SECTION 87.103. Creation of the Office and Populations Served

(a) OO is established by Texas Government Code §531.0171.

(1) OO has authority and responsibility over the HHS system in:

(A) providing dispute resolution services;

(B) performing consumer protection and advocacy functions; and

(C) collecting consumer contact data.

(2) OO is responsible for a standard process for tracking and reporting consumer contacts within the HHS system, including centralized tracking of consumer contacts submitted to field, regional, or other local offices.

(b) HHSC's Compact With Texans outlines customer service principles and standards, including a complaint process for consumers. As part of that process, a consumer is directed to first contact the HHS program for which they have an inquiry or a complaint. If the concern is not resolved to the consumer's satisfaction, the consumer is directed to contact OO. In accordance with HHSC's Compact With Texans, OO is committed to providing high quality services in a professional and ethical manner by:

(1) treating consumers with courtesy and respect;

(2) ensuring access to and provision of services is fair and equitable;

(3) implementing new and creative approaches to improve quality of services;

(4) operating based on consumers' overall needs and feedback;

(5) providing understandable information in a variety of formats;

(6) ensuring sound management of programs and funds;

(7) working in cooperation with consumers; and

(8) protecting private information and sharing public information in accordance with applicable laws.

(c) In accordance with Texas Government Code §531.0171(b), OO does not have authority to process case actions or overturn HHS program decisions. OO staff also cannot give legal advice.

(d) OO strives to adhere to the United States Ombudsman Association's government ombudsman standards by:

(1) maintaining independence from HHS programs through an organizational structure that has OO report to the HHSC Executive Commissioner through a separate chain of command than program staff;

(2) remaining impartial by receiving and reviewing each contact in an objective and fair manner, free from bias, and treating all parties without favor or prejudice;

(3) maintaining discretion to keep confidential or release information related to a contact or a complaint investigation, if authorized by a consumer to do so; and

(4) providing a credible review process by performing responsibilities in a manner that engenders respect, confidence, and accessibility to all consumers.

(e) Several ombudsman programs are part of OO.

(1) The Ombudsman Managed Care Assistance Team (OMCAT) provides support and information services to persons enrolled in or applying for Medicaid who experience barriers to receiving health care services, in accordance with Texas Government Code §531.0213. Administrative rules for this program can be found in Subchapter B of this chapter (relating to Ombudsman Managed Care Assistance).

(2) The Ombudsman for Children and Youth in Foster Care (FCO) established by Texas Government Code Chapter 531, Subchapter Y, as enacted by Senate Bill 830 (84th Legislature, Regular Session, 2015). FCO serves as a neutral party in assisting children and youth in the conservatorship of the Department of Family and Protective Services (DFPS) with complaints regarding issues within the authority of DFPS or an HHS agency. Administrative rules for this program can be found in Subchapter C of this chapter (relating to Ombudsman for Children and Youth in Foster Care).

(3) The Ombudsman for Behavioral Health access to care (OBH) established by Texas Government Code §531.02251. OBH serves as a neutral party to help consumers, including consumers who are uninsured or have public or private health benefit coverage, and behavioral health care providers navigate and resolve issues related to consumer access to behavioral health care, including care for mental health conditions and substance use disorders. Administrative rules for this program can be found in Subchapter D of this chapter (relating to Ombudsman for Behavioral Health).

(4) The Intellectual or Developmental Disability Ombudsman (IDDO) transferred to OO after an assessment required by Senate Bill 1021, 85th Legislature, Regular Session, 2017, found a conflict of interest existed with its previous organizational placement. IDDO helps individuals with IDD, their LARs, their providers, or LIDDAs to navigate and resolve concerns related to the Home and Community-based Services (HCS) program, the Texas Home Living (TxHmL) program, or LIDDA services. Additionally, Texas Government Code §534.051 requires HHSC to promote independent ombudsmen services as part of its system for individuals with IDD. Administrative rules for this program can be found in Subchapter E of this chapter (relating to the Intellectual or Developmental Disability Ombudsman).

(5) The State Long-term Care Ombudsman authorized by Texas Human Resources Code Subchapter F of Chapter 101a; 42 USC 3058f and 3058g; and 45 CFR Part 1324. The purpose of the State Long-term Care Ombudsman program is to protect the health, safety, welfare, and rights of people living in nursing facilities and assisted living facilities. Administrative rules for this program can be found in 26 TAC Chapter 88 (relating to State Long-term Care Ombudsman Program). The rules in this chapter do not apply to the State Long-term Care Ombudsman program.

Source Note: The provisions of this §87.103 adopted to be effective January 10, 2019, 44 TexReg 252; amended to be effective December 21, 2022, 47 TexReg 8273