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TITLE 26HEALTH AND HUMAN SERVICES
PART 1HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 263HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC)
SUBCHAPTER HTRANSFER, DENIALS, SUSPENSION, REDUCTION, AND TERMINATION
RULE §263.701Process for Individual to Transfer to a Different Program Provider or FMSA

(a) If a service coordinator receives information that an individual wants to transfer to a different program provider or FMSA, or that an LAR wants the individual to transfer to a different program provider or FMSA, the service coordinator must:

  (1) if the information was received from the individual or LAR, document the date the information was received in the individual's record;

  (2) if the information was received from a person other than the individual or LAR, within three business days after the information was received:

    (A) contact the individual or LAR to confirm whether the individual wants to transfer or the LAR wants the individual to transfer to a different program provider or FMSA; and

    (B) if the service coordinator makes the confirmation described in subparagraph (A) of this paragraph, document such confirmation in the individual's record; and

  (3) within three business days after receiving information from the individual or LAR that the individual wants to transfer or the LAR wants the individual to transfer to a different program provider or FMSA or making the confirmation described in paragraph (2)(A) of this subsection:

    (A) explain to the individual or LAR that the individual may transfer to a program provider whose enrollment has not reached its service capacity in the HHSC data system or FMSA of the individual's or LAR's choice; and

    (B) provide the individual or LAR the names and contact information of all program providers or FMSAs in the geographic location preferred by the individual or LAR.

(b) After the individual or LAR selects a different program provider or FMSA, the service coordinator must coordinate with the individual, LAR, the transferring program provider or FMSA, and the receiving program provider or FMSA to determine a transfer effective date that is:

  (1) not earlier than the date of the meeting described in subsection (c)(2) of this section; and

  (2) agreed to by the service coordinator, the individual or LAR, and the receiving program provider.

(c) On or before the transfer effective date, the service coordinator must:

  (1) take action to complete the HHSC Request for Transfer of Waiver Program Services form in accordance with the HCS Handbook;

  (2) convene a meeting with the individual or LAR and the receiving program provider or receiving FMSA to develop a transfer IPC;

  (3) send the individual's IPC, ID/RC, and PDP to the receiving program provider or the receiving FMSA;

  (4) if the individual is transferring to a different program provider, request the following records of the individual from the transferring program provider;

    (A) pertinent medication records and medical information;

    (B) Medicaid card;

    (C) Medicare information, if applicable;

    (D) the ICAP booklet and summary sheet;

    (E) trust fund/financial records and any money due the individual;

    (F) behavior support plan, if applicable;

    (G) guardianship information, if applicable; and

    (H) any other pertinent information to ensure health and safety or continuity of services;

  (5) within two business days after receipt of the records requested in accordance with paragraph (4) of this subsection, send the records to the receiving program provider; and

  (6) if, within three business days after requesting that the program provider provide records as described in paragraph (4) of this subsection, the service coordinator does not receive all of the records requested, notify HHSC that the records were not received.

(d) If an individual was evicted by a program provider or service provider of host home/companion care and the individual or LAR has not paid the delinquent room or board, but wants to include residential support, supervised living, or host home/companion care on the individual's IPC, the service coordinator must inform the individual or LAR at the meeting described in subsection (c)(2) of this section that HHSC will deny residential support, supervised living, or host home/companion care, if included on the individual's IPC, until the individual pays the delinquent room or board.

(e) Within 10 business days after the transfer effective date, the service coordinator must:

  (1) complete data entry into the HHSC data system in accordance with the HCS Handbook after the activities described in subsection (c) of this section are completed; and

  (2) send the transfer IPC and HHSC Request for Transfer of Waiver Program Services form to HHSC.


Source Note: The provisions of this §263.701 adopted to be effective March 1, 2023, 48 TexReg 1080

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