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 § 363.215
Current through Reg. 50, No. 13; March 28, 2025
(a) HHSC terminates authorization for PPECC services when:
(1) the participant is no longer eligible for the Texas Health Steps
Comprehensive Care Program;
(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) the participant declines to continue receiving PPECC services and chooses to receive services at
home.
(b) Notice to approve, reduce, deny, or terminate requested PPECC services.
(1) HHSC notifies the participant and the responsible adult in writing of the approval, reduction, denial, or
termination of PPECC services.
(2) HHSC notifies the provider in writing of the approval, reduction,
denial, or termination of PPECC services.
(3) The effective date of the service reduction or denial is 30
calendar 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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