SECTION 261.248. Lapsed Level of Care

(a) The department will not pay a program provider for ICF/MR Program services provided during a period of time in which the individual's LOC lapsed unless the program provider requests and is granted a reinstatement of the LOC in accordance with this section.

(b) To request reinstatement of an LOC, a program provider must electronically transmit to the department an MR/RC Assessment indicating:

(1) a code "E" in the "Purpose" section; and

(2) the beginning and ending dates of the period of time for which the individual's LOC lapsed.

(c) The department will not grant a request for reinstatement of an LOC:

(1) if the individual does not have a current LOC;

(2) to establish program eligibility;

(3) to renew an LOC;

(4) to obtain an LOC for a period of time for which an LOC has been denied;

(5) to revise an LON; or

(6) for a period of time during which the individual is not eligible for Medicaid.

(d) If the department grants a reinstatement, the reinstatement will be for a period of not more than 180 days prior to the date of electronic transmission of the MR/RC Assessment described in subsection (b) of this section.

(e) A program provider must maintain a paper copy of the completed MR/RC Assessment with all necessary signatures in the individual's record. The signed MR/RC Assessment must contain information identical to the information on the electronically transmitted MR/RC Assessment.

Source Note: The provisions of this §261.248 adopted to be effective September 1, 2001, 26 TexReg 5384; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; transferred effective October 1, 2020, as published in the Texas Register August 28, 2020, 45 TexReg 6127