SECTION 47.43. Referrals and Authorizations

(a) Referrals in the PHC Program and CAS Program. HHSC makes a referral to a provider to begin pre-initiation activities in the PHC Program and CAS Program.

(1) Methods of referral.

(A) If an individual's needs require that a provider complete pre-initiation activities in less than 14 days after a referral, the case worker makes an expedited referral by oral notice and on HHSC's Authorization for Community Care Services form.

(B) If an individual's needs do not require that a provider complete pre-initiation activities in less than 14 days after a referral, the case worker makes a routine referral on HHSC's Authorization for Community Care Services form.

(2) A provider must accept all referrals.

(3) After a provider receives a referral, the provider must conduct the pre-initiation activities as described in §47.45 of this subchapter (relating to Pre-Initiation Activities).

(b) Authorizations in the PHC Program and CAS Program. After a provider completes the pre-initiation activities, HHSC makes an authorization determination and notifies the provider that services are authorized by sending the provider an HHSC Authorization for Community Care Services form.

(c) Authorizations in the FC Program. HHSC does not make a referral to a provider before authorizing services in the FC Program.

(1) HHSC authorizes services for an individual in the FC Program by sending a provider an HHSC Authorization for Community Care Services form.

(2) A provider must accept all authorizations.

(3) After a provider receives an authorization, the provider must conduct the pre-initiation activities as described in §47.45 of this subchapter.

Source Note: The provisions of this §47.43 adopted to be effective October 1, 2019, 44 TexReg 5138