(a) If HHSC receives an oral or written allegation that indicates a contractor may have violated a contract or program requirement, HHSC conducts an unannounced investigation of the contractor. The investigation is conducted on-site or by a desk review.

(b) To conduct an investigation, HHSC:

(1) conducts an entrance conference with the contractor if the investigation is conducted on-site;

(2) performs other activities, which may include: (A) reviewing the contractor's records; (B) reviewing the contractor's policies and procedures; (C) reviewing consumer satisfaction surveys; (D) interviewing a person with knowledge relevant to the contract, including an individual receiving services or the contractor's employee; and (E) observing an individual receiving services.

(c) A contractor must provide records requested by HHSC as follows:

(1) for an investigation conducted on-site, the contractor must provide the records to HHSC within one hour after the entrance conference described in subsection (b)(1) of this section, unless another time period is agreed to by HHSC in writing for an EVV report; and

(2) for an investigation conducted by a desk review, the contractor must provide the records to HHSC within one business day after HHSC's request.

(d) HHSC notifies the contractor, in writing, of the results of the investigation.

(e) If, based on an investigation, HHSC determines that the contractor is out of compliance with the contract, HHSC may:

(1) impose an action or sanction in accordance with Subchapter E of this chapter (relating to Enforcement by HHSC and Termination by Contractor);

(2) conduct additional monitoring in accordance with §49.411 of this division (relating to Contract and Fiscal Monitoring); or

(3) take a combination of the actions described in paragraphs (1) and (2) of this subsection.

(f) If, during an investigation, HHSC determines that the contractor is not protecting an individual's health and safety, HHSC may require the contractor to:

(1) immediately protect the individual's health and safety; and

(2) submit an immediate protection plan in accordance with §49.511 of this chapter (relating to Immediate Protection and Immediate Protection Plan).

Source Note: The provisions of this §49.413 adopted to be effective September 1, 2014, 39 TexReg 6637; amended to be effective September 1, 2018, 43 TexReg 5230