8.00 Abuse, Neglect and Exploitation
Home and Community Based Services Manual
8.00 Abuse, Neglect and Exploitation
The Missouri Department of Health and Senior Services (DHSS), Division of Senior and Disability Services (DSDS) has statutory authority (192.2415, RSMo) for investigating all allegations of Abuse, Neglect, and Exploitation (ANE) of eligible adults, age 60 and older or age 18-59 with a disability, with a protective service need. This includes eligible adults that are unable to protect his or her own interests or adequately perform or obtain services which are necessary to meet his or her essential human needs.
Mandated reporters are required by law (192.2475, 565.188, 208.912, and 198.070, RSMo) to report suspicions or allegations of ANE immediately to the DSDS Central Registry Unit (CRU) at 800-392-0210. Mandated reporters do not have to witness the ANE in order to make a report. Information gained from a secondary source may reveal ANE and those instances shall also be reported to CRU.
Mandated Reporting of Abuse/Neglect
The law requires mandated reporters to report any suspected abuse or neglect regarding eligible adults, age 60 and older or age 18-59 with a disability, residents of facilities, and Home and Community Based Services (HCBS) participants. A mandated reporter shall immediately report to CRU any situation in which he/she:
- Has reasonable cause to believe that an HCBS participant has been abused or neglected as a result of HCBS (192.2475, RSMo); or
- Has reasonable cause to suspect that a person sixty years of age or older has been subjected to abuse or neglect (565.188, RSMo); or
- Observes a person sixty years of age or older being subjected to conditions or circumstances which would reasonably result in abuse or neglect (565.188, RSMo); or
- Believes that a participant has been abused or neglected as a result of the delivery or failure to deliver Personal Care Assistance within the Consumer-Directed Model (CDS) (208.912, RSMo); or
- Believes that a resident of a facility has been abused or neglected (198.070, RSMo).
Reporter Immunity
Reporters (witnesses) who report (testify) in good faith or cooperate in the administrative or judicial proceedings arising from a report which alleges abuse, neglect, misappropriation of funds/property, or falsification of service delivery documents of HCBS shall be immune from criminal or civil liability for making a report or testifying.
CRU is the central point of intake for reports of ANE. CRU operates from 7 a.m. to midnight, 365 days a year. When calling CRU, DSDS or its designee, shall have available as much information regarding the situation occurring as possible. This includes, but is not limited to:
- The reported adult’s (RA) name, address, and phone number;
- The alleged perpetrator (AP) of the ANE and relationship to the RA, if any;
- Nature and extent of the RA’s condition;
- A description of the current situation and any information regarding the nature of the ANE;
- The date, time, and frequency of event(s);
- Any involved persons or witnesses to the event;
- Name, address, and phone number of any person responsible for the RA’s care; and
- The reporter’s name and daytime phone number.
I. Abuse
The infliction of physical, sexual, or emotional injury or harm including financial exploitation by any person, firm or corporation (192.2400, RSMo).
A. Physical abuse: The infliction of physical injury or harm by any person, firm or corporation in accordance with section 192.2400, RSMo. Physical injury or harm may include but is not limited to punching, kicking, striking, wounding, burning, choking, restraining, etc. Other examples include: mistreatment or maltreatment of the eligible adult in a brutal or inhumane manner; handling the eligible adult with more force than is reasonable or apparently necessary under the circumstances; physical contact with an eligible adult knowing it will be regarded as harmful; placing an eligible adult in apprehension of immediate physical injury. Actual observable injury is not required.
B. Sexual abuse: The infliction of sexual injury or harm by any person, firm or corporation in accordance with section 192.2400, RSMo. Sexual injury or harm is considered the result of any actions of a sexual nature inflicted upon an eligible adult by another person, when the eligible adult has not given or is incapable of giving consent. This may involve the use of forcible compulsion. Forcible compulsion means either the use of physical force that overcomes reasonable resistance or a threat, express or implied, that places a person in reasonable fear of death, serious physical injury or kidnapping. Sexual injury or harm includes rape or molestation and may include but is not limited to: punching, striking or wounding a person in the genitals or the breast, touching of another person with the genitals or any touching of the genitals or anus of another person, or the breast directly or through clothing for the purpose of arousing or gratifying sexual desire of any person, promoting/observing activities of the eligible adult for sexual purposes, failure to prevent inappropriate activity observed by a third person when it is known or believed that the eligible adult is at risk of harm or injury, etc.
C. Emotional abuse: The infliction of emotional injury or harm by any person, firm or corporation in accordance with section 192.2400, RSMo. Emotional injury or harm includes incidents that would cause emotional distress to a reasonable adult regardless of age or physical/mental impairment. Emotional injury or harm may result from acts of verbal abuse or the act of purposefully withholding or withdrawing affection from the eligible adult with the intent to provoke distress. Other examples include referring to an eligible adult in their presence with profanity or in a demeaning, undignified, or derogatory manner, etc.
II. Neglect
The failure to provide services to an eligible adult by any person, firm or corporation with a legal or contractual duty to do so, when such failure presents either an imminent danger to the health, safety, or welfare of the client or a substantial probability that death or serious physical harm would result (192.2400, RSMo).
A. Passive neglect: Careless conduct or a breach of a duty resulting in injury by the unintentional failure to fulfill a caregiving obligation or failure to provide based on ignorance.
B. Active neglect: Careless conduct or a breach of a duty resulting in injury by the intentional failure to fulfill caregiving needs (for example, the deliberate denial of food or medicine).
III. Financial Exploitation
The crime of Financial Exploitation involves allegations that a person (whether a family member, joint tenant, caregiver/attendant, or someone who has assumed fiduciary responsibility) has knowingly by deception, intimidation, undue influence, or force obtained control over an eligible adult’s property with the intent to permanently deprive the eligible adult benefit or possession of his or her property as directed in 570.145, RSMo.
IV. Misappropriation of Funds/Property of In-Home Services Participants or CDS Consumers:
Reports which allege an HCBS provider, its employee, or a personal care attendant is believed to have diverted personal property or funds from an HCBS participant for personal use (or the use of the provider) meet the statutory definition of Misappropriation of Funds/Property of in-home services participants or CDS consumers. Such investigations may result in a referral to the Employee Disqualification List (EDL) (APS Policy 1702.90[FILE NOT FOUND])
V. Falsification of Documents, Verifying Service Delivery:
Allegations of falsification of any documents verifying service delivery to an HCBS participant by any HCBS provider employee or personal care attendant are considered Class A misdemeanors as directed in 192.2480, RSMo, and may result in a referral to the EDL (APS Policy 1702.90[FILE NOT FOUND]).
VI. Misappropriation of Funds of Elderly or Disabled Nursing Facility Residents:
Reports which allege that a responsible party has misappropriated funds or failed to pay for care of an elderly person in a facility meet the statutory definition of misappropriation of funds of elderly nursing facility residents. Such breach of fiduciary duty is a criminal offense as defined in the statute:
"Misappropriation of funds of elderly or disabled nursing home residents, penalty:” 198.097(1), RSMo. Any person who assumes the responsibility of managing the financial affairs of an elderly or disabled person who is a resident of any facility licensed under this chapter shall be guilty of a Class E felony if such person misappropriates the funds and fails to pay for the facility care of the elderly person or disabled person.
Failure to remit funds of a Medicaid eligible facility resident to a licensed facility is also addressed under the Crime of Financial Exploitation 570.145 (7)(1), RSMo.
8.00 Appendix 1 Abuse, Neglect and Exploitation Indicators
Home and Community Based Services Manual
8.00 Abuse, Neglect and Exploitation
The following list contains typical indicators of abuse, neglect, and exploitation (ANE) for the reported adult (RA). This list, while not all inclusive, should serve as a guide for making a report of ANE.
ABUSE
- PHYSICAL INDICATORS:
- Unexplained bruises and welts
- Bruises in the shape of an object
- Unexplained fractures
- Unexplained burns
- Unexplained lacerations or abrasions
- Broken bones
- Injuries on the neck, bottom of feet or genitals
- SEXUAL INDICATORS:
- Sudden interest in sexual issues
- Questions regarding pregnancy
- Bruising on breasts or genital area
- Acting out inappropriately in a sexual manner
NEGLECT
- ENVIRONMENTAL:
- Excessive garbage in home
- Inadequate/exposed wiring
- Rodent or insect infestation
- Inadequate/unsafe structure such as holes in walls or ceiling of home
- Inadequate/ no food in home
- Inadequate/no utilities or shut-off notices for utilities
- Inadequate/no plumbing or running water
- PHYSICAL:
- Inadequate/lack of personal hygiene: not clean, has bad odor, hair matted or tangled
- Soiled clothing/bedding or same clothing all the time
- MEDICAL:
- Inadequate/lack of essentials: eyeglasses; hearing aid; teeth; walker; crutches; wheelchair; and/or other prosthetic devices.
- Excessive number of old medicine bottles with outdated prescriptions
- Inadequate/lack of medical care
- Malnourishment and/or dehydration
- Unhealed sores/untreated injuries
- Untreated infections/conditions
EXPLOITATION
- Eviction notices
- Disparity between income/assets and lifestyle
- Sudden or numerous changes to wills or powers of attorney
- Property or money missing
- Sudden change in banking practices
- Unexplained/unauthorized bank withdrawals
- Sudden lack of money or inability to purchase essentials
- Unpaid bills
BEHAVIORAL INDICATORS
- Destructive behaviors unusual to the reported adult
- Yells obscenities at others
- Assaults others
- Tears up belongings of others or themselves
- Threatens self-harm or suicide
- Refuses needed life-sustaining services (medical care)
- Inappropriately displays rage in public
- Steals without an apparent need for the things stolen
- New onset of depression or apathy
- Anger
- Withdrawal - stops talking to others, pulls away from usual social pursuits
8.00 Appendix 2 Abuse, Neglect and Exploitation Alleged Perpetrator Indicator List
Home and Community Based Services Manual
8.00 Abuse, Neglect and Exploitation
The following list, while not all inclusive, contains typical indicators of the alleged perpetrator’s (AP) behaviors or actions regarding abuse, neglect, and exploitation (ANE). This list, along with ANE Indicators list, should serve as a guide for making a report of ANE.
ABUSE
- Explanation of abuse not feasible
- Isolates reported adult (RA) from others
- Will not allow visitors
- Hides injuries which were not reported
- Past history of similar incidents
NEGLECT
- Explanation of neglect not feasible or not consistent with injury
- Does not provide needed personal or medical care
- Withholds food and/or medication
- Prolonged interval between treatment and injury
- Doctor hopping
- Inability to articulate care needs of RA
EXPLOITATION
- Implausible explanations about property/finances of the RA
- Financial problems/lack of money
- Transfers property and/or savings of individual
- Unexplained cash flow
- Evasiveness on payment of bills
- Excessive payment for care
- Unusual expenses with no visible means of income
BEHAVIOR INDICATORS
- Lack of physical, facial, or eye contact
- Hostile, secretive, or frustrated
- Shows little concern or blames RA
- Blaming someone or something else for problems
- Denial of problem
- Resentment toward RA
- Treats RA as a child
- Unrealistic expectations of RA
8.00 appendix 3 - HCBS Referral Form
Home and Community Based Services Manual
8.00 Abuse, Neglect and Exploitation
HCBS Referral Form
8.00 Appendix 4 General Health Evaluation & Level of Care Recommendation Instructions/Form
Home and Community Based Services Manual
8.00 Abuse, Neglect and Exploitation
The Home and Community Based Services (HCBS) provider nurse shall complete the General Health Evaluation and Level of Care Recommendation (GHE) form for all agency model personal care participants during the semi-annual GHE nurse visits. The GHE form shall be uploaded to the participant’s electronic case record promptly after the date of completion, but no later than ten (10) working days after the nurse visit. The GHE form may also be completed for participants during their regular monthly nurse visits; however, uploading a copy to the participant’s electronic case record is unnecessary unless there has been a significant change in the participant’s condition.
The form shall be completed in its entirety for each semi-annual evaluation to best serve the participant's needs.
Instructions
A: Participant Information
The following information shall be entered in the appropriate fields:
- DATE: Enter the date the form is completed
- PARTICIPANT: Enter NAME, DCN, DATE OF BIRTH, ADDRESS, COUNTY, and PHONE NUMBER
B: Provider Nurse Information
The following information shall be entered in the appropriate fields:
- NAME OF PROVIDER NURSE: Enter the name of the nurse completing the evaluation
- PROVIDER: NAME and PHONE NUMBER
C: Reason for Nurse Visit
- Select all boxes that apply and explain when requested
Note: DSDS shall be notified via the online Person Centered Care Plan (PCCP) request form of any needed changes identified during the visit.
D: Health Care Information
The following information shall be entered in the appropriate fields.
- PRIMARY HEALTH CARE PROVIDERS: List all pertinent health providers currently treating the participant
- CURRENT DIAGNOSIS/CONCERNS
- RECENT HOSPITALIZATIONS, SURGERIES, OR PROCEDURES
- ANY ADDITIONAL HEALTH INFORMATION: List any upcoming surgeries, procedures, or additional health information relevant to the participant
E: Allergies and Vital Signs
The information shall be entered in the appropriate fields.
Note: A1C may not be available for all participants.
F: Cardiopulmonary Assessment
- Select the appropriate boxes and provide the additional information requested
G: Integumentary Assessment
- Select the appropriate box
- Concerns can be indicated on the available body diagram
H: Level of Care Determination
This section shall, at minimum, be completed during the semi-annual GHE and LOC Recommendation and at any time requested by DSDS staff or its designee.
- Evaluate and mark the box with the corresponding point value for each of the twelve (12) LOC categories
- Add a comment to each corresponding section for any additional information used to determine the point value assigned
I: Current Authorization Review
- Select the appropriate boxes and explain when requested
- Complete the Emergency Back-up Plan
- Select the appropriate risk box (see Policy 4.15 Risk Indicators section)
- Document directions to locate, safety concerns, or additional comments
J: Veteran History
- Select the appropriate boxes
Signatures
The form must be signed and dated by both the participant and the HCBS provider nurse. If an LPN completes the evaluation, the supervisory RN or physician must sign and date it in the appropriate fields.
8.00 appendix 5 - Physician Prescription for Personal Care Services
Home and Community Based Services Manual
8.00 Abuse, Neglect and Exploitation
Physician Prescription for Personal Care Services
8.00 Appendix 6 - FSD HCB Medicaid Referral
Home and Community Based Services Manual
8.00 Abuse, Neglect and Exploitation
FSD HCB Medicaid Referral
8.00 Appendix 7 - Online Grievance Portal
Home and Community Based Services Manual
8.00 Abuse, Neglect and Exploitation
Revised July 2026
Online Grievance Portal
8.00, Appendix 9 Person Centered Care Plan Instructions
Home and Community Based Services Manual
8.00 Abuse, Neglect and Exploitation
The Person Centered Care Plan (PCCP) form shall be utilized by Home and Community Based Services (HCBS) providers when requesting care plan changes for HCBS participants. It is not to be utilized to report abuse, neglect, or exploitation or disclose hotline information. Mandated Reporters are required to report these concerns to the Adult Abuse & Neglect Hotline via the Online Reporting System.
The form shall be completed in its entirety to best serve the needs of the participant. Information can be entered into the fillable areas.
Instructions
PARTICIPANT NAME: Enter the participant’s last name and first name
DCN: Enter the participant’s Departmental Client Number (DCN)
DOB: Enter the participant’s full date of birth.
PHONE NUMBER: Enter the participant’s current phone number with the area code
ALTERNATIVE PHONE NUMBER: Enter the participant’s alternative phone number with the area code, if applicable
PARTICIPANT EMAIL: Enter the participant’s e-mail address, if applicable
PHYSICAL ADDRESS: Enter the participant’s full address where they currently reside
MAILING ADDRESS: Enter the participant’s complete mailing address if different from the physical address
Care Plan Change Request
Utilize the dropdown for the following:
- Select the task or waivered service that is being requested in each area
Utilize the columns to the right of the task to select the following actions:
- Request to add, increase, decrease, or remove the task or waiver
- If more than two actions are requested, add the information in the “Details of Requests/Additional Information” section.
Closing Requested
This section should only be used when the participant’s HCBS authorization and case need to be closed. In this circumstance, select “Yes”.
Utilize the dropdown to select the following:
- Reason the participant’s authorization for HCBS needs to be closed
- All participants who voluntarily request all HCBS authorizations be closed must contact DSDS to confirm.
- Enter the anticipated closing date
NOTE: If a case closing is a request for any other reason besides the reason listed in the dropdowns, utilize the “Other Reason” field to provide an explanation.
21-Day Notice
This section should only be used by Agency Model (IHS) providers when a participant has been given a formal 21 Day Notice.
- In this circumstance, select “YES”
- Upload a copy of the 21 Day Notice to the Documents tab in the participant’s electronic case record
- Enter the participant’s last day of service, as noted on the 21 Day Notice
Provider Change
This section should be used to communicate instances where a participant needs or requests a new HCBS provider.
- In this circumstance, select “YES”
- Indicate if the request is to switch from one program to another
Select the reason for the provider change request based on guidance below:
- Participant Choice: Select when the participant requests a new provider
- Provider Choice: Select when the provider is unable/unwilling to continue providing services
- Unable To Self-Direct: Select when there are concerns that the participant is unable to direct their own care
- Moved Out of Service Area: Select when the participant moved out of the provider’s coverage area
Enter the proposed new provider’s name, if applicable.
Enter the proposed new provider’s phone number, if applicable.
Indicate if the new provider is willing and able to accept the participant as a client.
- Provide the tentative start date for the proposed new provider.
- All provider changes require DSDS approval. Services with the proposed provider may not start until authorized by DSDS.
Indicate if the participant needs a provider list to select a new provider.
- DSDS will utilize the participant’s e-mail address to send the provider list, if applicable.
- If the participant does not have an e-mail address, DSDS will mail the participant a provider list.
Details of Request/Additional Information
Add any additional information pertinent to the request being submitted.
Requestor Information
The following shall be entered:
- Name
- Affiliation
- Phone Number
- E-mail of the person submitting the request
Other Reponsible Party/Legal Guardian Contact Information
The following shall be entered:
- Name, Phone
- Number
- Alternate Phone Number
- Mailing Address
- E-mail of the guardian or other responsible party of the participant
8.05 Participant Case Records
Home and Community Based Services Manual
8.00 Abuse, Neglect and Exploitation
The information in the Home and Community Based Services (HCBS) Web Tool is the participant’s official electronic record. DSDS staff shall document and upload information accurately and timely in order to ensure the participant’s record is up to date. HCBS participant’s records shall be maintained for seven (7) years.
The Department of Health and Senior Services (DHSS), Division of Senior and Disability Services (DSDS) may receive a request for a copy of the HCBS participant’s case record. A caserecord request shall be processed by the appropriate DSDS staff. DSDS staff shall document and upload information accurately and timely in order to ensure the participant’s case record is up to date. Any verbal request for the participant case record shall be documented in Case Notes in the participant’s electronic case record. Any written request shall be uploaded to the participant’s electronic case record, with corresponding notation in Case Notes. DSDS staff shall complete the case record request no later than thirty (30) business days from receipt of the request. Staff shall refer to Adult Protective Services Policy 1706.40 for guidance in processing requests received for hotline investigation records.
A participant and/or their legal representative, acting on behalf of the participant, may request the participant’s electronic case record either verbally or in writing using the Authorization for Disclosure of Consumer Medical Health Information Form. The Authorization for Disclosure should be uploaded to the participant’s electronic record when received. Any requestor, other than the participant or legal representative, must provide an Authorization for Disclosure of Consumer Medical Health Information Form signed by the participant or legal representative. The participant and/or legal representative can ask for the electronic case record be sent directly to them to provide to others.
Additionally, DSDS staff may receive requests for documentation of HCBS eligibility. A participant and/or their legal may request this information either verbally or in writing using the Authorization for Disclosure of Consumer Medical Health Information Form. The participant may request the records be sent directly to them or, if the records are to be sent to the participant’s legal representative, staff shall advise the legal representative to use this form. Any requestor other than the participant or legal representative must provide an Authorization for Disclosure of Consumer Medical Health Information Form signed by the participant and/or legal representative.
The participant’s information shall be entered into the Participant Level of Care (LOC) Eligibility Letter (see Policy 8.00 Appendix 8) to respond to these types of requests. The Participant LOC Eligibility Letter shall only be completed in response to a request for documentation of eligibility. This letter is only to be utilized after the initial assessment or reassessment has been completed.
A subpoena for records may be received requesting a copy of the participant’s case record. For this type of request, prior to the release of the record, either 1) the participant or legal representative will need to authorize the disclosure through use of the Authorization for Disclosure of Consumer Medical Health Information or 2) the request must be reviewed by the Office of General Counsel (OGC) for validity.
Once it is determined that the participant’s case record is to be released, DSDS staff shall perform a thorough review of the record and redact any confidential information prior to release of the record.
Items to be redacted are as follows:
- Protected Health Information (PHI) regarding persons other than the HCBS participant.
- Social Security Number (SSN)/Departmental Client Number (DCN) of persons other than the requesting party.
- SSN/DCN of the participant may need to be redacted in situations where asubpoena has been received for a copy of the case record.
- Information received from third parties (e.g., DMH, hospital records, and physician records).
Requested documents may include but are not limited to the following:
- Prescreen
- All case notes
- InterRAI HC
- Saint Louis University Mental Status (SLUMS)
- Self-Direction Assessment Questions
- Participant Choice Statement
- Health Care Professional Inquiry
- Adverse Action Information
- HCBS Assessment Attestation
8.15 Grievance Process
Home and Community Based Services Manual
8.00 Abuse, Neglect and Exploitation
INTRODUCTION
The Centers for Medicare & Medicaid Services (CMS) require each state to maintain a standardized grievance process for Home and Community‑Based Services (HCBS). This process ensures participants have a formal way to report concerns related to person‑centered planning, service delivery, or HCBS settings requirements. It outlines the ways participants may report concerns and explains how DSDS receives, reviews, and resolves grievances in a consistent, timely, and fair manner.
Missouri uses a single, statewide grievance process covering all HCBS programs operated by:
- Division of Senior and Disability Services (DSDS)
- Division of Developmental Disabilities (DDD) at the Department of Mental Health (DMH)
GRIEVANCE TYPES
Grievances are used when a participant has concerns about how an assessment was completed, how the care plan was developed, how services were delivered or potential violations of the HCBS settings requirements.
Grievances may include but are not limited to the following:
- Assessment Process
- Delays in scheduling or completing the assessment
- Conduct or professionalism of the assessor
- Disagreement with how the assessment was performed or how the participant was treated
- Care Plan Development
- Delays in developing or approving the care plan
- Conduct or professionalism of the care planning specialist
- Care plan that does not accurately reflect the participant’s goals, preferences, or identified needs
- Care plan that unnecessarily limits participant choices, privacy, or autonomy
- Provider‑Related Issues
- Conduct and professionalism of aide/attendant, including ethical concerns or violation of professional standards.
- Timeliness, availability, and overall reliability of the aide/attendant
- Services not delivered as authorized or to an appropriate standard
- Lack of meaningful choice regarding how or when services are provided
- Living environment restricts privacy or autonomy
The grievance process also allows participants to raise concerns related to Medicaid eligibility handled by the Family Support Division (FSD) at the Department of Social Services. These grievances may include issues such as Medicaid application processing, spend‑down payment delays, the HCB Medicaid eligibility process, or the Miller Trust process.
PROCESS
REPORTING
- Anyone may assist an HCBS participant in filing a grievance; however, the participant or their legally responsible representative must give approval before the grievance review process may begin.
- Grievances may be submitted using one of the following options:
- Online Grievance Portal
- HCBS Call Center: 1-866-835-3505
When DSDS staff receive a grievance outside these formal routes, staff should encourage the participant to submit it through the Grievance Portal or enter the information on the participant’s behalf, selecting “state staff” as the person submitting.
REVIEW AND RESOLUTION
- The HCBS Constituent Service (CS) Unit is responsible for reviewing and coordinating the resolution of all grievances submitted to DSDS.
- A participant or their legal representative must be contacted within 7 calendar days of the grievance being filed.
- The HCBS CS Unit will review the case to determine what action is needed and work with the applicable parties to reach a resolution. This may include DSDS staff, other state agencies, providers, and/or the participant.
- Resolution shall not exceed 90 calendar days.
- A grievance is considered resolved when DSDS has completed its review, taken any necessary action within its authority, and provided the participant with notification of the final determination. Examples of resolution may include, but are not limited to:
- Education of provider, participant, or DSDS staff
- Care plan adjustment, including modification of services or provider change
- Reassessment to ensure participants' needs are accurately identified and addressed
- Referral to the appropriate oversight entity when issues fall outside of HCBS (e.g., Missouri Medicaid Audit and Compliance, Family Support Division, Office of Special Investigations).
RESTRICTIONS
The grievance process should not be used for issues that already have established procedures. Examples include:
- Appeals and Hearings Requests: Used when a participant wishes to challenge a denial, reduction, or termination of services. See Chapter 6.00 for more information.
- Reporting Abuse, Neglect, or Exploitation (ANE): Used to report abuse, neglect, or exploitation. For more information visit the Adult Protective Services webpage: Stop Adult Abuse | Missouri Department of Health and Senior Services
RETALIATION PROHIBITED
Retaliation against anyone for submitting a grievance or participating in the grievance process is strictly prohibited. This includes retaliation by DSDS team members, state designees, provider agencies, or provider employees. Individuals shall not experience negative consequences for raising concerns, asking questions, or exercising their rights.
Reporting Retaliation: Concerns or allegations of retaliation shall be reported to the HCBS Constituent Services Unit at HCBSConstituentServices@health.mo.gov for review and follow‑up.