Current through Reg. 49, No. 38; September 20, 2024
(a) Required
notification. A provider must provide written notification to the case manager
if:
(1) an individual complains of
pain;
(2) an individual requests
that services end;
(3) an
individual is temporarily admitted to an institution;
(4) an individual abuses the service by
activating:
(A) four false alarms within a
six-month period that result in a response by the fire department, police,
sheriff, or ambulance; or
(B) 20
false alarms of any kind within a six-month period;
(5) a provider makes three unsuccessful
attempts for three consecutive months to contact an individual for a monthly
system check;
(6) an individual or
someone in an individual's home engages in illegal discrimination against a
provider staff or DADS employee; or
(7) an individual or someone in an
individual's home exhibits reckless behavior, which may result in imminent
danger to the health and safety of the individual, provider staff, or another
person. If this occurs, the provider must immediately notify:
(A) the Department of Family and Protective
Services or other appropriate protective services agency;
(B) local law enforcement, if appropriate;
and
(C) the case manager.
(b) Method and due
date. A provider must notify the case manager orally or by fax no later than
one working day after becoming aware of a circumstance detailed in subsection
(a) of this section. If the provider's first notification is oral, the provider
must send written notification to the case manager within five working days of
the oral notification. Written notification must include:
(1) the date the provider became aware of a
circumstance detailed in subsection (a) of this section; and
(2) the reason for the written
notification.
(c)
Allowed payment. A provider may continue to receive payment when the provider
is unable to conduct a monthly system check for the reasons outlined in
subsection (a) of this section for three consecutive months. In order to
receive payment, the provider must:
(1) comply
with the requirements of §52.407(b) of this chapter (relating to System
Checks); and
(2) convene an IDT
meeting, as described in §52.413 of this chapter (relating to
Interdisciplinary Team) to address subsection (a)(5) and (6) of this
section.
