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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 §9.166Renewal and Revision of an IPC

(a) Renewal of the IPC. At least annually and before the expiration of an individual's IPC, the individual's IPC must be renewed in accordance with this subsection and with DADS instructions.

  (1) At least 60 but no more than 90 calendar days before the expiration of an individual's IPC, the service coordinator must:

    (A) notify the service planning team that the individual's PDP must be reviewed and updated; and

    (B) convene the service planning team to:

      (i) review and update the individual's PDP; and

      (ii) if CFC PAS/HAB is included on the PDP, complete DADS HCS/TxHmL CFC PAS/HAB Assessment form to determine the number of CFC PAS/HAB hours the individual needs.

  (2) The service coordinator, within 10 calendar days after the PDP is updated, must send the program provider and FMSA, if applicable, a copy of:

    (A) the updated PDP; and

    (B) if CFC PAS/HAB is included on the PDP, a copy of the completed DADS HCS/TxHmL CFC PAS/HAB Assessment form.

  (3) The program provider must ensure that a meeting between the service planning team and the program provider occurs at least 30 but no more than 60 calendar days before the expiration of the individual's IPC to:

    (A) review the PDP and, if CFC PAS/HAB is included on the PDP, the completed DADS HCS/TxHmL CFC PAS/HAB Assessment form; and

    (B) develop the proposed renewal IPC in accordance with §9.159(c) of this subchapter (relating to IPC), including completion of the CDS option portion of the proposed renewal IPC, if applicable, and the non-HCS Program services and non-CFC services.

  (4) The program provider must develop, before the effective date of the proposed renewal IPC:

    (A) an implementation plan for:

      (i) HCS Program services, except for transportation as a supported home living activity, that is based on the individual's PDP and proposed renewal IPC; and

      (ii) CFC services, except for CFC support management, that is based on the individual's PDP, and proposed renewal IPC, and if CFC PAS/HAB is included on the PDP, the completed DADS HCS/TxHmL CFC PAS/HAB Assessment form; and

    (B) a transportation plan, if transportation as a supported home living activity is included on the PDP.

  (5) Within seven calendar days after development of the proposed renewal IPC as required by paragraph (3) of this subsection, the program provider must comply with the requirements in subsection (e)(1) and (2) of this section.

  (6) Within seven calendar days after the program provider electronically transmits the proposed renewal IPC to DADS as required by subsection (e)(2) of this section, the service coordinator must comply with the requirements in subsection (e)(3) of this section.

  (7) The program provider must provide HCS Program services and CFC services in accordance with:

    (A) an implementation plan that is based on:

      (i) the individual's PDP;

      (ii) the renewal IPC; and

      (iii) if CFC PAS/HAB is included on the PDP, the completed DADS HCS/TxHmL CFC PAS/HAB Assessment form; and

    (B) a transportation plan, if transportation as a supported home living activity is included on the PDP.

(b) Revisions to the IPC. Except as provided in subsection (f) of this section, the service coordinator or the program provider may determine whether an individual's IPC needs to be revised to add a new HCS Program service or CFC service or change the amount of an existing service.

  (1) The service coordinator must notify the program provider if the service coordinator determines that the IPC needs to be revised.

  (2) The program provider must notify the service coordinator if the program provider determines that the IPC needs to be revised.

  (3) Within 14 calendar days after the notification required by paragraph (1) or (2) of this subsection:

    (A) if the IPC needs to be revised to add CFC PAS/HAB or change the amount of CFC PAS/HAB:

      (i) the service planning team must complete DADS HCS/TxHmL CFC PAS/HAB Assessment form to determine the number of CFC PAS/HAB hours the individual needs; and

      (ii) the service coordinator must send a copy of the completed form to the program provider for review;

    (B) the service planning team and the program provider must develop a proposed revised IPC;

    (C) the service planning team must revise the PDP, if appropriate, and if the PDP is not revised, the service coordinator must document the reasons for the proposed IPC revision;

    (D) the program provider must revise:

      (i) the implementation plan for:

        (I) HCS Program services, except for transportation as a supported home living activity, that is based on the individual's PDP and proposed revised IPC; and

        (II) CFC services, except for CFC support management, that is based on the individual's PDP, proposed revised IPC, and if CFC PAS/HAB is included on the PDP, the completed DADS HCS/TxHmL CFC PAS/HAB Assessment form; and

      (ii) the transportation plan, if transportation as a supported home living activity is modified on the PDP or IPC; and

    (E) the program provider must comply with the requirements in subsection (e)(1) and (2) of this section.

  (4) Within seven calendar days after the program provider electronically transmits the proposed revised IPC to DADS as required by subsection (e)(2) of this section, the service coordinator must comply with the requirements in subsection (e)(3) of this section.

  (5) The program provider must provide HCS Program services and CFC services in accordance with:

    (A) an implementation plan that is based on:

      (i) the individual's PDP;

      (ii) the revised IPC; and

      (iii) if CFC PAS/HAB is included on the PDP, the completed DADS HCS/TxHmL CFC PAS/HAB Assessment form; and

    (B) the revised transportation plan, if revised in accordance with paragraph (3)(C)(ii) of this subsection.

(c) Revision of IPC before delivery of services. Except as provided by subsection (d) of this section, if an individual's service planning team and program provider determine that the IPC must be revised to add a new HCS Program service or CFC service or change the amount of an existing service, the program provider must revise the IPC in accordance with subsection (b) of this section before the delivery of a new or increased service.

(d) Emergency provision of services and revision of the IPC.

  (1) If an emergency necessitates the provision of an HCS Program service or CFC service to ensure the individual's health and safety and the service is not on the IPC or exceeds the amount on the IPC, the program provider may provide the service before revising the IPC. The program provider must, within one business day after providing the service:

    (A) document:

      (i) the circumstances that necessitated providing the new HCS Program service or CFC service or the increase in the amount of the existing HCS Program service or CFC service; and

      (ii) the type and amount of the service provided;

    (B) notify the service coordinator of the emergency provision of the service and that the IPC must be revised; and

    (C) upon request, provide a copy of the documentation required by subparagraph (A) of this paragraph to the service coordinator.

  (2) Within seven calendar days after providing the service:

    (A) the service planning team and the program provider must develop a proposed revised IPC;

    (B) the service planning team must revise the PDP, if appropriate;

    (C) the program provider must:

      (i) revise the implementation plan that is based on the individual's PDP and proposed revised IPC; and

      (ii) develop or revise a transportation plan, if transportation as a supported home living activity is added to or modified on the PDP or IPC; and

    (D) the program provider must comply with the requirements in subsection (e)(1) and (2) of this section.

  (3) Within seven calendar days after the program provider electronically transmits the proposed revised IPC to DADS as required by subsection (e)(2) of this section, the service coordinator must comply with the requirements in subsection (e)(3) of this section.

  (4) The program provider must provide HCS Program services and CFC services in accordance with:

    (A) an implementation plan that is based on the individual's PDP and the revised IPC; and

    (B) the transportation plan developed or revised in accordance with paragraph (2)(C)(ii) of this subsection.

(e) Submitting a proposed renewal and revised IPC to DADS. A proposed renewal or revised IPC must be submitted to DADS for authorization in accordance with this subsection.

  (1) The program provider must:

    (A) sign and date the proposed renewal or revised IPC demonstrating agreement that the services will be provided to the individual; and

    (B) ensure that a proposed renewal or revised IPC is signed and dated by the individual or LAR.

  (2) The program provider must:

    (A) electronically transmit a proposed renewal or revised IPC to DADS;

    (B) keep the original proposed renewal or revised IPC in the individual's record and, within three calendar days after electronic transmission, ensure the service coordinator receives a copy of the signed proposed renewal or revised IPC; and

    (C) ensure the electronically transmitted proposed renewal or revised IPC contains information identical to that on the original proposed renewal or revised IPC.

  (3) The service coordinator must review the electronically transmitted proposed renewal or revised IPC and:

    (A) enter the service coordinator's name and date in the DADS data system;

    (B) enter in the DADS data system whether the service coordinator agrees or disagrees that the requirements described in §9.159(c) of this subchapter have been met; and

    (C) if the service coordinator disagrees that the requirements described in §9.159(c) of this subchapter have been met, notify the individual or LAR, the program provider, and DADS of the service coordinator's disagreement in accordance with DADS instructions.

(f) Revision of IPC to include CFC support management. If an individual or LAR requests CFC support management during an IPC year, the service coordinator or the program provider must revise the IPC as described in the HCS Handbook available at www.dads.state.tx.us.

(g) Renewal and revision of IPC when all services are through the CDS option. For an individual who is receiving all services through the CDS option and, therefore, does not have a program provider, the service coordinator must perform the functions of the program provider described in this section.


Source Note: The provisions of this §9.166 adopted to be effective June 1, 2010, 35 TexReg 4441; amended to be effective December 1, 2011, 36 TexReg 8043; amended to be effective January 1, 2013, 37 TexReg 9969; 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

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