|(a) An IRP must:
(1) prepare for the individual's effective transition
to the community;
(2) promote the individual's inclusion into the community;
(3) protect the individual's health and welfare in
(4) supplement, rather than replace, the individual's
natural support systems and resources;
(5) be designed to prevent or reduce the individual's
(A) an inpatient psychiatric facility admission;
(B) a correctional facility admission; and
(C) an emergency department visit in which services
(6) include the most appropriate type and amount of
services to meet the individual's needs;
(7) prevent the provision of unnecessary or inappropriate
(8) be based on the individual's preferences, needs,
and goals; and
(9) be developed with the individual, LAR, individual's
treatment team and providers, and other persons according to the needs
and desire of the individual.
(b) An HHSC-approved designee must review the IRP and
submit it to HHSC for its approval.
(c) An HHSC-approved designee must submit to HHSC,
with the IRP:
(1) an HCBS-AMH assessment of the individual identifying
the individual's needs and supporting the HCBS-AMH included in the
(2) documentation that non-HCBS-AMH support systems
and resources are unavailable or are insufficient to meet the goals
specified in the IRP.
(d) A provider must obtain HHSC's approval of the IRP
before the provider may deliver HCBS-AMH program services.
(e) HHSC may conduct a utilization review of an IRP
and supporting documentation at any time to determine if the services
specified in the IRP meet the requirements described in subsection
(a) of this section.
(f) If HHSC determines one or more of the services
specified in the IRP do not meet the requirements described in subsection
(a) of this section, HHSC may:
(1) deny, reduce, or terminate the service; or modify
the IRP; and
(2) send written notification to the individual, LAR,
and the provider according to §307.57 of this subchapter (relating
to Fair Hearings Process).
(g) The cost of the IRP must be reasonable as determined