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.
