Texas Administrative Code
Title 26 - HEALTH AND HUMAN SERVICES
Part 1 - HEALTH AND HUMAN SERVICES COMMISSION
Chapter 259 - COMMUNITY LIVING ASSISTANCE AND SUPPORT SERVICES (CLASS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC) SERVICES
Subchapter B - ELIGIBILITY, ENROLLMENT, AND REVIEW
Division 3 - REVIEWS
Section 259.83 - Utilization Review of an IPC by HHSC
Current through Reg. 49, No. 38; September 20, 2024
(a) At HHSC's discretion, HHSC conducts a utilization review of an IPC to determine if:
(b) If requested by HHSC, a program provider must submit documentation supporting an IPC to HHSC no later than 10 calendar days after HHSC's request.
(c) If HHSC determines that an IPC does not have an IPC cost at or below the amount in § 259.51(a)(4) of this subchapter, HHSC notifies the individual's CMA and DSA of such determination and sends written notice to the individual or LAR that the individual's CLASS Program services and CFC services are proposed for termination and includes in the notice the individual's right to request a fair hearing in accordance with § 259.101 of this chapter (relating to Individual's Right to a Fair Hearing).
(d) HHSC denies or proposes reduction of a CLASS Program service or CFC service if HHSC determines that an IPC has an IPC cost at or below the amount in § 259.51(a)(4) of this subchapter but one or more of the CLASS Program services or CFC services specified in the IPC do not meet the requirements described in §259.65(a)(1)(E)(iii) or (iv) and § 259.65(b) of this subchapter.
(e) If HHSC denies or proposes reduction of a CLASS Program service or CFC service, as described in subsection (d) of this section, HHSC:
(f) If HHSC notifies a CMA of the denial or proposed reduction of an individual's CLASS Program services or CFC services and of the IPC modified in accordance with subsection (e) of this section:
(g) The IPC period of an enrollment IPC or a renewal IPC modified by HHSC in accordance with subsection (e) of this section does not change as a result of HHSC's modification.
