| (a) Required notification. A provider must provide
written notification to the case manager if:
(1) an individual complains of pain;
(2) an individual requests that services end;
(3) an individual is temporarily admitted to an institution;
(4) an individual abuses the service by activating:
(A) four false alarms within a six-month period that
result in a response by the fire department, police, sheriff, or ambulance;
or
(B) 20 false alarms of any kind within a six-month
period;
(5) a provider makes three unsuccessful attempts for
three consecutive months to contact an individual for a monthly system
check;
(6) an individual or someone in an individual's home
engages in illegal discrimination against a provider staff or DADS
employee; or
(7) an individual or someone in an individual's home
exhibits reckless behavior, which may result in imminent danger to
the health and safety of the individual, provider staff, or another
person. If this occurs, the provider must immediately notify:
(A) the Department of Family and Protective Services
or other appropriate protective services agency;
(B) local law enforcement, if appropriate; and
(C) the case manager.
(b) Method and due date. A provider must notify the
case manager orally or by fax no later than one working day after
becoming aware of a circumstance detailed in subsection (a) of this
section. If the provider's first notification is oral, the provider
must send written notification to the case manager within five working
days of the oral notification. Written notification must include:
(1) the date the provider became aware of a circumstance
detailed in subsection (a) of this section; and
(2) the reason for the written notification.
(c) Allowed payment. A provider may continue to receive
payment when the provider is unable to conduct a monthly system check
for the reasons outlined in subsection (a) of this section for three
consecutive months. In order to receive payment, the provider must:
(1) comply with the requirements of §52.407(b)
of this chapter (relating to System Checks); and
(2) convene an IDT meeting, as described in §52.413
of this chapter (relating to Interdisciplinary Team) to address subsection
(a)(5) and (6) of this section.
|
| Source Note: The provisions of this §279.97 adopted to be effective March 1, 2006, 31 TexReg 1307; transferred effective July 1, 2021, as published in the June 11, 2021 issue of the Texas Register, 46 TexReg 3617 |
