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TITLE 40SOCIAL SERVICES AND ASSISTANCE
PART 1DEPARTMENT OF AGING AND DISABILITY SERVICES
CHAPTER 9INTELLECTUAL DISABILITY SERVICES--MEDICAID STATE OPERATING AGENCY RESPONSIBILITIES
SUBCHAPTER DHOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC)
RULE §9.162Lapsed LOC

(a) DADS does not pay the program provider for HCS Program services or CFC services provided during a period of time in which the individual's LOC has lapsed unless a reinstatement of the LOC determination is requested and granted in accordance with this section. DADS does not grant a request for reinstatement of an LOC determination to:

  (1) establish program eligibility;

  (2) renew an LOC determination;

  (3) obtain an LOC determination for a period of time for which an LOC has been denied;

  (4) revise an LON; or

  (5) obtain an LON determination for a period of time for which an individual's IPC is not current.

(b) The program provider must request reinstatement of an LOC determination in accordance with this subsection.

  (1) The program provider must:

    (A) complete an ID/RC Assessment signed and dated by the program provider;

    (B) include on the ID/RC Assessment an end date of the LOC period that is not later than 365 calendar days after the end date of the previously authorized LOC period; and

    (C) within 180 calendar days after the end date of the previously authorized LOC period, electronically transmit to DADS the completed ID/RC Assessment.

  (2) The program provider must ensure that 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 submission, provide the service coordinator with a paper copy of the signed and dated ID/RC Assessment.

(c) 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 is considered in DADS review of an ID/RC Assessment transmitted in accordance with subsection (b) of this section.

(e) DADS notifies the program provider of its decision to grant or deny the request for reinstatement of an LOC determination within 45 calendar days after DADS receives the ID/RC Assessment from the program provider in accordance with subsection (b)(1) of this section.

(f) If DADS grants a reinstatement, the period of reinstatement will be for a period of not more than 180 calendar days after the end date of the previously authorized LOC period.


Source Note: The provisions of this §9.162 adopted to be effective June 1, 2010, 35 TexReg 4441; amended to be effective November 15, 2015, 40 TexReg 7827; amended to be effective March 20, 2016, 41 TexReg 1867

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