SECTION 87.101. Definitions

The following words and terms, when used in this chapter, have the following meanings unless the context clearly indicates otherwise.

(1) Compact with Texans--A document that describes the Texas Health and Human Services Commission's services, principles, and the process for filing complaints and requesting information.

(2) Complaint--Any expression of dissatisfaction by a consumer of a Texas Health and Human Services (HHS) program or service about HHS benefits or services. Complaints do not include the following, which are handled through other processes:

(A) allegations of abuse, neglect, or exploitation;

(B) allegations of discrimination or other civil rights violations;

(C) allegations of fraud, waste, or abuse;

(D) requests for Fair Hearings or administrative appeals; or

(E) concerns about regulated individuals and entities.

(3) Consumer--An applicant or a client of HHS programs, as well as a member of the public seeking information about HHS programs.

(4) Contact--A consumer's written or oral inquiry or complaint about HHS programs or services.

(5) Dispute resolution services--An independent and impartial review of a program's actions regarding an HHS consumer complaint that has not been resolved to the consumer's satisfaction.

(6) Health care provider--A physician, pharmacist, or other licensed provider who is authorized under state law to provide health care services, or a credentialed professional who provides behavioral health, mental health, or substance use disorder services.

(7) HEART--HHS enterprise administrative report and tracking system. A web-based system that the HHSC Office of the Ombudsman and some HHS programs use to track inquiries and complaints.

(8) HHS--Texas Health and Human Services. The system for providing or otherwise administering health and human services in this state established in Texas Government Code Chapter 531, comprised of HHSC and the Department of State Health Services.

(9) HHSC--Texas Health and Human Services Commission. The agency established by Texas Government Code Chapter 531.

(10) IDD--Intellectual or developmental disability.

(11) Inquiry--A request by a consumer for information about HHS programs or services.

(12) LAR--Legally authorized representative. A person legally authorized to act on behalf of an individual with regard to a matter described in this chapter, and may include a parent, guardian, or managing conservator of a minor, or the guardian of an adult.

(13) LBHA--Local behavioral health authority. An entity designated as the local behavioral health authority in accordance with the Texas Health and Safety Code §533.0356(a).

(14) LIDDA--Local intellectual and developmental disability authority. An entity designated as the local intellectual and developmental disability authority in accordance with the Texas Health and Safety Code §533A.035(a).

(15) LMHA--Local mental health authority. An entity designated as the local mental health authority in accordance with the Texas Health and Safety Code §533.035(a).

(16) OO--Office of the Ombudsman. The HHSC office established by Texas Government Code §531.0171, with oversight of the HHS system.

(17) Substantiated complaint--A complaint for which research clearly indicates HHS policy was violated or HHS expectations were not met.

(18) Unable to substantiate a complaint--A complaint for which research does not clearly indicate if HHS policy was violated or HHS expectations were met.

(19) Unsubstantiated complaint--A complaint for which research clearly indicates HHS policy was not violated or HHS expectations were met.

Source Note: The provisions of this §87.101 adopted to be effective January 10, 2019, 44 TexReg 252; amended to be effective December 21, 2022, 47 TexReg 8273