Source: https://www.dads.state.tx.us/services/crs/incidentforms/index.html
Timestamp: 2017-08-18 10:33:28
Document Index: 653089942

Matched Legal Cases: ['§142', '§97', 'art 1', '§98', '§98', '§92', '§19', '§19', '§90', '§4', '§3', '§9']

Licensed or certified Texas Department of Aging and Disability Services (DADS) providers must notify the agency if someone in their care has been or may be physically or mentally abused, neglected or exploited.
Depending on their reporting guidelines and DADS rules, providers may be required to report other incidents including:
Situations that pose a threat to residents, employees or the public, including calling the police or the local fire authority to maintain safety
Click on a plus sign to read the answer to the question.
How soon must an incident be reported?
Providers must make a report immediately upon learning of the incident (unless otherwise required by Regulatory Services reporting guidelines).
You can report an incident online.
You can call 1-800-458-9858, regardless of the day or time; select option 5 from the main menu.
Where can I get help learning how to use the online report?
Click here to learn more about the online reporting system (PDF format).
What happens when I call to make a report?
The following announcement plays when option 5 is selected from the main menu:
This option is not for the general public to report a complaint or request program information. Please re-dial and choose another option from the main menu. If you are reporting on behalf of a DADS provider, please continue.
To return to the beginning of this announcement at any time, press 9.
Home health or hospice providers, press 2.
To report a death, press 3.
Missing resident, press 4.
Drug diversion, press 5.
Nursing home, assisted living or adult day care providers, press 6.
State supported living center, Local Authorities and private ICF group home providers, press 7.
To report environmental issues, press 8.
To speak with an intake specialist between the hours of 7 a.m. to 7 p.m. Monday through Friday, press 1.
Incident reporting guideline information is available on our website, www.dads.state.tx.us. On the home page, click 'Doing business with DADS,' then select 'Resources for DADS service providers,' choose a program service type from the menu on the left of the page and then, select 'Reporting incidents to Consumer Rights & Services' from the menu.
To repeat the menu options, press 9.
Once you select a script from the menu, you will begin to hear the incident form script. After each response, you will need to press the # key to move to the next query. It's important that you talk slowly and clearly and answer in complete sentences.
If information is not available at the time of the report or is not pertinent to the incident being reported, press the # key after the tone to move to the next query.
At the end of the script, you will be given an opportunity to provide additional information relevant to the incident report or to add to the information already recorded.
When you hang up, the report is submitted.
When can I report an incident?
Providers can make a report any time of day or night. DADS intake employees monitor the incident form application from 7 a.m. to 7 p.m. Central time, Monday through Friday.. On weekends and holidays, it is monitored from 8 a.m. — 5 p.m.
An intake specialist will call you to:
Give you the incident intake ID number which you will need to complete the Provider Investigation Report, DADS Form 3613 or 3613-A
You need to provide the following information in the initial report:
The name of the facility, home health or hospice agency on whose behalf you are making the report. Please include the facility ID number or home health or hospice agency license number.
Whether or not the incident was reported to the police or the Texas Department of Family and Protective Services (DFPS). Please include the name of the employee who made the report and the DFPS call ID reference number or the police report number.
The person’s level of cognition
The person’s pertinent medical history
The immediate action taken to protect other people and to prevent occurrences of similar incidents while you conduct and complete your investigation.
How soon must a facility complete a provider investigation report?
Note: The following applies to nursing facilities, skilled nursing facilities, adult day care facilities, assisted living facilities and Intermediate care facilities (ICF/IIDs).
After the electronic or phone report has been made, you must submit DADS Form 3613-A, Provider Investigation Report, with statements and other relevant documentation. A separate Form 3613-A must be completed and submitted for each incident reported.
5 working days for nursing facilities, skilled nursing facilities and licensed ICF/IIDs;
5 calendar days for adult day care providers and assisted living facilities;
unlicensed ICF/IDs must submit a status report within 5 working days along with a copy of the Texas Department of Family and Protective Services (DFPS) final investigation report within 14 calendar days.
A "working day" is any 24-hour period, Monday through Friday, excluding state and federal holidays.
Where do facilities submit the provider investigation report?
Either fax the report and any attachments OR mail the report and any attachments, based on the length of the report. You do not need to do both.
If the report is 15 pages or fewer
If Form 3613-A, with statements and other relevant documentation, is 15 pages or fewer, fax the report and attachments to 1-877-438-5827.
If the report is 16 pages or more
If Form 3613-A, with statements and other relevant documentation, is 16 pages or more, mail the report and attachments to:
A report sent by mail must be postmarked by the regulatory due date after the oral report is made.
How soon does a provider investigation report need to be completed by home and community support services agency (HCSSA)?
After the electronic or phone report has been made, you must submit DADS Form 3613, Provider Investigation Report, with statements and other relevant documentation no later than the 10th calendar day after reporting the alleged act to DADS.
A separate Form 3613 must be completed and submitted for each incident reported.
Where do HCSSAs submit the report?
If Form 3613, with statements and other relevant documentation, is 15 pages or fewer, fax the report and attachments to 1-877-438-5827.
If Form 3613, with statements and other relevant documentation, is 16 pages or more, mail the report and attachments to:
Where do I find the provider investigation report form?
The forms are available on the DADS website:
Form 3613-A, Provider Investigation Report (for use by skilled nursing facilities, nursing facilities, licensed ICFs, assisted living facilities and day activity and health care facilities)
Form 3613, Provider Investigation Report (for use by home health, hospice and personal assistance service providers)
Can I submit the provider investigation report form online?
Provider reports can be sent via email to CRSProvider@dads.state.tx.us.
Links to the reporting guidelines are available below.
All Provider Letters for This Provider Type
Provider Letters Specific to Reportable Incidents
Home and community support service agencies (Home health and hospice) 2016-22 Health and Safety Code Chapter §142.018
40 TAC §97.249
Human Resource Code Chapter 48
Human Resource Code, Chapter 48
Texas Administrative Code (TAC), Title 40, Part 1, Chapter 98, §98.61(d)(1)
40 TAC §98.92
Health and Safety Code, Chapter 260A
40TAC §92.102
Licensed nursing facilities and skilled nursing facilities
40 TAC §19.602(a)
40 TAC §19.601(c)(2)
Licensed intermediate care facilities for persons with an intellectual disability (ICF/ID)
Health and Safety Code, Chapter 252
40 TAC §90.212(a)
Non-licensed ICF/IDs
40 TAC §4.554
40 TAC §3.302(a)
40 TAC §9.225 (2)-(3)
Memorandum of Understanding (MOU) between Texas Department of Mental Health and Mental Retardation, Texas Department of Human Services and Texas Department of Protective and Regulatory Services dated March, 25, 1996.