March 4th, 2022
If you attended the 2/9/22 Plans of Correction (POC’s) training webinar for HCS & TxHmL, here are the answers to some of the follow-up questions asked during the session:
Q: I have experienced that the POC has a date that is 8 days in the past but the postage stamp would be 2 days ago. This leaves me with 6 days to complete the POC. Do I use the date on the letter or the postage date for the 14-day time period?
A: §9.183(f) states the program provider must submit the POC within 14 calendar days of receiving the final report for each violation identified in the plan of correction. The start date of the 14 days is when the program provider receives the final survey report, not the date of the letter or the postage date. The final report can be emailed to the program provider if the email address is on file.
If you have specific questions about the due date for the POC, please contact your regional program manager.
Q: Can we sign the 3724 electronically?
A: If the program provider has the capability to electronically sign, this is acceptable.
Q: Isn’t HHSC supposed to send the provider a pdf or word version of the violations that the provider can actually edit on the right side to enter in their POC’s? That seems to be an issue some providers have had.
A: Form 3724s are e-mailed to program providers PDF format. A program provider should be able to edit the PDF to enter their POCs on the right-hand side. Please see Instructions for Electronic 2567/3724 for how to do this. If you’re still having trouble, you can contact your regional program manager.
Q: If the 3724 is mailed to the provider in a protected PDF format, how can the provider type the corrections on the form if they do not wish to hand write them?
A: Please contact your regional program manager.
Q: Can a POC be completed in the HCS portal?
A: No, the POC cannot be completed in the provider portal. The POC information needs to be entered on the final 3724 report that is submitted to the program provider.
Q: Are those letters certified to verify when the letter was actually received by the provider?
A: No, the letters are not required to be certified.
Q: I was told there are no debriefings during the survey process. Has this changed?
A: The surveyor will review Form 3701-A, Statement of Preliminary Findings during the survey exit conference to review each of the areas of noncompliance that were identified during the course of the survey, including findings that may result in a critical violation. Per §9.171(j), if HHSC identifies a finding that may be a critical violation not discussed during an exit conference, a new exit conference with the program provider will be held to discuss those additional finding(s).
Q: Is this Form 3724 that is used in the ICF Program as the CAP replacing Form 8581 that was previously used in the HCS and TxHmL Program as the CAP?
A: Form 3724 should be used for Plans of Correction for the HCS program. Form 3724 is the state form from ASPEN for the Statement of Licensing Violations and Plan of Correction.
Form 8581, Corrective Action Plan has been retired and removed from the HHSC website.
Q: Will HHSC surveyors provide a separate form for administrative penalties for any violations not corrected?
A: All violations must be corrected before the imposition of penalties. If violations aren’t corrected the provider will be decertified. Decertification triggers contract termination.
Enforcement notifies the provider through certified and first-class mail of the imposition of penalties.
Q: Is the IDT the same as the SPT (service planning team) for HCS and TxHmL?
A: The concept is similar. Per 40 TAC 9.153(106), the definition of a Service Planning Team is
“One of the following:
(A) for an applicant or individual other than one described in subparagraphs (B) or (C) of this paragraph, a planning team consisting of:
(i) an applicant or individual and LAR;
(ii) service coordinator; and
(iii) other persons chosen by the applicant or individual or LAR, for example, a staff member of the program provider, a family member, a friend, or a teacher;
(B) for an applicant 21 years of age or older who is residing in a nursing facility and enrolling in the HCS Program, a planning team consisting of:
(i) the applicant and LAR;
(ii) service coordinator;
(iii) a staff member of the program provider;
(iv) providers of specialized services;
(v) a nursing facility staff person who is familiar with the applicant’s needs;
(vi) other persons chosen by the applicant or LAR, for example, a family member, a friend, or a teacher; and
(vii) at the discretion of the LIDDA, other persons who are directly involved in the delivery of services to persons with an intellectual or developmental disability; or
(C) for an individual 21 years of age or older who has enrolled in the HCS Program from a nursing facility or has enrolled in the HCS Program as a diversion from admission to a nursing facility, for 365 calendar days after enrollment, a planning team consisting of:
(i) the individual and LAR;
(ii) service coordinator;
(iii) a staff member of the program provider;
(iv) other persons chosen by the individual or LAR, for example, a family member, a friend, or a teacher; and
(v) with the approval of the individual or LAR, other persons who are directly involved in the delivery of services to persons with an intellectual or developmental disability.
Q: What do we do if the 45-day PoC completion date has already passed by the time we get the final report?
A: If you receive the final report near or after the 45-day PoC completion date, please contact your regional program manager for assistance.
Instructions for Documenting Your POC’s On Electronic Form 2567/3724 Received From HHSC
Provider:
- Open the 2567/3724 document
- Go to “Insert” on the toolbar
- Select “Text” Box
- Insert the “Text” Box where you want to write the PoC
- Insert a second “Text” Box where you put the PoC date.
- Right-click on the text box’s border, and choose “copy”. (For copy and pasting)
- Scroll down to the second page of 2567, left-click anywhere on the page, then press “Ctrl-V” on the keyboard
( or right-click with the mouse and choose “paste” ) – the text box will paste in nearly centered into the POC field
( to center, press two cursors spaces to the left and two cursor spaces up ).
Repeat on the remaining pages
Save the document.
Send the document back to the region.
