(a) A designated resident's IHSS are suspended if:

(1) the designated resident is admitted to an acute care hospital for fewer than 30 days and is returning to the same NF;

(2) the designated resident loses Medicaid eligibility;

(3) the designated resident or LAR requests that IHSS be suspended when transferring from one NF to another NF without an intervening hospital stay; or

(4) the designated resident has a change in health condition that temporarily prohibits participation in IHSS.

(b) HHSC may terminate one or more of a designated resident's IHSS if:

(1) the designated resident no longer meets the eligibility criteria specified in §368.202 of this chapter (relating to Eligibility Criteria);

(2) the designated resident loses Medicaid eligibility for more than 90 days;

(3) the designated resident or LAR requests that IHSS be terminated; or

(4) the designated resident exhibits a persistent and prolonged pattern of failing to comply with the requirements described in subsection (c) of this section.

(c) A designated resident or LAR must comply with the following participation requirements in the delivery of IHSS:

(1) participating on the SPT to: (A) develop an initial plan of care as described in §368.204 of this chapter (relating to Process for Service Initiation); and (B) renew and revise the plan of care as described in §368.302 of this chapter (relating to Renewal and Revision of a Plan of Care);

(2) reviewing, agreeing to, signing, and dating a plan of care in accordance with §368.301 of this chapter (relating to Plan of Care);

(3) cooperating with the service provider agency and habilitation coordinator in the delivery of IHSS listed on the designated resident's plan of care;

(4) cooperating with the service provider agency and habilitation coordinator to ensure progress toward achieving the outcomes, goals, and objectives described in the HSP and implementation plan;

(5) not engaging in illegal behavior in the presence of the habilitation coordinator, individual service provider, or a staff member, volunteer, or controlling person of the service provider agency;

(6) not repeatedly acting in a manner that is threatening to the health and safety of the individual service provider or a staff member, volunteer, or controlling person of the service provider agency;

(7) not exhibiting behavior that places the health and safety of the individual service provider or a staff member, volunteer, or controlling person of the service provider agency in immediate jeopardy; and

(8) not knowingly initiating or participating in fraudulent health care practices.

(d) The service provider agency must develop a written policy that describes the process the service provider agency will follow to address challenges related to the designated resident's or LAR's participation in the program.

(e) When requesting to terminate a designated resident's IHSS for the reason described in subsection (b)(4) of this section, the service provider agency and LIDDA must provide documentation demonstrating the service provider agency and LIDDA have followed the written policy required by subsection (d) of this section and made every attempt to:

(1) engage the designated resident or LAR in meeting the participation requirements; and

(2) ensure the designated resident's or LAR's inability to meet the participation requirements is not due to a failure of the designated resident's SPT.

(f) The LIDDA and service provider agency must notify each other immediately if IHSS are suspended or terminated.

Source Note: The provisions of this §368.601 adopted to be effective September 1, 2021, 46 TexReg 4151