7000 Provider Investigations (PI) Community
SWI Policy and Procedures July 2023
The Provider Investigations (PI) program is part of the Texas Health and Human Services (HHS) Regulatory Services Division. PI operates under the authority of the following laws:
Texas Human Resources Code, Chapter 48
Texas Family Code, Chapter 261
Texas Administrative Code, Title 26, Chapter 711
See the PI Handbook.
PI Facility and PI Community
In the SWI Handbook, for SWI’s purposes of allegation assessment, the type of provider to be investigated by PI is identified as one of the following:
- A facility provider investigated by PI Facility.
- A community provider investigated by PI Community.
References to PI Facility and PI Community are strictly for SWI identification and clarity purposes. PI does not have investigatory bodies or staff separated into these areas or categories.
The PI program investigates abuse, neglect, and exploitation of clients receiving services from certain providers. PI calls clients “individuals receiving services.”
7100 Provider Investigations—Community
SWI Policy and Procedures December 2023
Provider Investigations (PI) Community has authority to investigate allegations of abuse, neglect, or exploitation of clients who are any age when the following apply:
- The alleged perpetrator is a community provider.
- The community provider is not employed by a Home and Community Support Services Agency (HCSSA).
- The services are paid for with Medicaid funds. This includes consumer directed services (CDS).
When concerns do not meet the legal definition of abuse, neglect, or exploitation, the intake specialist completes an I&R AFC Client Rights/Fac Admn Issues. See 3110 AFC Client Rights/Fac Admn Issues.
The intake specialist completes an I&R Referred to HHSC when a report is about an employee, officer, agent, contractor, or subcontractor of an HCSSA, unless the information is included in an APS or PI intake. See 3172 Referred to HHSC.
7110 Types of Community Providers
SWI Policy and Procedures March 2024
Provider Investigations (PI) Community investigates the following types of community providers:
- People or businesses who provide services through a Medicaid managed care organization (MCO).
- People or businesses who provide Home and Community-Based Services (HCBS).
- People or businesses who provide behavioral health services (BHS) and contract with a Medicaid MCO.
- An employee, agent, manager, or coordinator of a person participating in the consumer-directed services (CDS) option.
- An employee, officer, agent, contractor, or subcontractor of any of the above.
Exception for Certain Medicaid Waiver Programs
PI Facility investigates providers who are paid through the following Medicaid waiver programs:
Home and Community-based Services (HCS)
Youth Empowerment Services (YES)
See 6111 Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Waiver Programs.
Transportation
Transportation provided by a facility or agency, such as an HCS group home, is under the jurisdiction of PI Facility as an HCS service.
Medicaid-paid medical transportation services are not PI Community providers. These services are paid for through independent Medicaid contracts with the transportation provider. The intake specialist refers the reporter to the HHS ombudsman to report any concerns about these services.
Unclear Type of Provider
When the type of community provider is unclear, the intake specialist determines whether the alleged perpetrator fits the definition of a community provider. See 7222 Alleged Perpetrator (AP).
7120 Settings in Which a Community Provider May Provide Services
SWI Policy and Procedures December 2023
A community provider may provide services to a client in any of the following places or ways:
- Where the client lives, including residential, group, or institutional settings.
- In a community setting.
- At the community provider’s place of business.
- Over the phone or by other forms of technology.
7200 PI Community Person List
SWI April 2021
The person list of an intake for PI Community should include the alleged victim or victims, the alleged perpetrator or perpetrators, and other people who might have additional information.
See 2200 Person List.
7210 Types
SWI April 2021
The intake specialist identifies each person on the person list with an appropriate person type. A person can be a principal (PRN) or collateral (COL). The intake specialist must get identifying information for all principals, as well as at least one relevant collateral.
See 2240 Types.
7211 Principal (PRN)
SWI April 2021
PI Community defines a principal as an alleged victim or an alleged perpetrator.
See:
7212 Collateral (COL)
SWI April 2021
PI Community defines a collateral (COL) as a witness or other person who has additional information about the situation. A COL cannot be an alleged perpetrator or an alleged victim.
7213 Anonymous Reporters
SWI Policy and Procedures September 2023
A reporter may mention concerns about child abuse or neglect under CPI’s jurisdiction while making a report for PI Community. A reporter can remain anonymous when making a report of abuse, neglect, or exploitation under the jurisdiction of any program except CPI. If the reporter chooses to remain anonymous, SWI cannot accept the report of child abuse or neglect under CPI’s jurisdiction.
7220 Roles
SWI April 2021
PI Community uses the following roles:
- Alleged victim
- Alleged perpetrator
- No role
PI Community does not use the “alleged victim/perpetrator” and “unknown” roles.
See 2250 Roles.
7221 Alleged Victim (VC)
SWI April 2021
A client may be an adult or child with either of the following:
- A chronic and substantial intellectual, emotional, or physical disability.
- A short-term impairment that causes the client to be temporarily unable to live independently and to need services from a community provider during the time he or she is impaired.
PI Community defines an alleged victim (VC) as a client who receives services from a community provider under the jurisdiction of PI Community and who is alleged to have been abused, neglected, or exploited by a community provider. There can be multiple VCs in an intake.
7222 Alleged Perpetrator (AP)
SWI Policy and Procedures September 2023
A community provider is an employee of a business that helps clients by providing services such as the following:
- Rehabilitation, medical, or nursing services.
- Mental health or substance abuse services.
- Help with activities of daily living.
- Help coordinating the client’s services.
PI Community defines an alleged perpetrator as a community provider who is reported to be responsible for the abuse, neglect, or exploitation of a client.
There must always be an alleged perpetrator on the person list, even when there is no specific identifying information available. An intake can have multiple alleged perpetrators.
The intake specialist never lists a client as an alleged perpetrator. When the alleged perpetrator is deceased, the intake specialist assesses the report as if he or she were still alive.
A community provider who works for a home and community support services agency (HCSSA) cannot be an alleged perpetrator for PI Community. If the provider is employed by an HCSSA, the intake specialist completes an I&R Referred to HHSC unless the information is included in an APS or PI intake.
See:
7222.3 Limited or No Specific Identifying Information about the AP
Provider Investigations Handbook, 1200, Definitions
7222.1 Alleged Perpetrator and Payment Source
SWI Policy and Procedures September 2023
The alleged perpetrator is under the jurisdiction of PI Community if he or she is not an employee, officer, agent, contractor, or subcontractor of an HCSSA and any of the following apply:
- The alleged perpetrator is paid by Medicaid
- The client receives Medicaid and Medicare, but it is unknown which pays the alleged perpetrator.
- It is believed the alleged perpetrator is paid, but it is unknown how the alleged perpetrator is paid.
When the alleged perpetrator is not an employee, officer, agent, contractor, or subcontractor of an HCSSA and is not paid by Medicaid, APS or CPI has jurisdiction based on the age of the client.
When another agency or program has jurisdiction to investigate the alleged perpetrator, the intake specialist does not complete a PI Community intake.
See:
4741 Care Provided in a Child’s Home
7222.2 Alleged Perpetrator Is On or Off the Clock
SWI April 2021
It is not necessary to determine whether the AP was on or off the clock at the time of the incident, except in situations where the client has suffered an injury of unknown origin. Otherwise, SWI assesses reports as if the AP is always on the clock.
See:
7631 Injuries of Unknown Origin
7222.3 Limited or No Specific Identifying Information about the AP
SWI April 2021
Reporters are not always able to provide specific identifying information for an alleged perpetrator (AP). In these instances, the reporter knows details about the incident, but not the AP’s identity. For example, the reporter may know only a physical description or a nickname.
When the reporter is not able to provide identifying information for the AP or APs, the intake specialist does the following:
- Adds an AP to the person list.
- Documents any known demographic information.
- Documents any descriptive information in the person notes (for example: short, thin, bald).
If there is more than one AP and the reporter knows how many APs there are, then the intake specialist follows the bullets above for each AP.
If there is more than one AP but the number of APs is unknown, then the intake specialist only adds one AP to the person list to represent them all.
7223 No Role (NO)
SWI April 2021
If the person is not involved as an alleged victim or alleged perpetrator, then the person is assigned a role of No Role (NO). In PI Community intakes, only a collateral can be assigned a role of NO.
See 2260 Relationship or Interest (Rel/Int.).
7230 Relationship or Interest (Rel/Int)
SWI April 2021
The client who is an alleged victim is assigned the relationship or interest (rel/int) of self (SL). Each other person on the person list is assigned the rel/int option that best describes his or her relationship to the client. See 2260 Relationship or Interest (Rel/Int).
If multiple clients are alleged victims, the intake specialist chooses a primary client and assigns that client the rel/int of self (SL). The rel/int for any other alleged victim should reflect the option that best describes the relationship to the primary client (for example, unrelated home member (UH)). See 7510 Case Name.
Although the IMPACT abbreviation for self is “SL,” SWI uses the abbreviation “CL,” which is short for “client.” See the Narrative Abbreviations document on the DFPS intranet.
See 2255 No Role (NO).
7300 PI Community Allegations
SWI Policy and Procedures March 2023
Each report is assessed on a case-by-case basis. It is essential for the intake specialist to consult SWI policy, state statutes, applicable resources, and use his or her professional judgement to determine if one or more allegations are supported. If at least one allegation is supported, the intake specialist completes an intake.
7310 Abuse Allegations
SWI April 2021
PI Community investigates allegations of the following types of abuse:
- Emotional abuse
- Physical abuse
- Sexual abuse
7311 Emotional Abuse (EMAB)
SWI Policy and Procedures March 2023
Verbal or emotional abuse is defined as:
- Willful infliction of an act or repeated acts of verbal or other communication, including gestures, to harass, intimidate, humiliate, or degrade a client.
- Threats of physical or emotional harm against a client.
In order for the definition of verbal or emotional abuse to be met, the act or communication must meet one or more of the following criteria:
- Result in a client experiencing significant impairment to his or her physical, mental, or emotional health.
- Result in a client experiencing substantial physical, mental, or emotional distress, as identified by an appropriate medical professional.
- Be of such a serious nature that a reasonable person would consider it causing significant impairment to the physical, mental, or emotional health of the client.
26 Texas Administrative Code §711.17
See:
HHSC Provider Investigations Handbook, 1200, Definitions
HHSC Provider Investigations Handbook, 2130 Verbal or Emotional Abuse Allegations
Provider Investigations (PI) Community Intake Guidelines on the DFPS intranet
7312 Physical Abuse (PHAB)
SWI Policy and Procedures March 2023
Physical abuse is any of the following:
- 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 a client.
- An act of inappropriate or excessive force or corporal punishment, regardless of whether the act results in a physical injury to a client.
- The use of chemical or bodily restraints or seclusion on a client when the use is not in compliance with federal and state laws and regulations.
26 Texas Administrative Code §711.11
See:
7631 Injuries of Unknown Origin
HHSC Provider Investigations Handbook, 1200, Definitions
HHSC Provider Investigations Handbook, 2110 Physical Abuse Allegations
Provider Investigations (PI) Community Intake Guidelines on the DFPS intranet
7313 Sexual Abuse (SXAB)
SWI Policy and Procedures March 2023
Sexual abuse is defined as any sexual activity with a client or in the presence of a client, including, but not limited to, the following:
- Kissing a client with sexual intent.
- Hugging a client with sexual intent.
- Stroking a client with sexual intent.
- Fondling a client with sexual intent.
- Engaging, requesting, soliciting, or compelling a client to engage in either of the following:
- Sexual conduct, as defined in the Texas Penal Code §43.01.
- Any activity that is obscene, as defined in the Texas Penal Code §43.21.
- Doing any of the following in the presence of a client: Engaging in, displaying, 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 abuse, as defined in 26 Texas Administrative Code §711.13, against a client. Sexual abuse is:
- A pattern, practice, or scheme of conduct against a client, which may include sexual contact, that can reasonably be construed as being for the purposes of sexual arousal or gratification or sexual abuse of any person.
- The term does not include getting information about a patient’s sexual history within standard, accepted, clinical practice.
- Continuous sexual abuse of young child or disabled individual, as defined in Texas Penal Code §21.02.
- Committing sexual assault against a client, as defined in the Texas Penal Code §22.011.
- Committing aggravated sexual assault against a client, as defined in the Texas Penal Code §22.021.
- Causing, permitting, encouraging, engaging in, or allowing the photographing, filming, videotaping, or depicting of a client, if the provider or facility staff member knew or should have known that the resulting photograph, film, videotape, or depiction of the client is obscene or is pornographic, as defined in the Texas Penal Code §43.21.
Exception: Consensual sexual activity between a community provider and a client is not considered sexual abuse, if the consensual sexual relationship began before the community provider became a community provider to the client.
26 Texas Administrative Code §711.13
See:
7632 Sexual Activity between a Community Provider and a Client
HHSC Provider Investigations Handbook, 1200, Definitions
HHSC Provider Investigations Handbook, 2120 Sexual Abuse Allegations
Provider Investigations (PI) Community Intake Guidelines on the DFPS intranet
7320 Neglect (NEGL)
SWI Policy and Procedures March 2023
Neglect is defined as a negligent act or omission that caused physical or emotional injury or death to a client.
26 Texas Administrative Code §711.19
When the reporter describes any effects of the alleged neglect on the client, through any method of reporting (phone, e-report, mail, or fax), the intake specialist assesses based on those known effects.
The intake specialist assesses an intake when the reporter does not know or did not document whether the alleged neglect affected the client.
See:
7631 Injuries of Unknown Origin
7632 Sexual Activity between a Community Provider and a Client
HHSC Provider Investigations Handbook, 1200, Definitions
HHSC Provider Investigations Handbook, 2140 Neglect Allegations
Provider Investigations (PI) Community Intake Guidelines on the DFPS intranet
7330 Exploitation (EXPL)
SWI Policy and Procedures December 2023
When the alleged perpetrator is a community provider, exploitation is defined as the illegal or improper act or process of using a client or a client’s resources for monetary or personal benefit, profit, or gain.
When a client’s resources are alleged to be used for a provider’s benefit, profit, or gain, the resources must be valued at $25.00 or more for the allegation to be considered exploitation. Estimates are used when the exact dollar amount is unknown. When the actual client is alleged to be used, there is no minimum dollar amount.
Exploitation does not include the following:
- Theft. There is no consent given in theft.
- A loan, which is money or property given to someone to use for a period of time with an understanding that it will be paid back or returned. (However, see 7331 When a Loan Is Exploitation.)
26 Texas Administrative Code §711.21
See:
7612 Multiple Incidents or Multiple APs of Exploitation
HHSC Provider Investigations Handbook, 1200, Definitions
HHSC Provider Investigations Handbook, 2150 Exploitation Allegations
Provider Investigations (PI) Community Intake Guidelines on the DFPS intranet
7331 When a Loan Is Exploitation
SWI April 2021
A loan, valued at $25.00 or more, is exploitation when either of the following applies:
- The community provider uses force, fraud, or coercion to get the client to agree to the loan.
- The community provider knew or should have known that the client was not competent to make the loan.
7400 PI Community Priorities
SWI April 2021
The intake specialist assesses a PI Community intake with one of the following priorities:
- Priority 1 (P1)
- Priority 2 (P2)
- Priority 3 (P3)
See 2560 Priorities.
7410 Priority 1
SWI April 2021
The intake specialist assesses a PI Community intake as a P1 when the client is alleged to have been subjected to abuse, neglect, or exploitation by an act or failure to act that caused, or may have caused, serious physical or emotional harm.
P1 intakes may include, but are not limited to, the following:
- Death.
- Sexual abuse.
- Incitement to harm self or others.
- Serious physical injury caused by abuse or neglect, including a broken bone, dislocation of any joint, internal injury, bruise larger than two and a half inches in diameter, concussion, second- or third-degree burn, or cut or tear requiring stitches.
- Serious verbal or emotional abuse that caused or may have caused serious emotional harm. For example, as a result of verbal or emotional abuse, the client caused serious harm to self or others.
Texas Administrative Code §711.413
See:
7632 Sexual Activity between a Community Provider and a Client
HHSC PI Handbook, 3120 Intake Priority
Provider Investigations – Community Intake Guidelines on the DFPS intranet
7420 Priority 2
SWI April 2021
The intake specialist assesses a PI Community intake as a P2 when the client is alleged to have been subjected to abuse, neglect, or exploitation by act or failure to act that caused, or may have caused, non-serious physical injury, or emotional harm.
P2 intakes may include, but are not limited to, the following:
- Non-serious physical injury caused by abuse or neglect, including superficial cuts or tears, or bruises or scrapes two and a half inches in diameter or less.
- Verbal or emotional abuse that is not severe.
Texas Administrative Code §711.413
See:
HHSC PI Handbook, 3120 Intake Priority
Provider Investigations – Community Intake Guidelines on the DFPS intranet
7430 Priority 3
SWI April 2021
The intake specialist assesses a PI Community intake as a P3 when either of the following applies:
- The intake would otherwise be a priority 1 or priority 2, but the alleged incident occurred more than 30 days before the date of the report, there is currently no known or perceived risk, and the client is not a child.
- The only allegation is exploitation, and the client is not a child.
When an intake includes an allegation of exploitation as well as an additional allegation, the intake specialist assesses the priority based on the additional allegation.
Texas Administrative Code §711.413
See:
7632 Sexual Activity between a Community Provider and a Client
HHSC PI Handbook, 3120 Intake Priority
Provider Investigations – Community Intake Guidelines on the DFPS intranet
7500 Processing PI Community Intakes
SWI April 2021
The sections below describe how to process a PI Community intake.
7510 Case Name
SWI April 2021
The case name for a PI Community intake is the name of the client.
When multiple clients are victims, the intake specialist chooses the case name option that lists the primary client’s name followed by “et al.” (which means “and others”). The primary client is the client with the relationship or interest (rel/int) of “Self.”
The name of the home health agency or community provider is never the case name.
See:
2620 Case Name and In Regards To
7520 County
SWI April 2021
A PI Community intake is assigned to the county where the client lived at the time of the incident. If there are multiple clients, the intake is assigned to the county of the client who is chosen as the case name.
See:
7642 Past Allegations Related to a Client Who Is Deceased
7643 Past Allegations Related to a Client Who Was a Child at the Time of Incident
7530 Resource Section
SWI Policy and Procedures July 2023
The intake specialist completes the Resource section when processing a PI Community intake. The resource the intake specialist chooses is the business that employs the alleged perpetrator.
See:
Community providers may be listed in IMPACT resources. The intake specialist can choose only one resource. If more than one resource is involved because there are multiple perpetrators employed by different businesses, the intake specialist chooses one resource for the intake.
If the business’s address is unknown, or it is known but not listed in IMPACT, then the intake specialist chooses the listed location that is closest to where the client lives.
Resource Is Unknown or Not Found
When the business that employs the community provider is unknown or not found in IMPACT resources, the intake specialist chooses the generic Community Provider Hcbs resource. The intake specialist does not change any resource information, such as the address or phone number.
7540 PI Community Assignment
SWI April 2021
Intake specialists assign all PI Community intakes following established procedures. See the Manual Assignment section of the Assignment Charts in the SWI section of the DFPS intranet.
See 2687 Routing.
7600 PI Community Special Topics
SWI April 2021
The sections below describe topics specific to PI Community.
7610 Multiple Incidents
7611 Multiple Incidents of Abuse or Neglect
SWI April 2021
PI Community investigates and reaches an investigative finding (disposition) for each incident of abuse or neglect. To allow for a more accurate representation of one incident per allegation, SWI assesses as follows.
The intake specialist assesses one intake when multiple incidents of abuse or neglect are reported to have occurred within the same two-hour period.
The intake specialist assesses multiple intakes when there are multiple incidents of abuse or neglect and one or more of the incidents are reported to have occurred more than two hours apart. The number of intakes is equal to the number of non-overlapping two-hour periods within which at least one incident of abuse or neglect occurred.
For example, the perpetrator physically abused the client four times in one day – at 10:00 a.m., 10:30 a.m., 11:00 a.m., and 12:15 p.m. The intake specialist assesses two intakes (for example, one for the first three incidents and another for the last incident). Each intake covers a time period of two hours or less.
However, the intake specialist assesses only one intake when multiple incidents of abuse or neglect are reported and either of the following applies:
- The date or time of the incidents is unknown or vague. (For example, the reporter says that the client gets hit “all the time”.)
- The incident is ongoing and spans more than two hours. (For example, the reporter says that a client on one-to-one supervision was left unsupervised for three consecutive hours.)
7612 Multiple Incidents or Multiple APs of Exploitation
SWI Policy and Procedures December 2023
Multiple incidents of exploitation reported at one time are assessed as one ongoing incident of exploitation, regardless of how much time passes between each incident. The incidents do not have to be the same type of exploitation to be considered one ongoing incident. The intake specialist completes one intake when the report includes one or more incidents of exploitation only.
The intake specialist uses the total dollar amount of all the incidents of exploitation combined to determine the value. The value needs to be at least $25.00. This includes when there are multiple alleged perpetrators (APs) who exploited a client of $25.00 or more combined, even though individual amounts may be less than $25.00.
7613 Incidents of Abuse or Neglect, and Exploitation
SWI Policy and Procedures December 2023
The intake specialist completes one intake when the report includes one or more incidents of exploitation and either of the following:
- One incident of abuse or neglect.
- More than one incident of abuse or neglect that occurred within the same two-hour period.
The intake specialist completes one intake regardless of the amount of time between the incidents of exploitation and the abuse or neglect.
When the intake specialist completes more than one intake because of incidents of abuse or neglect happening more than two hours apart, the intake specialist includes the allegation of exploitation in only one of those intakes.
7620 Reports Involving Children in DFPS Conservatorship
SWI Policy and Procedures July 2023
PI Community and other divisions within HHS notify CPS when a child in DFPS conservatorship is involved in a PI Community intake or an HHS investigation.
There are some exceptions in which SWI is responsible for immediately notifying CPS. For those exceptions and for reports that do not result in a PI Community intake, see 4561.1 Situations That Require an I&R to Existing CPS Case.
To determine whether an I&R CVS Caseworker Notification is necessary, see 3101 CVS Caseworker Notification.
7630 Assessment of Specific Scenarios for PI Community
SWI April 2021
The sections below describe scenarios specific to PI Community and how SWI assesses those scenarios.
7631 Injuries of Unknown Origin
SWI April 2021
The intake specialist completes an intake when there are allegations that the client has an injury, it is unknown how the injury occurred, and the community provider was responsible for the client’s care at the time of the injury. The intake specialist assesses the allegation as physical abuse or neglect depending on the circumstances.
Physical Abuse (PHAB)
An intake for physical abuse is assessed when there is an indication that the injury is the result of physical abuse (for example, a bruise in the shape of a handprint).
The intake is assessed as follows:
- With the injured client as the victim.
- With an unknown alleged perpetrator. (The intake specialist adds one alleged perpetrator to the person list.)
- With the priority being assessed according to standard policy.
See 7400 PI Community Priorities.
Neglect (NEGL)
An intake for neglect is assessed when there is no indication that the injury is the result of physical abuse.
The intake is assessed as follows:
- With the injured client as the victim.
- With an unknown alleged perpetrator. (The intake specialist adds one alleged perpetrator to the person list.)
- With the priority being assessed according to standard policy.
See 7400 PI Community Priorities.
7632 Sexual Activity between a Community Provider and a Client
SWI April 2021
If a community provider is alleged to be having a sexual relationship with a client, and the relationship started after the community provider started providing services to the client, then the intake specialist completes an intake for PI Community.
The intake is assessed as follows:
- With the client as the victim of sexual abuse.
- With the community provider who has had sexual contact with the client as the alleged perpetrator.
- As a priority 1 (P1), unless the incident occurred more than 30 days ago, there is no known or perceived risk, and the client is not a child, in which case the priority is priority 3 (P3).
See 7430 Priority 3.
7640 Incidents that Occurred in the Past
SWI April 2021
The sections below describe how to handle alleged incidents of abuse, neglect, or exploitation that happened in the past.
7641 Past Allegations Related to a Client Who No Longer Receives Services from the Community Provider
SWI April 2021
The intake specialist completes an intake if a client is alleged to have been abused, neglected, or exploited by a community provider while receiving services from that community provider, even if the client no longer receives services from the community provider.
The priority of the intake is assessed according to normal procedures. The correct resource is the business the community provider worked for when the incident occurred.
See:
7642 Past Allegations Related to a Client Who Is Deceased
SWI April 2021
The intake specialist completes an intake when it is alleged that a client, who is now deceased, was abused, neglected, or exploited by a community provider when he or she was still alive.
The priority of the intake is assessed according to normal procedures. The correct resource is the business the community provider worked for when the incident occurred.
See:
7643 Past Allegations Related to a Client Who Was a Child at the Time of Incident
SWI Policy and Procedures July 2023
When the report is an intake, the intake specialist assesses the priority based on the client’s age at the time of the intake, not the client’s age at the time of the incident.
If the community provider was an employee, officer, agent, contractor, or subcontractor of a home and community support services agency, the intake specialist completes an I&R Referred to HHSC.
7650 Death of a Client
SWI Policy and Procedures June 2023
The intake specialist completes a priority 1 (P1) intake involving the death of a client served by a community provider if both of the following apply:
- There is some indication that abuse, neglect, or exploitation was a contributing factor in the death.
- The alleged perpetrator is a community provider under the jurisdiction of Provider Investigations.
However, the intake specialist completes a priority 3 (P3) intake involving the death of a client if the situation meets all of the following criteria:
- The situation meets the criteria for a P1 intake (see above in this section).
- The death was more than 30 days before the date of the report.
- There is currently no known or perceived risk.
- The situation does not involve a child client.
The intake specialist assesses whether to complete an APS intake if all of the following apply:
- The client was living in his or her own home or family’s home at the time of death.
- There is some indication that abuse, neglect, or exploitation was a contributing factor in the death.
- The alleged perpetrator is not a provider under the jurisdiction of Provider Investigations.
The intake specialist completes an I&R of the most appropriate type if both of the following apply:
- The cause of death is known.
- There is no indication that abuse, neglect, or exploitation was a contributing factor in the death.
If the client was a child in DFPS conservatorship at the time of death, see:
3101 CVS Caseworker Notification
4561.1 Situations That Require an I&R to Existing CPS Case
4632.1 Program Jurisdiction for the Death of a Child in DFPS Conservatorship
7620 Reports Involving Children in DFPS Conservatorship
See:
5630 Death Caused by Abuse or Neglect
7642 Past Allegations Related to a Client Who Is Deceased
7643 Past Allegations Related to a Client Who Was a Child at the Time of Incident
7700 Special Program or Agency Jurisdictional Topics
SWI April 2021
The sections below describe how to handle complex issues related to jurisdiction for PI Community.
7710 Providers Not Investigated by PI Community
SWI Policy and Procedures September 2023
PI Community does not investigate the following types of facilities and providers:
- Day activity health services (DAHS) or individualized skills and socialization (ISS) facilities (day habs). See the Texas DAHS Directory on the HHS website.
- Unpaid providers.
- Providers paid by sources other than Medicaid.
- Boarding homes and personal care homes.
- Retirement centers.
- Home and community support services agencies (HCSSA).
For more information about most of these types of facilities and providers, see the Adult Protective Services Handbook, Appendix I: Facilities and Jurisdictions.
See also:
4563 Youth in the Custody of the Texas Juvenile Justice Department (TJJD)
5735 Facility under the Jurisdiction of Another Health and Human Services (HHS) Division
Provider Investigations Handbook, 1340 Other State Agencies and Investigative Entities
Provider Investigations Handbook, 3600, PI Does Not Investigate
7720 Ensuring the Community Provider Does Not Work for a Facility
SWI April 2021
Sometimes, community providers and facility staff can be mistaken for one another. To verify that a community provider is not actually a facility staff member, the intake specialist uses IMPACT resources. IMPACT resources can identify whether the business a community provider works for is a facility. When the business a community provider works for is unknown, the intake specialist uses professional judgment in determining whether the alleged perpetrator is a community provider or facility provider.
The community provider works for a facility when the Investigation Jurisdiction column says “AFC” and the Facility Type column says one of the following:
- AFC Licensed ICF-MR.
- AFC Private HCS.
- AFC CMHMR Oper HCS.
- AFC DADS Oper HCS.
- AFC CMHMR Center.
- AFC DADS Center.
- AFC CMHMR Non-Res.
- AFC DADS Non-Res.
- AFC CMHMR Contract.
- AFC DADS Contract.
- AFC State Center.
- AFC State Supported Living Center.
- AFC State Hospital.
- Limited Svc Provider-LSP (APS Only).
When the Investigation Jurisdiction column says “AFC” and the Facility Type column says any of the bullets above, the intake specialist follows standard policy and procedures for a PI Facility intake or I&R. See 6100 Provider Investigations – Facility.
When the Facility Type column says anything else, the intake specialist follows standard policy and procedures for a PI Community intake.
7730 Dual Jurisdiction between PI Community and Another HHS Division
SWI Policy and Procedures July 2023
When a report includes abuse, neglect, or exploitation under the jurisdiction of both PI Community and another division within HHS, the intake specialist completes only one of the following:
- PI Community intake
- I&R Call Regarding an Existing PI Case
PI Community staff notifies the other HHS division when PI Community receives information that is under another HHS division’s jurisdiction.
See:
7740 Incidents Away from the Client’s Residence
SWI April 2021
When a community provider abuses, neglects, or exploits a client and the incident occurs away from the client’s residence, the jurisdiction is PI Community.
For instance, some community providers accompany clients while the client runs errands in the community or attends a public school or youth camp.