|(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
(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;
(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
(2) submit an immediate protection plan in accordance
with §49.511 of this chapter (relating to Immediate Protection
and Immediate Protection Plan).