| (a) Required suspensions. A provider must suspend services
if:
(1) an individual temporarily or permanently leaves
the provider's contracted service delivery area during a time when
the individual would routinely receive services and the individual
does not request the provision of services outside the provider's
contracted service delivery area;
(2) the provider declines the request of the individual
for the provision of services outside of the provider's contracted
service delivery area and the individual leaves the service delivery
area;
(3) the individual moves to a location where services
cannot be provided under the PHC Program, CAS Program, or FC Program;
(4) the individual dies;
(5) the individual is admitted to an institution, which
is a:
(A) hospital;
(B) nursing facility;
(C) state supported living center;
(D) state hospital;
(E) intermediate care facility serving individuals
with an intellectual disability or related conditions; or
(F) correctional facility.
(6) the individual requests that services end;
(7) for individuals receiving services in the PHC Program
or CAS Program, HHSC denies the individual's Medicaid eligibility;
or
(8) the individual or someone in the individual's home
exhibits reckless behavior, which may result in imminent danger to
the health and safety of the individual, the attendant, or another
person, in which case the provider must make an immediate referral
to:
(A) DFPS or other appropriate protective services agency;
(B) local law enforcement, if appropriate; and
(C) the individual's case worker.
(b) Optional suspensions. The provider may suspend
services if:
(1) the individual or someone in the individual's home
engages in discrimination against a provider or HHSC employee in violation
of applicable law; or
(2) the individual refuses services for more than 30
consecutive days.
(c) Notification of service suspension. A provider
must notify the case worker of any suspension by the first working
day after the provider suspends services. The notice must include:
(1) the date of service suspension;
(2) the reason for the suspension;
(3) the duration of the suspension, if known; and
(4) for a suspension under subsection (a)(8) or (b)
of this section, a written explanation of the circumstances surrounding
the suspension.
(d) Interdisciplinary Team (IDT) meeting. A provider
must convene an IDT meeting, as described in §47.49 of this chapter
(relating to Interdisciplinary Team), if services are suspended under
subsection (a)(8) or (b) of this section.
(e) Resuming services after suspension. This subsection
does not apply to subsection (a)(8) or (b)(1) of this section.
(1) A provider must resume services after suspension
on the earliest of the following:
(A) after the individual's return home, or the date
the provider becomes aware of the individual's return home, if applicable;
(B) on the date specified in writing by the case worker;
(C) as a result of a recommendation by the IDT; or
(D) upon the provider's receipt of notification from
the case worker that the provider must resume services pending the
outcome of an appeal.
(2) A provider must notify the case worker of the date
services resume within seven days after that date.
|
| Source Note: The provisions of this §47.71 adopted to be effective June 1, 2004, 29 TexReg 5113; amended to be effective June 1, 2009, 34 TexReg 2802; amended to be effective October 1, 2013, 38 TexReg 6621; amended to be effective October 1, 2019, 44 TexReg 5138 |
