Current through Reg. 49, No. 38; September 20, 2024
(a) A LIDDA must
request an LOC from HHSC for an applicant in accordance with this subsection.
(1) The LIDDA must complete an ID/RC
Assessment for an applicant that:
(A) includes
the LOC recommended by a person qualified to perform an initial evaluation of
LOC in accordance with Appendix B of the TxHmL Program waiver application
approved by CMS; and
(B) is signed
and dated in accordance with the instructions for completing the ID/RC
Assessment.
(2) The
LIDDA must enter information from the completed ID/RC Assessment in the HHSC
data system and electronically submit the information to HHSC.
(3) The LIDDA must ensure that the
information entered in the HHSC data system and electronically submitted to
HHSC in accordance with paragraph (2) of this subsection is identical to the
information on the completed ID/RC Assessment.
(4) The LIDDA must send a copy of the
completed ID/RC Assessment and supporting documentation to HHSC, as requested
by HHSC.
(b) A LIDDA must
request an LOC for an individual from HHSC in accordance with this subsection.
(1) No more than 60 calendar days before the
expiration date of an individual's ID/RC Assessment, a LIDDA must:
(A) complete an ID/RC Assessment that:
(i) includes the LOC recommended by a person
qualified to perform a reevaluation of LOC in accordance with Appendix B of the
TxHmL Program waiver application approved by CMS; and
(ii) is signed and dated in accordance with
the instructions for completing the ID/RC Assessment; and
(B) enter information from the completed
ID/RC Assessment in the HHSC data system and electronically submit the
information to HHSC.
(2)
A LIDDA must:
(A) ensure that the information
entered in the HHSC data system and electronically submitted to HHSC is
identical to the information on the completed ID/RC Assessment;
(B) within three calendar days after entering
the information in the HHSC data system and electronically submitting the
information to HHSC, provide the program provider with a copy of the completed
ID/RC Assessment; and
(C) send a
copy of the completed ID/RC Assessment and supporting documentation to HHSC, as
requested by HHSC.
(3) If
the LIDDA enters information from a completed ID/RC Assessment in the HHSC data
system and electronically submits the information to HHSC on a date that is
more than 180 calendar days after the expiration date of the previous ID/RC
Assessment, the LIDDA must:
(A) send to HHSC a
copy of the completed ID/RC Assessment by a method, as instructed by HHSC,
that:
(i) includes the recommended LOC;
and
(ii) is signed and dated in
accordance with the instructions for completing the ID/RC
Assessment;
(B) within
three calendar days after sending the completed ID/RC Assessment to HHSC,
provide the program provider with a copy of the completed ID/RC Assessment;
and
(C) submit documentation
supporting the ID/RC Assessment to HHSC, as requested by
HHSC.
(c)
Information on an ID/RC Assessment must be supported by current data obtained
from standardized evaluations and formal assessments that measure physical,
emotional, social, and cognitive factors. A LIDDA must maintain the signed and
dated ID/RC Assessment and documentation supporting the recommended LOC in an
applicant's or individual's record.
(d) When HHSC receives a request for an LOC
in accordance with subsection (a) or (b) of this section, HHSC determines if an
applicant or individual qualifies for an LOC required by §
262.101(a)(2) of
this subchapter (relating to Eligibility Criteria for TxHmL Program Services
and CFC Services).
(e) HHSC
approves an LOC or sends a written notification:
(1) to the applicant, individual, or LAR that
the applicant or individual is not eligible for TxHmL Program services or CFC
services and provides the applicant, individual, or LAR with an opportunity to
request a fair hearing in accordance with §
262.601 of this chapter (relating
to Fair Hearing);
(2) to the LIDDA
that the LOC has been denied; and
(3) to the program provider using the HHSC
data system that the LOC has been denied, if the applicant has selected a
program provider or an individual is receiving services from a program
provider.
(f) An LOC
determination is valid for a period of time as described in this subsection.
(1) Except as provided in paragraph (2) of
this subsection, an LOC determination is valid for a 365-calendar day period
starting on the begin date of the ID/RC Assessment.
(2) If the begin date of the ID/RC Assessment
is March 1 or later in a year before a leap year or January 1 - February 28 of
a leap year, the LOC determination is valid for a 366-calendar day period
starting on the begin date of the ID/RC Assessment.
(g) An ID/RC Assessment submitted in
accordance with subsection (b) of this section is effective on the date after
the individual's previous ID/RC Assessment expires.
