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TITLE 40SOCIAL SERVICES AND ASSISTANCE
PART 1DEPARTMENT OF AGING AND DISABILITY SERVICES
CHAPTER 9INTELLECTUAL DISABILITY SERVICES--MEDICAID STATE OPERATING AGENCY RESPONSIBILITIES
SUBCHAPTER DHOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM
RULE §9.162Lapsed LOC

(a) DADS does not pay the program provider for HCS Program services provided during a period of time in which the individual's LOC has lapsed unless a reinstatement of the LOC determination is requested and granted in accordance with this section. DADS does not grant a request for reinstatement of an LOC determination to:

  (1) establish program eligibility;

  (2) renew an LOC determination;

  (3) obtain an LOC determination for a period of time for which an LOC has been denied;

  (4) revise an LON; or

  (5) obtain an LON determination for a period of time for which an individual's IPC is not current.

(b) The program provider must request reinstatement of an LOC determination within 180 calendar days after the end of any month during which services were provided to the individual while the individual's LOC was lapsed.

(c) The program provider must request reinstatement of an LOC determination in accordance with this subsection.

  (1) The program provider must electronically transmit to DADS a completed MR/RC Assessment that is signed and dated by the program provider that includes:

    (A) a code "E" in the "Purpose" section; and

    (B) the beginning and ending dates of the period of time for which the individual's LOC lapsed.

  (2) The program provider must ensure that the electronically transmitted MR/RC Assessment contains information that is identical to the information on the signed and dated MR/RC Assessment.

  (3) The program provider must, within three calendar days after submission, provide the service coordinator with a paper copy of the signed and dated MR/RC Assessment.

(d) Within seven calendar days after the MR/RC Assessment is electronically transmitted by the program provider, the service coordinator must review the MR/RC Assessment in CARE and:

  (1) enter the service coordinator's name and date in CARE;

  (2) enter in CARE whether the service coordinator agrees or disagrees with the MR/RC Assessment; and

  (3) if the service coordinator disagrees with the MR/RC Assessment, notify the individual, LAR, DADS, and the program provider of the service coordinator's disagreement in accordance with DADS instructions.

(e) The service coordinator's agreement or disagreement is considered in DADS' review of an MR/RC Assessment transmitted in accordance with subsection (c) of this section.

(f) DADS notifies the program provider of its decision to grant or deny the request for reinstatement of an LOC determination within 45 calendar days after DADS' receipt of the program provider's request.


Source Note: The provisions of this §9.162 adopted to be effective June 1, 2010, 35 TexReg 4441

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