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RULE §511.113Complaint Investigations

(a) A limited services rural hospital (LSRH) shall provide each patient and applicable consenter at the time of admission with a written statement identifying the Texas Health and Human Services Commission (HHSC) as the agency responsible for investigating complaints against the LSRH.

  (1) The statement shall inform persons that they may direct a complaint to HHSC's Complaint and Incident Intake (CII) and include current CII contact information, as specified by HHSC.

  (2) The LSRH shall prominently and conspicuously post this information in each patient common area, visitor area, and waiting room so that it is readily visible to patients, employees, and visitors. The information shall be in English and in a second language appropriate to the demographic makeup of the community served.

(b) HHSC evaluates all complaints. A person must submit a complaint using HHSC's current CII contact information for complaint submission, as described in subsection (a) of this section.

(c) HHSC documents, evaluates, and prioritizes complaints based on the seriousness of the alleged violation and the level of risk to patients, personnel, and the public.

  (1) HHSC may investigate allegations determined to be within HHSC's regulatory jurisdiction relating to LSRH's under this chapter.

  (2) HHSC may refer complaints outside HHSC's jurisdiction to an appropriate agency, as applicable.

(d) HHSC shall conduct an investigation to evaluate an LSRH's compliance following a complaint of abuse, neglect, or exploitation; or a complaint related to the health and safety of patients. HHSC may coordinate complaint investigations with the federal Centers for Medicare & Medicaid Services and its agents responsible for surveying LSRHs to determine compliance with the conditions of participation under Title XVIII of the Social Security Act, (42 USC, §§1395 et seq), to avoid duplicate investigations.

(e) HHSC may conduct an unannounced, on-site investigation of an LSRH at any reasonable time, including when treatment services are provided, to inspect or investigate:

  (1) an LSRH's compliance with any applicable statute or rule;

  (2) an LSRH's plan of correction;

  (3) an LSRH's compliance with an order of the executive commissioner or the executive commissioner's designee;

  (4) an LSRH's compliance with a court order granting injunctive relief; or

  (5) for other purposes relating to regulation of the LSRH.

(f) An applicant or licensee, by applying for or holding a license, consents to entry and investigation of any of its LSRHs by HHSC.

(g) An LSRH shall cooperate with any HHSC investigation and shall permit HHSC to examine the LSRH's grounds, buildings, books, records, video surveillance, and other documents and information maintained by, or on behalf of, the LSRH.

(h) An LSRH shall permit HHSC access to interview members of the governing body, personnel, and patients, including the opportunity to request a written statement.

(i) An LSRH shall permit HHSC to inspect and copy any requested information. If it is necessary for HHSC to remove documents or other records from the LSRH, HHSC provides a written description of the information being removed and when it is expected to be returned. HHSC makes a reasonable effort, consistent with the circumstances, to return any records removed in a timely manner.

(j) HHSC shall maintain the confidentiality of LSRH records as applicable under state or federal law. All information and materials obtained or compiled by HHSC in connection with an investigation are confidential and not subject to disclosure under Texas Government Code Chapter 552 (relating to Public Information), and not subject to disclosure, discovery, subpoena, or other means of legal compulsion for their release to anyone other than HHSC or its employees or agents involved in the enforcement action except that this information may be disclosed to:

  (1) persons involved with HHSC in the enforcement action against the LSRH;

  (2) the LSRH that is the subject of the enforcement action, or the LSRH's authorized representative;

  (3) appropriate state or federal agencies that are authorized to inspect, survey, or investigate LSRH services;

  (4) law enforcement agencies; and

  (5) persons engaged in bona fide research, if all individual-identifying and LSRH-identifying information has been deleted.

(k) The following information is subject to disclosure in accordance with Texas Government Code Chapter 552:

  (1) a notice of alleged violation against the LSRH, which notice shall include the provisions of law that the LSRH is alleged to have violated, and a general statement of the nature of the alleged violation;

  (2) the pleadings in the administrative proceeding;

  (3) a final decision or order by HHSC; and

  (4) any other information required by law to be disclosed under public information request laws.

(l) On entry, HHSC holds an entrance conference with the LSRH's designated representative to explain the nature, scope, and estimated duration of the investigation.

(m) HHSC holds an exit conference with the LSRH representative to inform the LSRH representative of any preliminary findings of the investigation. The LSRH may provide any final documentation regarding compliance during the exit conference.

(n) Once HHSC completes an investigation, HHSC reviews the evidence from the investigation to evaluate whether there is a preponderance of evidence supporting the allegations contained in the complaint.

Source Note: The provisions of this §511.113 adopted to be effective October 5, 2023, 48 TexReg 5668

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