| (a) HHSC suspends an individual's HCS Program services
and CFC services if the individual is under a temporary admission
to one of the following facilities:
(1) a hospital;
(2) an ICF/IID;
(3) a nursing facility;
(4) an ALF;
(5) a residential child care facility licensed by HHSC
unless it is an agency foster home;
(6) an inpatient chemical dependency treatment facility;
(7) a mental health facility;
(8) a residential facility operated by the Texas Workforce
Commission; or
(9) a residential facility operated by the Texas Juvenile
Justice Department, a jail, or a prison.
(b) If a service coordinator becomes aware that an
individual who is receiving a service from a program provider is under
a temporary admission, the service coordinator must, within one business
day after becoming aware of the temporary admission, notify the individual's
program provider of the temporary admission.
(c) If a program provider becomes aware that an individual
is under a temporary admission, the program provider must, within
one business day after becoming aware of the temporary admission,
enter a suspension of the individual's HCS Program services and CFC
services in the HHSC data system.
(d) If a program provider enters a suspension of the
individual's HCS Program services and CFC services in the HHSC data
system, the program provider must notify the individual's service
coordinator of the suspension within one business day after the suspension
is entered in the system.
(e) During a temporary admission, an individual is
not considered to be residing in the facility.
(f) If an individual's program services are suspended,
the service coordinator must, at least every 30 calendar days after
the effective date of the suspension, review the individual's circumstances
and document in the individual's record:
(1) the reasons for continuing the suspension if the
individual is likely to remain in the facility;
(2) whether the individual anticipates resuming participation
in the HCS Program after the suspension ends; and
(3) the anticipated date the individual will be discharged
from the facility, if the individual is not likely to remain in the
facility.
(g) If a service coordinator determines that an individual's
suspension should be extended, the service coordinator must request
that HHSC extend the suspension by completing and submitting the HHSC
Request to Continue Suspension of Waiver Program Services form to
HHSC before:
(1) the end of the first 270 calendar days of the temporary
admission; or
(2) the end of a 30 calendar-day extension previously
granted by HHSC.
(h) HHSC may extend an individual's suspension for
30 calendar days based on a service coordinator's request as described
in subsection (g) of this section.
(i) A program provider must remove the entry of a suspension
of the individual's HCS Program services and CFC services from the
HHSC data system and resume the provision of services to the individual
if the program provider becomes aware that the individual is discharged
from the facility to which the individual has been under temporary
admission.
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