SECTION 275.65. Suspension of Services

(a) A provider must suspend services to an individual if:

(1) the individual changes residence to outside the state of Texas;

(2) the individual moves to a location where the provider does not provide CMPAS Program services to the individual except as provided for in §44.403 of this chapter (relating to Attendant Services Provided Outside the Provider Contracted Service Delivery Area in the Traditional Services Option);

(3) the individual dies;

(4) the individual is admitted to:

(A) a hospital;

(B) a nursing facility;

(C) a state supported living center;

(D) a state mental health facility; or

(E) an intermediate care facility for individuals with an intellectual disability or related conditions;

(5) the individual requests that services end;

(6) the individual, representative, or someone in the individual's home, as applicable, refuses to:

(A) supervise the attendant;

(B) adhere to the service plan; or

(C) otherwise comply with a requirement of the CMPAS Program;

(7) the individual or representative, as applicable, does not have the ability to:

(A) supervise the attendant;

(B) adhere to the service plan; or

(C) otherwise comply with a requirement of the CMPAS Program;

(8) the individual does not submit a co-payment as required by §44.501 of this chapter (relating to Determining an Individual's Co-payment);

(9) the individual does not provide a practitioner's statement as required by §44.307 of this subchapter (relating to Individual Responsibilities in All CMPAS Service Delivery Options); or

(10) the provider becomes aware that the individual no longer meets eligibility requirements for the CMPAS Program.

(b) The provider may suspend services if:

(1) the individual or someone in the individual's home engages in discrimination in violation of law;

(2) the individual or representative fails to effectively manage attendant care, including problems with:

(A) hiring, selecting, or retaining an attendant for reasons other than workforce issues;

(B) reaching an agreement on the amount of reimbursement the provider will retain in the block grant option; or

(C) completing or submitting required program documentation; or

(3) the individual or someone in the individual's home exhibits reckless behavior that may result in imminent danger to the health or safety of the individual, the attendant, or another person.

(c) Under the circumstances described in subsection (b)(3) of this section, the provider must immediately report the situation to:

(1) DFPS or other appropriate protective services agency;

(2) local law enforcement; and

(3) the HHSC regional designee.

(d) Within seven days after suspending an individual's services, the provider must notify the HHSC regional designee of the suspension in writing and provide a copy of the notice to the individual. The written notice of suspension must include:

(1) the date of service suspension;

(2) the reason for the suspension;

(3) the duration of the suspension, if known; and

(4) an explanation of the provider's attempts to resolve the problem that caused the suspension, and the reasons why the problem was not resolved.

(e) A provider must convene an IDT meeting, as described in §44.502 of this chapter (relating to Convening an IDT), within seven days after sending the written notice of suspension, if services are suspended for a reason described in subsection (a)(6) and (7) or (b)(1) - (3) of this section.

(f) A provider must resume services after a suspension:

(1) after an individual returns home, if applicable;

(2) on the date specified in writing by the HHSC regional designee;

(3) as a result of a recommendation by the IDT; or

(4) after the provider receives notification from the HHSC regional designee that the provider must resume services pending the outcome of a fair hearing.

(g) The provider must send written notice to the HHSC regional designee that services have resumed within seven days after the date services resume.

Source Note: The provisions of this §275.65 adopted to be effective October 1, 2013, 38 TexReg 6606; amended to be effective October 1, 2019, 44 TexReg 5106; transferred effective August 1, 2022, as published in the Texas Register July 8, 2022, 47 TexReg 3983