SECTION 263.107. HHSC Review of LON

(a) HHSC may review a recommended or assigned LON at any time to determine if it is appropriate. If HHSC reviews an LON, documentation supporting the LON must be submitted to HHSC in accordance with HHSC's request. HHSC may modify an LON and recoup or deny payment based on its review.

(b) Before assigning an LON, HHSC reviews documentation supporting the recommended LON if:

(1) an LON is requested that is an increase from the individual's current LON;

(2) an LON 9 is requested in accordance with §263.106(j) of this subchapter (relating to LON Assignment);

(3) an LON is requested in accordance with §263.106(i) of this subchapter; or

(4) an LON is requested in accordance with §263.106(k) and (l) of this subchapter.

(c) Documentation supporting a recommended LON described in subsection (b) of this section must be submitted to HHSC and received by HHSC within seven calendar days after electronically submitting the recommended LON.

(1) Within 21 calendar days after receiving the supporting documentation, HHSC:

(A) requests additional documentation;

(B) electronically approves the recommended LON; or

(C) notifies the program provider and the service coordinator in the HHSC data system that the recommended LON has been denied.

(2) HHSC reviews any additional documentation submitted in accordance with HHSC's request and:

(A) electronically approves the recommended LON; or

(B) notifies the program provider and the service coordinator in the HHSC data system that the recommended LON has been denied.

Source Note: The provisions of this §263.107 adopted to be effective March 1, 2023, 48 TexReg 1080