| (a) A LIDDA must request an LOC from HHSC for an applicant
in accordance with this subsection.
(1) The LIDDA must complete an ID/RC Assessment for
an applicant that:
(A) includes the LOC recommended by a person qualified
to perform an initial evaluation of LOC in accordance with Appendix
B of the TxHmL Program waiver application approved by CMS; and
(B) is signed and dated in accordance with the instructions
for completing the ID/RC Assessment.
(2) The LIDDA must enter information from the completed
ID/RC Assessment in the HHSC data system and electronically submit
the information to HHSC.
(3) The LIDDA must ensure that the information entered
in the HHSC data system and electronically submitted to HHSC in accordance
with paragraph (2) of this subsection is identical to the information
on the completed ID/RC Assessment.
(4) The LIDDA must send a copy of the completed ID/RC
Assessment and supporting documentation to HHSC, as requested by HHSC.
(b) A LIDDA must request an LOC for an individual from
HHSC in accordance with this subsection.
(1) No more than 60 calendar days before the expiration
date of an individual's ID/RC Assessment, a LIDDA must:
(A) complete an ID/RC Assessment that:
(i) includes the LOC recommended by a person qualified
to perform a reevaluation of LOC in accordance with Appendix B of
the TxHmL Program waiver application approved by CMS; and
(ii) is signed and dated in accordance with the instructions
for completing the ID/RC Assessment; and
(B) enter information from the completed ID/RC Assessment
in the HHSC data system and electronically submit the information
to HHSC.
(2) A LIDDA must:
(A) ensure that the information entered in the HHSC
data system and electronically submitted to HHSC is identical to the
information on the completed ID/RC Assessment;
(B) within three calendar days after entering the information
in the HHSC data system and electronically submitting the information
to HHSC, provide the program provider with a copy of the completed
ID/RC Assessment; and
(C) send a copy of the completed ID/RC Assessment and
supporting documentation to HHSC, as requested by HHSC.
(3) If the LIDDA enters information from a completed
ID/RC Assessment in the HHSC data system and electronically submits
the information to HHSC on a date that is more than 180 calendar days
after the expiration date of the previous ID/RC Assessment, the LIDDA
must:
(A) send to HHSC a copy of the completed ID/RC Assessment
by a method, as instructed by HHSC, that:
(i) includes the recommended LOC; and
(ii) is signed and dated in accordance with the instructions
for completing the ID/RC Assessment;
(B) within three calendar days after sending the completed
ID/RC Assessment to HHSC, provide the program provider with a copy
of the completed ID/RC Assessment; and
(C) submit documentation supporting the ID/RC Assessment
to HHSC, as requested by HHSC.
(c) Information on an ID/RC Assessment must be supported
by current data obtained from standardized evaluations and formal
assessments that measure physical, emotional, social, and cognitive
factors. A LIDDA must maintain the signed and dated ID/RC Assessment
and documentation supporting the recommended LOC in an applicant's
or individual's record.
(d) When HHSC receives a request for an LOC in accordance
with subsection (a) or (b) of this section, HHSC determines if an
applicant or individual qualifies for an LOC required by §262.101(a)(2)
of this subchapter (relating to Eligibility Criteria for TxHmL Program
Services and CFC Services).
(e) HHSC approves an LOC or sends a written notification:
(1) to the applicant, individual, or LAR that the applicant
or individual is not eligible for TxHmL Program services or CFC services
and provides the applicant, individual, or LAR with an opportunity
to request a fair hearing in accordance with §262.601 of this
chapter (relating to Fair Hearing);
(2) to the LIDDA that the LOC has been denied; and
(3) to the program provider using the HHSC data system
that the LOC has been denied, if the applicant has selected a program
provider or an individual is receiving services from a program provider.
(f) An LOC determination is valid for a period of time
as described in this subsection.
(1) Except as provided in paragraph (2) of this subsection,
an LOC determination is valid for a 365-calendar day period starting
on the begin date of the ID/RC Assessment.
(2) If the begin date of the ID/RC Assessment is March
1 or later in a year before a leap year or January 1 - February 28
of a leap year, the LOC determination is valid for a 366-calendar
day period starting on the begin date of the ID/RC Assessment.
(g) An ID/RC Assessment submitted in accordance with
subsection (b) of this section is effective on the date after the
individual's previous ID/RC Assessment expires.
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