SECTION 263.705. Suspension of HCS Program Services and CFC Services

(a) HHSC suspends an individual's HCS Program services and CFC services if the individual is under a temporary admission to one of the following facilities:

(1) a hospital;

(2) an ICF/IID;

(3) a nursing facility;

(4) an ALF;

(5) a residential child care facility licensed by HHSC unless it is an agency foster home;

(6) an inpatient chemical dependency treatment facility;

(7) a mental health facility;

(8) a residential facility operated by the Texas Workforce Commission; or

(9) a residential facility operated by the Texas Juvenile Justice Department, a jail, or a prison.

(b) If a service coordinator becomes aware that an individual who is receiving a service from a program provider is under a temporary admission, the service coordinator must, within one business day after becoming aware of the temporary admission, notify the individual's program provider of the temporary admission.

(c) If a program provider becomes aware that an individual is under a temporary admission, the program provider must, within one business day after becoming aware of the temporary admission, enter a suspension of the individual's HCS Program services and CFC services in the HHSC data system.

(d) If a program provider enters a suspension of the individual's HCS Program services and CFC services in the HHSC data system, the program provider must notify the individual's service coordinator of the suspension within one business day after the suspension is entered in the system.

(e) During a temporary admission, an individual is not considered to be residing in the facility.

(f) If an individual's program services are suspended, the service coordinator must, at least every 30 calendar days after the effective date of the suspension, review the individual's circumstances and document in the individual's record:

(1) the reasons for continuing the suspension if the individual is likely to remain in the facility;

(2) whether the individual anticipates resuming participation in the HCS Program after the suspension ends; and

(3) the anticipated date the individual will be discharged from the facility, if the individual is not likely to remain in the facility.

(g) If a service coordinator determines that an individual's suspension should be extended, the service coordinator must request that HHSC extend the suspension by completing and submitting the HHSC Request to Continue Suspension of Waiver Program Services form to HHSC before:

(1) the end of the first 270 calendar days of the temporary admission; or

(2) the end of a 30 calendar-day extension previously granted by HHSC.

(h) HHSC may extend an individual's suspension for 30 calendar days based on a service coordinator's request as described in subsection (g) of this section.

(i) A program provider must remove the entry of a suspension of the individual's HCS Program services and CFC services from the HHSC data system and resume the provision of services to the individual if the program provider becomes aware that the individual is discharged from the facility to which the individual has been under temporary admission.

Source Note: The provisions of this §263.705 adopted to be effective March 1, 2023, 48 TexReg 1080