14500, Death Reviews

Revision 22-1; Effective February 4, 2022

See also Section 17000, Critical Incident and Death Reporting.

In accordance with 40 TAC, Chapter 9, Subchapter D, §9.178(r), and 40 TAC, Chapter 9, Subchapter N, §9.580(l), HCS and TxHmL program providers must report the death of an individual in their program to HHSC and the service coordinator by the end of the next business day following the death or the program provider's learning of the death. Form 8493, Notification Regarding a Death in HCS, TxHmL and DBMD Programs, must be faxed to LTCR at 512-206-3999 or submitted through the WSC Portal. The Risk Assessment coordinators (RACs) collect specific information regarding the death from the program provider and may request additional records, depending on the conditions existing at the time of death. The Death Review Group (DRG) meets routinely to review the circumstances surrounding each death. Additional regulatory follow up, including an on-site visit, may be scheduled to evaluate the program provider's compliance with HCS or TxHmL certification principles as the result of the DRG review.


14510 Death Review Policy and Procedures

Revision 22-1; Effective February 4, 2022

As part of the death review, the Risk Assessment coordinators (RACs) collect the following information:

  • Date of death;
  • Provider contract number and component code;
  • Person reporting the death, including contact telephone, email address and fax number;
  • Individual's identification number in the HHSC data system;
  • Type of setting ─ HCS, Texas Home Living (TxHmL) or Deaf Blind with Multiple Disabilities (DBMD);
  • Cause of death;
  • Date provider notified of death;
  • Admission date to the provider;
  • Dates of hospitalizations in the last three months (if applicable);
  • Dates of hospice (if applicable);
  • If the Department of Family and Protective Services (DFPS) Statewide Intake was notified;
  • Types of residence (Host Home/Companion Care, 3-Person, 4-Person, Own Home or Family Home);
  • Place of death;
  • Type of death (expected, unexpected, or accident);
  • Description of events surrounding the death; and
  • If an autopsy was ordered.

Information Gathering

If abuse  or neglect is suspected in relation to the death of the individual, the RAC will immediately contact DFPS Statewide Intake.

Requests for Additional Information

The following records may be requested by the RAC for specified time frames, depending on the conditions existing at the time of death.

  • Most recent person directed plan and implementation plan(s);
  • Any training regarding the individual’s special needs provided to service providers;
  • Last two months of medication administration records;
  • Most current nursing assessment;
  • Last three months of nursing notes, physician orders and lab work;
  • Last three weeks of residential support services, supervised living, Community First Choice personal assistance services/habilitation, supported home living, community support or host home/companion care notes;
  • Last week of day habilitation notes;
  • State supported living center transition notes (if applicable);
  • Hospice notes (if applicable); and
  • RN/LVN names/signature sample key.

Additional documents may be requested after the initial review by the RAC nurse.

Suspicious Deaths

If any circumstances surrounding the death are suspicious, LTCR may take further actions, including, but not limited to, referral to local police departments and DFPS Statewide Intake, completion of an intermittent survey or referral to pursue contract actions. The regional director or assistant director is informed immediately of suspicious circumstances surrounding a death or if other issues of concern are noted.

Follow-up Activities

RACs may conduct a desk review based on the information received from the program provider, requested records and/or the information received from HHSC Provider Investigations (PI).

The RAC manager may recommend an on-site visit based on the circumstances of the death, information obtained from a desk review or information obtained from HHSC PI. If the survey team determines that the program provider is not in compliance with one or more of the certification principles during an on-site visit, an intermittent survey will be opened.