|(a) The Texas Health and Human Services Commission
(HHSC) provides an informal dispute resolution (IDR) process for Texas
Home Living (TxHmL) and Home and Community-based Service (HCS) providers
(hereinafter referred to collectively as "provider") through which
a provider may dispute citations cited against that provider by the
State survey agency.
(b) The HHSC IDR Department must receive a provider's
written request for an IDR no later than the tenth calendar day after
the provider's receipt of the final report from the State survey agency,
or its designee. The provider must submit its written request for
an IDR on the form designated for that purpose by HHSC. HHSC will
make that form publicly available, e.g., maintained on the HHSC website.
The provider must also submit the final report containing the citations
the provider wishes to dispute.
(c) Within three business days of its receipt of the
provider's written request for an IDR, HHSC will notify the provider
and the State survey agency of its receipt of the request.
(d) Within five calendar days of HHSC's receipt of
the provider's request for an IDR, HHSC must receive from the provider,
the provider's rebuttal letter and attached supporting documentation.
The rebuttal letter must contain:
(1) a list of the citations disputed (only those citations
listed on the IDR request form and addressed in the rebuttal letter
and supporting documentation will be reviewed);
(2) the reason or reasons each citation is disputed;
(3) the outcome desired by the provider for each disputed
(e) The provider submits its supporting documentation
or information in the following format:
(1) organize the attachments by citation and cross-reference
to the disputed citation in the rebuttal letter;
(2) ensure all information is labeled and legible;
(3) highlight information relevant to the disputed
citation, such as a particular portion of a narrative;
(4) describe the relevance of the documentation or
information to the disputed citation; and
(5) do not de-identify documents that name individuals
referenced in disputed citations.
(f) If the provider substantially complies with the
procedures set out in subsections (d) and (e) of this section, HHSC
will proceed with its review of the provider's IDR request.
(g) It is the provider's responsibility to present
sufficient credible information to HHSC to support the outcome requested
by the provider.
(h) Possible outcomes of an IDR for TxHmL and HCS are:
(1) a determination that there is insufficient evidence
to sustain a citation;
(2) a determination that there is insufficient evidence
to sustain a portion of or a finding of a citation;
(3) a determination that there is sufficient evidence
to sustain a citation;
(4) a determination that there is insufficient evidence
to sustain the citation as cited but that there is sufficient evidence
to sustain a different citation;
(5) a determination that there is insufficient evidence
to sustain the severity and scope assessment but that there is sufficient
evidence to sustain a reduced severity and scope assessment (for Immediate
Threat only); or
(6) a determination that there is sufficient evidence
to sustain the severity and scope assessment as cited.
(i) HHSC will not conduct an IDR based on alleged surveyor
misconduct, alleged State survey agency failure to comply with survey
protocol, complaints about existing federal or State standards, or
attempts to clear previously corrected citations.
(j) Upon receipt of the provider's IDR request, the
State survey agency must submit the following to HHSC:
(1) report Log ID;
(2) contract number; and
(3) component code.
(k) Any information related to an IDR request that
is received by HHSC from either the provider or the State survey agency
will be made available by HHSC to the opposing party. Parties have
until the end of the second business day after receipt of such shared
IDR information to respond to HHSC about that information. HHSC will
share any responses with the opposing party.
(l) HHSC may request additional information from the
provider and/or the State survey agency. Both parties will be notified
of the request for additional information and have until the end of
the second business day after notification to respond to the request.
The opposing party will be provided with copies of the response submitted
(m) All responses to shared information as described
in subsections (j) and (k) above must be received no later than the
tenth calendar day after the provider's rebuttal letter and supporting
documentation are submitted.
(n) Ex parte communications by the provider or by the
State survey agency with HHSC personnel conducting the IDR are prohibited.
(o) A provider may participate in an IDR conference
provided that the provider requested an IDR conference on the IDR
(p) Any IDR conference will be scheduled by HHSC, or
its designee on or before the 22nd calendar day after HHSC received
the IDR request. If the provider is unable to participate on the scheduled
date, the IDR conference will be cancelled, and the IDR will continue
as though no conference had been requested.
(q) The IDR conference is an opportunity for an eligible
provider to present important information previously submitted in
the provider's rebuttal letter or responses to shared information.
The provider and the State survey agency may attend any IDR conference,
but neither party may present information that was not previously
included in the final report, submitted in the provider's rebuttal
letter, or responses to shared information.
(r) HHSC will complete the IDR no later than the 30th
calendar day after its receipt of the provider's written request.
The IDR recommendation shall be in writing, address all the issues
raised by the provider, and explain the rationale for the recommendation.
(s) The time frames designated in the IDR process shall
be computed in accordance with Texas Government Code §311.014.
(t) HHSC may issue and enforce operating procedures
concerning the IDR process and the conduct of IDR participants. IDR
participants must comply with any such procedures. HHSC may deny an
IDR request if the information submitted is incorrect, incomplete,
or otherwise not in compliance with applicable HHSC operating procedures.
(u) The State survey agency may revise an IDR recommendation
as a result of a review and subsequent determination that the IDR
recommendation may violate a federal law, regulation, or State of
(v) HHSC may contract with an appropriate disinterested
organization to adjudicate disputes between a provider and the State
survey agency. Texas Government Code §2009.053 does not apply
to the selection of an appropriate disinterested organization. For
purposes of this section, a reference to HHSC with respect to HHSC's
role in the IDR process includes an organization with which HHSC has
contracted for the purpose of performing IDR, and a contracted organization
is bound by the same requirements to which HHSC is bound for the purposes
of conducting an IDR. The results of an IDR conducted by a contracted
organization serve only as a recommendation to the State survey Agency.
The State survey Agency maintains responsibility for and makes final