(a) Except as described in §260.81 of this subchapter (relating to Personal Leave for Individual Receiving Licensed Assisted Living or Licensed Home Health Assisted Living) or if the individual receives out-of-home respite, HHSC suspends an individual's DBMD Program services and CFC services if the individual:
  (1) is admitted to one of the following facilities:
    (A) an ICF/IID;
    (B) a nursing facility;
    (C) an ALF that does not provide licensed assisted living in the DBMD Program;
    (D) a residential child-care facility unless it is an agency foster home;
    (E) a hospital;
    (F) a mental health facility;
    (G) an inpatient chemical dependency treatment facility;
    (H) a facility operated by the Texas Workforce Commission;
    (I) a residential facility operated by the Texas Juvenile Justice Department; or
    (J) a jail or prison; or
  (2) leaves the state.
(b) HHSC suspends services during the time that an individual is admitted to the facility or that the individual spends outside the state but is limited to 180 consecutive calendar days unless HHSC approves an extension in accordance with subsection (g) of this section.
(c) Within two business days after a program provider becomes aware that an individual has been admitted to a facility or has left the state as described in subsection (a) of this section, the program provider must submit a written request that HHSC suspend the individual's services.
(d) If HHSC suspends an individual's services, HHSC sends a written notice to the program provider that includes the effective date of the suspension and the individual's right to request a fair hearing as described in §260.111 of this subchapter (relating to Individual's Right to a Fair Hearing).
(e) Within two business days after a program provider receives a notice described in subsection (d) of this section, the program provider must send the notice to the individual or LAR and, if applicable, the FMSA.
(f) If an individual or LAR requests a fair hearing, the program provider is not required to provide services to the individual while the appeal is pending.
(g) HHSC may approve one or more 30-calendar-day extensions of a suspension if extenuating circumstances exist and the individual anticipates resuming participation in the DBMD Program during the extension.
(h) To request an extension described in subsection (g) of this section, a program provider must:
  (1) submit the request, in writing, to HHSC; and
  (2) include documentation of the extenuating circumstances.
(i) During the time HHSC suspends an individual's services, as described in subsection (b) of this section, the individual is not considered to be residing in a facility listed in subsection (a)(1)of this section or out of the state.

Source Note: The provisions of this §260.85 adopted to be effective February 26, 2023, 48 TexReg 896