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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 §9.164DADS' Review of LON

(a) DADS may review a recommended or assigned LON at any time to determine if it is appropriate. If DADS reviews an LON, documentation supporting the LON must be submitted to DADS in accordance with DADS' request. DADS may modify an LON and recoup or deny payment based on its review.

(b) Before assigning an LON, DADS reviews documentation supporting the recommended LON if:

  (1) an LON is requested that is an increase from the individual's current LON;

  (2) an LON 9 is requested in accordance with §9.163(i) of this subchapter (relating to LON Assignment); or

  (3) an LON is requested in accordance with §9.163(h) of this subchapter.

(c) Documentation supporting a recommended LON described in subsection (b) of this section must be submitted to DADS and received by DADS within seven calendar days after electronically transmitting the recommended LON.

  (1) Within 21 calendar days after receiving the supporting documentation:

    (A) DADS requests additional documentation;

    (B) electronically approves the recommended LON; or

    (C) sends written notification that the recommended LON has been denied.

  (2) DADS reviews any additional documentation submitted in accordance with DADS' request and:

    (A) electronically approves the recommended LON; or

    (B) sends written notification that the recommended LON has been denied to the program provider, the service coordinator, and the individual or LAR.


Source Note: The provisions of this §9.164 adopted to be effective June 1, 2010, 35 TexReg 4441

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