Current through Reg. 50, No. 13; March 28, 2025
(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 HCS 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 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 program provider 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 program provider 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 HCS Program waiver application
approved by CMS; and
(ii) is signed
and dated by the program provider 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.
(2) A
program provider must:
(A) ensure that the
information entered and electronically submitted in the HHSC data system is
identical to the information on the completed ID/RC Assessment;
(B) within three calendar days after entering
and electronically submitting the information in the HHSC data system, provide
the service coordinator 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
program provider enters information from a completed ID/RC Assessment in the
HHSC data system and electronically submits the information on a date that is
more than 180 calendar days after the expiration date of the previous ID/RC
Assessment, the program provider 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 by the program provider 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 service coordinator 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) For an LOC requested in accordance with
subsection (b) of this section, within seven calendar days after a program
provider enters information from a completed ID/RC Assessment in the HHSC data
system and electronically submits the information, the service coordinator or a
LIDDA representative other than the service coordinator must:
(1) review the information entered in the
HHSC data system and electronically submitted, to determine if the information
in the HHSC data system is identical to the information on the completed ID/RC
Assessment the service coordinator received from the program
provider;
(2) enter in the HHSC
data system:
(A) the service coordinator's
name and date of review; and
(B)
one of the following:
(i) that the service
coordinator agrees with the ID/RC Assessment, if the information in the HHSC
data system is identical to the completed ID/RC Assessment; or
(ii) that the service coordinator disagrees
with the ID/RC Assessment, if the information in the HHSC data system is not
identical to the completed ID/RC Assessment; and
(3) if the service coordinator or a LIDDA
representative other than the service coordinator enters in the HHSC data
system that the service coordinator disagrees with the ID/RC Assessment, notify
HHSC and the program provider of the service coordinator's disagreement in
accordance with HHSC's instructions.
(d) For an LOC requested in accordance with
subsection (b) of this section, HHSC considers a service coordinator's
agreement or disagreement with an ID/RC Assessment in making an LOC
determination.
(e) 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 signed and dated ID/RC Assessment
and documentation supporting the recommended LOC must be maintained in an
individual's record.
(f) 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 §
263.101(a)(2) of
this subchapter (relating to Eligibility Criteria for HCS Program Services and
CFC Services).
(g) 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 HCS Program services or CFC services and provides the applicant,
individual, or LAR with an opportunity to request a fair hearing in accordance
with §
263.801 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.
(h) 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.
(i) 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.
(j) If the LON of an individual receiving HCS
Program services changes from a LON 5, LON 8, LON 6, or LON 9 to a LON 1, HHSC
notifies the LIDDA of the change using the HHSC HCS Level of Care
Redetermination Cover Sheet form.
(1) The
LIDDA must, within 30 business days after receiving the notification:
(A) conduct a DID in accordance with §
304.401 of this title (relating to
Conducting a Determination of Intellectual Disability);
(B) complete the LIDDA section of the HHSC
HCS Level of Care Redetermination Cover Sheet form, and return the form to
HHSC; and
(C) submit a copy of the
results of the new DID and any other pertinent information regarding the
reassessment of the individual to HHSC.
(2) If the LIDDA is unable to complete the
requirements described in paragraph (1) of this subsection within the
30-business day timeframe, the LIDDA must notify HHSC of the reasons for the
delay.
(3) HHSC reviews the
information submitted by the LIDDA regarding the redetermination and notifies
the LIDDA and the HCS program provider of the review decision using the HHSC
HCS Level of Care Redetermination Cover Sheet form.
(k) For an individual who is receiving all
services through the CDS option and, therefore, does not have a program
provider, the service coordinator:
(1) must
perform the functions of the program provider described in subsection (b) of
this section; and
(2) is not
required to comply with subsection (c) of this section.