Current through Reg. 50, No. 13; March 28, 2025
(a) Required suspensions. A provider must
suspend services if:
(1) an individual
temporarily or permanently leaves the providerTs contracted service delivery
area during a time when the individual would routinely receive services and the
individual does not request the provision of services outside the provider's
contracted service delivery area;
(2) the provider declines the request of the
individual for the provision of services outside of the provider's contracted
service delivery area and the individual leaves the service delivery
area;
(3) the individual moves to a
location where services cannot be provided under the PHC Program, CAS Program,
or FC Program;
(5) the individual is
admitted to an institution, which is a:
(C) state supported
living center;
(E) intermediate care
facility serving individuals with an intellectual disability or related
conditions; or
(F) correctional
facility.
(6) the
individual requests that services end;
(7) for individuals receiving services in the
PHC Program or CAS Program, HHSC denies the individual's Medicaid eligibility;
or
(8) the individual or someone in
the individual's home exhibits reckless behavior, which may result in imminent
danger to the health and safety of the individual, the attendant, or another
person, in which case the provider must make an immediate referral to:
(A) DFPS or other appropriate protective
services agency;
(B) local law
enforcement, if appropriate; and
(C) the individual's case worker.
(b) Optional
suspensions. The provider may suspend services if:
(1) the individual or someone in the
individual's home engages in discrimination against a provider or HHSC employee
in violation of applicable law; or
(2) the individual refuses services for more
than 30 consecutive days.
(c) Notification of service suspension. A
provider must notify the case worker of any suspension by the first working day
after the provider suspends services. The notice must include:
(1) the date of service suspension;
(2) the reason for the suspension;
(3) the duration of the suspension, if known;
and
(4) for a suspension under
subsection (a)(8) or (b) of this section, a written explanation of the
circumstances surrounding the suspension.
(d) Interdisciplinary Team (IDT) meeting. A
provider must convene an IDT meeting, as described in § 47.49 of this
chapter (relating to Interdisciplinary Team), if services are suspended under
subsection (a)(8) or (b) of this section.
(e) Resuming services after suspension. This
subsection does not apply to subsection (a)(8) or (b)(1) of this section.
(1) A provider must resume services after
suspension on the earliest of the following:
(A) after the individual's return home, or
the date the provider becomes aware of the individual's return home, if
applicable;
(B) on the date
specified in writing by the case worker;
(C) as a result of a recommendation by the
IDT; or
(D) upon the provider's
receipt of notification from the case worker that the provider must resume
services pending the outcome of an appeal.
(2) A provider must notify the case worker of
the date services resume within seven days after that date.
