CMS and State Enforcement Mary T. Henderson, Assistant Commissioner, Regulatory Services, Texas Department of Aging and Disability Services Derek Jakovich, Enforcement Director, Regulatory Services, Texas Department of Aging and Disability Services

CMS Perspective Ginger Odle, CMS Region 6 Enforcement Branch Manager

State Attorney General’s Perspective William Carpenter, Texas Assistant Attorney General

When a case is referred to the Office of the Attorney General (OAG) LAWSUIT! DUTY TO PRESERVE EVIDENCE COLLECTING EVIDENCE IDENTIFYING THE DEFENDANTS

When a case is referred to the OAG DUTY TO PRESERVE EVIDENCE There is a legal duty to preserve evidence that is relevant to a lawsuit regarding a violation. Examples: Database Records, Documents, Reports, Letters, E-mails. Document retention policies

When a case is referred to the OAG COLLECTING EVIDENCE A lawsuit requires solid evidence that defendants violated the law. Need evidence for each element to the cause of action Look to the statute for elements What is good evidence for a lawsuit?

When a case is referred to the OAG IDENTIFYING THE DEFENDANTS A lawsuit requires evidence that identifies the defendants and connects the defendants to the facility References in survey documents: facility and owner(s) Review documents filed with agency. Verify the information. Sources to verify

CMS and State Enforcement – State Enforcement Organization – Enforcement Staff in State Office; Enforcement Coordinators in Regional Offices across the state The enabling statute and administrative rules govern all state enforcement actions Texas Administrative Procedures Act (APA)

CMS and State Enforcement Communication and coordination between staff is the key to success Regional Staff Enforcement Staff Office of General Counsel – Regional Enforcement Attorneys CMS Enforcement Branch

CMS and State Enforcement Process It all starts with a survey or an investigation Deficiencies or violations found Issuance of a federal 2567 or a State Form Regional Enforcement Review Is there a Right To Correct? Evidence

CMS and State Enforcement Due Process Notice Informal Settlement Conferences Administrative Hearings PFDs – ALJs proposed decisions Commissioner’s Final Decisions Appeals Enforcement Action Taken