Current through Reg. 50, No. 13; March 28, 2025
(a) A
designated resident's IHSS are suspended if:
(1) the designated resident is admitted to an
acute care hospital for fewer than 30 days and is returning to the same
NF;
(2) the designated resident
loses Medicaid eligibility;
(3) the
designated resident or LAR requests that IHSS be suspended when transferring
from one NF to another NF without an intervening hospital stay; or
(4) the designated resident has a change in
health condition that temporarily prohibits participation in IHSS.
(b) HHSC may terminate one or more
of a designated resident's IHSS if:
(1) the
designated resident no longer meets the eligibility criteria specified in
§
368.202 of this chapter (relating
to Eligibility Criteria);
(2) the
designated resident loses Medicaid eligibility for more than 90 days;
(3) the designated resident or LAR requests
that IHSS be terminated; or
(4) the
designated resident exhibits a persistent and prolonged pattern of failing to
comply with the requirements described in subsection (c) of this
section.
(c) A designated
resident or LAR must comply with the following participation requirements in
the delivery of IHSS:
(1) participating on the
SPT to:
(A) develop an initial plan of care as
described in §
368.204 of this chapter (relating
to Process for Service Initiation); and
(B) renew and revise the plan of care as
described in §
368.302 of this chapter (relating
to Renewal and Revision of a Plan of Care);
(2) reviewing, agreeing to, signing, and
dating a plan of care in accordance with §
368.301 of this chapter (relating
to Plan of Care);
(3) cooperating
with the service provider agency and habilitation coordinator in the delivery
of IHSS listed on the designated resident's plan of care;
(4) cooperating with the service provider
agency and habilitation coordinator to ensure progress toward achieving the
outcomes, goals, and objectives described in the HSP and implementation
plan;
(5) not engaging in illegal
behavior in the presence of the habilitation coordinator, individual service
provider, or a staff member, volunteer, or controlling person of the service
provider agency;
(6) not repeatedly
acting in a manner that is threatening to the health and safety of the
individual service provider or a staff member, volunteer, or controlling person
of the service provider agency;
(7)
not exhibiting behavior that places the health and safety of the individual
service provider or a staff member, volunteer, or controlling person of the
service provider agency in immediate jeopardy; and
(8) not knowingly initiating or participating
in fraudulent health care practices.
(d) The service provider agency must develop
a written policy that describes the process the service provider agency will
follow to address challenges related to the designated resident's or LAR's
participation in the program.
(e)
When requesting to terminate a designated resident's IHSS for the reason
described in subsection (b)(4) of this section, the service provider agency and
LIDDA must provide documentation demonstrating the service provider agency and
LIDDA have followed the written policy required by subsection (d) of this
section and made every attempt to:
(1) engage
the designated resident or LAR in meeting the participation requirements;
and
(2) ensure the designated
resident's or LAR's inability to meet the participation requirements is not due
to a failure of the designated resident's SPT.
(f) The LIDDA and service provider agency
must notify each other immediately if IHSS are suspended or
terminated.
