Texas Administrative Code
Title 26 - HEALTH AND HUMAN SERVICES
Part 1 - HEALTH AND HUMAN SERVICES COMMISSION
Chapter 87 - OMBUDSMAN SERVICES
Subchapter D - OMBUDSMAN FOR MANAGED CARE ASSISTANCE
Section 87.419 - Substantiating and Closing Complaints

Universal Citation: 26 TX Admin Code § 87.419

Current through Reg. 50, No. 13; March 28, 2025

(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).

(c) If the consumer provides consent, OBH staff also notify the consumer's health care provider of the outcome of a complaint.

(d) OBH staff notify the rights protection officer that reviewed a case of the OBH finding. On a substantiated complaint, the superintendent of the relevant state hospital or the HHSC staff responsible for enforcement of the LBHA or LMHA contract is also asked to respond with a summary of actions taken. If a response is received, OBH staff upload the response into the HEART system.

Disclaimer: These regulations may not be the most recent version. Texas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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