|(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
(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
(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
(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