(a) Increase in hours or terminations.
(1) A provider must submit written notification to
the case worker within seven days after learning of any change that
may:
(A) require an increase in hours in the individual's
service delivery plan; or
(B) result in the termination of services due to the
individual receiving no ADLs, except for the FC Program.
(2) The notification must include the:
(A) date the provider learned of the need for the change;
(B) reason for the change;
(C) type of change, including the number of hours of
service; and
(D) signature and date of the provider representative.
(b) Decrease in hours. The provider must develop a
new service delivery plan, as described in §47.45(a)(2) of this
chapter (relating to Pre-Initiation Activities), within 21 days of
the provider identifying the need for an ongoing decrease in hours
from the service delivery plan currently approved by the individual.
(c) Immediate increase in hours of service.
(1) The provider must notify the case worker, or designee,
of the reason an individual requires an immediate increase in hours
of service, and must obtain approval from HHSC of both the number
of additional hours of service to be provided the individual and the
effective date of the change.
(2) The provider must implement the immediate increase
in hours of service on the negotiated effective date of the change.
(3) The provider must document the immediate increase
in hours of service. Documentation must include:
(A) the date the provider received approval for the
change;
(B) the name of the HHSC staff who approved the change;
(C) the effective date of the change; and
(D) the number of hours of service authorized.
(4) The provider must maintain documentation regarding
an immediate increase in hours of service in the individual's file.
(d) Implementation of service delivery plan changes
described in subsections (a) - (c) of this section. The provider must
implement the service delivery plan change on the following date,
whichever is later:
(1) the authorization begin date on HHSC's Authorization
for Community Care Services form; or
(2) five days after the date the provider receives
HHSC's Authorization for Community Care Services form, unless the
provider fails to stamp the receipt date on the form, in which case
the authorization begin date on the form will be used to determine
timeliness.
(e) Delay in implementation of service delivery plan
changes described in subsections (a) - (c) of this section. If a provider
does not implement a service delivery plan change on the effective
date of the change, the provider must set a new implementation date.
The provider must document by the next working day any failure to
implement a service delivery plan change on the effective date of
the change. The documentation must include:
(1) the reason for the failure to timely implement
the service delivery plan change; and
(2) the new implementation date.
(f) Temporary service delivery plan changes.
(1) A provider may temporarily change an individual's
service delivery plan if:
(A) the individual requests and requires temporary
assistance with allowable tasks not identified on the service delivery
plan due to a change in circumstances or available supports; and
(B) the change in tasks does not increase the total
approved hours of service or continue for more than 60 days.
(2) If a temporary change in tasks on the service delivery
plan will continue for more than 60 days or result in more hours of
service provided than have been approved, a provider must:
(A) request and obtain a new HHSC Authorization for
Community Care Services form; and
(B) provide services according to HHSC's Authorization
for Community Care Services form until the provider receives a new
form from the case worker.
(3) A provider must maintain the following documentation
in an individual's file regarding a temporary change in the service
delivery plan:
(A) the specific change in the service delivery plan;
(B) the duration of the temporary change; and
(C) the reason for the temporary change.
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Source Note: The provisions of this §47.67 adopted to be effective June 1, 2004, 29 TexReg 5113; amended to be effective June 1, 2009, 34 TexReg 2802; amended to be effective October 1, 2019, 44 TexReg 5138 |