| (II) includes nursing, intervener services, or CFC
PAS/HAB, develop a service backup plan or a service backup plan revision
if required by §260.213 of this chapter (relating to Service
Backup Plans); and
(vii) ensure the renewal IPP and proposed renewal IPC
is signed and dated by each member of the service planning team; and
(F) the case manager must:
(i) provide an oral and written explanation of the
topics described in §260.61(c)(1) - (3) of this subchapter (relating
to Process for Enrollment of an Individual) to the individual or LAR;
(ii) educate the individual and LAR about protecting
the individual from abuse, neglect, and exploitation;
(iii) provide an oral explanation to the individual
or LAR that the individual may transfer to a different program provider;
(iv) give the individual or LAR an HHSC Documentation
of Provider Choice form and have the individual or LAR designate the
selection of a DBMD program provider on the form;
(v) if the individual or LAR selects a different DBMD
program provider on the HHSC Documentation of Provider Choice form,
coordinate the individual's transfer in accordance with §260.79
of this subchapter (relating to Coordination of Transfers);
(vi) orally explain that the individual or LAR may
request the provision of transportation provided as a residential
habilitation activity, case management, nursing, out-of-home respite
in a camp, adaptive aids, intervener services, or CFC PAS/HAB while
the individual is staying at a location outside the contracted service
delivery area but within the state of Texas for a period of no more
than 60 consecutive days; and
(vii) have documentation that the activities required
under clauses (i) - (vi) of this subparagraph were performed.
(2) A case manager must, no later than 10 business
days after the date of the service planning team meeting described
in paragraph (1)(E) of this subsection, but at least 30 calendar days
before the end of the current IPC period, submit to HHSC:
(A) the signed and dated proposed renewal IPC;
(B) the signed and dated renewal IPP;
(C) the PAS/HAB plan;
(D) the renewal ID/RC Assessment;
(E) the results of an adaptive behavior screening assessment,
if completed as described in paragraph (1)(D) of this subsection;
(F) the HHSC Related Conditions Eligibility Screening
Instrument form;
(G) the HHSC Non-Waiver Services form;
(H) the HHSC Documentation of Provider Choice form;
(I) the HHSC CLASS/DBMD Nursing Assessment form;
(J) an individual transportation plan, if required
by subsection (a)(4)(C)(i) of this section; and
(K) the documentation described in subsection (a)(5)(B)
of this section.
(c) Review and revision in an emergency. If a program
provider delivers a DBMD Program service or CFC PAS/HAB to an individual
in an emergency to ensure the individual's health and welfare and
the service is not on the IPC and IPP or exceeds the amount on the
IPP, a case manager must:
(1) as soon as possible, but no later than five business
days after providing the service, convene a service planning team
meeting at a time and location convenient to the individual or LAR
to:
(A) develop a revised IPP that:
(i) meets the requirements described in §260.65
of this subchapter; and
(ii) includes documentation of how the requested service
addressed the emergency; and
(B) develop a proposed revised IPC that meets the requirements
described in §260.67(a)(1) and (b) of this chapter;
(2) if the revised IPP and proposed revised IPC includes
nursing, intervener services, or CFC PAS/HAB, develop a service backup
plan of service backup plan revision, if required by §260.213
of this chapter;
(3) ensure the revised IPP and proposed revised IPC
is signed and dated by each member of the service planning team; and
(4) no later than 10 business days after the service
planning meeting described in paragraph (1) of this subsection, submit
to HHSC:
(A) a copy of the signed and dated proposed revised
IPC;
(B) a copy of the signed and dated revision IPP; and
(C) the documentation described in subsection (a)(5)(B)
of this section.
(d) Review and revision other than the reviews described
in subsections (a) - (c) of this section. If a program provider becomes
aware at any time during an individual's IPC period that changes to
the individual's services may be necessary, the case manager must:
(1) as soon as possible but no later than five business
days after becoming aware that changes to the individual's services
may be necessary, convene a service planning team meeting at a time
and location convenient to the individual or LAR to review and, if
determined necessary, develop:
(A) a revised IPP that meets the requirements described
in §260.65 of this chapter; and
(B) a proposed revised IPC that meets the requirements
described in §260.67(a)(1) and (b) of this subchapter;
(2) if the revised IPP and proposed revised IPC:
(A) include transportation provided as a residential
habilitation activity or as an adaptive aid, develop an individual
transportation plan; or
(B) include nursing, intervener services, or CFC PAS/HAB
services, ensure compliance with §260.213 of this chapter;
(3) ensure the revised IPP and proposed revised IPC
are signed and dated by each member of the service planning team;
and
(4) no later than 10 business days after the date of
the service planning meeting described in paragraph (1) of this subsection,
submit to HHSC:
(A) a copy of the signed and dated proposed revised
IPC;
(B) a copy of the signed and dated revised IPP;
(C) an individual transportation plan, if required
by paragraph (2)(A) of this subsection; and
(D) the documentation described in subsection (a)(5)(B)
of this section.
(e) Determination by HHSC of whether an individual
meets LOC VIII and additional criteria.
(1) HHSC reviews the documentation described in subsection
(b)(1)(A) - (E) of this section to determine whether an individual
meets the LOC VIII and additional criteria required by §260.51(a)(2)
and (3) of this subchapter (relating to Eligibility Criteria for DBMD
Program Services and CFC Services).
(2) HHSC may request current data obtained from standardized
evaluations and formal assessments related to an individual's LOC
VIII. If HHSC makes such a request, the case manager must submit the
information to HHSC no later than 10 calendar days after the date
of the request.
(3) HHSC notifies a program provider, in writing, of
whether or not an individual meets the LOC VIII. If HHSC determines
that an individual meets the LOC VIII, the LOC VIII is effective:
(A) on a date determined by HHSC; and
(B) through the last calendar day of the IPC period.
(4) If an individual's LOC VIII expires before HHSC
determines whether the individual meets the LOC VIII, as described
in paragraphs (1) - (3) of this subsection:
(A) a program provider must continue to provide services
to the individual until HHSC approves a proposed renewal IPC to ensure
continuity of care and prevent the individual's health and welfare
from being jeopardized; and
(B) if HHSC determines that an individual meets the
LOC VIII, and the individual is otherwise eligible for the DBMD Program,
HHSC will reimburse the program provider for services provided, as
required by subparagraph (A) of this paragraph, for a period of not
more than 180 calendar days before the date HHSC receives the documentation
described in subsection (b)(2)(E) - (G) of this section.
(f) HHSC's review of a proposed revised IPC or a proposed
renewal IPC.
(1) HHSC reviews a proposed revised IPC or a proposed
renewal IPC to determine if the proposed IPC meets:
(A) the requirement described in §260.51(a)(4)
of this subchapter; and
(B) the requirements described in §260.67(a)(1)
and (b) of this subchapter.
(2) At HHSC's request, a case manager must submit additional
documentation supporting a revised IPC or a proposed renewal IPC no
later than 10 calendar days after the date of the request.
(3) If HHSC determines that a proposed revised IPC
or a proposed renewal IPC meets the requirements:
(A) HHSC notifies the program provider, in writing,
of its determination; and
Cont'd... |
