Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 363 - TEXAS HEALTH STEPS COMPREHENSIVE CARE PROGRAM
Subchapter B - PRESCRIBED PEDIATRIC EXTENDED CARE CENTER SERVICES
Section 363.215 - Termination, Reduction, or Denial of Authorization for Prescribed Pediatric Extended Care Center Services
Universal Citation: 1 TX Admin Code ยง 363.215
Current through Reg. 49, No. 38; September 20, 2024
(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).
Disclaimer: These regulations may not be the most recent version. Texas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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