reglab/statecodes huggingface dataset:
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter A - OFFICE OF THE OMBUDSMAN › Section 87.113 - Intake of Contacts

Current through Reg. 49, No. 28; July 12, 2024
(a) A contact
				  received through an online submission is automatically and immediately loaded
				  in the HEART system and assigned to available OO staff for action.
(b) A contact received by postal mail, fax,
				  or email is uploaded to the HEART system and assigned to available OO staff for
				  action within one business day of receipt.
(c) A call received by OO staff is
				  immediately entered in the HEART system.
(d) When OO staff begin to review a contact,
				  they take the following actions:
(1) notify
				  the consumer, the consumer's LAR, or a health care provider of OO's roles and
				  responsibilities;
(2) explain any
				  referrals to other HHS staff or external organizations that are
				  recommended;
(3) explain the OO
				  complaint resolution process;
(4)
				  clarify the preferred method and timeline of follow-up communications;
				  and
(5) provide an estimated
				  timeline in which a response can be expected.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter A - OFFICE OF THE OMBUDSMAN › Section 87.115 - Research and Communication with HHS Programs

Current through Reg. 49, No. 28; July 12, 2024
(a) OO staff review all available information
				  about a consumer through inquiry into HHS program systems before referring a
				  contact to HHS staff for review.
(b) Each complaint is investigated to
				  determine if HHS policy was followed by HHS staff and vendors contracted to
				  provide services on behalf of an HHS program. Applicable policies include
				  federal and state law, administrative rules, program handbooks, contracts, and
				  internal program policies and procedures.
(c) OO staff consider the following when
				  investigating a complaint:
(1) Legal
				  authority. What is the basis of the HHS program's decision, and was the
				  decision made within the scope of that authority?
(2) Procedural fairness and rights. Was the
				  consumer given a full understanding of the situation, offered all applicable
				  opportunities to appeal, and given sufficient time to respond when information
				  was requested?
(3) Agreed
				  expectations. Did the HHS program follow through after agreeing to take
				  particular actions, and did the program provide an adequate explanation of
				  decisions?
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter A - OFFICE OF THE OMBUDSMAN › Section 87.117 - Follow-up with Consumers

Current through Reg. 49, No. 28; July 12, 2024
(a) OO staff
				  follow-up with a consumer or the consumer's LAR within five business days of
				  the date of receipt of a contact, and then at least every ten business days
				  thereafter, until the contact is closed. If the consumer provides consent, OO
				  staff also follow-up with the consumer's health care provider.
(b) OO staff may establish a more structured
				  communication plan if a consumer's or LAR's conduct hinders the effective
				  investigation and resolution of a case. To determine what actions may be
				  appropriate to structure future communication, the case and all communication
				  between OO staff and the consumer or LAR will be reviewed by an OO supervisor.
				  If the supervisor determines more structured communication would achieve
				  effective investigation and resolution of the case, a written communication
				  will be shared with the consumer or LAR outlining what OO finds has hindered
				  complaint resolution. If a consumer's or LAR's conduct continues to hinder the
				  investigation or resolution, the HHS Ombudsman will communicate with the
				  consumer or LAR in writing to outline how future communication with OO staff
				  will be structured. The consumer's or LAR's conduct will continue to be
				  monitored to determine if communication has improved to the point that the
				  additional structure can be discontinued.
(c) The process outlined in subsection (b) of
				  this section will never result in a consumer being left without a way to
				  contact OO staff.
(d) State law and
				  HHS policy require disclosure of an employee's full name, work phone number,
				  and work email address, if requested by a consumer. However, a consumer or the
				  consumer's LAR is asked to use the OO toll-free line and shared email address
				  when corresponding with OO staff.
(e) A consumer or the consumer's LAR
				  requesting the direct phone number or individual email address of any HHS staff
				  not already listed on the HHS website, including OO staff, is directed to
				  HHSC's Open Records process.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter A - OFFICE OF THE OMBUDSMAN › Section 87.119 - Substantiating and Closing Complaints

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  Once OO staff have determined all pertinent information has been gathered and
				  their investigation of a complaint is complete, they determine if it is
				  substantiated, unsubstantiated, or unable to be substantiated.
(b) A consumer or the consumer's LAR is
				  notified of the outcome of a complaint. A written summary is provided upon
				  request of a consumer or the consumer's LAR, or if OO staff cannot reach the
				  consumer by telephone to relay the findings. If the consumer provides consent
				  and requests, OO staff also notify the consumer's health care provider of the
				  outcome.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter B - OMBUDSMAN MANAGED CARE ASSISTANCE › Section 87.201 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this
					 subchapter, have the following meanings unless the context clearly indicates
					 otherwise.
(1) MCO--Managed care
				  organization. An entity contracted with HHSC to provide health care services in
				  a Medicaid managed care program.
(2) Medicaid managed care programs--Includes:
(A) STAR;
(B) STAR+PLUS, including the Texas Dual
				  Eligibles Integrated Care Demonstration Project;
(C) STAR Kids; and
(D) STAR Health.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter B - OMBUDSMAN MANAGED CARE ASSISTANCE › Section 87.203 - Creation of the Program and Populations Served

Current through Reg. 49, No. 28; July 12, 2024
(a) OMCAT coordinates a network of entities
				  to provide support and information services to persons enrolled in or applying
				  for Medicaid who experience barriers to receiving health care services, in
				  accordance with Texas Government Code §
										531.0213.
(b) As a part of the support and information
				  services, OMCAT is responsible for operating a statewide toll-free assistance
				  telephone number and for intervening promptly with HHSC Medicaid program staff,
				  MCOs, health care providers, and any other appropriate entity on behalf of a
				  person who has an urgent need for medical services.
(c) OMCAT is responsible for assisting
				  persons who are experiencing barriers in the Medicaid application and
				  enrollment process and educating them so that they understand the concept of
				  managed care; understand their rights under Medicaid, including grievance and
				  appeal procedures; and are able to advocate for themselves.
(d) In accordance with Texas Government Code
				  §
										531.0213(e),
				  OMCAT is sufficiently independent from other aspects of Medicaid managed care
				  to represent the best interests of consumers in complaint resolution.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter B - OMBUDSMAN MANAGED CARE ASSISTANCE › Section 87.205 - Contact Information

Current through Reg. 49, No. 28; July 12, 2024
(a) OO staff
				  maintain a public website for OMCAT with its contact information and develop
				  brochures and other materials that can be distributed to consumers and Medicaid
				  health care providers.
(b) In
				  accordance with requirements of the Uniform Managed Care Manual maintained by
				  HHSC Medicaid program staff and available on the HHSC web site, each MCO
				  includes OMCAT contact information on its member web sites and in member
				  handbooks.
(c) An HHS consumer, the
				  consumer's LAR, or a health care provider may contact OMCAT through the
				  following methods:
(1) toll-free phone:
(A) 1-866-566-8989 (8:00 a.m. to 5:00 p.m.,
				  Central Standard Time, Monday through Friday); or
(B) 7-1-1 or 1-800-735-2989 for a person who
				  has a hearing or speech disability;
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter B - OMBUDSMAN MANAGED CARE ASSISTANCE › Section 87.207 - Confidentiality

Current through Reg. 49, No. 28; July 12, 2024
(a) Before sharing a consumer's information,
				  OMCAT staff confirm the identity of the individual receiving the
				  information.
(b) OMCAT staff obtain
				  a consumer's consent before sharing the consumer's information with anyone
				  other than HHS or MCO staff involved in the review of the contact. This
				  includes sharing information with a consumer's health care provider. Consent
				  can be obtained from the consumer's LAR.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter B - OMBUDSMAN MANAGED CARE ASSISTANCE › Section 87.209 - Reports

Current through Reg. 49, No. 28; July 12, 2024
(a) OMCAT collects and maintains statistical
				  information on contacts relating to each MCO, by region and Medicaid managed
				  care program.
(b) Reports of OMCAT
				  contacts are distributed to HHSC executive staff and Medicaid program staff
				  quarterly and are posted on the HHS website. The reports include the number of
				  contacts by region, trends identified in delivery of services and access to
				  care complaints, identified recurring barriers, and other problems identified
				  with Medicaid managed care.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter B - OMBUDSMAN MANAGED CARE ASSISTANCE › Section 87.211 - Referrals to Other HHS Offices or Other Entities

Current through Reg. 49, No. 28; July 12, 2024
(a) If a consumer or the consumer's LAR
				  contacts OMCAT seeking information or wishing to complain about an HHS program
				  other than Medicaid, the consumer or the consumer's LAR is transferred to OO
				  staff that handle complaints regarding those programs. OMCAT staff inform the
				  consumer or the consumer's LAR of this referral and document it in the HEART
				  system.
(b) In accordance with the
				  requirement at 42 CFR §
											438.408(f)(1) that a fair
				  hearing related to managed care is only available after an MCO appeal, a
				  request for a fair hearing is referred to the consumer's MCO so it can be
				  submitted to HHSC Appeals Division staff. A request for an appeal of a decision
				  by an MCO is referred to that MCO. OMCAT staff inform the consumer or the
				  consumer's LAR of these referrals and document them in the HEART
				  system.
(c) A request from a
				  Medicaid health care provider that does not relate to a consumer's Medicaid
				  case is referred to the HHSC office designated to receive these complaints, in
				  accordance with the Texas Medicaid Provider Procedures Manual maintained by
				  HHSC Medicaid program staff and available on the HHS web site. OMCAT staff
				  inform the health care provider of this referral and document it in the HEART
				  system.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter B - OMBUDSMAN MANAGED CARE ASSISTANCE › Section 87.213 - Intake of Contacts

Current through Reg. 49, No. 28; July 12, 2024
(a) A contact
				  received through an online submission is automatically loaded in the HEART
				  system and assigned to available OMCAT staff for action.
(b) A contact received by postal mail, fax,
				  or email is uploaded to the HEART system and assigned to available OMCAT staff
				  for action within one business day of receipt.
(c) A call received by OMCAT staff is
				  immediately entered in the HEART system.
(d) When OMCAT staff begin to review a
				  contact, they take the following actions:
(1)
				  notify the consumer, the consumer's LAR, or a health care provider of OMCAT's
				  roles and responsibilities;
(2)
				  explain any referrals to other HHS staff or external organizations that are
				  recommended;
(3) explain the OMCAT
				  complaint resolution process;
(4)
				  clarify the preferred method and timeline of follow-up communications;
				  and
(5) provide an estimated
				  timeline in which a response can be expected.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter B - OMBUDSMAN MANAGED CARE ASSISTANCE › Section 87.215 - Research and Communication with HHS Programs, Health Care Providers, and Medicaid Managed Care Organizations

Current through Reg. 49, No. 28; July 12, 2024
(a) OMCAT
				  staff review all available information about a consumer through inquiry into
				  HHS program systems before referring a contact to HHS staff or MCO staff for
				  review.
(b) OMCAT staff may contact
				  a consumer's health care provider as part of their work on a contact.
(c) Each complaint is investigated to
				  determine if HHS policy was followed by HHS staff and vendors contracted to
				  provide services, including MCO staff. Applicable policies include federal and
				  state law, administrative rules, the MCO's contract with HHSC, and internal
				  program policies and procedures.
(d) When OMCAT research through available
				  systems is not sufficient to address a concern or determine whether a complaint
				  can be substantiated, OMCAT staff request a response to the complaint from
				  appropriate HHS or MCO staff. OMCAT staff may also contact the consumer's
				  health care provider directly in order to resolve a complaint.
(e) HHS or MCO staff are asked to respond to
				  an OMCAT request. If no response is received, a second communication is made,
				  and documented in the HEART system. If still no response is received, the
				  request is escalated to leadership within the HHSC Medicaid program.
(f) Upon receipt of information from HHS or
				  MCO staff, OMCAT staff review to determine if the concern has been addressed
				  and if OMCAT staff can determine whether the complaint can be substantiated. If
				  the response is found to be inadequate by OMCAT staff or if additional
				  information is required, OMCAT staff refer the contact back to HHS or MCO staff
				  for additional review.
(g) OMCAT
				  staff seek assistance from HHSC Medicaid program staff on some contacts,
				  including complaints that raise questions about policy or contract
				  compliance.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter B - OMBUDSMAN MANAGED CARE ASSISTANCE › Section 87.217 - Follow-Up with Consumers

Current through Reg. 49, No. 28; July 12, 2024
(a) OMCAT staff
				  follow-up with a consumer or the consumer's LAR within five business days of
				  the date of receipt of the contact, and then at least every ten business days
				  thereafter, until the contact is closed.
(b) If the consumer provides consent, OO
				  staff also follow-up with the consumer's health care provider.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter B - OMBUDSMAN MANAGED CARE ASSISTANCE › Section 87.219 - Substantiating and Closing Complaints

Current through Reg. 49, No. 28; July 12, 2024
Once OMCAT staff have determined all pertinent information
					 has been gathered and their investigation of a complaint is complete, they
					 determine if the complaint is substantiated, unsubstantiated, or unable to be
					 substantiated.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter C - OMBUDSMAN FOR CHILDREN AND YOUTH IN FOSTER CARE › Section 87.301 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this
					 subchapter, have the following meanings unless the context clearly indicates
					 otherwise.
(1) DFPS--Department of
				  Family and Protective Services. The state agency established by Chapter
				  40 of the Human
				  Resources Code and responsible for administration of Child Protective
				  Services.
(2) DFPS OIA --DFPS
				  Office of Internal Affairs. A neutral party that reviews complaints regarding
				  case-specific activities of DFPS program areas to determine if policies and
				  procedures were followed in compliance with DFPS administrative rules at Title
				  40, Part 19, Chapter 702, Subchapter I.
(3) FCO--Foster Care Ombudsman. The Ombudsman
				  for Children and Youth in Foster Care established by Texas Government Code
				  Chapter 531, Subchapter Y, as enacted by Senate Bill 830 (84th Legislature,
				  Regular Session, 2015).
(4)
				  Retaliation--A harmful action taken because of, or substantially motivated by,
				  reprisal or revenge in response to a legally protected activity, such as making
				  a good faith complaint.
(5) Vendor
				  contracted to provide services on behalf of DFPS--A vendor contracted as part
				  of the community-based care model established by Texas Family Code Chapter 264,
				  Subchapter B-1, Community-Based Care, including single source continuum
				  contractors that provide placement and case management services.
(6) Youth-- Children and youth in the
				  conservatorship of DFPS, which ends at age 18.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter C - OMBUDSMAN FOR CHILDREN AND YOUTH IN FOSTER CARE › Section 87.303 - Creation of Program and Population Served

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  FCO is established by Subchapter Y of Chapter 531 of the Government Code as
				  enacted by Senate Bill 830 (84th Legislature, Regular Session, 2015) and is
				  administratively attached to OO.
(b) FCO serves as a neutral party in
				  assisting children and youth in the conservatorship of DFPS with complaints
				  regarding issues within the authority of DFPS or an HHS agency.
(c) While individuals age 18 and older may
				  continue to receive DFPS services, they are not considered part of the
				  population served by FCO because they are no longer "in the conservatorship" of
				  DFPS. However, if FCO receives a complaint from a youth who turns 18 during the
				  course of FCO's investigation, the complaint will be completed.
(d) FCO is responsible for receiving and
				  investigating inquiries and complaints from youth in the conservatorship of
				  DFPS, including youth placed by vendors contracted to provide services on
				  behalf of DFPS.
(e) FCO may refer
				  youth to any DFPS or HHS program or service that can assist with the youth's
				  inquiry. With permission from the youth, FCO may work with staff in any DFPS or
				  HHS program to resolve a complaint.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter C - OMBUDSMAN FOR CHILDREN AND YOUTH IN FOSTER CARE › Section 87.305 - Contact Information

Current through Reg. 49, No. 28; July 12, 2024
(a) OO staff
				  maintain a public website for FCO with its contact information and develop
				  brochures and other materials that can be distributed to foster youth and
				  vendors contracted to provide services on behalf of DFPS.
(b) In accordance with requirements in Texas
				  Family Code § 40.0041(h), all residential child-care facilities in which
				  foster youth are placed must display FCO contact information in a location that
				  is easily accessible and offers maximum privacy to the youth.
(c) A youth may contact FCO through the
				  following methods:
(1) toll-free phone,
				  1-844-286-0769 (8:00 a.m. to 5:00 p.m., Monday through Friday);
(2) toll-free fax, 1-888-780-8099;
(3) mail to Texas Health and Human Services
				  Commission, Foster Care Ombudsman, P.O. Box 13247, Austin TX
				  78711-3247;
(4) online at
				  hhs.texas.gov/foster-care-help; or
(5) in person when FCO staff present to a
				  meeting of youth organized by DFPS or visit a residential treatment center or
				  hospital where a youth is placed.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter C - OMBUDSMAN FOR CHILDREN AND YOUTH IN FOSTER CARE › Section 87.307 - Confidentiality

Current through Reg. 49, No. 28; July 12, 2024
(a) FCO maintains the confidentiality of its
				  communications and records, including records FCO receives from
				  others.
(b) The disclosure of
				  confidential information to FCO does not constitute a waiver of
				  confidentiality. Any information disclosed to FCO remains confidential and
				  privileged following disclosure.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter C - OMBUDSMAN FOR CHILDREN AND YOUTH IN FOSTER CARE › Section 87.309 - Data and Reports

Current through Reg. 49, No. 28; July 12, 2024
(a) FCO maintains
				  records of all inquiries and complaints in the HEART system. FCO contact
				  records are maintained separate from other OO contact records.
(b) FCO staff have access to any DFPS and HHS
				  data and systems necessary to complete their investigations of contacts,
				  including:
(1) Information Management
				  Protecting Adults and Children in Texas (IMPACT); and
(2) Child Care Licensing Automated Support
				  System (CLASS).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter C - OMBUDSMAN FOR CHILDREN AND YOUTH IN FOSTER CARE › Section 87.311 - Referrals to Other HHS Offices or Other Entities

Current through Reg. 49, No. 28; July 12, 2024
(a) If a person other than a youth contacts
				  FCO indicating the person wishes to provide information about a DFPS case, the
				  person is given DFPS OIA's contact information and transferred to that
				  office.
(b) If a youth contacts FCO
				  with a complaint that does not allege a violation of a DFPS or HHS policy or
				  procedure, FCO staff explains to the youth that it is outside the scope of
				  FCO's ability to assist and offers the youth resources for working on the
				  issue.
(c) If an adjudicated youth
				  that is not in foster care contacts FCO, the youth is referred to the
				  Independent Ombudsman for the Texas Juvenile Justice System.
(d) If a person other than a youth contacts
				  FCO seeking information about HHS programs, or indicating the person wishes to
				  complain about an HHS program, the person is transferred to OO staff that
				  handle complaints regarding those programs.
(e) Notwithstanding subsections (a) and (d)
				  of this section, if FCO receives a case from the court-appointed attorney of a
				  youth who cannot verbalize the youth's own concern, either due to age or IDD,
				  FCO staff does not refer the case but rather investigates the case and
				  maintains communication with the court-appointed attorney on behalf of the
				  youth.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter C - OMBUDSMAN FOR CHILDREN AND YOUTH IN FOSTER CARE › Section 87.313 - Intake of Contacts

Current through Reg. 49, No. 28; July 12, 2024
(a) A contact
				  received by online submission, postal mail, fax, or email is uploaded to the
				  HEART system and assigned to available FCO staff for action within one business
				  day of receipt.
(b) A call received
				  by FCO staff is immediately entered in the HEART system.
(c) When FCO staff begin to review a contact,
				  they take the following actions:
(1) notify
				  the youth of FCO's roles and responsibilities;
(2) explain any referrals to DFPS or HHS
				  staff or external organizations that are recommended;
(3) explain the FCO complaint resolution
				  process;
(4) clarify the preferred
				  method and timeline of follow-up communications; and
(5) provide an estimated timeline in which a
				  response can be expected.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter C - OMBUDSMAN FOR CHILDREN AND YOUTH IN FOSTER CARE › Section 87.315 - Research Using DFPS and HHS Systems and Policies

Current through Reg. 49, No. 28; July 12, 2024
(a) FCO staff review any available
				  information about a foster care case through inquiry into DFPS and HHS systems,
				  including IMPACT and CLASS, and any system used by vendors contracted to
				  provide services on behalf of DFPS.
(b) Each complaint is investigated to
				  determine if DFPS or HHS policy was followed by agency staff and vendors
				  contracted to provide services on behalf of DFPS or an HHS program. Applicable
				  policies include federal and state law, administrative rules, program
				  handbooks, contracts, and internal program policies and procedures.
(c) If FCO staff discover a violation of DFPS
				  or HHS policy during the course of their research that was not outlined in the
				  original submission from the youth, an additional complaint is entered in the
				  existing HEART record.
(d) If FCO
				  staff determine a youth is adjudicated, they note this in the contact record
				  and outreach to the Independent Ombudsman for the Texas Juvenile Justice System
				  to determine if coordination would be helpful.
(e) FCO staff request a response to the
				  complaint from appropriate DFPS or HHS staff, or vendors contracted to provide
				  services on behalf of DFPS or HHS, if the youth has authorized sharing of the
				  youth's information.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter C - OMBUDSMAN FOR CHILDREN AND YOUTH IN FOSTER CARE › Section 87.317 - Follow-up Communication with Youth

Current through Reg. 49, No. 28; July 12, 2024
(a) FCO
				  staff follow-up with the youth within one business day of the date of receipt
				  of the contact, and then at least every five business days thereafter, until
				  the contact is closed.
(b) All
				  follow-up communication is in a secure format, unless FCO has received the
				  youth's written consent to provide information in an unsecure format.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter C - OMBUDSMAN FOR CHILDREN AND YOUTH IN FOSTER CARE › Section 87.319 - Substantiating and Closing Complaints

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  Once FCO staff have determined all pertinent information has been gathered and
				  their investigation of a complaint is complete, they enter a resolution in the
				  contact record, choosing substantiated, unable to substantiate, or
				  unsubstantiated.
(b) For
				  substantiated complaints, FCO staff also enter a program corrective action
				  based on the response provided by program staff.
(c) An FCO complaint cannot be closed without
				  a resolution and, for substantiated complaints, a program corrective
				  action.
(d) The complaint record
				  documents informing program staff and the youth of the resolution.
(e) A written response to program staff
				  includes additional recommended corrective actions, when applicable. Regardless
				  of whether DFPS, a vendor contracted to provide services on behalf of DFPS, or
				  an HHS agency was the subject of the youth's complaint, DFPS is provided a copy
				  of the written response to program staff.
(f) A written response may be provided to the
				  youth, if requested, and includes:
(1) a
				  description of the steps taken to investigate the complaint;
(2) a general description of what FCO found
				  as a result of the investigation; and
(3) if a complaint is:
(A) substantiated, a description of the
				  actions taken by DFPS, a vendor contracted to provide services on behalf of
				  DFPS, or the HHS agency in response to that finding; or
(B) unsubstantiated, a description of
				  additional steps the youth can take to have someone review the youth's concern
				  (e.g., speak to a court-appointed advocate or to the judge assigned to the
				  youth's case).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter C - OMBUDSMAN FOR CHILDREN AND YOUTH IN FOSTER CARE › Section 87.321 - Retaliation

Current through Reg. 49, No. 28; July 12, 2024
(a) DFPS is asked to review each case where
				  FCO staff believe a youth has been retaliated against based on the definition
				  of retaliation in this subchapter and applicable DFPS policies and procedures.
				  DFPS is asked to respond with its view of whether retaliation
				  occurred.
(b) If after reviewing
				  the DFPS response FCO staff finally determine a youth has been retaliated
				  against because of a complaint submitted to FCO, FCO staff opens a new
				  complaint within the HEART record.
(c) FCO staff collaborate with DFPS staff to
				  identify consequences for any retaliatory action taken against a youth by any
				  person in response to a complaint filed with FCO.
(d) FCO highlights retaliation cases in its
				  annual report.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter D - OMBUDSMAN FOR BEHAVIORAL HEALTH › Section 87.401 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this
					 subchapter, have the following meanings unless the context clearly indicates
					 otherwise.
(1) AMH--Adult Mental
				  Health program. The home and community-based services adult mental health
				  program, operated under a Texas Medicaid state plan amendment and 26 TAC
				  Chapter 307, Subchapter B.
(2)
				  OBH--Ombudsman for Behavioral Health. The ombudsman for behavioral health
				  access to care established by the Texas Government Code §
										531.02251.
(3) Parity--The requirement outlined in Texas
				  Insurance Code Subchapter F of Chapter 1355 that a health benefit plan provide
				  benefits and coverage for mental health conditions and substance use disorders
				  under the same terms and conditions applicable to the plan's medical and
				  surgical benefits and coverage.
(4)
				  State hospital--A state mental health facility operated by HHSC.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter D - OMBUDSMAN FOR BEHAVIORAL HEALTH › Section 87.403 - Creation of the Program and Populations Served

Current through Reg. 49, No. 28; July 12, 2024
(a) OBH is established by Texas Government
				  Code §
										531.02251, and is
				  administratively attached to OO.
(b) OBH serves as a neutral party to help
				  consumers, including consumers who are uninsured or have public or private
				  health benefit coverage, and behavioral health care providers navigate and
				  resolve issues related to consumer access to behavioral health care, including
				  care for mental health conditions and substance use disorders. OBH identifies,
				  tracks, and helps report potential violations of Texas Insurance Code
				  Subchapter F of Chapter 1355.
(c)
				  OBH advocates for the rights and service needs of consumers who have questions,
				  concerns, or complaints regarding services provided by a state hospital, an
				  LBHA or LMHA, or through a contract with HHSC as part of the AMH program.
				  Specific rights of these consumers are outlined in 25 TAC Chapter 404,
				  Subchapter E (relating to Rights of Persons Receiving Mental Health
				  Services).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter D - OMBUDSMAN FOR BEHAVIORAL HEALTH › Section 87.405 - Contact Information

Current through Reg. 49, No. 28; July 12, 2024
(a) OO staff
				  maintain a public website with OBH contact information and develop brochures
				  and other materials that can be distributed to consumers seeking behavioral
				  health services and health care providers.
(b) In accordance with 25 TAC Chapter 404,
				  Subchapter E (relating to Rights of Persons Receiving Mental Health Services),
				  OBH's toll-free number is published in consumer rights handbooks made available
				  at all service locations at state hospitals or LBHAs or LMHAs. Consumers at
				  these facilities also have a right to be verbally explained all of their rights
				  -- including the right to complain to OBH -- within 24 hours of admission.
				  Additional situations that require a state hospital or an LBHA or LMHA to
				  notify a consumer of OBH's contact information include:
(1) any time an LBHA or LMHA determines a
				  consumer is not in their priority population during the admission screening
				  process, as outlined in 26 TAC §
											306.161(Screening and
				  Assessment);
(2) any time an LBHA
				  or LMHA determines a consumer requesting interstate transfer is not eligible
				  for admission to a state hospital; and
(3) in each state hospital and LBHA or LMHA's
				  "Notice of Privacy Practice."
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter D - OMBUDSMAN FOR BEHAVIORAL HEALTH › Section 87.407 - Confidentiality

Current through Reg. 49, No. 28; July 12, 2024
(a) OBH staff adhere to statutory
				  requirements and policy of the HHSC Health & Specialty Care System when
				  protecting records of consumers receiving services at state
				  hospitals.
(b) OBH staff adhere to
				  statutory requirements and policy of the HHSC IDD-Behavioral Health Services
				  Department when protecting records of consumers receiving services at LBHAs or
				  LMHAs.
(c) OBH staff obtain a
				  consumer's consent before sharing the consumer's information with anyone other
				  than HHS staff or LBHA or LMHA staff required to receive and respond to OBH
				  complaints. This includes sharing information with a federal or state agency
				  that regulates a consumer's health plan. Consent can be obtained from the
				  consumer's LAR.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter D - OMBUDSMAN FOR BEHAVIORAL HEALTH › Section 87.409 - Data and Reports

Current through Reg. 49, No. 28; July 12, 2024
(a) OBH staff have
				  access to data and systems maintained by the HHSC Health & Specialty Care
				  System and the HHSC IDD-Behavioral Health Services Department necessary to
				  complete their investigation of a contact. Specifically, OBH staff have access
				  to the Client Assignment and Registration (CARE) system, and the Clinical
				  Workstation (CWS) system.
(b) In
				  accordance with Texas Insurance Code §
										1355.2572(b),
				  OBH collaborates with the Texas Department of Insurance on an annual report on
				  the status of rights and responsibilities for mental health condition and
				  substance use disorder benefits, and resolved and unresolved parity
				  complaints.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter D - OMBUDSMAN FOR BEHAVIORAL HEALTH › Section 87.413 - Intake of Contacts

Current through Reg. 49, No. 28; July 12, 2024
(a) A contact
				  received by postal mail, fax, or online submission is uploaded to the HEART
				  system and assigned to available OBH staff for action within one business day
				  of receipt.
(b) A call received by
				  OBH staff is immediately entered in the HEART system.
(c) When OBH staff begin to review a contact,
				  they take the following actions:
(1) notify
				  the consumer, the consumer's LAR, or a health care provider of OBH's roles and
				  responsibilities;
(2) explain any
				  referrals to other HHS staff or external organizations that are
				  recommended;
(3) explain the OBH
				  complaint resolution process;
(4)
				  clarify the preferred method and timeline of follow-up communications;
				  and
(5) provide an estimated
				  timeline in which a response can be expected.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter D - OMBUDSMAN FOR BEHAVIORAL HEALTH › Section 87.415 - Research and Communication with HHS Programs and Agencies that Regulate Health Plans

Current through Reg. 49, No. 28; July 12, 2024
(a) For a contact
				  involving a consumer receiving services at a state hospital, an LBHA or LMHA,
				  or the AMH program:
(1) OBH staff review all
				  available information about a consumer through inquiry into HHS program systems
				  before referring a contact to the appropriate rights protection officer, who is
				  responsible for receiving complaints from OBH.
(2) Each complaint is investigated to
				  determine if HHS policy was followed by HHS staff and vendors contracted to
				  provide services, including LBHA or LMHA staff. Applicable policies include
				  federal and state law, administrative rules, HHSC contracts, and internal
				  program policies and procedures.
(3) When OBH research through available
				  systems is not sufficient to address the concern or determine whether a
				  complaint can be substantiated, OBH staff request a response from the
				  appropriate rights protection officer, if the consumer has consented to
				  discussion of the contact.
(4) Upon
				  receipt of a response from a rights protection officer, OBH staff review to
				  determine if the concerns have been addressed and if OBH staff can determine
				  whether a complaint can be substantiated. If the response is found to be
				  inadequate by OBH staff or if additional information is required, OBH staff
				  refer the contact back to the rights protection officer for additional
				  review.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter D - OMBUDSMAN FOR BEHAVIORAL HEALTH › Section 87.417 - Follow-up with Consumers

Current through Reg. 49, No. 28; July 12, 2024
(a) OBH staff
				  follow-up with a consumer or the consumer's LAR within five business days of
				  the date of receipt of a contact, and then at least every ten business days
				  thereafter, until the contact is closed.
(b) If the consumer provides consent, OBH
				  staff also follow-up with the consumer's health care provider.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter D - OMBUDSMAN FOR BEHAVIORAL HEALTH › Section 87.419 - Substantiating and Closing Complaints

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  Once OBH staff have determined all pertinent information has been gathered and
				  their investigation of a complaint is complete, they determine if the complaint
				  is substantiated, unsubstantiated, or unable to be substantiated.
(b) A written response requested by a
				  consumer or the consumer's LAR includes:
(1)
				  a description of the steps taken to investigate the complaint;
(2) a description of what OBH found as a
				  result of their investigation; and
(3) if a complaint is:
(A) substantiated, a description of the
				  actions taken in response; or
(B)
				  unsubstantiated, a description of additional steps the consumer can take to
				  have someone review the consumer's concerns (e.g., a referral to Disability
				  Rights Texas).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter E - INTELLECTUAL OR DEVELOPMENTAL DISABILITY OMBUDSMAN › Section 87.501 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this
					 subchapter, have the following meanings unless the context clearly indicates
					 otherwise.
(1) HCS--The Home and
				  Community-based Services Program. A program operated by HHSC in accordance with
				  §1915(c) of the Social Security Act.
(2) IDDO--Intellectual or Developmental
				  Disability Ombudsman.
(3) Program
				  provider--A person that has a contract with HHSC to provide HCS or TxHmL
				  program services.
(4) TxHmL--The
				  Texas Home Living Program. A program operated by HHSC in accordance with
				  §1915(c) of the Social Security Act.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter E - INTELLECTUAL OR DEVELOPMENTAL DISABILITY OMBUDSMAN › Section 87.503 - Creation of the Program and Populations Served

Current through Reg. 49, No. 28; July 12, 2024
(a) IDDO serves as a neutral party to assist
				  individuals with IDD, their LARs, their program providers, and LIDDAs as they
				  navigate and resolve issues related to individuals seeking and receiving HCS,
				  TxHmL, or LIDDA services.
(b) IDDO
				  advocates for the rights and service needs of individuals with IDD or their
				  LARs who have questions, concerns, or complaints regarding HCS, TxHmL, or LIDDA
				  services.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter E - INTELLECTUAL OR DEVELOPMENTAL DISABILITY OMBUDSMAN › Section 87.505 - Contact Information

Current through Reg. 49, No. 28; July 12, 2024
(a) OO staff
				  maintain a public website with IDDO contact information and develop brochures
				  and other materials that can be distributed to individuals with IDD seeking or
				  receiving services, their LARs, their program providers, or LIDDAs.
(b) In accordance with 40 TAC Chapter 4,
				  Subchapter C (relating to Rights of Individuals with an Intellectual
				  Disability) a LIDDA must post IDDO's toll-free number conspicuously in every
				  program area. IDDO publishes handbooks describing the rights of individuals
				  with IDD, including the right to contact IDDO. The handbooks must be given to
				  an individual or the individual's LAR when the individual applies for services,
				  and annually thereafter. Additionally, in accordance with 40 TAC Chapter 9
				  Subchapter D (relating to Home and Community-based Services (HCS) Program and
				  Community First Choice (CFC)) and Subchapter N (relating to Texas Home Living
				  (TxHmL) Program and Community First Choice (CFC)) HCS and TxHmL program
				  providers must protect and promote the rights of individuals with IDD,
				  including informing them of their right to complain to IDDO and providing
				  IDDO's toll-free number.
(c) An
				  individual with IDD or the individual's LAR may contact IDDO through the
				  following methods:
(1) toll-free phone:
(A) 1-800-252-8154 (8:00 a.m. to 5:00 p.m.,
				  Central Standard Time, Monday through Friday); or
(B) 7-1-1 or 1-800-735-2989 for a person who
				  has a hearing or speech disability;
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter E - INTELLECTUAL OR DEVELOPMENTAL DISABILITY OMBUDSMAN › Section 87.507 - Confidentiality

Current through Reg. 49, No. 28; July 12, 2024
(a) IDDO staff adhere to statutory
				  requirements and policy of the HHSC Medicaid & CHIP Services Department
				  when protecting records of individuals with IDD receiving services through the
				  HCS and TxHmL programs.
(b) IDDO
				  staff adhere to statutory requirements and policy of the HHSC IDD-Behavioral
				  Health Services Department when protecting records of individuals with IDD
				  receiving services at LIDDAs.
(c)
				  IDDO staff obtain consent from individuals with IDD or their LARs before
				  sharing information with anyone other than HHS staff, the individual's program
				  provider, or LIDDA staff required to receive and respond to IDDO
				  complaints.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter E - INTELLECTUAL OR DEVELOPMENTAL DISABILITY OMBUDSMAN › Section 87.509 - Data and Reports

Current through Reg. 49, No. 28; July 12, 2024
IDDO staff have access to data and systems maintained by
					 HHSC and DFPS necessary to complete their investigation of a contact, including
					 the Client Assignment and Registration (CARE) system, the Community Services
					 Interest List (CSIL) system, Information Management Protecting Adults and
					 Children in Texas (IMPACT), and the Texas Unified License Information Portal
					 (TULIP).