SECTION 259.305. DSA Services Outside the Catchment Area

(a) If a CMA is notified by the DSA in accordance with §259.359(g)(2) of this chapter (relating to DSA: Service Delivery) that an individual is receiving transportation as a habilitation activity, out-of-home respite in a camp, adaptive aids, nursing, or CFC PAS/HAB outside the catchment area in which the individual resides, the CMA must:

(1) provide an oral explanation to the individual or LAR, on or before the 35th day of the period services have been provided outside the catchment area, that:

(A) the individual must do one of the following before the 61st day of the period services have been provided outside the catchment area to ensure the continued provision of transportation as a habilitation activity, out-of-home respite in a camp, adaptive aids, nursing, or CFC PAS/HAB:

(i) transfer to a DSA contract for the catchment area in which the individual is receiving transportation as a habilitation activity, out-of-home respite in a camp, adaptive aids, nursing, or CFC PAS/HAB; or

(ii) return to the catchment area in which the individual resides; and

(B) if the individual receives transportation as a habilitation activity, out-of-home respite in a camp, adaptive aids, nursing, or CFC PAS/HAB outside the catchment area during a period of 60 consecutive days, the individual must return to the catchment area in which the individual resides and receive services in that catchment area before the DSA may accept another request from the individual or LAR that the DSA provide transportation as a habilitation activity, out-of-home respite in a camp, adaptive aids, nursing, or CFC PAS/HAB outside the catchment area;

(2) document that the CMA provided the oral explanation required by paragraph (1) of this subsection; and

(3) if the individual or LAR expresses a desire for the individual to transfer to a DSA contract for the catchment area in which the individual is receiving transportation as a habilitation activity, out-of-home respite in a camp, adaptive aids, nursing, or CFC PAS/HAB:

(A) give the individual and LAR or actively involved person a written list of CMAs and DSAs serving the catchment area in which the individual is receiving transportation as a habilitation activity, out-of-home respite in a camp, adaptive aids, nursing, or CFC PAS/HAB;

(B) have the individual or LAR select a CMA and DSA by completing an HHSC Selection Determination form, as described in the Community Living Assistance and Support Services Provider Manual; and

(C) coordinate the individual's transfer in accordance with §259.151 of this chapter (relating to Coordination of Transfers).

(b) If an individual requests that the case manager convene a meeting of the service planning team to discuss the DSA's reasons for declining a request to allow services to be provided outside the catchment area, as described in §259.359(h)(1)(B) of this chapter, the case manager must:

(1) convene a meeting to review the reasons the DSA declined the request to allow services outside the catchment area;

(2) facilitate a discussion between the individual or LAR and the DSA during the meeting regarding the reasons the DSA declined the request; and

(3) document the results of the meeting.

Source Note: The provisions of this §259.305 adopted to be effective January 30, 2023, 48 TexReg 362