SECTION 260.87. Reduction of a DBMD Program Service or a CFC Service

(a) HHSC reduces an individual's DBMD Program services or CFC services if, during review of an individual's IPC conducted as described in §260.75 of this subchapter (relating to Utilization Review of an IPC by HHSC), HHSC determines that the amount or a service on the individual's IPC does not meet the requirements described in §260.67(a)(1) and (b) of this subchapter (relating to Development of a Proposed Enrollment IPC).

(b) HHSC sends a written notice with the effective date of the reduction to the program provider that the program provider, upon receipt but no later than 12 calendar days before the effective date of reduction, must send to the individual or LAR, copying the FMSA if applicable.

(c) If an individual or LAR requests a fair hearing before the effective date of the reduction specified in the written notice, the program provider must provide the DBMD Program service or the CFC service at the amount or level approved by HHSC on the prior IPC while the appeal is pending.

Source Note: The provisions of this §260.87 adopted to be effective February 26, 2023, 48 TexReg 896