| (a) General. The procedure in this section shall be utilized by providers when there is a disagreement with surveyors' findings and/or recommendations, when additional written information becomes available that was not shared with the survey team, or when a complaint is filed relating to the conduct of the survey. The provider may request a face-to-face, telephone, or paper review when one of the following termination actions is taken against the facility: 90-day termination, denial of certification, or when the automatic cancellation clause is invoked. If no action was taken against the facility but deficiencies were written, the provider will be given a paper review only. These procedures shall only be used if the deficiencies cited in the survey report do not pose an imminent threat or danger to the health and/or safety of a resident. Twenty-three day terminations are not entitled to utilize the Informal Review process. (b) Review process.
(1) Exit conference. (A) At the time of the survey the provider will furnish any information requested by the surveyor. The facility staff must not wait until the exit conference to provide information requested earlier during the survey. Information needed to conduct the survey must be made available during the survey; however, additional information will be accepted for review at the time of the exit conference. (B) At the time of the exit conference, the facility will receive written notice from a member of the survey team of its right to an informal review. (C) If there are issues which are not resolved during the exit conference, the administrator or his designee may make a written or faxed request for an informal review with the associate commissioner for Long Term Care Regulatory or his state office designee. The request for the review and any additional information must be submitted and received in
the associate commissioner's or his designee's office within ten calendar days after receipt of the official statement of deficiencies. (2) Associate commissioner's review. The associate commissioner for long term care regulatory or his state office designee: (A) will review all information and make an impartial decision as to whether deficiencies shall be sustained, altered, or reversed from the original findings of the survey team. The Texas Department of Human Services (DHS) will not accept additional information or schedule an informal review after ten calendar days following receipt of the official statement of deficiencies; (B) may conduct, at the request of the provider, a face-to-face, telephone, or paper review when one of the following actions was taken against the facility: 90-day termination, denial of certification, or when the automatic cancellation clause is invoked; (C) will
conduct a paper review only, if no action was taken against the facility, but deficiencies were written; (D) may request additional information if necessary; (E) will determine a resolution and present the resolution to the associate commissioner for long term care regulatory for concurrence; and (F) will notify the provider of a decision before the forty-fifth day after the provider receives the official statement of deficiencies. Time frames for all certification actions must be adhered to by the facility and DHS.
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| Source Note: The provisions of this §96.6 adopted to be effective August 31, 1993, 18 TexReg 2725; transferred effective September 1, 1993, as published in the Texas Register September 3, 1993, 18 TexReg 5885; amended to be effective January 1, 1997, 21 TexReg 11291; amended to be effective September 1, 1997, 22 TexReg 7905; amended to be effective September 1, 1998, 23 TexReg 8186.
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