APS IH / June 2012
APS and HHSC Guardianship Services work jointly in emergency situations to take immediate action to protect APS clients. Emergency situations sometimes necessitate a referral to HHSC Guardianship Services before all of the steps required for a standard referral can be completed.
APS may need to make an emergency referral to HHSC when an Emergency Order for Protective Services (EOPS) is obtained or when APS determines a client has rapidly diminishing assets and immediate legal intervention is necessary to protect the client’s remaining assets.
APS is authorized to petition the court twice for a Motion for Extension of Emergency Order for Protective Services to extend the Emergency Order for Protective Services up to 60 days so that adequate and appropriate arrangements to protect the client can be made.
If APS has …
• validated abuse, neglect, or financial exploitation, and
• obtained an Emergency Order for Protective Services, or determined the client’s assets are rapidly diminishing …
it appears that guardianship is appropriate, …
APS takes immediate action to ensure that the referral form is completed and sent to HHSC Guardianship Services within 3 calendar days following the EOPS, or a determination that an emergency referral for rapidly diminishing assets is appropriate.
For all cases being referred for guardianship, at least one validated finding of abuse, neglect, or financial exploitation is required at the time of the referral.
The HHSC guardianship specialist completes the guardianship assessment in 14 days, unless an extension is granted by the guardianship supervisor, and makes every effort to file an application for guardianship within 33 days.
4500 Emergency Order for Protective Services (EOPS)
4782.1 Procedure for Assessing Appropriateness of Standard Referrals to HHSC Guardianship Services
4783.1 Procedure for Emergency Referrals to HHSC Guardianship Services During an Emergency Order for Protective Services (EOPS)
APS IH / June 2012
Once APS has obtained an Emergency Order for Protective Services (EOPS), the APS specialist completes the referral form as completely as possible. The supervisor or subject matter expert sends HHSC the referral within three days of obtaining the EOPS, except in extenuating circumstances. APS may need to seek an extension of the EOPS to continue APS’s authority to keep the client safe during the HHSC assessment process. APS’s authority under an EOPS, including extensions, does not exceed 60 calendar days.
It is important to note that the 70-calendar day timeframe for HHSC to assess the client and file a guardianship application, if appropriate, does not start until the referral form is received by HHSC.
Delay in Guardianship Referral After an EOPS
After obtaining an EOPS or extension, APS may not believe a referral to HHSC for guardianship is necessary because it appears that less restrictive alternatives or an alternate guardian will be available to protect the client. In rare cases, the less restrictive alternative or alternate guardian may no longer be an option before the extension order expires. If this occurs, APS immediately makes the referral to HHSC, including an explanation as to what has happened, and requests HHSC act as quickly as possible to assess the client’s appropriateness for guardianship.
4530 Termination or Expiration of a Court Order for Emergency Protective Services
4783.5 Documenting the APS Guardianship Referral Form for Emergency Referrals
APS IH / June 2012
If there are indicators that the client is in need of guardianship and is appropriate for HHSC Guardianship Services, the APS supervisor or subject matter expert (SME) immediately sends the HHSC Guardianship Services supervisor a notification email containing:
• the client’s name and locating address;
• the date of the Emergency Order for Protective Services and whether or not an extension has been granted; and
• notification that an emergency referral for guardianship services and an expedited assessment is necessary.
The APS specialist, supervisor, and SME expert then follow the steps below.
The APS Specialist:
• consults with the SME regarding approval to send an emergency referral to HHSC Guardianship Services;
• informs the supervisor of the decision to pursue guardianship;
• completes the APS Guardianship Referral Form in the IMPACT case management system as soon as possible, but no later than three calendar days of the EOPS. The referral form is located in the Contact Detail dropdown box on the Contact Detail page;
• notifies the SME that the APS Guardianship Referral Form is ready for review; and
• saves and submits the APS Guardianship Referral Form to the supervisor or SME in IMPACT for review and approval.
The Subject Matter Expert:
• reviews the APS case;
• consults with the APS specialist and, as necessary, the APS supervisor regarding the appropriateness of the emergency guardianship referral;
• reviews the APS Guardianship Referral Form to ensure that all of the information for an emergency referral is provided; and
• recommends revisions to the content entered in the APS Guardianship Referral Form, if needed.
The APS Supervisor or Subject Matter Expert:
• reviews the APS Guardianship Referral Form to ensure enough information is provided as outlined in 4781 Minimum Information for HHSC Guardianship Referrals and then:
• saves the guardianship referral form as an HTML document,
• approves the form; and
• alerts the HHSC Guardianship Services supervisor via email of the emergency referral with the HTML document as an attachment the same day the referral is approved.
• if necessary, within the next three business days, arranges an initial case review meeting face-to-face or by conference call with the HHSC supervisor; and
• at the case review meeting, discusses the referral with the HHSC supervisor to resolve any questions related to the referral form.
See 4783.5 Documenting the APS Guardianship Referral Form for Emergency Referrals.
APS IH September 2014
In some cases, seeking an EOPS is not appropriate as there is no threat to life or safety, but an emergency exists concerning the client’s assets. There are two possible causes for this: self-neglect or financial exploitation. In either case, intervention to protect the client’s property is needed immediately to prevent loss. Most often the legal action needed is a temporary guardianship over the client’s estate.
Estates Code §1251.001 permits the appointment of a temporary guardian for individuals whose person or estate requires the immediate appointment of a guardian. The court appoints a temporary guardian with powers limited to those required by the case circumstances.
The application for temporary guardianship requests only the powers and duties necessary to protect the ward and his or her estate from imminent danger. HHSC Guardianship Services seeks a temporary guardianship in appropriate cases after conducting minimal assessment.
Before APS staff make a referral to HHSC for guardianship services, an allegation of abuse, neglect, or financial exploitation must be validated. If the cause of the rapidly diminishing assets is self-neglect, then APS validates self-neglect and submits an emergency referral to HHSC. In these cases, it is likely that the client’s mental faculties are so impaired that the client cannot handle his or her financial affairs.
The APS specialist may determine that the client’s assets are rapidly diminishing because of financial exploitation by a family member, caretaker, or person with an ongoing relationship. In these instances, APS works cooperatively with HHSC Guardianship Services to protect the client’s assets by rendering a finding of Valid for the financial exploitation allegation and submitting an emergency referral to HHSC. If APS obtains an Emergency Order for Protective Services, APS continues to gather evidence while HHSC seeks temporary guardianship to address the rapidly diminishing assets.
For the steps to complete an emergency referral to HHSC, see 4783.1 Procedure for Emergency Referrals to HHSC Guardianship Services During an Emergency Order for Protective Services (EOPS).
In addition to following the steps outlined under 4783.1 Procedure for Emergency Referrals to HHSC Guardianship Services During an Emergency Order for Protective Services (EOPS), the APS specialist must also complete the following actions when a client’s assets are rapidly diminishing. The APS specialist:
• ensures an financial exploitation subject matter expert is involved, if appropriate;
• documents in a contact detail narrative in IMPACT that the finding of Valid is preliminary and is being made so that an emergency referral for guardianship services can be completed;
• continues investigating and gathering evidence;
• notifies the APS supervisor when evidence gathering is complete, whether the finding of financial exploitation is correct or needs to be changed;
• notifies HHSC within three calendar days if the final finding of financial exploitation is anything other than Valid, and whether any other allegations in the case are Valid;
• revises the Allegation Detail in IMPACT to reflect the final finding for financial exploitation if a preponderance of the evidence does not support a finding of Valid;
• if appropriate, validates other findings that support the client’s need for a guardian; and
• if appropriate, notifies HHSC of the need to withdraw the referral (for example, the client’s needs were met without requiring HHSC to file for guardianship).
HHSC’s Role in Rapidly Diminishing Asset Investigations
If the client fits all other criteria for guardianship, HHSC files an application for temporary guardianship. Although a certified medical examination (CME) is not required for a temporary guardianship, HHSC seeks one to provide to the court, if available in time. If APS is ultimately unable to gather sufficient evidence to support the finding of Valid regarding financial exploitation and APS has insufficient evidence to validate any other finding, HHSC may:
• withdraw the application for temporary guardianship, if the hearing has not yet been held; or
• seek dismissal from the guardianship if guardianship has been granted.
HHSC notifies APS immediately if guardianship is not granted or HHSC seeks to dismiss a guardianship. If a temporary guardianship is not granted, HHSC completes the guardianship assessment of the client within 30 calendar days of the APS referral.
If temporary guardianship is granted, HHSC completes the guardianship assessment of the client during the term of the temporary guardianship to determine whether seeking a permanent guardianship of the client is appropriate.
APS IH September 2014
After the APS guardianship referral form is submitted to HHSC, a guardianship specialist is assigned to conduct an assessment. The APS specialist works jointly with the HHSC Guardianship Services specialist and shares information to promote a positive outcome for the client.
Within five calendar days of submitting the guardianship referral to HHSC, the APS specialist:
• provides hard copies via email, mail, fax, or hand delivery of any minimum required information outlined in 4781 Minimum Information for HHSC Guardianship Referrals left pending on the referral form or other documentation in the case file that supports the referral such as:
• current investigation (copy of APS Case Review), and any relevant prior history not already provided in the referral form,
• medical assessments, determination of intellectual disabilities, medical records,
• financial information; and
• notifies HHSC in writing via email if any of the minimum required information cannot be provided in the five-day time frame and reaches an agreement with HHSC as to when this information will be provided.
Ongoing Responsibilities of the APS Specialist
In addition to ensuring all minimum required information is sent to HHSC via hard copy in five calendar days, the APS specialist:
• completes a full investigation of any additional allegations of abuse, neglect, or financial exploitation that were outstanding at the time of the guardianship referral;
• completes all additional case documentation per policy and ensure HHSC is provided any additional case information that is relevant to the pending guardianship assessment;
• notifies and provides hard copies to HHSC via email, mail, fax, or hand delivery within two business days of other important information the APS specialist obtains during the course of the investigation, such as information regarding:
• power of attorney (POA),
• bank accounts (name, address, phone, account numbers, balances),
• income (SSI, SSDI, RSDI, retirement, VA, and other sources of income),
• Medicaid number,
• medical insurance (if other than Medicare or Medicaid),
• real property,
• personal property,
• the existence and location of the will, and
• life insurance;
• completes a service authorization in IMPACT to pay for a written Certificate of Medical Examination (CME) only when requested by the HHSC Guardianship Services specialist or HHSC Guardianship Services supervisor;
• provides an affidavit for the guardianship application, if requested by HHSC, within five calendar days;
• attends the guardianship hearing without a subpoena, if requested by HHSC;
• remains responsible for routine case actions until HHSC Guardianship Services or a HHSC-contracted guardianship service program has taken the oath of guardianship or the situation is otherwise resolved; and
• closes the service delivery stage (Maintenance or Intensive Case Services) by selecting the Referred to other agency closure code on the Stage Closure page in IMPACT.
APS IH / June 2012
In emergency situations, the APS specialist may be missing some minimum referral information needed to complete the referral form. It is not necessary in an emergency to complete all of the person information in IMPACT (for example, family, friends, and collaterals such as the client’s physician) before submission of the referral form to HHSC. However, it is important to ensure that all available information is entered, including the information required in Section V of the referral form.
To document the referral form, the APS specialist:
• accesses the APS Guardianship Referral Form located in the Contact Type drop down box on the Contact Detail page in the IMPACT system;
• addresses all sections of the guardianship referral form in IMPACT if the information is known at the time of referral;
• leaves sections blank if certain information is not known at the time of referral; and
• provides HHSC with any minimum required information that is left blank within five calendar days of sending the referral form to HHSC. If the information does not exist or cannot be obtained in that timeframe, the APS specialist, supervisor, or subject matter expert (SME) must notify HHSC in writing via email. The APS specialist, supervisor, or SME notifies HHSC as soon as APS is aware that the information cannot be provided within five calendar days.
4781 Minimum Information for HHSC Guardianship Referrals
4783.2 Procedure for Staffing and Completing Emergency Referrals During an EOPS