| (a) HHSC terminates authorization for PPECC services
when:
(1) the participant is no longer eligible for THSteps-CCP;
(2) the participant no longer meets the medical necessity
criteria for PPECC services;
(3) the PPECC cannot ensure the health and safety of
the participant;
(4) the participant or the participant's responsible
adult refuses to comply with the plan of care, and compliance is necessary
to assure the health and safety of the participant;
(5) the participant changes PPECC providers, and the
change of notification is submitted to HHSC in writing with a prior
authorization request from the new PPECC provider; or
(6) after receiving PPECC services, the participant
declines PPECC services and receives services at home. The home health
agency or independent provider offering these services must submit
and update all required authorization documentation.
(b) Notice to approve, reduce, or deny requested PPECC
services.
(1) HHSC notifies the participant and the responsible
adult in writing of the approval, reduction, or denial of PPECC services.
(2) HHSC notifies the provider in writing of the approval,
reduction, or denial of PPECC services.
(3) The effective date of the service reduction or
denial is 30 days after the date on the individual's notification
letter.
(4) HHSC notifies the individual in writing of the
process to appeal the reduction or denial of services.
(c) All participants of Medicaid-funded services have
the right to appeal actions or determinations made by HHSC as described
in Chapter 357, Subchapter A of this title (relating to Uniform Fair
Hearing Rules).
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