530.002 Section Expectations and Provider Rights Regarding the Delivery of Client Service

Policy Number 530.002
Effective Date June 3, 1998
Revision Date December 27, 2023
Approval Authority HIV/STD Section Director
Signed by D'Andra Luna

1.0 Purpose

This policy clarifies the rights of a contractor or subcontractor (Provider) in responding to unacceptable client behavior while providing HIV/STD prevention, treatment, and social services under a contract with the Texas Department of State Health Services (DSHS), HIV/STD Section (Section). Providers reviewing this policy should be able to identify unacceptable client behavior and respond accordingly with reasonable confidence that the actions taken on behalf of the provider agency regarding a client were appropriate. The policy also outlines what the Section expects from the Provider in delivering client services.
 

2.0 Background

One part of the Section's mission is to provide a wide array of services to persons living with HIV or other STDs. Contracts with various Providers who deliver those services achieve that mission. The Section has the responsibility to ensure Providers understand their rights when addressing unacceptable, illegal, or disruptive client behaviors. The Provider, therefore, can ensure they offer services in a manner free from disruption. In addition, the Section has certain expectations of how Providers deliver those services to clients and how providers respect client rights.
 

3.0 Authority

Civil Rights Code, Title 42, Chapter 21; Rehabilitation Act of 1973, Sect. 794; Age Discrimination Act of 1974; Public Law 88-352; Title VI, and Part 80 of 45 CFR; 25 TAC §§98.41-98.44.
 

4.0 Definitions as Applied to this Policy

Contractor – a legal entity under contract with DSHS to provide goods or services to people living with HIV or STDs, or to implement goals supporting the Section's mission.

Provider – a person, agency, or facility approved by the DSHS that has entered into a contract with DSHS, or with a DSHS contractor, to deliver state or federal HIV/STD programs to clients.

Services – program activities offered by a Provider on behalf of the Section for prevention, health, medical, and social services.
 

5.0 Section Expectations Regarding the Provider/Client Relationship

The Section expects the Provider to maintain client relations of the highest possible quality.
 

5.1 General Section Expectations

  1. Treat each client with respect, consideration, and recognition of the client's dignity and individuality. Communicate the need for treatment, care, or services in a culturally sensitive manner.
  2. Allow the client to select any core or support service or to refuse any service without fear of reprisal.
  3. Inform the client of their service options, emphasize the client’s right to pick an option, and advise the client of several of the alternatives when multiple providers are available for the same service.
  4. Assure the client the provider cooperates with the client to determine service planning.
  5. Maintain a climate in the office or other service delivery setting free of physical or mental abuse or exploitation.
  6. Enforce local, state, or federal laws and regulations (such as no smoking or maintaining a drug-free environment) required to conduct business.
  7. Review any decision to modify, suspend, or terminate services.
  8. Re-evaluate any modification, suspension, or termination of services to determine if the client’s situation has changed.
  9. Give clients an avenue to file a grievance about treatment, services, or both and the Provider’s decision to deny an application, modify, suspend, or terminate client benefits; a mechanism to receive an appropriate and fair review of the complaint; and ensure no reprisal of any type against the client for filing the complaint or grievance occurs.
     

5.2 Confidentiality

For confidentiality requirements, see Section Policy 2016.01, HIV/STD Section Confidential Information Security.
 

5.3 Equal Access to Programs and Services

The Provider considers client eligibility regardless of age, gender, sexual orientation, marital status, ethnic origin, physical challenge, or religious practice. Conversely, the client has a right to refuse any recommended services.
 

5.4 Impartial Treatment

Providers must allow the client to make an application for any service, program, or both. The Provider must give the client fair, impartial treatment during the application process and in the receipt of services.
 

5.5 Filing a Complaint or Grievance

Contractors must have a written client grievance procedure in place to meet the minimum requirements for client complaints.
Clients have a right to file a grievance regarding inappropriate Provider behavior, actions, or perceptions of discrimination. Clients may file the complaint in accordance with the grievance procedures of the Provider. When the client has exhausted all other sources, the client may file a grievance with the Section by calling 737-255-4300.

For a complaint related to the delivery of clinical services, the client may file a grievance directly with the Section. The Section investigates complaints in accordance with Section procedure 020.050, Public Complaints and Allegations Related to the Delivery of HIV or STD Programs.
 

6.0 General Provider Rights When Dealing With a Client

Each Provider develops written procedures to deal with clients who may be disruptive or uncooperative. The Provider’s responsibility is to inform staff about the procedures and use the procedures consistently in every situation. Providers use good judgment and attempt to resolve these situations fairly without undue limitation or denial of client services.
 

7.0 Modifying, Suspending, or Terminating Client Services

The Provider has the responsibility of providing a work environment that remains free from undue disruption, turmoil, or interference. Whenever possible, the Provider must take steps to serve clients in a manner that supports a healthy work environment.

While accessing services, a client may behave in a disruptive, abusive, or threatening manner toward staff or other clients. When this occurs, the Provider may take the following progressive actions:

  1. Modify all or part of the services provided to the client
  2. Suspend all or part of the services provided to the client
  3. Terminate all or part of the services provided to the client

Depending on the severity of the client’s behavior (e.g., threatening the life of staff or other clients), the Provider may skip one or more of the above steps and take appropriate action. Refer to Section Policy 530.003, How to Deal With Clients Who Threaten to Harm Themselves or Others, for information on dealing with clients who threaten to harm themselves or others.
 

7.1 Modifying Client Services

The Provider may modify all or part of the services provided to the client in situations where the client is disruptive or uncooperative. Modification may include, but is not limited to:

  • Rescheduling the client’s appointment for a later time or day,
  • Arranging client services by telephone or videoconference,
  • Mailing food vouchers, bus passes, etc., or
  • Other modalities of service delivery require prior approval from AA.
     

7.2 Suspending Client Services

Suspension is the temporary withdrawal of a service or services provided to a client by a Provider. The Provider may suspend all or part of the services provided to the client for a specific time when alternative service delivery methods do not produce appropriate client behavior (e.g., the client is repeatedly disruptive or abusive towards staff or other clients).
 

7.3 Terminating Client Services

The Provider may choose to terminate all or part of the services provided to the client when alternative service delivery methods are inappropriate to the situation (e.g., the client threatens injury or homicide to a staff member or another client) or when modification or suspension of services do not produce appropriate client behavior.

Clinical service providers (e.g., physicians, advanced practitioners, and registered nurses) who terminate services must follow professional practice standards regarding how they terminate client services. Professional organizations or licensing bodies can provide guidance to clinical service providers for managing these situations.
 

7.4 Denying, Suspending, or Terminating a Client’s Service on the Basis of Substance Abuse

The Provider may not deny, suspend, or terminate any service funded through DSHS because they suspect a client of substance abuse or refuse to accept treatment for substance abuse. Refer to the Housing Opportunities to Persons with AIDS (HOPWA) Program Manual or the HIV/STD Health Resources Division, Field Operations Branch, for information regarding HOPWA assistance and substance abuse.

Exceptions to this may occur while delivering medical care when a client's active substance abuse contraindicates the prescription of certain medications, treatments, or both.

The treating clinician must evaluate the professional decisions on a case-by-case basis.
 

7.5 Notification of the Decision to Modify, Suspend, or Terminate Client Services

The Provider must communicate its decision to modify, suspend, or terminate services to the client in a timely and appropriate manner. The provider may use any verifiable method for this notification, such as in person or by certified letter. When Providers plan to modify or suspend services, staff must establish and communicate a specific time period for the suspension and inform the client that resumption of services depends on the client’s willingness and ability to meet certain behavior expectations. The Provider must clearly outline and communicate the behavior expectations to the client. The client should receive information about alternative methods of service delivery or where to obtain assistance.
 

7.6 Documentation

The Provider clearly documents actions regarding modification, suspension, and termination in the client’s record.
 

7.7 Technical Assistance

When desired, the Provider may contact the Section to discuss specific situations or to obtain technical assistance. Decisions regarding whether to modify, suspend, or terminate client services remain with the Provider.
 

7.8 Section Review of Decisions to Modify, Suspend, or Terminate Client Services

As part of a routine review of the quality of client services or a complaint investigation, Section staff reviews the events which led to a modification, suspension, or termination of client services. Section staff will evaluate, at minimum, whether the Provider:

  • Followed their internal policies and those of the Section in taking action to resolve the situation;
  • Respected the client’s rights; and
  • Applied the least restrictive limitation on client services necessary to maintain a service delivery setting free of physical, mental, and emotional abuse and exploitation.
     

8.0 Associated Policies

Policy Number Policy Title
020.050 Public Complaints Related to the Delivery of Section Programs
530.003 How to Deal With Clients Who Threaten to Harm Themselves or Others
2016.01 HIV/STD Section Confidential Information Security

 

9.0 Revision History

Date Action Section
12/27/2023 Update for change in Section organizational structure and clarifying language. All
9/1/2017 Changed "TB/HIV/STD Unit" to "TB/HIV/STD Section" to reflect new program designation -
9/17/2014 Converted format (Word to HTML) -
11/13/2002 Converted format (WordPerfect to Word) -
9/7/2001 Numerous changes All