Current through Reg. 49, No. 38; September 20, 2024
(a) If HHSC receives an oral or written
allegation that indicates a contractor may have violated a contract or program
requirement, HHSC conducts an unannounced investigation of the contractor. The
investigation is conducted on-site or by a desk review.
(b) To conduct an investigation, HHSC:
(1) conducts an entrance conference with the
contractor if the investigation is conducted on-site;
(2) performs other activities, which may
include:
(A) reviewing the contractor's
records;
(B) reviewing the
contractor's policies and procedures;
(C) reviewing consumer satisfaction
surveys;
(D) interviewing a person
with knowledge relevant to the contract, including an individual receiving
services or the contractor's employee; and
(E) observing an individual receiving
services.
(c) A
contractor must provide records requested by HHSC as follows:
(1) for an investigation conducted on-site,
the contractor must provide the records to HHSC within one hour after the
entrance conference described in subsection (b)(1) of this section, unless
another time period is agreed to by HHSC in writing for an EVV report;
and
(2) for an investigation
conducted by a desk review, the contractor must provide the records to HHSC
within one business day after HHSC's request.
(d) HHSC notifies the contractor, in writing,
of the results of the investigation.
(e) If, based on an investigation, HHSC
determines that the contractor is out of compliance with the contract, HHSC
may:
(1) impose an action or sanction in
accordance with Subchapter E of this chapter (relating to Enforcement by HHSC
and Termination by Contractor);
(2)
conduct additional monitoring in accordance with §49.411 of this division
(relating to Contract and Fiscal Monitoring); or
(3) take a combination of the actions
described in paragraphs (1) and (2) of this subsection.
(f) If, during an investigation, HHSC
determines that the contractor is not protecting an individual's health and
safety, HHSC may require the contractor to:
(1) immediately protect the individual's
health and safety; and
(2) submit
an immediate protection plan in accordance with §
49.511
of this chapter (relating to Immediate Protection and Immediate Protection
Plan).
