SECTION 259.81. Revised IPC and Revised IPP for Services Provided to Prevent Immediate Jeopardy

(a) If a DSA provides nursing, respite, an adaptive aid, dental treatment, or CFC PAS/HAB to an individual that is not included on the individual's IPC in accordance with §259.359(b) of this chapter (relating to DSA: Service Delivery), the DSA, must, no later than seven calendar days after providing the service, submit to the CMA:

(1) documentation describing the circumstances necessitating the provision of the new service or the increase in the amount of the existing service; and

(2) documentation by an RN of the RN's determination that the service was necessary to prevent the individual's health and safety from being placed in immediate jeopardy as required by §259.359(b) of this chapter.

(b) No later than seven calendar days after the date a CMA receives the documentation described in subsection (a) of this section, the CMA must:

(1) based on the documentation, develop a proposed revised IPC and a revised IPP; and

(2) submit the proposed revised IPC, revised IPP, and documentation to HHSC.

(c) HHSC authorizes a proposed revised IPC submitted in accordance with subsection (b) of this section only if, after reviewing the documentation described in subsection (a) of this section, it determines that the service was necessary to prevent an individual's health and safety from being placed in immediate jeopardy. At HHSC's request, a CMA must submit additional documentation supporting the proposed revised IPC to HHSC within 10 calendar days after HHSC's request.

(d) If HHSC does not authorize a proposed revised IPC submitted in accordance with subsection (b) of this section, HHSC does not pay the DSA for the service provided.

Source Note: The provisions of this §259.81 adopted to be effective January 30, 2023, 48 TexReg 362