(a) An individual or organization on behalf of a child enrolled in the HHSC Children's Autism Program may file a complaint with HHSC alleging that a requirement of the HHSC Children's Autism Program was violated. A complaint may be filed directly with HHSC without having been filed with the contractor.

(b) A complaint regarding the HHSC Children's Autism Program must be filed within 180 calendar days of the alleged violation. A complaint filed 180 calendar days after the alleged violation may be dismissed without further review by the HHSC Children's Autism Program.

(c) A complaint may be filed in any of the following ways:

(1) by phone to the HHS Office of the Ombudsman at 1-877-787-8999; or

(2) by online submission at hhs.texas.gov/ombudsman.

(d) The complaint must contain the following information:

(1) the name of the person filing the complaint;

(2) the name of the child for whom the complaint is filed;

(3) the name of the contractor;

(4) the date of the incident;

(5) the requirement and/or rule that was allegedly violated;

(6) a summary of the facts of the alleged violation; and

(7) the relief requested.

(e) HHSC staff:

(1) logs the date the complaint was received;

(2) evaluates the complaint and seeks facts from the parties involved;

(3) provides a written decision within 60 calendar days to the complainant addressing each allegation;

(4) provides technical assistance and appropriate follow-up to the parties involved in the complaint as necessary; and

(5) retains the documentation of the complaint for five years.

(f) A complainant may appeal the determination of the complaint in writing. Such appeals must be submitted within 30 calendar days from the date of the written decision and will be addressed within 30 calendar days of receipt by HHSC. The appeal determination is final.

(g) More information regarding the complaint process may be obtained by calling the HHS Office of the Ombudsman at 1-877-787-8999.

Source Note: The provisions of this §358.509 adopted to be effective September 1, 2014, 39 TexReg 6680; amended to be effective September 4, 2018, 43 TexReg 5683; transferred effective August 1, 2021, as published in the July 9, 2021 issue of the Texas Register, 46 TexReg 4173