| (a) OO is established by Texas Government Code §531.0171.
(1) OO has authority and responsibility over the HHS
system in:
(A) providing dispute resolution services;
(B) performing consumer protection and advocacy functions;
and
(C) collecting consumer contact data.
(2) OO is responsible for a standard process for tracking
and reporting consumer contacts within the HHS system, including centralized
tracking of consumer contacts submitted to field, regional, or other
local offices.
(b) HHSC's Compact With Texans outlines customer service
principles and standards, including a complaint process for consumers.
As part of that process, a consumer is directed to first contact the
HHS program for which they have an inquiry or a complaint. If the
concern is not resolved to the consumer's satisfaction, the consumer
is directed to contact OO. In accordance with HHSC's Compact With
Texans, OO is committed to providing high quality services in a professional
and ethical manner by:
(1) treating consumers with courtesy and respect;
(2) ensuring access to and provision of services is
fair and equitable;
(3) implementing new and creative approaches to improve
quality of services;
(4) operating based on consumers' overall needs and
feedback;
(5) providing understandable information in a variety
of formats;
(6) ensuring sound management of programs and funds;
(7) working in cooperation with consumers; and
(8) protecting private information and sharing public
information in accordance with applicable laws.
(c) In accordance with Texas Government Code §531.0171(b),
OO does not have authority to process case actions or overturn HHS
program decisions. OO staff also cannot give legal advice.
(d) OO strives to adhere to the United States Ombudsman
Association's government ombudsman standards by:
(1) maintaining independence from HHS programs through
an organizational structure that has OO report to the HHSC Executive
Commissioner through a separate chain of command than program staff;
(2) remaining impartial by receiving and reviewing
each contact in an objective and fair manner, free from bias, and
treating all parties without favor or prejudice;
(3) maintaining discretion to keep confidential or
release information related to a contact or a complaint investigation,
if authorized by a consumer to do so; and
(4) providing a credible review process by performing
responsibilities in a manner that engenders respect, confidence, and
accessibility to all consumers.
(e) Several ombudsman programs are part of OO.
(1) The Ombudsman Managed Care Assistance Team (OMCAT)
provides 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.
Administrative rules for this program can be found in Subchapter B
of this chapter (relating to Ombudsman Managed Care Assistance).
(2) The Ombudsman for Children and Youth in Foster
Care (FCO) established by Texas Government Code Chapter 531, Subchapter
Y, as enacted by Senate Bill 830 (84th Legislature, Regular Session,
2015). FCO serves as a neutral party in assisting children and youth
in the conservatorship of the Department of Family and Protective
Services (DFPS) with complaints regarding issues within the authority
of DFPS or an HHS agency. Administrative rules for this program can
be found in Subchapter C of this chapter (relating to Ombudsman for
Children and Youth in Foster Care).
(3) The Ombudsman for Behavioral Health access to care
(OBH) established by Texas Government Code §531.02251. 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. Administrative rules for this
program can be found in Subchapter D of this chapter (relating to
Ombudsman for Behavioral Health).
(4) The Intellectual or Developmental Disability Ombudsman
(IDDO) transferred to OO after an assessment required by Senate Bill
1021, 85th Legislature, Regular Session, 2017, found a conflict of
interest existed with its previous organizational placement. IDDO
helps individuals with IDD, their LARs, their providers, or LIDDAs
to navigate and resolve concerns related to the Home and Community-based
Services (HCS) program, the Texas Home Living (TxHmL) program, or
LIDDA services. Additionally, Texas Government Code §534.051
requires HHSC to promote independent ombudsmen services as part of
its system for individuals with IDD. Administrative rules for this
program can be found in Subchapter E of this chapter (relating to
the Intellectual or Developmental Disability Ombudsman).
(5) The State Long-term Care Ombudsman authorized by
Texas Human Resources Code Subchapter F of Chapter 101a; 42 USC 3058f
and 3058g; and 45 CFR Part 1324. The purpose of the State Long-term
Care Ombudsman program is to protect the health, safety, welfare,
and rights of people living in nursing facilities and assisted living
facilities. Administrative rules for this program can be found in
26 TAC Chapter 88 (relating to State Long-term Care Ombudsman Program).
The rules in this chapter do not apply to the State Long-term Care
Ombudsman program.
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