SECTION 259.75. Annual Review by HHSC of Whether an Individual Meets LOC VIII Criteria

(a) A DSA must:

(1) ensure that, no more than 120 calendar days before the expiration of an individual's IPC period, an RN must, in accordance with the Community Living Assistance and Support Services Provider Manual:

(A) complete with the individual and LAR or actively involved person:

(i) the HHSC Related Conditions Eligibility Screening Instrument form; and

(ii) the ID/RC Assessment; and

(B) meet in person with the individual and LAR or actively involved person at a time and place convenient to the individual to complete a nursing assessment of the individual using the HHSC CLASS/DBMD Nursing Assessment form;

(2) submit to HHSC at least 60 calendar days before the expiration of an individual's IPC period:

(A) the results of the most current adaptive behavior screening assessment;

(B) the completed HHSC Related Conditions Eligibility Screening Instrument form; and

(C) the completed ID/RC Assessment; and

(3) send the completed HHSC CLASS/DBMD Nursing Assessment form to the CMA.

(b) Information on the ID/RC Assessment must be supported by current data obtained from standardized evaluations and formal assessments of the individual.

(c) HHSC reviews the documentation submitted by a DSA in accordance with subsection (a)(2) of this section to determine whether an individual meets the LOC VIII criteria required by §259.51(a)(2) of this subchapter (relating to Eligibility Criteria for CLASS Program Services and CFC Services). HHSC notifies the DSA of its determination in accordance with §259.63 of this subchapter (relating to Determination by HHSC of Whether an Individual Meets LOC VIII Criteria).

(d) A DSA must ensure an appropriate professional completes an adaptive behavior screening assessment in accordance with the assessment instructions:

(1) at least every five years after completion of the most current assessment; and

(2) if significant changes that may be permanent occur in the individual's functioning.

(e) If an individual's LOC VIII expires before HHSC determines whether the individual meets the LOC VIII criteria, as described in subsection (c) of this section:

(1) the CMA and the DSA must continue to provide services to the individual until HHSC authorizes the proposed renewal IPC to ensure continuity of care and prevent the individual's health and welfare from being jeopardized; and

(2) if HHSC determines that the individual meets the LOC VIII criteria, and the individual is otherwise eligible for the CLASS Program, HHSC will reimburse the CMA and DSA for services provided, as required by paragraph (1) of this subsection, for a period of not more than 180 calendar days before the date HHSC receives the documentation described in subsection (a)(2) of this section.

Source Note: The provisions of this §259.75 adopted to be effective January 30, 2023, 48 TexReg 362