SECTION 260.89. Termination of DBMD Program Services and CFC Services With Advance Notice Due to Ineligibility or Leave from the State

(a) Except as provided in subsection (c) of this section, HHSC terminates:

(1) an individual's DBMD Program services if the individual does not meet the eligibility criteria described in §260.51(a) of this subchapter (relating to Eligibility Criteria for DBMD Program Services and CFC Services);

(2) an individual's CFC services if the individual does not meet the eligibility criteria described in §260.51(b) or (c) of this subchapter; and

(3) an individual's DBMD Program services and CFC services if:

(A) the individual is admitted to one of the facilities listed in§260.85(a) of this subchapter (relating to Suspension of DBMD Program Services and CFC Services) for more than 180 consecutive calendar days or beyond an extension of the individual's suspension that HHSC approved in accordance with §260.85(g) of this subchapter; or

(B) the individual leaves the State of Texas for more than 180 consecutive calendar days and HHSC has not extended the individual's suspension in accordance with §260.85(g) of this subchapter.

(b) Within two business days after becoming aware that a situation described in subsection (a) of this section exists, the program provider must request, in writing, that HHSC terminate DBMD Program services and CFC services, or DBMD Program services, or CFC services for the individual.

(1) The program provider must include supporting documentation with the request to terminate services.

(2) If the reason for the requested termination of services is that the program provider is not willing to provide DBMD Program services or CFC services to the individual, the program provider must document the following in the individual's record:

(A) the specific reasons the program provider is not willing to provide DBMD Program services or CFC services to the individual; and

(B) efforts made to locate another DBMD program provider willing to provide DBMD Program services and CFC services to the individual and the results of those efforts.

(c) HHSC may, under extenuating circumstances, temporarily continue DBMD Program services and CFC services if an individual is determined by HHSC not to be financially eligible for Medicaid.

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

(e) If the individual or LAR requests a fair hearing before the effective date of the termination specified in the written notice, the program provider must continue to provide services to the individual while the appeal is pending.

Source Note: The provisions of this §260.89 adopted to be effective February 26, 2023, 48 TexReg 896