Form 1741, Corrective Action Plan

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Documents

Effective Date: 1/2018

Instructions

Updated: 10/2024

Purpose

To document the corrective action plan (CAP) developed by the employer or designated representative (DR) at the request of a case manager, service coordinator, financial management services agency (FMSA), service planning team or Texas Health and Human Services Commission (HHSC) representative.

Procedure

When to Prepare

The employer or DR completes this form upon written request from a case manager, service coordinator, FMSA, service planning team or HHSC to submit a CAP.

Note: An employer or DR may request help developing or implementing a CAP. Refer to Texas Administrative Code (TAC), Title 26, Part 1, Chapter 264, Sections 264.221 and 264.319 for CAP rules.

Number of Copies

Original and at least two copies.

Transmittal

The employer or DR keeps a signed copy in the file for the person or member receiving services through the CDS option and sends a copy to the person, agency or service planning team requesting the CAP. The employer or DR must send a copy to the case manager or service coordinator. Other service planning team members receive copies, as applicable.

Form Retention

The employer or DR, the case manager or service coordinator and the FMSA keep this form while in effect and for five years thereafter.

Detailed Instructions

Person/Member Name — Enter the name of the person or member receiving services.

Program — Enter the program name.

Employer — Enter the employer's name. If the person or member receiving services is the employer, enter the person’s or member's name again.

Designated Representative — Enter the DR’s name if applicable.

Support Advisor — Enter the support advisor's name if applicable.

Corrective Action Plan Requested By — Enter the name of the person who requested the CAP.

Position — Enter the position of the person who requested the CAP.

Agency — Enter the name of the agency of the person who requested the CAP.

Date of Request — Enter the date of the written request.

Due Date — Enter the CAP due date, which is 10 days after the date of the request.

Reason(s) for Requested Corrective Actions — State the reason(s) a CAP is being requested.

Note: A written CAP may be required from an employer or DR if the employer or DR:

  • hires an ineligible service provider;
  • submits incomplete, inaccurate or late documentation of service delivery;
  • does not follow the budget;
  • does not comply with program requirements related to the CDS option; or
  • does not meet other employer responsibilities.

Corrective Action Plan* — State how the employer or DR will correct the problem.

Specific Action(s) to Be Taken* — Enter the specific action to be taken to implement the CAP.

Responsible Person* — Enter the name of the person responsible for each action.

Due Date* — Enter the date by which the action must be completed.

* This field expands to contain up to 2,000 characters. All text entered will show when the form is printed.

Plan Approval — A person’s service planning team must approve the CAP.

Completion of Corrective Action Plan — Whoever requested the CAP signs and enters the due date, indicates if the due date was or was not met and if corrective actions were or were not completed, and enters any comments.*

* The comments field expands up to 2,000 characters.