Texas Administrative Code
Title 26 - HEALTH AND HUMAN SERVICES
Part 1 - HEALTH AND HUMAN SERVICES COMMISSION
Chapter 52 - CONTRACTING FOR COMMUNITY SERVICES
Subchapter C - REQUIREMENTS OF A CONTRACTOR
Section 52.117 - Complaint Process

Universal Citation: 26 TX Admin Code ยง 52.117

Current through Reg. 49, No. 38; September 20, 2024

(a) A contractor must develop and implement written procedures for investigating and resolving a complaint about services provided under a contract, other than an allegation of abuse, neglect, or exploitation, that:

(1) allow a complaint to be submitted to the contractor:
(A) either orally or in writing; and

(B) anonymously; and

(2) require the contractor to:
(A) request, but not require disclosure of, the name, mailing address, and telephone number of a complainant;

(B) investigate and resolve a complaint within 30 days after the complaint is received by the contractor;

(C) document the name of the person who conducted the investigation;

(D) document the name of persons contacted during an investigation;

(E) obtain written statements from persons contacted during an investigation or document conversations with those persons; and

(F) provide the following information to the complainant within 30 days after a complaint is received by the contractor, unless the complainant did not provide a mailing address or phone number:
(i) the findings of the investigation;

(ii) the contractor's resolution of the complaint;

(iii) the telephone number of:
(I) HHSC Consumer Rights and Services (1-800-458-9858), if the contractor has a contract for:
(-a-) CLASS-CFS;

(-b-) CLASS-DSA;

(-c-) CLASS-SFS;

(-d-) the DBMD Program;

(-e-) the HCS Program;

(-f-) the TxHmL Program;

(-g-) hospice;

(-h-) the PHC Program;

(-i-) the CAS Program;

(-j-) DAHS;

(-k-) Title XX AFC and services are provided in an AFC home serving four to eight people;

(-l-) Title XX RC;

(-m-) the CMPAS Program;

(-n-) the FC Program;

(-o-) SSPD and services are provided in a DAHS facility; or

(-p-) SSPD-24-hour shared attendant care; or

(II) the HHSC Office of the Ombudsman (1-877-787-8999), if the contractor has a contract for:
(-a-) CLASS-CMA;

(-b-) TAS;

(-c-) Title XX AFC and services are provided in an AFC home serving fewer than four people;

(-d-) emergency response services;

(-e-) the HDM Program;

(-f-) SSPD and services are not provided in a DAHS facility;

(-g-) FMSA-CLASS;

(-h-) FMSA-DBMD;

(-i-) FMSA-HCS;

(-j-) FMSA-PHC/CAS/FC; or

(-k-) FMSA-TxHmL; and

(iv) an explanation that the telephone number may be used if the complainant is not satisfied with the contractor's resolution of the complaint.

(b) The contractor must give the information described in subsection (a)(2)(F) of this section as follows:

(1) in person, if the complainant is the individual receiving services; or

(2) if the complainant is not the individual receiving services:
(A) by mail, if the contractor knows the complainant's mailing address; or

(B) by telephone, if the contractor does not know the complainant's mailing address, but knows the complainant's telephone number.

(c) A contractor must maintain a written log that contains the following information:

(1) the date the contractor received a complaint;

(2) a description of the complaint;

(3) the findings of the investigation;

(4) the contractor's resolution of the complaint and the date of resolution; and

(5) the date the contractor provided information to the complainant in accordance with subsection (b) of this section.

(d) A contractor must provide the following information to an individual and LAR:

(1) a description of the contractor's complaint process;

(2) the telephone number of:
(A) HHSC Consumer Rights and Services (1-800-458-9858), if the contractor has a contract for:
(i) CLASS-CFS;

(ii) CLASS-DSA;

(iii) CLASS-SFS;

(iv) the DBMD Program;

(v) the HCS Program;

(vi) the TxHmL Program;

(vii) hospice;

(viii) the PHC Program;

(ix) the CAS Program;

(x) DAHS;

(xi) Title XX AFC and services are provided in an AFC home serving four to eight people;

(xii) Title XX RC;

(xiii) the CMPAS Program;

(xiv) the FC Program;

(xv) SSPD and services are provided in a DAHS facility; or

(xvi) SSPD-24-hour shared attendant care; or

(B) the HHSC Office of the Ombudsman (1-877-787-8999), if the contractor has a contract for:
(i) CLASS-CMA;

(ii) TAS;

(iii) Title XX AFC and services are provided in an AFC home serving fewer than four people;

(iv) emergency response services;

(v) the HDM Program;

(vi) SSPD and services are not provided in a DAHS facility;

(vii) FMSA-CLASS;

(viii) FMSA-DBMD;

(ix) FMSA-HCS;

(x) FMSA-PHC/CAS/FC; or

(xi) FMSA-TxHmL; and

(3) an explanation that the telephone number may be used to file a complaint with HHSC.

(e) A contractor must provide the information described in subsection (d) of this section orally and in writing, as follows:

(1) before or at the time the individual begins receiving program services from the contractor; and

(2) at least once every 12 months thereafter.

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