26 Tex. Admin. Code § 510.83 - Complaint Investigations
(a) A facility
shall provide each patient and applicable legally authorized representative at
the time of admission with a written statement identifying the Texas Health and
Human Services Commission (HHSC) as the agency responsible for investigating
complaints against the facility.
(1) The
statement shall inform persons that they may direct a complaint to HHSC
Complaint and Incident Intake (CII) and include current CII contact
information, as specified by HHSC.
(2) The facility shall prominently and
conspicuously post this statement in patient common areas and in visitor's
areas and waiting rooms so that it is readily visible to patients, employees,
and visitors. The information shall be in English and in a second language
appropriate to the demographic makeup of the community served.
(b) HHSC evaluates all complaints.
A complaint must be submitted using HHSC's current CII contact information for
that purpose, as described in subsection (a) of this section.
(c) HHSC documents, evaluates, and
prioritizes complaints directed to HHSC CII based on the seriousness of the
alleged violation and the level of risk to patients, personnel, and the public.
(1) Allegations determined to be within
HHSC's regulatory jurisdiction relating to health care facilities may be
investigated under this chapter.
(2) HHSC may refer complaints outside HHSC's
jurisdiction to an appropriate agency, as applicable.
(d) HHSC conducts investigations to evaluate
a facility's compliance following a complaint of abuse, neglect, or
exploitation; or a complaint related to the health and safety of patients.
Complaint investigations may be coordinated with the federal Centers for
Medicare & Medicaid Services and its agents responsible for the inspection
of hospitals to determine compliance with the Conditions of Participation under
Title XVIII of the Social Security Act, (42 USC, §
1395
et seq.), so as to avoid duplicate investigations.
(e) HHSC may conduct an unannounced, on-site
investigation of a facility at any reasonable time, including when treatment
services are provided, to inspect or investigate:
(1) a facility's compliance with any
applicable statute or rule;
(2) a
facility's plan of correction;
(3)
a facility's compliance with an order of the HHSC executive commissioner or the
executive commissioner's designee;
(4) a facility's compliance with a court
order granting injunctive relief; or
(5) for other purposes relating to regulation
of the facility.
(f) An
applicant or licensee, by applying for or holding a license, consents to entry
and investigation of any of its facilities by HHSC.
(g) A facility shall cooperate with any HHSC
investigation and shall permit HHSC to examine the facility's grounds,
buildings, books, records, video surveillance, and other documents and
information maintained by, or on behalf of, the facility, unless prohibited by
law.
(h) A facility shall permit
HHSC access to interview members of the governing body, personnel, and
patients, including the opportunity to request a written statement.
(i) A facility shall permit HHSC to inspect
and copy any requested information, unless prohibited by law. If it is
necessary for HHSC to remove documents or other records from the facility, HHSC
provides a written description of the information being removed and when it is
expected to be returned. HHSC makes a reasonable effort, consistent with the
circumstances, to return any records removed in a timely manner.
(j) Upon entry, the HHSC representative holds
an entrance conference with the facility's designated representative to explain
the nature, scope, and estimated duration of the investigation.
(k) The HHSC representative holds an exit
conference with the facility representative to inform the facility
representative of any preliminary findings of the investigation. The facility
may provide any final documentation regarding compliance during the exit
conference.
(l) Once an
investigation is complete, HHSC reviews the evidence from the investigation to
evaluate whether there is a preponderance of evidence supporting the
allegations contained in the complaint.
(m) HHSC shall maintain the confidentiality
of facility records as applicable under state or federal law. Except as
provided by (n) of this subsection, all information and materials in the
possession of or obtained or compiled by HHSC in connection with an
investigation are confidential and not subject to disclosure, discovery,
subpoena, or other means of legal compulsion for their release to anyone other
than HHSC or its employees or agents involved in the enforcement action except
that this information may be disclosed to:
(1)
persons involved with HHSC in the enforcement action against the
facility;
(2) the facility that is
the subject of the enforcement action, or the facility's authorized
representative;
(3) appropriate
state or federal agencies that are authorized to inspect, survey, or
investigate licensed mental health facility services;
(4) law enforcement agencies as allowed by
law; and
(5) persons engaged in
bona fide research, if all individual-identifying information and information
identifying the facility has been deleted.
(n) The following information is subject to
disclosure in accordance with Texas Government Code Chapter 552, only to the
extent that all personally identifiable information of a patient or health care
provider is omitted from the information:
(1)
a notice of the facility's alleged violation, which must include the provisions
of law the facility is alleged to have violated, and a general statement of the
nature of the alleged violation;
(2) the number of investigations HHSC has
conducted of the facility;
(3) the
pleadings in any administrative proceeding to impose a penalty against the
facility for the alleged violation;
(4) the outcome of each investigation HHSC
conducted of the facility, including:
(A)
reprimand issuance;
(B) license
denial or revocation;
(C)
corrective action plan adoption; or
(D) administrative penalty imposition and the
penalty amount;
(5) a
final decision investigative report, or order issued by HHSC to address the
alleged violation; and
(6) any
other information required by law to be disclosed under public information
laws.
(o) Within 90 days
after the date HHSC issues a final decision, investigative report, or order to
address a facility's alleged violation, HHSC posts certain information on the
HHSC website in accordance with Texas Health and Safety Code §
577.013.
(p) HHSC notifies complainants regarding the
investigation's outcome within 10 business days after completing the
investigation.
Notes
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