| (a) OO staff review all available information about
a consumer through inquiry into HHS program systems before referring
a contact to HHS staff for review.
(b) Each complaint is investigated to determine if
HHS policy was followed by HHS staff and vendors contracted to provide
services on behalf of an HHS program. Applicable policies include
federal and state law, administrative rules, program handbooks, contracts,
and internal program policies and procedures.
(c) OO staff consider the following when investigating
a complaint:
(1) Legal authority. What is the basis of the HHS program's
decision, and was the decision made within the scope of that authority?
(2) Procedural fairness and rights. Was the consumer
given a full understanding of the situation, offered all applicable
opportunities to appeal, and given sufficient time to respond when
information was requested?
(3) Agreed expectations. Did the HHS program follow
through after agreeing to take particular actions, and did the program
provide an adequate explanation of decisions?
(d) When OO staff research through available systems
is not sufficient to address a concern or determine whether a complaint
can be substantiated, OO staff request a response to the complaint
from appropriate HHS staff.
(e) HHS staff are asked to respond to OO requests.
If no response is received, a second communication is made, and documented
in the HEART system. If still no response is received, the request
is escalated to leadership within the HHSC program.
(f) Upon receipt of information from HHS staff, OO
staff review to determine if the concern has been addressed and if
OO staff can determine whether a complaint can be substantiated. If
the response is found to be inadequate by OO staff or if additional
information is required, OO staff refer the contact back to HHS staff
for additional review.
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