26 Tex. Admin. Code § 552.11 - Informal Review Process for Intermediate Care Facilities for Persons with Mental Retardation and Related Conditions
(a)
General. The procedure in this section shall be utilized by providers when
there is a disagreement with surveyors' findings and/or recommendations, when
additional written information becomes available that was not shared with the
survey team, or when a complaint is filed relating to the conduct of the
survey. The provider may request a face-to-face, telephone, or paper review
when one of the following termination actions is taken against the facility:
90-day termination, denial of certification, or when the automatic cancellation
clause is invoked. If no action was taken against the facility but deficiencies
were written, the provider will be given a paper review only. These procedures
shall only be used if the deficiencies cited in the survey report do not pose
an imminent threat or danger to the health and/or safety of a resident.
Twenty-three day terminations are not entitled to utilize the Informal Review
process.
(b) Review process.
(1) Exit conference.
(A) At the time of the survey the provider
will furnish any information requested by the surveyor. The facility staff must
not wait until the exit conference to provide information requested earlier
during the survey. Information needed to conduct the survey must be made
available during the survey; however, additional information will be accepted
for review at the time of the exit conference.
(B) At the time of the exit conference, the
facility will receive written notice from a member of the survey team of its
right to an informal review.
(C) If
there are issues which are not resolved during the exit conference, the
administrator or his designee may make a written or faxed request for an
informal review with the associate commissioner for Long Term Care Regulatory
or his state office designee. The request for the review and any additional
information must be submitted and received in the associate commissioner's or
his designee's office within ten calendar days after receipt of the official
statement of deficiencies.
(2) Associate commissioner's review. The
associate commissioner for long term care regulatory or his state office
designee:
(A) will review all information and
make an impartial decision as to whether deficiencies shall be sustained,
altered, or reversed from the original findings of the survey team. The Texas
Department of Human Services (DHS) will not accept additional information or
schedule an informal review after ten calendar days following receipt of the
official statement of deficiencies;
(B) may conduct, at the request of the
provider, a face-to-face, telephone, or paper review when one of the following
actions was taken against the facility: 90-day termination, denial of
certification, or when the automatic cancellation clause is invoked;
(C) will conduct a paper review only, if no
action was taken against the facility, but deficiencies were written;
(D) may request additional information if
necessary;
(E) will determine a
resolution and present the resolution to the associate commissioner for long
term care regulatory for concurrence; and
(F) will notify the provider of a decision
before the forty-fifth day after the provider receives the official statement
of deficiencies. Time frames for all certification actions must be adhered to
by the facility and DHS.
Notes
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