| (a) A designated resident's IHSS are suspended if:
(1) the designated resident is admitted to an acute
care hospital for fewer than 30 days and is returning to the same
NF;
(2) the designated resident loses Medicaid eligibility;
(3) the designated resident or LAR requests that IHSS
be suspended when transferring from one NF to another NF without an
intervening hospital stay; or
(4) the designated resident has a change in health
condition that temporarily prohibits participation in IHSS.
(b) HHSC may terminate one or more of a designated
resident's IHSS if:
(1) the designated resident no longer meets the eligibility
criteria specified in §368.202 of this chapter (relating to Eligibility
Criteria);
(2) the designated resident loses Medicaid eligibility
for more than 90 days;
(3) the designated resident or LAR requests that IHSS
be terminated; or
(4) the designated resident exhibits a persistent and
prolonged pattern of failing to comply with the requirements described
in subsection (c) of this section.
(c) A designated resident or LAR must comply with the
following participation requirements in the delivery of IHSS:
(1) participating on the SPT to:
(A) develop an initial plan of care as described in §368.204
of this chapter (relating to Process for Service Initiation); and
(B) renew and revise the plan of care as described
in §368.302 of this chapter (relating to Renewal and Revision
of a Plan of Care);
(2) reviewing, agreeing to, signing, and dating a plan
of care in accordance with §368.301 of this chapter (relating
to Plan of Care);
(3) cooperating with the service provider agency and
habilitation coordinator in the delivery of IHSS listed on the designated
resident's plan of care;
(4) cooperating with the service provider agency and
habilitation coordinator to ensure progress toward achieving the outcomes,
goals, and objectives described in the HSP and implementation plan;
(5) not engaging in illegal behavior in the presence
of the habilitation coordinator, individual service provider, or a
staff member, volunteer, or controlling person of the service provider
agency;
(6) not repeatedly acting in a manner that is threatening
to the health and safety of the individual service provider or a staff
member, volunteer, or controlling person of the service provider agency;
(7) not exhibiting behavior that places the health
and safety of the individual service provider or a staff member, volunteer,
or controlling person of the service provider agency in immediate
jeopardy; and
(8) not knowingly initiating or participating in fraudulent
health care practices.
(d) The service provider agency must develop a written
policy that describes the process the service provider agency will
follow to address challenges related to the designated resident's
or LAR's participation in the program.
(e) When requesting to terminate a designated resident's
IHSS for the reason described in subsection (b)(4) of this section,
the service provider agency and LIDDA must provide documentation demonstrating
the service provider agency and LIDDA have followed the written policy
required by subsection (d) of this section and made every attempt
to:
(1) engage the designated resident or LAR in meeting
the participation requirements; and
(2) ensure the designated resident's or LAR's inability
to meet the participation requirements is not due to a failure of
the designated resident's SPT.
(f) The LIDDA and service provider agency must notify
each other immediately if IHSS are suspended or terminated.
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