| (a) HHSC may review a recommended or assigned LON at
any time to determine if it is appropriate. If HHSC reviews an LON,
documentation supporting the LON must be submitted to HHSC in accordance
with HHSC's request. HHSC may modify an LON and recoup or deny payment
based on its review.
(b) Before assigning an LON, HHSC reviews documentation
supporting the recommended LON if:
(1) an LON is requested that is an increase from the
individual's current LON;
(2) an LON 9 is requested in accordance with §263.106(j)
of this subchapter (relating to LON Assignment);
(3) an LON is requested in accordance with §263.106(i)
of this subchapter; or
(4) an LON is requested in accordance with §263.106(k)
and (l) of this subchapter.
(c) Documentation supporting a recommended LON described
in subsection (b) of this section must be submitted to HHSC and received
by HHSC within seven calendar days after electronically submitting
the recommended LON.
(1) Within 21 calendar days after receiving the supporting
documentation, HHSC:
(A) requests additional documentation;
(B) electronically approves the recommended LON; or
(C) notifies the program provider and the service coordinator
in the HHSC data system that the recommended LON has been denied.
(2) HHSC reviews any additional documentation submitted
in accordance with HHSC's request and:
(A) electronically approves the recommended LON; or
(B) notifies the program provider and the service coordinator
in the HHSC data system that the recommended LON has been denied.
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