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7000 The Adult Protective Services Provider Investigations Division

SWI Policy and Procedures May 2017

APS Provider Investigations operates under the authority of Chapter 48, Title 2, Texas Human Resources Code (HRC) and 40 Texas Administrative Code (TAC), Chapter 711. The APS Provider Investigations (APS PI) division investigates abuse, neglect, and exploitation of individuals receiving services from certain providers.

See the APS Provider Investigations Handbook, 1100 Legal Base.

7100 APS Provider Investigations (APS PI) Jurisdiction

SWI Policy and Procedures May 2017

APS Provider Investigations (APS PI) has authority to investigate allegations of abuse, neglect, or exploitation of individuals receiving services from the following providers:

  •   facilities (see 7110 Definitions of Facility and Provider for the types of facilities PI investigates);

  •   persons who contract with an HHS agency to provide inpatient mental health services;

  •   community centers, local mental health authorities, local intellectual and developmental disability authorities;

  •   managed care organizations (MCOs);

  •   persons who contract with a Health and Human Services (HHS) agency or MCO to provide home and community-based services;

  •   persons who contract with an MCO to provide behavioral health services;

  •   an officer, employee, agent, contractor, or subcontractor of the operations listed above; or

  •   an employee, agent, case manager, or services coordinator of an individual participating in the consumer directed services option.

APS PI also investigates allegations of abuse, neglect, or exploitation of:

  •   individuals residing in a Home and Community-based Services (HCS) group home regardless of whether the individual is receiving services under the waiver program from the provider; and 

  •   children receiving services from a home and community support services agency (HCSSA),

APS PI does not investigate if the provider is licensed and another agency has authority to investigate abuse, neglect, or exploitation in that operation.

In the APS Provider Investigations handbook, see 1310 APS Provider Investigations Jurisdiction.

7110 Definitions of Facility and Provider

SWI Policy and Procedures May 2017

In the SWI handbook, for allegation assessment purposes specific to SWI, the entities being investigated by APS Provider Investigations (APS PI) are identified as either facilities or providers.

Facilities

APS PI has authority to investigate allegations of abuse, neglect, or exploitation of individuals receiving services in the following facilities:

  •   state hospitals;

  •   state-supported living centers;

  •   intermediate care facilities for individuals with an intellectual disability (ICF-IIDs);

  •   community services operated by DADS or DSHS; and

  •   an individual if he or she is contracting with an HHS agency and is providing inpatient mental health services at a facility;

  •   community centers, local mental health authorities, local intellectual and developmental disability authorities when the client is receiving services at the facility; and

  •   a Home and Community-based services (HCS) group home whether or not the individual is receiving services under the waiver program from the provider.

See 7210 Assessing Jurisdiction Based on Facility.

Providers

APS PI has authority to investigate the following entities regarding allegations of abuse, neglect, or exploitation of clients receiving services in their homes or at a behavioral health service provider's office:

  •   community centers, local mental health authorities, local intellectual and developmental disability authorities providing services to a client in the client's own home;

  •   persons providing HCS or TxHmL services in the client's own home; 

  •   managed care organizations (MCOs);

  •   persons who contract with a Health and Human Services (HHS) agency or MCO to provide home and community-based services (HCBS);

  •   persons who contract with an MCO to provide behavioral health services;

  •   an officer, employee, agent, contractor, or subcontractor of any of the above;

  •   an employee, agent, manager, or coordinator of an individual participating in the consumer directed services option; and

  •   a home and community support services agency (HCSSA) providing services to a child.

See 7220 Assessing Jurisdiction Based on Provider.

7200 Entities Investigated by APS Provider Investigations

SWI Policy and Procedures May 2017

See 7100 APS Provider Investigations Jurisdiction for a list of all providers and facilities investigated by APS Provider Investigations (APS PI).

At intake, the information provided is sometimes limited, so some of these entities will be easier to identify than others.

For example, if a person residing in a state-supported living center (SSLC) or a state hospital is abused by staff, this would clearly be an intake for APS Provider Investigations. However, it may not be immediately apparent when a report is being made whether a person is receiving services from a home and community support services agency (HCSSA) contracting with a Health and Human Services (HHS) agency or managed care organization (MCO) to provide Home and community-based Services (HCBS) to the client. A reporter may simply know that the person has a provider coming out to the home.

Intake specialists must refer to the instructions in 7240 Assessing Jurisdiction for Provider Based on Payment Source when there is uncertainty about what kind of provider is involved in a report. The instructions help determine whether a report should be assessed for APS Provider Investigations or APS In-Home Investigations.

Documenting the Resource in IMPACT

Intake specialists must complete the Resource section of the Report Information page in IMPACT for all APS Provider Investigation intakes.

Facilities can be found in IMPACT by clicking the Search button and entering the search criteria. The Resource Search Results willbring back most facilities, but not all providers are listed in IMPACT. Providers may be listed with a client's home address or a business address, depending on the provider type. Therefore, it is important for intake specialists to search both the client's home and business addresses for a possible match. Running a facility search by Zip code is a reliable way to determine whether the provider is listed in IMPACT.

When the provider is not in IMPACT or the provider is unknown the intake specialist chooses the Community Provider Hcbs resource.

7210 Assessing Jurisdiction Based on Facility

SWI Policy and Procedures May 2017

APS Provider investigations has jurisdiction to investigate allegations of abuse, neglect, and exploitation of individuals residing in the facilities described in the following items, regardless of how the services are funded. See:

7211 Facilities for Individuals with an Intellectual Disability or Related Condition

7211.1 State Supported Living Centers

7211.2 Rio Grande State Center (ICF/IID Component)

7211.3 Intermediate Care Facilities

7211.4 Home and Community-based Services (Facility)

7212 Mental Health Providers

7212_1 State Hospitals

7212.2 Rio Grande State Center

7212.3 Private Psychiatric Facilities Contracted with DSHS

72137213 Community Centers (Facility)

7213.1 Local Authorities (Facility)

7211 Facilities for Individuals with an Intellectual Disability or Related Condition

SWI Policy and Procedures May 2017

DADS operates 13 facilities for individuals with intellectual disabilities or related conditions. The 13 facilities include 12 state-supported living centers (SSLCs) and the intermediate care facilities for individuals with an intellectual disability (ICF/IID) component of the Rio Grande State Center. These facilities provide campus-based services for individuals with an intellectual disability or related conditions, including, but not limited to:

  •   case management;

  •   health care;

  •   basic skills training;

  •   vocational training; and

  •   family support services.

7211.1 State Supported Living Centers

SWI Policy and Procedures May 2017

The state supported living centers (SSLCs) provide campus-based direct services and supports for individuals with intellectual and developmental disabilities who are medically fragile or who have behavioral problems.

Examples of SSLCs include:

  •   Abilene State Supported Living Center

  •   Austin State Supported Living Center

  •   Brenham State Supported Living Center

  •   Corpus Christi State Supported Living Center

  •   Denton State Supported Living Center

  •   El Paso State Supported Living Center

  •   Lubbock State Supported Living Center

  •   Lufkin State Supported Living Center

  •   Mexia State Supported Living Center

  •   Richmond State Supported Living Center

  •   San Angelo State Supported Living Center

  •   San Antonio State Supported Living Center

Documenting the Resource in IMPACT

SSLCs are listed as resources in IMPACT.

7211.2 Rio Grande State Center (ICF/IID Component)

SWI Policy and Procedures May 2017

Services are accredited by the Joint Commission and certified by DADS as an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) for people diagnosed with an intellectual disability, ages 18 and older. (See the APS In-Home Investigations handbook 1560 Allegations Involving the Texas Department of State Health Services (DSHS) for information about the Joint Commission.)

The ICF/IID component of the Rio Grande State Center is only half of the services that the facility provides.

See:

7731 IMPACT Procedures Specific to Rio Grande State Center

7322.2 Rio Grande State Center

Documenting the Resource in IMPACT

The Rio Grande State Center (ICF/IID Component) is listed in IMPACT as a resource.

7211.3 Intermediate Care Facilities

SWI Policy and Procedures May 2017

DADS licenses intermediate care facilities for individuals with intellectual disabilities or related conditions (ICFs/IID). However, allegations of abuse, neglect, and exploitation are investigated by APS Provider Investigations. ICFs/IID are operated by both private and public entities (community centers and state agencies). These facilities provide diagnosis, treatment, rehabilitation, ongoing evaluation, planning, 24-hour supervision, coordination, and integration of health or rehabilitative services.

Documenting the Resource in IMPACT

ICF/IID group homes are listed in IMPACT as resources.

7211.4 Home and Community-based Services (HCS) (Facility)

SWI Policy and Procedures May 2017

The Home and Community-based Services (HCS) program provides services to people with intellectual disability disorder (IDD) who live with their families, in their own homes, or in a group home with other residents who receive services.

At Statewide Intake, when a client receives HCS services in a group home he or she is considered to be in a facility.

When a client receives HCS services at home he or she is considered to be receiving services from a provider. See 7222 Home and Community-based Services (HCS) (Provider).

HCS is a Medicaid program authorized under Section 1915(c) of the federal Social Security Act (42 U.S.C. Section 1396n(c)) for the provision of services to persons with an intellectual or developmental disability described by §534.001(11)(B), Texas Government Code.

Documenting the Resource in IMPACT

HCS group homes are listed in IMPACT as resources.

7212 Mental Health Services Providers

SWI Policy and Procedures May 2017

Mental health services providers provide both short and long-term residential mental health services. Services provided may include, but are not limited to, case management, mental health services, medication-related services, rehabilitation and vocational services, and family support services.

Mental health services providers are described in the following items. See:

7212.1 State Hospitals

7212.2 Rio Grande State Center

7212.3 Private Psychiatric Facilities Contracted with DSHS

7212.1 State Hospitals

SWI Policy and Procedures May 2017

APS Provider Investigations has jurisdiction to investigate abuse, neglect, and exploitation in the following state hospitals:

  •   Austin State Hospital

  •   Big Spring State Hospital

  •   El Paso State Hospital

  •   Kerrville State Hospital

  •   Rusk State Hospital

  •   San Antonio State Hospital

  •   Terrell State Hospital

  •   North Texas State Hospital (Vernon)

  •   Waco Center for Youth

  •   North Texas State Hospital (Wichita Falls)

Documenting the Resource in IMPACT

State Hospitals are listed in IMPACT as resources.

7212.2 Rio Grande State Center

SWI Policy and Procedures May 2017

Rio Grande State Center (RGSC) offers outpatient medical health care, inpatient mental health services, and long-term services for individuals with intellectual and developmental disabilities.

See 7731 IMPACT Procedures Specific to Rio Grande State Center

Documenting the Resource in IMPACT

The Rio Grande State Center is listed in IMPACT as a resource.

7212.3 Private Psychiatric Facilities Contracted with DSHS

SWI Policy and Procedures May 2017

APS Provider Investigations has jurisdiction to investigate abuse, neglect, and exploitation in private psychiatric facilities contracted with DSHS. Examples of these include but are not limited to:

  •   University of Texas Tyler (not listed in IMPACT as a resource)

  •   El Paso Psychiatric Center (listed in IMPACT as a resource)

7213 Community Centers (Facility)

SWI Policy and Procedures May 2017

Services provided by community centers in the actual facility include, but are not limited to, case management, medication monitoring, and family support services. A center may also operate its own group homes, intermediate care facilities for individuals with an intellectual disability (ICF/IID) facilities, Home and Community-based Services (HCS) programs, or may contract for services with private providers. Community centers are governed by a local board of trustees. In most instances, community centers are the local authorities.

If community center services are provided in a client's home, see 7221 Community Centers (Provider).

Community centers are not state agencies and are not affiliated with DADS or DSHS facilities. They contract with and receive a portion of their funding through DSHS.

Documenting the Resource in IMPACT

Community Centers are resources in IMPACT and can be found by their names.  The names of Community Centers can be found here:

Local mental health authority (LMHA)

Local intellectual and developmental disability authority (LIDDA)

HCS and ICF/IID facilities are listed in IMPACT as resources. These homes are most easily located in IMPACT by conducting a resource search on the residence's zip code and finding the matching address.

7213.1 Local Authorities (Facility)

SWI Policy and Procedures May 2017

A local authority providing services in the facility is either:

  •   a local mental health authority (LMHA) designated by the Health and Human Services Commission (HHSC) executive commissioner in accordance with §533.035, Health and Safety Code and as defined by §531.002, Health and Safety Code (for examples of these, see the Local Mental Health Authorities (LMHAs) page on the HHS website); or

  •   a local intellectual and developmental disability authority (LIDDA) designated by the HHSC executive commissioner in accordance with §533A.035, Health and Safety Code and as defined by §531.002, Health and Safety Code (for examples of these, see the Local Intellectual and Developmental Disability Authorities Directory page on the HHS website).

7220 Assessing Jurisdiction Based on Provider

SWI Policy and Procedures May 2017

APS Provider investigations has jurisdiction to investigate allegations of abuse, neglect, and exploitation of individuals receiving services from the providers described in the following items. See:

7221 Managed Care Organization

7222 Home and community-based Services (HCBS) (Provider)

7223 Home and Community Support Services Agency

7224 Behavioral Health Services

7225 Consumer Directed Services

7226 Community Centers (Provider)

7226.1 Local Authorities (Provider)

7227 Home and Community-based Services (HCS) and Texas Home Living (TxHmL) (Provider)

7221 Managed Care Organization

SWI Policy and Procedures May 2017

APS Provider investigations has jurisdiction to investigate employees of managed care organizations (MCOs) when the client is participating in a Medicaid-managed care program.

An MCO is a company that is authorized or otherwise permitted by law to arrange for or provide a managed care plan. Texas Medicaid provides health care services to most clients through a managed care model.

Under the Medicaid managed care model, HHSC contracts with MCOs and pays them a monthly amount to coordinate and reimburse providers for health services for Medicaid members enrolled in their health plan. Each member receives Medicaid health care services and long-term services and supports (LTSS) through an MCO-contracted with a network of doctors, hospitals, and other health care providers responsible for managing and delivering quality, cost-effective care services through an MCO's network of providers.

Examples of Managed Care Organizations:

  •   Aetna Better Health

  •   Superior HealthPlan

  •   UnitedHealthCare Community Plan

  •   Amerigroup

  •   Molina Healthcare of Texas

Documenting the Resource in IMPACT

In most cases, Managed Care Organizations are listed in IMPACT as resources.  If the MCO is not found,the intake specialist:

  •   selects the Community Provider Hcbs resource; and

  •   changes the address in the Resource section of the Report Information page to match the client's residence.

7221.1 Programs Provided by Managed Care Organizations

SWI Policy and Procedures DRAFT 9567-SWI

Programs provided by managed care organizations (MCOs) include:

  •   NorthSTAR 1915(b) Behavioral Health Program

  •   STAR Health

  •   STAR Kids

  •   STAR+PLUS

Documenting the Resource in IMPACT

MCOs are listed as resources in IMPACT.

7222 Home and community-based Services (HCBS) (Provider)

SWI Policy and Procedures May 2017

Contracted Medicaid long-term services and supports (LTSS) enable people age 65 and over and those with disabilities to experience dignified, independent, and productive lives in safe living environments through a continuum of services provided in the client's own home.

Services can be:

  •   contracted through a Health and Human Services (HHS) agency or managed care organization; and

  •   provided by an individual or home and community support services agency (HCSSA).

Home and community-based (HCBS) Services providers are investigated by APS Provider Investigations (APS PI) when the services are provided in the client's home and paid for by Medicaid. Additionally, APS PI investigates Home and community-based Services (HCBS) that are provided to children through a HCSSA regardless of payment source.

See also 7211.4 Home and Community-based Services (HCS) (Facility).

See:

7223 Home and Community Support Services Agency

7227 Home and Community-based Services (HCS) and Texas Home Living (TxHmL) (Provider)

Examples of Home and community-based Services (HCBS) Programs include but are not limited to: 

  •   Community Living Assistance and Support Services (CLASS)

  •   Deaf-Blind and Multiple Disabilities (DBMD)

  •   Medically Dependent Children Program (MDCP)

  •   Primary Home Care (PHC)

  •   Community Attendant Services (CAS)

  •   Personal Care Services (PCS)

  •   Youth Empowerment Services (YES)

See 7227 Home and Community-based Services (HCS) and Texas Home Living (TxHmL) (Provider).

In the APS Provider Investigations Handbook, see Appendix II: Jurisdictions.

Documenting the Resource in IMPACT

Home and community-based Services (HCBS) are provided by home and community support services agencies (HCSSAs). HCSSAs are listed in IMPACT as resources. The resource listing may include the terms "Non-DFPS" or "APS Only." If both options are present, the intake specialist selects the HCSSA with the term "APS Only."

If the HCSSA is not known, the intake specialist:

  •   selects the Community Provider Hcbs Resource; and

  •   changes the address in the Resource section of the Report Information page to match the client's residence.

7223 Home and Community Support Services Agency

SWI Policy and Procedures May 2017

A home and community support services agency (HCSSA) employs individuals who provide home health, hospice, habilitation, or personal assistance services for pay or other consideration. These services are provided in a client's residence, an independent living environment, or another appropriate location.

HCSSAs are regulated by DADS. However, APS Provider Investigations has the authority to investigate allegations of abuse, neglect, or exploitation involving an HCSSA employee when:

  •   the HCSSA contracts with a Health and Human Services (HHS) agency or managed care organization (MCO) to provide Home and community-based services (HCBS) to an individual and these services are paid for by Medicaid, or

  •   when the individual receiving services is a child, regardless of the funding source for services.

HCSSAs provide home health care services in the individual's home, such as:

  •   nursing care;

  •   assistance with activities of daily living (ADLs);

  •   physical therapy; and

  •   hospice care.

Examples of HCSSAs:

  •   Girling Home Health

  •   Texas Home Health

  •   Premier Home Health Agency

  •   AAA Home Health Care Agency

Documenting the Resource in IMPACT

HCSSAs are listed in IMPACT as resources. The listing may include the terms "Non-DFPS" or "APS Only". If both options are present, the intake specialist selects the HCSSA with the term "APS Only."

If the HCSSA is not known, the intake specialist:

  •   selects the Community Provider Hcbs resource; and

  •   changes the address in the Resource section of the Report Information page to match the client's residence.

7224 Behavioral Health Services

SWI Policy and Procedures May 2017

Behavioral health services include:

  •   research, prevention, and detection of mental disorders and disabilities; and

  •   all services necessary to treat, care for, control, supervise, and rehabilitate persons who have a mental disorder or disability, including persons whose mental disorders or disabilities result from a substance abuse disorder (alcoholism or drug addiction).

Behavioral health services also include interventions provided to treat:

  •   abuse of alcohol or a controlled substance;

  •   psychological or physical dependence on alcohol or a controlled substance;  or

  •   addiction to alcohol or a controlled substance.

Behavioral Health Services (BHS) providers contract directly with the managed care organization (MCO) to provide the following Medicaid managed care services:

  •   mental health; and

  •   intervention provided to treat chemical dependency.

Examples of BHS providers include licensed professional counselors (LPCs), psychiatrists, and rehabilitation professionals.

APS Provider Investigations has authority to investigate allegations of abuse, neglect, and exploitation involving a BHS provider when the person contracts directly with a managed care organization.

Documenting the Resource in IMPACT

Behavioral Health Services may be listed in IMPACT as a resource. If the resource is not found, the intake specialist:

  •   selects the Community Provider Hcbs resource; and

  •   changes the address in the Resource section to match the client's residence.

7225 Consumer-Directed Services

SWI Policy and Procedures May 2017

All abuse, neglect, and exploitation allegations involving consumer-directed services (CDS) are investigated by APS Provider Investigations regardless of payment source.

CDS is a service delivery option that allows individuals (clients) to hire and manage the employees who provide their services. The client makes decisions related to the delivery of CDS services within his or her current Home and community-based Services program (HCBS). The client develops a budget, determines how much to pay employees, and sets schedules to meet his or her needs.

Frequently clients involved in consumer-directed services hire a family member or friend to be their provider through Home and community-based Services (HCBS) programs that have a CDS option. Examples of programs that offer the CDS option include, but are not limited to:

  •   Community Living Assistance Support Services (CLASS)

  •   Deaf-Blind Multiple Disabilities (DBMD)

  •   Home and Community-based Services (HCS)

  •   Texas Home Living (TxHmL)

  •   Medically Dependent Children Program (MDCP)

  •   STAR+PLUS

  •   STAR Health

  •   Community Attendant Services (CAS)

  •   Personal Care Services (PCS)

  •   Primary Home Care (PHC)

  •   Family Care (FC)

  •   Consumer Managed Personal Assistance (CMPAS)

Documenting the Resource in IMPACT

Some Consumer Directed Services will be listed in IMPACT. In order to find the resource, the intake specialist searches for the alleged perpetrator. If the resource is not found, the intake specialist:

  •   selects the Community Provider Hcbs resource; and

  •   changes the address in the Resource section to match the client's residence.

7226 Community Centers (Provider)

SWI Policy and Procedures May 2017

Services provided by community centers in the client's own home include, but are not limited to:

  •   case management;

  •   medication monitoring; and

  •   family support services.

In most instances, community centers are the local authorities. Community centers and local authorities are under the jurisdiction of APS Provider Investigations regardless of the funding source.

If community center services are provided at the actual facility, see 7213 Community Centers (Facility).

Community centers are not state agencies and are not affiliated with DADS or DSHS facilities.

Documenting the Resource in IMPACT

Community Centers are resources in IMPACT and can be found by their names.  The names of Community Centers can be found here:

Local mental health authority (LMHA)

Local intellectual and developmental disability authority (LIDDA)

7226.1 Local Authorities (Provider)

SWI Policy and Procedures May 2017

A local authority providing services in the client's own home is either:

  •   a local mental health authority (LMHA) designated by the Health and Human Services Commission (HHSC) executive commissioner in accordance with §533.035, Health and Safety Code and as defined by §531.002, Health and Safety Code (for examples of these, see the Local Mental Health Authorities (LMHAs) page on the HHS website); or

  •   a local intellectual and developmental disability authority (LIDDA) designated by the HHSC executive commissioner in accordance with §533A.035, Health and Safety Code and as defined by §531.002, Health and Safety Code (for examples of these, see the Local Intellectual and Developmental Disability Authorities Directory page on the HHS website).  

7227 Home and Community-based Services (HCS) and Texas Home Living (TxHmL) (Provider)

SWI Policy and Procedures May 2017

Home and Community-based Services (HCS) and Texas Home Living (TxHmL) are investigated by APS Provider.

HCS services provided in a client's own home is considered Provider. HCS group homes are considered facilities, not providers. See 7211.4 Home and Community-based Services (HCS) (Facility).

TxHmL services are only offered to clients residing in their own home.

HCS (provider) and TxHmL are always funded by Medicaid.

Documenting the Resource in IMPACT

For clients receiving HCS services in their own homes, IMPACT lists a resource with a matching address to the client's own home. The Facility Type is AFC Private HCS.

7230 Independent School Districts

SWI Policy and Procedures May 2017

In certain circumstances APS Provider Investigations (APS PI) has jurisdiction to investigate allegations involving an individual up to 23 years of age receiving services in a school setting. For APS-PI to investigate:

  •   the provider must be a home and community support services agency (HCSSA) provider or facility employee, such as Home and Community-based Services (HCS) or intermediate care facilities for individuals with an intellectual disability (ICF/IID);

  •   the school must be a contractor of the HCSSA provider or facility at which the employee works; and

  •   the HCSSA provider or facility employee is not a school employee.

HCSSA providers and facility employees who provide services to children in a school setting are under the jurisdiction of APS-PI regardless of payment source.

Facility employees who provide services to adults in a school setting are under the jurisdiction of APS-PI regardless of payment source. 

HCSSA providers who provide services to adults in a school setting must be paid by Medicaid to be under the jurisdiction of APS-PI. 

If the individual is 18 years old or older and also requires services as a result of or independent of the abuse, neglect, or exploitation, the intake specialist assesses for an APS In-Home intake.

If a school employee abuses, neglects, or exploits a child, the intake specialist assesses for a CPS intake.

If a school  employee abuses, neglects, or exploits an individual with a disability who is 18 or older, the intake specialist assesses for an APS In-Home intake.

7240 Assessing Jurisdiction for Provider Based on Payment Source

SWI Policy and Procedures May 2017

At times, intake specialists may not be able to determine with certainty whether a provider falls under APS Provider Investigation's jurisdiction. When this occurs, the intake specialist determines jurisdiction using the following guidelines.

Determining Whether the Client Receives Medicaid

The intake specialist determines whether the client receives Medicaid; if so, the intake specialist asks if the client's provider is paid with Medicaid. In some instances, the reporter may not know this information.

If…

then the intake specialist…

it is known that the provider is paid with Medicaid…

assesses for APS Provider Investigations.

The intake specialist asks the reporter for the client's Medicaid number and the name of the agency for which the provider works. If any of this information is known, the intake specialist documents it in the Narrative.

it is known that the provider is paid with private insurance, out-of-pocket, or with Medicare…

assesses for APS In-Home Investigations.

it is unknown if the provider is paid, and there is no indication the provider is paid…

assesses for APS In-Home Investigations.

it is believed the provider is paid, but it is unknown how the provider is paid…

assesses for APS Provider Investigation

the client receives both Medicare and Medicaid, and it is unknown with which the provider is paid…

assesses for APS Provider Investigations

7241 Always Investigated by APS PI Regardless of Payment Source

SWI Policy and Procedures May 2017

APS Provider Investigations has jurisdiction, regardless of payment source, to investigate allegations regarding:

  •   children receiving services from a home and community support services agency (HCSSA);

  •   consumer directed services; and

  •   community centers, local mental health authorities, local intellectual and developmental disability authorities.

See:

7223 Home and Community Support Services Agency

7225 Consumer-Directed Services

7213 Community Centers (Facility)

7226 Community Centers (Provider)

7250 Not Investigated by APS Provider Investigations

SWI Policy and Procedures May 2017

APS Provider Investigations (APS PI) does not investigate the following types of facilities:

  •   Nursing Facilities

  •   Day Activity Health Services (DAHS)

  •   Adult Foster Care

  •   Assisted Living Facilities

  •   Hospitals, Centers, Facilities, Clinics

  •   Drug and Alcohol Treatment Centers

  •   Texas Juvenile Justice Department

  •   Criss Cole Rehabilitation Center

  •   Texas School for the Blind and Visually Impaired

  •   Texas School for the Deaf

  •   Crisis Stabilization Units – Operated or contracted by the Department of State Health Services (DSHS) and located in some cases on the grounds of private hospitals

  •   Halfway houses (not operated or contracted by DSHS, Mental Health and Substance Abuse Division, or the Department of Aging and Disability Services (DADS), Intellectual Disability Authorities

7300 APS Provider Investigations Intake Assessment Guidelines

7310 Determining Physical Abuse

SWI Policy and Procedures May 2017

Physical abuse is defined as:

  •   an act or failure to act performed knowingly, recklessly, or intentionally, including incitement to act, which caused or may have caused physical injury or death to an individual receiving services;

  •   an act of inappropriate or excessive force or corporal punishment, regardless of whether the act results in a physical injury to an individual receiving services; or

  •   the use of chemical or bodily restraints on an individual receiving services not in compliance with federal and state laws and regulations.

Restraints

Rules regarding the use of chemical and bodily restraints are found in the Texas Administrative Code:

  •   25 TAC (Health Services) Chapter 415, Subchapter F (relating to Interventions in Mental Health Programs);

  •   25 TAC (Health Services) Chapter 404, Subchapter E (relating to Rights of Persons Receiving Mental Health Services);

  •   40 TAC Part 1 (DADS), Chapter 3, Subchapter F (relating to Restraints);

  •   40 TAC Part 1 (DADS), Chapter 90, Subchapter C (relating to Standards for Licensure);

  •   40 TAC Part 1 (DADS), Chapter 2, Subchapter G (relating to Role and Responsibilities of a Local Authority);

  •   40 TAC Part 1 (DADS), Chapter 9, Subchapter D (relating to Home and Community-based Services (HCS) Program and Community First Choice (CFC));

  •   40 TAC Part 1 (DADS), Chapter 9, Subchapter N (relating to Texas Home Living (TxHmL) Program and Community First Choice (CFC));

  •   40 TAC Part 1 (DADS), Chapter 97, Subchapter H (relating to Standards Specific to Agencies Licensed to Provide Hospice Services);

  •   40 TAC Part 1 (DADS), Chapter 42, Subchapter D (relating to Additional Program Provider Provisions); and

  •   1 TAC Part 15 (HHSC), Chapter 353, Subchapter C (Member Bill of Rights).

In the APS Provider Investigations Handbook see:

1200 Definitions

2300 Examples of Abuse, Neglect, and Exploitation

7311 Issues Related to Restraint, Seclusion, or Clinical Time-Out at a Facility

SWI Policy and Procedures May 2017

The intake specialist completes an intake when a client living in a facility that is under the jurisdiction of APS Provider Investigations is alleged to have been secluded or restrained in a manner that constitutes abuse or neglect.

See 7110 Definitions of Facility and Provider.

7320 Determining Neglect

SWI Policy and Procedures May 2017

Neglect is defined as a negligent act or omission which caused, or may have caused, physical or emotional injury or death to an individual receiving services, or which placed an individual receiving services at risk of physical or emotional injury or death.

Neglect includes, but is not limited to, the failure to:

  •   establish or carry out an appropriate individual program plan or treatment plan for a specific individual receiving services, if such failure results in a physical or emotional injury or death to an individual receiving services or which placed an individual receiving services at risk of physical or emotional injury or death;

  •   provide adequate nutrition, clothing, or health care to an individual receiving services in a residential or inpatient program if such failure results in physical or emotional injury or death to an individual receiving services or which placed an individual receiving services at risk of physical or emotional injury or death; or

  •   provide a safe environment for a specific individual receiving services, including the failure to maintain adequate numbers of appropriately trained staff, if such failure results in physical or emotional injury or death to an individual receiving services or which placed an individual receiving services at risk of physical or emotional injury or death.

In the APS Provider Investigations Handbook, see:

1200 Definitions

2300 Examples of Abuse, Neglect, and Exploitation

7321 Client-to-Client Sexual Contact at a Facility

SWI Policy and Procedures May 2017

APS Provider investigations has jurisdiction to investigate allegations of client-to-client sexual activity occurring in a facility to determine whether negligence by the staff of the facility allowed the activity to occur.

The intake specialist:

  •   completes a P1 intake and assigns it the allegation neglect (NEGL); and

  •   identifies as alleged perpetrators staff who were responsible for client supervision when the activity allegedly occurred.

See 7110 Definitions of Facility and Provider.

In the APS Provider Investigations Handbook, see 2600 Sexual Contact Between Individuals Receiving Services.

7322 Client-to-Client Aggression at a Facility

SWI Policy and Procedures May 2017

Aggression between clients is any incident in which a client is hostile or violent towards another client. Aggression can be verbal or physical in nature.

APS Provider Investigations (APS PI) investigates aggression between clients in a facility in some instances to determine if neglect by facility staff may have made it possible for the aggression to occur.

APS PI investigates aggression between clients when:

  •   one or both of the clients involved were on special precautions, such as close observation or one-to-one observation;

  •   one or both of the clients involved have a history of aggression;

  •   staff members verbally or physically encouraged one or both of the clients to become aggressive; or

  •   one or both of the clients received a serious physical injury.

See 7110 Definitions of Facility and Provider.

In the APS Provider Investigations Handbook, see 2700 Aggression Between Individuals Receiving Services.

7323 Failure by a Provider to Work a Scheduled Shift

SWI Policy and Procedures May 2017

When a provider fails to show up for a scheduled shift at a client's home, the intake specialist assesses this as a neglect (NEGL) intake, regardless of the impact to the client.

See 7110 Definitions of Facility and Provider.

7324 Injuries of Unknown Origin at a Facility

SWI Policy and Procedures May 2017

The intake specialist completes an intake if there are allegations that a client at a facility has injuries of unknown origin. If there is no information to indicate physical abuse (PHAB) by facility staff, the intake specialist assigns the allegation neglect (NEGL).

See 7110 Definitions of Facility and Provider.

In the APS Provider Investigations Handbook, see 3711.3 Does Not Meet the Definition of Abuse, Neglect, or Exploitation.

7330 Determining Sexual Abuse

SWI Policy and Procedures May 2017

Sexual abuse is defined as any sexual activity, including but not limited to:

  •   kissing an individual receiving services with sexual intent;

  •   hugging an individual receiving services with sexual intent;

  •   stroking an individual receiving services with sexual intent;

  •   fondling an individual receiving services with sexual intent;

  •   engaging in with an individual receiving services:

  •   sexual conduct as defined in the Texas Penal Code, §43.01 or

  •   any activity that is obscene as defined in the Texas Penal Code, §43.21;

  •   requesting, soliciting, or compelling an individual receiving services to engage in:

  •   sexual conduct as defined in the Texas Penal Code, §43.01, or

  •   any activity that is obscene as defined in the Texas Penal Code, §43.21;

  •   in the presence of an individual receiving services:

  •   engaging in or displaying any activity that is obscene, as defined in the Texas Penal Code §43.21, or requesting, soliciting, or

  •   compelling another person to engage in any activity that is obscene, as defined in the Texas Penal Code §43.21;

  •   committing sexual exploitation as defined in 40 TAC §711.13, against an individual receiving services;

  •   committing sexual assault as defined in the Texas Penal Code §22.011, against an individual receiving services;

  •   committing aggravated sexual assault as defined in the Texas Penal Code, §22.021, against an individual receiving services; and

  •   causing, permitting, encouraging, engaging in, or allowing the photographing, filming, videotaping, or depicting of an individual receiving services if the provider or facility staff knew or should have known that the resulting photograph, film, videotape, or depiction of the individual receiving services is obscene as defined in the Texas Penal Code, §43.21, or is pornographic.

In the APS Provider Investigations Handbook, see:

1200 Definitions

2300 Examples of Abuse, Neglect, and Exploitation

7331 Sexual Activity Between a Provider and a Client

SWI Policy and Procedures May 2017

Consensual sexual activity between a provider and a client is not considered sexual abuse if the consensual sexual relationship began before the provider became a paid provider.

See 7110 Definitions of Facility and Provider.

7332 Pregnancy and Sexually Transmitted Disease at a Facility

SWI Policy and Procedures May 2017

The intake specialist completes an intake when a reporter alleges that a client became pregnant or developed a sexually transmitted disease (STD) while a resident at a facility.

If is not known whether the pregnancy or STD was a result of sexual contact with another client, the intake specialist assigns the intake the allegation sexual abuse (SXAB) with unknown alleged perpetrator (AP).

See 7110 Definitions of Facility and Provider.

If the client is known to have had sexual contact with another client, see 7321 Client-to-Client Sexual Contact at a Facility.

7333 Sexual Activity Between a Facility Employee and Former Client

SWI Policy and Procedures May 2017

If a facility employee is alleged to be having a sexual relationship with a former client of the agency, the intake specialist completes an intake for sexual abuse (SXAB) and processes it following standard procedures.

See 7110 Definitions of Facility and Provider.

7340 Determining Emotional Abuse

SWI Policy and Procedures May 2017

Verbal or emotional abuse is defined as any act or use of verbal or other communication, including gestures, to curse, vilify, or degrade an individual receiving services or threaten an individual receiving services with physical or emotional harm. The act or communication must result in observable distress or harm to the individual receiving services, or be of such a serious nature that a reasonable person would consider it harmful or causing distress.

In the APS Provider Investigations Handbook, see:

1200 Definitions

2300 Examples of Abuse, Neglect, and Exploitation

7350 Determining Exploitation

7351 Exploitation by a Provider

SWI Policy and Procedures May 2017

Exploitation by a provider is defined as:

  •   the illegal or improper act or process of using or attempting to use an individual receiving services or the resources of an individual receiving services for monetary or personal benefit, profit, or gain; and

  •   theft, in most cases. However, theft is not considered to be exploitation when the provider services are obtained through Home and Community-based Services (HCS) or Texas Home Living (TxHmL).

Texas Penal Code, Chapter 31

Texas Administrative Code §711.21

See 7110 Definitions of Facility and Provider.

In the APS Provider Investigations Handbook, see:

1200 Definitions

2300 Examples of Abuse, Neglect, and Exploitation

7352 Exploitation in a Facility

SWI Policy and Procedures May 2017

When the alleged perpetrator is facility staff, exploitation is defined as the illegal or improper act or process of using an individual receiving services or the resources of an individual receiving services for monetary or personal benefit, profit, or gain.

Theft occurring in a facility is not exploitation (EXPL). See 7450 Assessment of an I&R Client Rights Fac/Admn Issues.

See 7110 Definitions of Facility and Provider.

In the APS Provider Investigations Handbook, see:

1200 Definitions

2300 Examples of Abuse, Neglect, and Exploitation

7400 APS Provider Assessment of Priority

SWI Policy and Procedures May 2017

Intake specialists classify an intake for an APS Provider investigation as Priority 1 (P I), Priority 2 (P II), or Priority 3 (P III).

In the APS Provider Investigations Handbook, see 2100 Priorities.

7410 Assessment of Priority 1

SWI Policy and Procedures May 2017

Priority 1 reports have a serious risk that a delay in the investigation will impede the collection of evidence, or allege that the victim has been subjected to maltreatment by an act or omission that caused, or may have caused, serious physical or emotional harm. Priority 1 reports may include, but are not limited to:

  •   death;

  •   sexual abuse;

  •   serious physical abuse injury;

  •   serious verbal or emotional abuse; or

  •   incitement to harm self or others.

7420 Assessment of Priority 2

SWI Policy and Procedures May 2017

Priority 2 reports have some risk that a delay in investigation will impede the collection of evidence, or allege that the victim has been subjected to maltreatment by an act or omission that caused, or may have caused, non-serious physical injury or emotional harm not included in Priority 1. Priority 2 reports may include, but are not limited to:

  •   non-serious physical abuse injury;

  •   non-serious verbal or emotional abuse; and

  •   exploitation.

7430 Assessment of Priority 3

SWI Policy and Procedures May 2017

Priority 3 reports allege maltreatment that would otherwise be classified as Priority 2 or 3, but the alleged incident occurred more than 30 days before the date of the report, and there is no known or perceived risk.

7440 Exceptions to Assessment of Priority

7441 Reports Regarding Sexual Abuse

SWI Policy and Procedures May 2017

Sexual abuse reports cannot be prioritized as a Priority 2.

7442 Reports Involving Children

SWI Policy and Procedures May 2017

Allegations involving a child cannot be prioritized as a Priority 3.

7443 Reports at State Supported Living Centers and the ICF/IID Component of the Rio Grande State Center

SWI Policy and Procedures May 2017

Intakes regarding state-supported living centers (SSLCs) and the intermediate care facility for individuals with an intellectual disability (ICF/IDD) component of the Rio Grande State Center cannot be prioritized as a Priority 3.

7450 Assessment of an I&R Client Rights Fac/Admn Issues

SWI Policy and Procedures May 2017

If a report regarding a facility or provider does not meet the criteria for investigation of abuse, neglect, or exploitation, the intake specialist:

  •   completes the report as an I&R type AFC Client Rights/Fac Admn Issues; and

  •   assigns the report for review to the regional office of APS Provider Investigations where the incident allegedly occurred.

See:

7100 APS Provider Investigations (APS PI) Jurisdiction

2323 Information & Referrals

Examples of an AFC Client Rights/Fac Admn Issues

Examples of issues referred to APS as an AFC Client Rights/Fac Admn Issues include:

  •   administrative issues, such as issues related to inadequate staffing, when no abuse or neglect has occurred; and

  •   clients' rights issues, such as when a resident is prevented from smoking or is asked to take a shower.

For additional examples of clients' rights and administrative issues, see the APS Provider Investigations Handbook, 3711.1 Client Rights Complaints.

How to Complete an I&R AFC Client Rights/Fac Admn Issues

To complete an I&R AFC Client Rights/Fac Admn Issues, the intake specialist:

  •   obtains from the reporter all pertinent information about the client, the facility, or the program and about the situation being reported;

  •   documents the information obtained following the Best Practice Narrative I&R AFC Client Rights/Fac Admn Issues; and

  •   assigns the I&R to the routing coordinator for APS Provider Investigations in the county where the facility or program is located.

No call out notification to the local office is required unless Office of the Inspector General (OIG) is reporting an I&R AFC Client Rights/Fac Admn Issues regarding a SSCL.

See 7560 When the Office of Inspector General (OIG) Reports an Incident at a State Supported Living Center (SSCL).

7500 Special Situations Regarding APS Provider

7510 Reports Involving Children in DFPS Conservatorship

SWI Policy and Procedures May 2017

APS Provider Investigations (APS PI) is responsible for notifying CPS when a child in CPS conservatorship is involved in an APS Provider Investigations intake.

It is not the responsibility of APS Provider Investigations to notify CPS when a child in CPS conservatorship is involved in an I&R AFC Client Rights/Fac Admn Issues. In that case, it is the intake specialist's responsibility to also process an I&R Call Regarding an Existing CPS Case.

See 7450 Assessment of an I&R Client Rights/Fac Admn Issues.

The intake specialist must complete both an I&R Call Regarding Existing CPS Case and an APS Provider Investigations report (intake or I&R) when:

  •   a child in CPS conservatorship runs away or is reported to be missing from a facility;

  •   a child in CPS conservatorship is hospitalized; or

  •   a child in CPS conservatorship dies in care.

See:

2323 Information & Referrals

2332 A Child's Death While in CPS Conservatorship

4480 Issues Involving Children in CPS Conservatorship

The intake specialist follows standard CPS and APS PI assessment protocol to determine if an I&R or an intake is appropriate. See:

4200 CPS Intake Assessment Guidelines

7300 APS Provider Intake Assessment Guidelines

When it is reported that the child has returned after running away from a facility, the intake specialist generates an I&R for the open CPS case. If there is already an open APS Provider Investigations case regarding the child, an I&R for the open APS PI case is also generated (I&R Call Regarding an Existing APS-PI Case). If there is no open case, an I&R AFC Client Rights/Fac Admn Issues is generated.

See 4481 Situations That Always Require an I&R Call Regarding Existing CPS Case.

7520 Intakes With Multiple Incidents and Victims Under the Jurisdiction of APS Provider

7521 An Intake With Multiple Incidents at a Facility or in a Provider Setting

SWI Policy and Procedures May 2017

When more than one incident is alleged in a single report of abuse, neglect, or exploitation, the intake specialist completes separate intakes for each incident that occurred more than two hours apart.

Incidents occurring more than two hours apart are handled separately, even if the injuries, client, and alleged perpetrator are the same.

7522 An Intake With Multiple Victims at a Facility

SWI Policy and Procedures May 2017

If multiple victims are involved in the same incident of abuse, neglect, or exploitation, the intake specialist:

  •   processes only one intake; and

  •   lists all of the victims on the Person List in IMPACT.

See:

7732 Day Habilitation Centers (Dayhabs)

7710 Completing the In Re: and Case Name Fields for Cases Related to APS Provider Investigations.

7523 Incidents Involving Multiple Clients and the Same Provider

SWI Policy and Procedures May 2017

If there are multiple clients receiving services from a single provider determined to be under APS PI jurisdiction, the report is assessed as one intake. In the Resource section, the Resource Name is documented as "Community Provider Hcbs" unless the home and community support services agency (HCSSA) is known.

An example of this may include a married couple who both receive services in their home from the same provider. If this provider is verbally abusive to them both during the same conversation, this would be assessed as one "Et Al" intake.

Please remember that when incidents occur two or more hours apart, new intakes must be generated.

7530 Emergency Services for Children and Adults Requested by APS Provider

SWI Policy and Procedures May 2017

The APS Provider Investigations program does not provide service delivery. However, the APS Provider investigator may encounter a situation in which emergency services are needed to immediately protect a client or other individuals from serious physical harm or death.

The APS Provider investigator is responsible for determining when other emergency services are needed and calls SWI. CPS or APS In-Home may provide emergency services in instances when the provider or DADS are unable to respond.

At the request of an APS Provider Investigator, the intake specialist enters either:

  •   a CPS CRSR (Request for Local Public Service) if there are no allegations of abuse or neglect or

  •   an APS In-Home intake.

Examples of emergency services include, but are not limited to:

  •   an emergency order for protective services;

  •   shelter;

  •   medical and psychiatric assessments;

  •   medical and psychiatric treatment;

  •   medication, food, and other supplies.

In the APS Provider Investigations Handbook, see:

9000 Emergency Services

9400 Requesting Assistance Through Statewide Intake for HCS Emergency Situations

7531 Dual Intakes for APS Provider and APS In-Home Determined by SWI

SWI Policy and Procedures May 2017

APS Provider Investigations only investigates allegations of abuse, neglect, and exploitation. APS Provider does not offer services.

When taking an APS PI intake, the intake specialist must assess whether an APS In-Home intake is also needed at the point of intake. For example, if an APS PI intake is generated because the provider neglected the client, that neglect can also place the client in a state of self-neglect. APS PI would investigate the neglect by the provider, and APS In-Home would offer services.

In the APS Provider Investigations Handbook, see 9000 Emergency Services.

See also 7530 Emergency Services in this handbook.

7540 Past Allegations of Abuse, Neglect, or Exploitation

7541 Past Allegations Related to a Client Who No Longer Lives in a Facility or Receives Services from a Provider

SWI Policy and Procedures May 2017

The intake specialist completes an intake if a client is alleged to have been abused, neglected, or exploited while a resident at a facility or receiving services from a provider, even if the client currently lives in a different facility or is no longer receiving services from a provider.

The intake is assigned to the regional office for APS Provider Investigations where the incident allegedly occurred.

7542 Past Allegations Regarding a Client Who is Deceased

SWI Policy and Procedures May 2017

When it is reported that a deceased client was abused, neglected, or exploited when he or she was still alive, the intake specialist assesses the information as an intake.

If the information reported does not meet the definition of abuse, neglect, or exploitation the intake specialist assesses an I&R AFC Client Rights/Fac Admn Issues.

The priority of the intake is assessed per normal procedures.

If the information reported indicates that the abuse, neglect, or exploitation contributed to the client's death, see 7580 Reports Regarding a Client's Death.

7550 Suicidal Callers Residing in Certain Facilities

SWI Policy and Procedures May 2017

Clients residing in a state hospital, state supported living center, or the Rio Grande State Center are in environments which provide varying degrees of supervision by staff. As a result, suicidal threats among this population are handled differently.

Suicidal Callers in a State Hospital, State Supported Living Center, or the Rio Grande State Center

When a caller living in one of these facilities appears to be suicidal, the following steps are taken, regardless of whether or not an intake or I&R AFC Client Rights/Fac Admn Issues is being taken:

  •   The intake specialist keeps the caller engaged in conversation and never puts him or her on hold or transfers the call.

  •   The intake specialist sends an Instant Message (IM) to the supervisor group to request assistance. If supervisory assistance is not provided quickly, the intake specialist contacts any available staff member by IM to ask for assistance in handling a suicidal caller.

  •   The supervisor (or designee) calls the facility and notifies the facility staff of the suicidal threat. The supervisor obtains the name of the facility staff receiving this information. Contact is made with the facility after each suicidal threat is reported. If the supervisor (or designee) is unable to make contact with the facility, the supervisor (or designee) contacts Law Enforcement.

  •   Should a client call multiple times making suicidal threats in a short period of time, a supervisor or PA may give the intake specialist special instructions regarding the frequency of call-outs to facility staff.

  •   Once the supervisor (or designee) confirms that contact with facility staff has been made, the supervisor (or designee) informs the intake specialist of the name of the facility staff member who was contacted. The intake specialist may then use professional judgment regarding when to end the call with the client.

  •   The intake specialist documents the suicidal threat information in the Narrative of either the intake or the I&R AFC Client Rights/Fac Admn Issues.

  •   The intake specialist documents that contact was made with the facility regarding the suicidal threat, beneath the intake specialist's name and title in the Narrative. This should include the name of the supervisor (or designee) who made the contact, the name of the facility staff member who received the information, and the time of the call.

If the caller hangs up before the intake specialist was able to contact a supervisor or other staff member for assistance, the intake specialist makes the call to the facility (or law enforcement if the facility cannot be contacted) and notifies the facility staff of the suicidal threat. Contacting law enforcement or the facility in this situation does not require supervisory approval.

Suicidal Callers Residing in or Receiving Services from All Other Facilities

Although these facilities and services are under APS Provider Investigations jurisdiction, the clients residing in them may not require 24 hour supervision.

When a caller residing in or receiving services from a facility such as a Home and Community-based Services (HCS) group home, intermediate care facility for individuals with an intellectual disability (ICF/IID), or community center appears to be suicidal, the intake specialist responds by following the procedures described in 2163 Suicidal Callers.

7560 When the Office of Inspector General (OIG) Reports an Incident at a State Supported Living Center (SSLC)

SWI Policy and Procedures May 2017

Assessment

If the Office of Inspector General (OIG) makes a report regarding a state supported living center (SSLC), the intake specialist assesses the information following standard assessment procedures. See 2300 Determining Whether Information Is an Intake, Special Request, or Information and Referral.

Processing the Intake

If the information obtained meets criteria for taking an intake, the intake specialist follows standard processing procedures. See the 3100 Entering Information into IMPACT and 7700 IMPACT Procedures Specific to APS Provider Investigations.

Processing the I&R

When Offices Are Open

If an I&R AFC Client Rights/Fac Admn Issues is completed when the APS Provider Investigations field office is open, the intake specialist:

  •   calls out the I&R within 40 minutes to the routing coordinator; and

  •   unchecks the "auto route" checkbox and manually assigns the I&R to the person who received the call-out.

See:

3600 Processing an Information and Referral

3900 Assignment and Call-Out

When Offices Are Closed

If an I&R AFC Client Rights/Fac Admn Issues is completed when the APS Provider Investigations field offices are closed, the intake specialist:

  •   calls out the I&R within 40 minutes to the on-call APS Provider Investigations field staff person; and

  •   unchecks the "auto route" checkbox and manually assigns the I&R to the person who received the call-out.

See

3600 Processing an Information and Referral

3900 Assignment and Call-Out

7570 Incidents Occurring Away from a Facility

7571 Contracted Services

SWI Policy and Procedures November 2017

Clients residing in facilities may receive services away from their facility of residence, through contracted providers. An example of this would be a client residing in an intermediate care facility for individuals with an intellectual disability (ICF/IID) group home attending a day habilitation center (dayhab) or vocational workshop during the week. If an incident rising to the level of abuse, neglect, or exploitation occurs under the care of facility staff or a contracted provider and:

  •   the client is a current resident of the facility that contracts the services, the intake specialist generates an intake for APS Provider. The Resource section in IMPACT is the client’s facility of residence; or

  •   the client is no longer a resident of the facility that contracted the services, the intake specialist still generates an intake for APS Provider Investigations. The Resource section in IMPACT is the facility of prior residence.

See 7732 Day Habilitation Centers (Dayhabs)

7572 Home Visits

SWI Policy and Procedures November 2017

A client may visit family members or friends away from the facility. If the client is abused, neglected, or exploited during a home visit, the intake specialist:

  •   generates an APS In-Home intake for an adult client, if the AP meets the definition of an APS In-Home perpetrator and the allegations meet the APS In-Home definition of abuse, neglect, or exploitation. See 6200 APS In-Home Perpetrators and 6300 Allegations that APS In-Home Investigates.

  •   generates a CPS intake for a child client, if the AP meets the definition of a CPS caretaker and the allegations meet the CPS definitions of abuse or neglect. See 4100 Definitions and 4200 CPS Intake Assessment Guidelines.

In order to determine if an APS Provider Investigations (PI) intake is necessary, the intake specialist considers the degree of supervision that the client needs and whether facility or contracted facility staff were negligent in allowing the client to have contact with the alleged perpetrator (AP). For example, certain family members may have been prohibited from having access because of the potential for abuse.

If an APS PI intake is not generated, the intake specialist generates an I&R – Client Rights/Fac Admn Issues.

See 7450 Assessment of an I&R Client Rights Fac/Admn Issues.

7580 Incidents Occurring in the Facility that Involve Family or Friends

SWI Policy and Procedures November 2017

A client may have visits with family members or friends at his or her facility of residence. If a visitor abuses, neglects, or exploits a client while at the facility, the intake specialist:

  •   generates an APS In-Home intake for an adult client, if the AP meets the definition of an APS In-Home perpetrator and the allegations meet the APS In-Home definition of abuse, neglect, or exploitation. See 6200 APS In-Home Perpetrators and 6300 Allegations that APS In-Home Investigates.

  •   generates a CPS intake for a child client, if the AP meets the definition of a CPS caretaker and the allegations meet the CPS definitions of abuse or neglect. See 4100 Definitions and 4200 CPS Intake Assessment Guidelines.

In order to determine whether an APS Provider Investigations (PI) intake is also necessary, the intake specialist considers the role of facility staff in the incident. If facility staff were negligent, participatory, or otherwise abusive, then an APS PI intake is also generated.

If an APS PI intake is not generated, the intake specialist generates an I&R – Client Rights/Fac Admn Issues.

See 7450 Assessment of an I&R Client Rights Fac/Admn Issues.

7590 Reports Regarding a Client’s Death

SWI Policy and Procedures November 2017

Reports involving the death of a client in a facility or under the care of a provider are assessed as an intake and assigned a Priority 1 (P1) when the death is the result of alleged abuse, neglect, or exploitation; or

  •   If the client lives in a facility and there are no allegations of abuse, neglect, or exploitation but the cause of death is unexplained or unknown, then the intake specialist assesses a P1.

  •   If the client receives services from a provider and there are no allegations of abuse, neglect, or exploitation but the cause of death is unexplained or unknown and there is reason to believe the provider may have contributed to the death, then the intake specialist assesses a P1.

Reports of the death of a client that do not meet the above criteria are processed as an I&R – AFC Client Rights/Fac Admn Issues.

See:

7450 Assessment of an I&R Client Rights Fac/Admin Issues

7740 Assigning and Calling Out Intakes Related to APS Provider Investigations

2332 A Child’s Death While in CPS Conservatorship

7600 Confidentiality for Reporters of Incidents at APS Facilities

SWI Policy and Procedures May 2017

There are several instances in which the APS Provider Investigations program may reveal the reporter's identity. The reporter's identity may be revealed to:

  •   the facility administrator, if the alleged perpetrator is reported to be sexually exploiting the client, and the alleged perpetrator is considered to be a mental health services provider,

  •   law enforcement for:

  •   any allegation of abuse, neglect, or exploitation involving a child; and

  •   any allegation of abuse, neglect, or exploitation involving an individual receiving services believed to constitute a criminal offense under any law.

  •   the Office of the Inspector General for any allegation of abuse, neglect, or exploitation believed to constitute a criminal offense under any law involving an individual receiving services:

  •   in a state supported living center;

  •   the intermediate care facility for individuals with an intellectual disability (ICF-IID) component of the Rio Grande State Center; or

  •   in a state hospital.

In the APS Provider Investigations Handbook, see 2311 The Reporter.

DFPS Rule, 40 TAC §711.401

7700 IMPACT Procedures Specific to APS Provider Investigations

SWI Policy and Procedures May 2017

This section explains the procedures for documenting reports in IMPACT that are related to facilities and providers that fall under the jurisdiction of APS Provider Investigations.

For a complete reference, see 3000 Processing Reports.

7710 Completing the In Regards To and Case Name Fields for Cases Related to APS Provider Investigations

SWI Policy and Procedures May 2017

When There Is One Victim

When there is one alleged victim involved in a report that falls under the jurisdiction of APS Provider Investigations, the Case Name is chosen from a drop-down menu that lists the names entered into the Person List. The intake specialist never enters the facility or provider's name as the Case Name. The In Regards To field auto-fills once the Case Name is chosen. 

When There Is More Than One Victim

The intake specialist selects the Case Name from a drop-down menu that lists the names entered into the Person List. Each victim's name appears in the drop-down menu twice; once by itself, and once followed by the term et al.

To choose the Case Name, the intake specialist selects the name of one of the clients, using the version that is followed by the term et al. The intake specialist never enters the facility or provider's name as the Case Name. The In Regards To field auto-fills once the Case Name is chosen.

7720 Listing Principals for Reports Related to APS Provider Investigations

SWI Policy and Procedures May 2017

When documenting reports in IMPACT for APS Provider Investigations, the intake specialist lists only victims and alleged perpetrators (APs) as principals.

Clients are never listed as alleged perpetrators. There must always be an AP listed on the Person List, even when there is no specific identifying information provided.

No Specific Identifying Information Regarding the AP

When a reporter gives only general information about the alleged perpetrator — for example, the tall white man who works the second shift or all second shift staff are abusing the client — and the reporter is unable or unwilling to provide names or other specifics, the intake specialist:

  •   lists only one AP on the Person List;

  •   leaves the name field blank, for IMPACT to automatically identify the person as Unknown 1; and

  •   documents in the Narrative field the information provided by the reporter about the AP (for example, Allegations are against the entire second shift; reporter was unwilling or unable to provide names or other descriptive information about possible AP).

Limited Identifying Information Regarding an AP

When a reporter provides only a nickname or other specific descriptions of an AP, the intake specialist:

  •   creates a person on the Person List for each known AP;

  •   does not enter the nickname on the Person List; and

  •   documents in each AP's Person Notes, the descriptive information provided (for example, male; short, trim, bald; works the third shift).

See 3121 Name Section.

7730 Using the Resource Section in IMPACT for Reports Related to APS Provider Investigations

SWI Policy and Procedures May 2017

The intake specialist must complete the Resource section when entering an intake into IMPACT that is related to APS Provider Investigations.

If the resource cannot be found or the resource has not been added to the database yet, and the resource is a provider, then the intake specialist chooses the generic Community Provider Hcbs resource. When the Community Provider Hcbs resource is selected, the intake specialist changes the address and phone in the Resource section to match that of the client's home address and phone.

To complete the Resource section, the intake specialist performs a resource search.

See:

3119 Facility Section

3210 Resource Directory

3211 Performing a Resource or Facility Search

7731 IMPACT Procedures Specific to Rio Grande State Center

SWI Policy and Procedures May 2017

The Rio Grande State Center is unique in that it is operated by DSHS (mental health services) and it also provides services through a contract with DADS (for individuals with intellectual disabilities). Because of changes to policies on investigations in facilities that serve individuals with intellectual disabilities, Rio Grande State Center is documented in IMPACT as two separate facilities, each with its own Resource ID:

  •   Rio Grande State Center-Mr: Resource ID 40 is marked "Mr", which is for the ICF/ID (formerly ICF/MR) side of the facility that serves individuals with intellectual disabilities. El Paisano dorm and La Paloma dorm are in this facility.

  •   Rio Grande State Center-Mh: Resource ID 24512725 is marked "Mh", which is for the side of Rio Grande that serves individuals with mental health issues. Unit 1 and Unit 2 are in this facility.

The names of the all units and dorms are listed in the Comments section of each of these two resources in IMPACT.

If a reporter is able to provide the client's unit or dorm, the intake specialist selects the correct facility based on that information. If the reporter does not know the client's unit or dorm but does know whether the client is receiving mental health services or services for persons with intellectual disabilities, the intake specialist selects the correct facility based on that information.

However, sometimes a reporter does not know the client's unit or dorm, or the type of services the client is receiving. In other cases, the reporter may be unwilling to provide it. If there is not enough information available at the time the report is made to determine which facility is correct, the intake specialist should select Rio Grande State Center-Mr (Resource ID 40).

7732 Day Habilitation Centers (Dayhabs)

SWI Policy and Procedures May 2017

APS Provider Investigations (APS PI) investigates allegations of abuse, neglect, and exploitation at day habilitation centers (dayhabs) that contract with agencies under the jurisdiction of APS PI. The agency that the dayhab contracts with is listed as a resource in IMPACT. Dayhabs are different from adult day care centers and are not listed as resources in IMPACT.

The agency could be:

  •   where the client lives (HCS home, ICF/IID home, adult foster care, etc.) or,

  •   through whom the client receives services when the client lives at home (HCS, TxHmL, county MHMR, etc.).

The Resource section of APS PI intakes is always the name of the agency, never the dayhab, because the agency is responsible for the client's safety. When a client is the victim of abuse, neglect, or exploitation at a dayhab, it is necessary to find out where the client lives in order to correctly complete the Facility section. 

  •   If the client lives in a facility, the agency that runs that facility is the agency documented in the Resource section. This agency is listed as a resource in IMPACT.

  •   The intake specialist completes the resource search using the name of the agency or zip code. When the address for the client is found, the specialist selects that option from the list and clicks Continue. The Resource section automatically populates with the agency information.

  •   If the agency is found, but no address matches the client's residential address, the intake specialist manually enters the agency name and address in the Resource section.

  •   If a client lives his or her own personal home, the agency through which the client receives services is the agency documented in the Resource section. This agency is listed as a resource in IMPACT.

  •   The intake specialist completes the Resource search using the name of the agency or zip code. When the address for the agency is found, the specialist selects that option from the list and clicks Continue.

  •   If the client's provider is a family member who is paid by the agency, the family member's address will be listed as a resource in IMPACT and this is the correct option to choose for the Resource section. The Resource section automatically populates with the agency information.

  •   If the agency is found, but no address matches the agency's address, the intake specialist manually enters the agency name and address in the Resource section.

  •   If it is unknown where the client lives or what the agency's name is, the intake specialist assesses the information as under the jurisdiction of APS PI when the client is abused, neglected, or exploited at dayhab. In the Resource section, the specialist enters "Unknown" as the resource name, chooses "Other" as the facility type, and documents a city and county for the address.

7732.1 Incidents Involving Multiple Clients and Dayhabs

SWI Policy and Procedures May 2017

When an incident involves multiple clients and the agencies through which the clients receive services are different, the intake specialist assesses the report as one intake.  The intake specialist chooses one of the agencies to document in the Resource section. The APS Provider Investigations caseworker can add multiple agencies to the case in IMPACT.

When clients who live in facilities located at different addresses receive services through the same agency, the intake specialist chooses one of the addresses for the Resource section and assesses one intake. The APS Provider Investigations caseworker can add multiple addresses to the case in IMPACT. 

If there are multiple clients involved and it is unknown through which agency they receive services, the intake specialist assesses the report as one intake. In the Resource section, the specialist enters "Unknown" as the resource name, chooses "Other" as the facility type, and documents a city and county for the address.

It is imperative to inform the on-call worker during the call-out when there are multiple agencies or addresses involved so that the on-call worker can notify all of the agencies or locations. It may be necessary to explain to the on-call worker that only one agency or address can be entered in the Resource section at intake. 

7740 Assigning and Calling Out Intakes Related to APS Provider Investigations

SWI Policy and Procedures May 2017

APS Provider Investigations staff are required to initiate an investigation within one hour of the time that the intake was received. For this reason, it is essential that intake specialists complete, process, and call out intakes as quickly as possible. The intake specialist documents the call-out in an I&R Worker Call Out.

The time of receipt of the report is shown on the intake in IMPACT.

When the APS Office Is Open

30 Minutes After Intake

If an intake is ready to be transmitted to the regional office within 30 minutes from the time of intake, the intake specialist:

1.   informs the routing coordinator that the intake is being assigned;

2.   documents in the Narrative field in IMPACT that the routing coordinator has been notified; and

3.   completes the intake.

40 Minutes After Intake

If an intake is not ready for transmission to the regional office within 40 minutes from the time of intake, the intake specialist:

  •   calls the routing coordinator by the 40 minute mark;

  •   informs the routing coordinator that the intake might not be processed to the routing coordinator's workload in time to meet the one hour contact requirement; and

  •   provides the intake information (name and unit of the facility as well as the names of the reporter, victim(s), and AP(s), and details about the incident (such as allegation and time frames) verbally, as requested.

When the APS Office Is Closed

When the regional office is closed, the intake specialist contacts the on-call staff.

Immediate call out to the on-call worker is required. The intake specialist does not wait until the documentation is complete but initiates the call-out as soon as possible after ending the call with the reporter. Call out to the on-call worker must be initiated no later than the 40-minute mark.

After completing the intake, the intake specialist assigns it to the staff person to whom it was called out.

 

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