| (a) A LIDDA must request an LOC from DADS for an applicant
at the time the applicant is enrolled into the HCS Program. The LOC
is requested by electronically transmitting a completed ID/RC Assessment
to DADS, indicating the recommended LOC, signed and dated by the service
coordinator. The electronically transmitted ID/RC Assessment must
contain information identical to the information on the signed and
dated ID/RC Assessment.
(b) A program provider must request an LOC for an individual
from DADS in accordance with this subsection.
(1) Before the expiration of an ID/RC Assessment, the
program provider must electronically transmit to DADS a completed
ID/RC Assessment, indicating the recommended LOC, that is signed and
dated by the program provider.
(2) The program provider must ensure the electronically
transmitted ID/RC Assessment contains information that is identical
to the information on the signed and dated ID/RC Assessment.
(3) The program provider must, within three calendar
days after transmission, provide the service coordinator with a paper
copy of the signed and dated ID/RC Assessment.
(c) For an LOC requested in accordance with subsection
(b) of this section, within seven calendar days after the ID/RC Assessment
is electronically transmitted by the program provider, the service
coordinator must review the ID/RC Assessment in the DADS data system
and:
(1) enter the service coordinator's name and date in
the DADS data system;
(2) enter in the DADS data system whether the service
coordinator agrees or disagrees with the ID/RC Assessment; and
(3) if the service coordinator disagrees with the ID/RC
Assessment, notify the individual, LAR, DADS, and the program provider
of the service coordinator's disagreement in accordance with DADS
instructions.
(d) The service coordinator's agreement or disagreement
will be considered in DADS review of an ID/RC Assessment transmitted
in accordance with subsection (b) of this section.
(e) For an LOC requested under subsection (a) or (b)
of this section, DADS makes an LOC determination in accordance with §9.238
of this chapter (relating to ICF/MR Level of Care I Criteria) and §9.239
of this chapter (relating to ICF/MR Level of Care VIII Criteria) based
on DADS review of information reported on the applicant's or individual's
ID/RC Assessment.
(f) Information on the ID/RC Assessment must be supported
by current data obtained from standardized evaluations and formal
assessments that measure physical, emotional, social, and cognitive
factors. The signed and dated ID/RC Assessment and documentation supporting
the recommended LOC must be maintained in the individual's record.
(g) DADS approves the LOC or sends written notification:
(1) to the applicant, individual, or LAR that the applicant
or individual is not eligible for HCS Program services or CFC services
and provides the applicant, individual, or LAR with an opportunity
to request a fair hearing in accordance with §9.169 of this subchapter
(relating to Fair Hearing); and
(2) to the LIDDA and program provider that the LOC
has been denied.
(h) An LOC determination is valid for 364 calendar
days after the LOC effective date determined by DADS.
(i) If the LON of an individual receiving HCS Program
services changes from a LON 5, LON 8, LON 6, or LON 9 to a LON 1,
DADS notifies the LIDDA of the change using DADS Form 1597, HCS Level
of Care Redetermination Cover Sheet.
(1) The LIDDA must, within 30 business days after receiving
the notification:
(A) assess the individual in-person and complete a
new Determination of Intellectual Disability (DID) in accordance with
Chapter 5, Subchapter D of this title (relating to Diagnostic Eligibility
for Services and Supports--Intellectual Disability Priority Population
and Related Conditions);
(B) complete the LIDDA section of DADS Form 1597, HCS
Level of Care Redetermination Cover Sheet, and return the form to
DADS; and
(C) submit a copy of the results of the new DID and
any other pertinent information regarding the reassessment of the
individual to DADS.
(2) If the LIDDA is unable to complete the requirements
described in paragraph (1) of this subsection within the 30 business
day timeframe, the LIDDA must notify DADS of the reasons for the delay.
(3) DADS reviews the information submitted by the LIDDA
regarding the redetermination and notifies the LIDDA and the HCS Program
provider of the review decision using DADS Form 1597, HCS Level of
Care Redetermination Cover Sheet.
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| Source Note: The provisions of this §9.161 adopted to be effective June 1, 2010, 35 TexReg 4441; amended to be effective September 1, 2014, 39 TexReg 6516; amended to be effective November 15, 2015, 40 TexReg 7827; amended to be effective March 20, 2016, 41 TexReg 1867 |
