(a) The contractor must suspend Individualized Family
Service Plan (IFSP) services subject to an out-of-pocket payment as
identified in §350.1413 of this subchapter (relating to IFSP
Services Subject to Out-of-Pocket Payment from the Family) when the
balance remains delinquent for 90 days. If the parent uses their public
or private insurance, the 90-day time period begins the date the contractor
receives notice that the claims are denied for reimbursement and all
appeals are exhausted.
(b) Before suspending IFSP services, the contractor
must inform the parent that:
(1) he or she has the option to request a:
(A) review of the family cost share agreement, as described
in §350.1417 of this subchapter (relating to Family Cost Share
Agreement); or
(B) reconsideration and adjustment of the family cost
share obligation, as described in §350.1437 of this subchapter
(relating to Extraordinary Circumstances);
(2) IFSP services subject to an out-of-pocket payment
will be suspended when a balance is delinquent for 90 days; and
(3) the contractor cannot guarantee the same schedule
or the same individual service provider if IFSP services are later
reinstated.
(c) Respite vouchers will be denied during a suspension
period.
(d) A notation must be made on the family cost share
agreement that IFSP services subject to an out-of-pocket payment have
been suspended due to non-payment.
(e) The contractor must reinstate suspended IFSP services
when the family's account is paid in full or the family negotiates
an acceptable payment plan with the contractor. The IFSP team must
reassess the appropriateness of the IFSP before reinstating IFSP services
if IFSP services are suspended for more than six months. The contractor
must document the reinstatement of IFSP services date on the IFSP
and the family cost share agreement.
(f) The contractor must maintain written local policy
for collecting delinquent family cost share accounts. Documentation
must reflect all reasonable attempts to collect unpaid balances. Reasonable
attempts include multiple attempts at written notification, phone
notification, and e-mail.
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Source Note: The provisions of this §350.1435 adopted to be effective May 1, 2014, 39 TexReg 3449; transferred effective March 1, 2021, as published in the Texas Register February 5, 2021, 46 TexReg 941; amended to be effective March 17, 2022, 47 TexReg 1277 |