(a) A provider must suspend services to an individual
if:
(1) the individual changes residence to outside the
state of Texas;
(2) the individual moves to a location where the provider
does not provide CMPAS Program services to the individual except as
provided for in §44.403 of this chapter (relating to Attendant
Services Provided Outside the Provider Contracted Service Delivery
Area in the Traditional Services Option);
(3) the individual dies;
(4) the individual is admitted to:
(A) a hospital;
(B) a nursing facility;
(C) a state supported living center;
(D) a state mental health facility; or
(E) an intermediate care facility for individuals with
an intellectual disability or related conditions;
(5) the individual requests that services end;
(6) the individual, representative, or someone in the
individual's home, as applicable, refuses to:
(A) supervise the attendant;
(B) adhere to the service plan; or
(C) otherwise comply with a requirement of the CMPAS
Program;
(7) the individual or representative, as applicable,
does not have the ability to:
(A) supervise the attendant;
(B) adhere to the service plan; or
(C) otherwise comply with a requirement of the CMPAS
Program;
(8) the individual does not submit a co-payment as
required by §44.501 of this chapter (relating to Determining
an Individual's Co-payment);
(9) the individual does not provide a practitioner's
statement as required by §44.307 of this subchapter (relating
to Individual Responsibilities in All CMPAS Service Delivery Options);
or
(10) the provider becomes aware that the individual
no longer meets eligibility requirements for the CMPAS Program.
(b) The provider may suspend services if:
(1) the individual or someone in the individual's home
engages in discrimination in violation of law;
(2) the individual or representative fails to effectively
manage attendant care, including problems with:
(A) hiring, selecting, or retaining an attendant for
reasons other than workforce issues;
(B) reaching an agreement on the amount of reimbursement
the provider will retain in the block grant option; or
(C) completing or submitting required program documentation;
or
(3) the individual or someone in the individual's home
exhibits reckless behavior that may result in imminent danger to the
health or safety of the individual, the attendant, or another person.
(c) Under the circumstances described in subsection
(b)(3) of this section, the provider must immediately report the situation
to:
(1) DFPS or other appropriate protective services agency;
(2) local law enforcement; and
(3) the HHSC regional designee.
(d) Within seven days after suspending an individual's
services, the provider must notify the HHSC regional designee of the
suspension in writing and provide a copy of the notice to the individual.
The written notice of suspension must include:
(1) the date of service suspension;
(2) the reason for the suspension;
(3) the duration of the suspension, if known; and
(4) an explanation of the provider's attempts to resolve
the problem that caused the suspension, and the reasons why the problem
was not resolved.
(e) A provider must convene an IDT meeting, as described
in §44.502 of this chapter (relating to Convening an IDT), within
seven days after sending the written notice of suspension, if services
are suspended for a reason described in subsection (a)(6) and (7)
or (b)(1) - (3) of this section.
(f) A provider must resume services after a suspension:
(1) after an individual returns home, if applicable;
(2) on the date specified in writing by the HHSC regional
designee;
(3) as a result of a recommendation by the IDT; or
(4) after the provider receives notification from the
HHSC regional designee that the provider must resume services pending
the outcome of a fair hearing.
(g) The provider must send written notice to the HHSC
regional designee that services have resumed within seven days after
the date services resume.
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Source Note: The provisions of this §275.65 adopted to be effective October 1, 2013, 38 TexReg 6606; amended to be effective October 1, 2019, 44 TexReg 5106; transferred effective August 1, 2022, as published in the Texas Register July 8, 2022, 47 TexReg 3983 |