deaf Blind with Multiple Disabilities
- Home and Community-based Services
- Texas Home Living
- Community Living Assistance and Support Services
- Medically Dependent Children Program
- STAR Kids MDCP/STAR Health
- LIDDA General Revenue Services
- STAR+PLUS Home and Community Based Services
Providers are still required to report ANE allegations to DFPS per current reporting guidelines.
- If a Home and Community Support Services Agencies 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:
- Nursing Facilities
- Assisted Living Facilities
- Day Activity Health Services Facilities
- Intermediate Care Facilities for Individuals with Intellectual Disabilities
- Prescribed Pediatric Extended Care Centers
- Home and Community Support Services Agencies
Resources
- Submit a complaint against a provider that is licensed or certified by Texas Health and Human Services
- HHSC Incidents Submission Portal for Long-Term Care Providers
- HHSC Long-Term Care Regulation Provider Letter (PDF)
- HHSC Reporting CIMS™
- Texas DFPS: Reporting Abuse, Neglect, or Exploitation
- By phone for urgent matters: 1-800-458-9858
Have questions?
Contact the STAR Kids Service Coordination: 1-877-301-4394 or STAR/ CHIP Service Coordination: 1-877-214-5630