Revision 22-1; Effective February 4, 2022

The HHSC IDD Ombudsman refers complaints to the RACs when the complaint is related to noncompliance with the HCS or TxHmL certification principles. HHSC departments refer internal complaints or concerns directly to LTCR. Complaints are reviewed by the RACs and appropriate follow-up actions are identified and completed as appropriate.

 

14810 Complaints Policy and Procedures

Revision 22-1; February 4, 2022

If LTCR staff receive a complaint from an external complainant, the person making the complaint should be immediately referred to the IDD Ombudsman at 800-252-8154.  

The IDD Ombudsman tries to resolve the complaint with the external complainant and the program provider. If the complaint cannot be resolved and it impacts the HCS certification principles, the IDD Ombudsman will refer it to LTCR. The complaint is received by the RACs, who review it to determine what actions are to be taken. The actions are determined by:

  • severity of the complaint; and
  • number and severity of other complaints received about that contract or program provider.

Actions to be taken include:

  • Enter the complaint into the LTCR database, for follow up on the next scheduled survey.
  • Desk Review – A desk review is conducted if there is low risk to the individual(s). The determination of low risk is made if the complaint did not involve issues that relate to the health or safety of the individual(s) served or if initial contact with the program provider indicates the situation has been satisfactorily resolved.
  • On-site visits are conducted if it is determined that significant risk exists for one or more individuals. RACs review the complaint with the RAC manager or designee prior to scheduling an on-site visit.