Section 88.201 - Access to Facilities, Residents, and Resident Records(a) The State Ombudsman and a representative of the Office have: (1) immediate, private, and unimpeded access to enter an LTC facility, in accordance with the Older Americans Act, §712(b)(1)(A) and 45 CFR §1324.11(e)(2)(i): (A) at any time during a facility's regular business hours or regular visiting hours; and(B) at a time other than regular business hours or visiting hours, if the State Ombudsman or a certified ombudsman determines access may be required by the circumstances to be investigated;(2) immediate, private, and unimpeded access to a resident, in accordance with the Older Americans Act, §712(b)(1)(A) and 45 CFR §1324.11(e)(2)(ii); and(3) access to the name and contact information of a resident representative, if any, when the State Ombudsman or representative of the Office determines the information is needed to perform functions of the Ombudsman Program, in accordance with 45 CFR §1324.11(e)(2)(iii).(b) Disclosure of information by the State Ombudsman or a representative of the Office related to any complaint, including a description of the circumstances to be investigated, is subject to requirements in the Ombudsman Policies and Procedures Manual related to disclosure of confidential information.(c) The State Ombudsman and a certified ombudsman have immediate access:(1) in accordance with the Older Americans Act, §712(b)(1)(B) and 45 CFR §1324.11(e)(2), to all medical, social, and other records relating to a resident regardless of format, including an incident report involving the resident, if:(A) in accordance with 45 CFR §1324.11(e)(2)(iv)(A) or (B), the State Ombudsman or certified ombudsman has the informed consent of the resident or legally authorized representative;(B) in accordance with the Older Americans Act, §712(b)(1)(B)(i)(II), the resident is unable to communicate informed consent to access and has no legally authorized representative; or(C) in accordance with 45 CFR §1324.11(e)(2)(iv)(C), such access is necessary to investigate a complaint and the following occurs: (i) the resident's legally authorized representative refuses to give consent to access the medical, social, and other records;(ii) the State Ombudsman or certified ombudsman has reasonable cause to believe that the legally authorized representative is not acting in the best interests of the resident; and(iii) if it is the certified ombudsman seeking access to the medical, social, and other records the certified ombudsman obtains the approval of the State Ombudsman to access the medical, social, and other records, without the legally authorized representative's consent; and(2) in accordance with 45 CFR §1324.11(e)(2)(v), to the administrative records, policies, and documents of an LTC facility to which the residents or general public have access.(d) In accordance with 45 CFR §1324.11(e)(2), access by the State Ombudsman and a certified ombudsman to a record, as described in subsection (c) of this section, includes obtaining a copy of the record upon request.(e) In accordance with the Ombudsman Policies and Procedures Manual, a certified ombudsman must document one of the following in the ombudsman database:(1) whether a resident who is able to communicate informed consent communicated informed consent for the ombudsman to access a record described in subsection (c)(1) of this section;(2) whether the legally authorized representative communicated informed consent to access a record described in subsection (c)(1) of this section;(3) whether the certified ombudsman has authority to access a record described in subsection (c)(1) of this section without consent because the resident is unable to communicate informed consent and does not have a legally authorized representative; or(4) whether the State Ombudsman has given approval to access a record described in subsection (c)(1) of this section accordance with subsection (c)(1)(C) of this section.(f) The rules adopted under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 45 CFR Part 160 and 45 CFR Part 164, subparts A and E, do not preclude an LTC facility from releasing protected health information or other identifying information regarding a resident to the State Ombudsman or a certified ombudsman if the requirements of subsections (a)(3) and (c) of this section are otherwise met. The State Ombudsman and a certified ombudsman are each a "health oversight agency" as that phrase is defined in 45 CFR §164.501.26 Tex. Admin. Code § 88.201
Adopted by Texas Register, Volume 43, Number 13, March 30, 2018, TexReg 2015, eff. 4/5/2018; Amended by Texas Register, Volume 49, Number 20, May 17, 2024, TexReg 3576, eff. 5/22/2024