Current through Reg. 49, No. 38; September 20, 2024
(a) A provider must
suspend services to an individual if:
(1) the
individual changes residence to outside the state of Texas;
(2) the individual moves to a location where
the provider does not provide CMPAS Program services to the individual except
as provided for in §44.403 of this chapter (relating
to Attendant Services Provided Outside the Provider Contracted Service Delivery
Area in the Traditional Services Option);
(3) the individual dies;
(4) the individual is admitted to:
(A) a hospital;
(B) a nursing facility;
(C) a state supported living
center;
(D) a state mental health
facility; or
(E) an intermediate
care facility for individuals with an intellectual disability or related
conditions;
(5) the
individual requests that services end;
(6) the individual, representative, or
someone in the individual's home, as applicable, refuses to:
(A) supervise the attendant;
(B) adhere to the service plan; or
(C) otherwise comply with a requirement of
the CMPAS Program;
(7)
the individual or representative, as applicable, does not have the ability to:
(A) supervise the attendant;
(B) adhere to the service plan; or
(C) otherwise comply with a requirement of
the CMPAS Program;
(8)
the individual does not submit a co-payment as required by §44.501 of this chapter (relating
to Determining an Individual's Co-payment);
(9) the individual does not provide a
practitioner's statement as required by §44.307 of this subchapter
(relating to Individual Responsibilities in All CMPAS Service Delivery
Options); or
(10) the provider
becomes aware that the individual no longer meets eligibility requirements for
the CMPAS Program.
(b)
The provider may suspend services if:
(1) the
individual or someone in the individual's home engages in discrimination in
violation of law;
(2) the
individual or representative fails to effectively manage attendant care,
including problems with:
(A) hiring,
selecting, or retaining an attendant for reasons other than workforce
issues;
(B) reaching an agreement
on the amount of reimbursement the provider will retain in the block grant
option; or
(C) completing or
submitting required program documentation; or
(3) the individual or someone in the
individual's home exhibits reckless behavior that may result in imminent danger
to the health or safety of the individual, the attendant, or another
person.
(c) Under the
circumstances described in subsection (b)(3) of this section, the provider must
immediately report the situation to:
(1) DFPS
or other appropriate protective services agency;
(2) local law enforcement; and
(3) the HHSC regional
designee.
(d) Within
seven days after suspending an individual's services, the provider must notify
the HHSC regional designee of the suspension in writing and provide a copy of
the notice to the individual. The written notice of suspension must include:
(1) the date of service suspension;
(2) the reason for the suspension;
(3) the duration of the suspension, if known;
and
(4) an explanation of the
provider's attempts to resolve the problem that caused the suspension, and the
reasons why the problem was not resolved.
(e) A provider must convene an IDT meeting,
as described in §44.502 of this chapter (relating
to Convening an IDT), within seven days after sending the written notice of
suspension, if services are suspended for a reason described in subsection
(a)(6) and (7) or (b)(1) - (3) of this section.
(f) A provider must resume services after a
suspension:
(1) after an individual returns
home, if applicable;
(2) on the
date specified in writing by the HHSC regional designee;
(3) as a result of a recommendation by the
IDT; or
(4) after the provider
receives notification from the HHSC regional designee that the provider must
resume services pending the outcome of a fair hearing.
(g) The provider must send written notice to
the HHSC regional designee that services have resumed within seven days after
the date services resume.
