| (a) HHSC conducts utilization review of a service delivery
plan and supporting documentation at any time to:
(1) determine the appropriateness of services;
(2) validate a service provision; or
(3) evaluate the quality of services.
(b) A provider, consumer directed services employer,
and FMSA must submit documentation supporting the service delivery
plan to HHSC as requested by HHSC.
(c) If HHSC determines that one or more of the tasks
specified in a service delivery plan do not meet the requirements
described in Subchapter D of this chapter (relating to Service Plan
Development) or Subchapter E of this chapter (relating to Service
Requirements), HHSC denies or reduces the hours or tasks, modifies
the service delivery plan effective from the date of the utilization
review, and sends written notification of the denial or reduction
to the individual and provider.
(d) In addition to the utilization review conducted
in accordance with subsection (a) of this section, HHSC may conduct
utilization reviews of providers and services based on utilization
patterns and trends.
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