Section 262.104 - LOC Determination(a) A LIDDA must request an LOC from HHSC for an applicant in accordance with this subsection. (1) The LIDDA must complete an ID/RC Assessment for an applicant that:(A) includes the LOC recommended by a person qualified to perform an initial evaluation of LOC in accordance with Appendix B of the TxHmL Program waiver application approved by CMS; and(B) is signed and dated in accordance with the instructions for completing the ID/RC Assessment.(2) The LIDDA must enter information from the completed ID/RC Assessment in the HHSC data system and electronically submit the information to HHSC.(3) The LIDDA must ensure that the information entered in the HHSC data system and electronically submitted to HHSC in accordance with paragraph (2) of this subsection is identical to the information on the completed ID/RC Assessment.(4) The LIDDA must send a copy of the completed ID/RC Assessment and supporting documentation to HHSC, as requested by HHSC.(b) A LIDDA must request an LOC for an individual from HHSC in accordance with this subsection. (1) No more than 60 calendar days before the expiration date of an individual's ID/RC Assessment, a LIDDA must: (A) complete an ID/RC Assessment that: (i) includes the LOC recommended by a person qualified to perform a reevaluation of LOC in accordance with Appendix B of the TxHmL Program waiver application approved by CMS; and(ii) is signed and dated in accordance with the instructions for completing the ID/RC Assessment; and(B) enter information from the completed ID/RC Assessment in the HHSC data system and electronically submit the information to HHSC.(2) A LIDDA must: (A) ensure that the information entered in the HHSC data system and electronically submitted to HHSC is identical to the information on the completed ID/RC Assessment;(B) within three calendar days after entering the information in the HHSC data system and electronically submitting the information to HHSC, provide the program provider with a copy of the completed ID/RC Assessment; and(C) send a copy of the completed ID/RC Assessment and supporting documentation to HHSC, as requested by HHSC.(3) If the LIDDA enters information from a completed ID/RC Assessment in the HHSC data system and electronically submits the information to HHSC on a date that is more than 180 calendar days after the expiration date of the previous ID/RC Assessment, the LIDDA must:(A) send to HHSC a copy of the completed ID/RC Assessment by a method, as instructed by HHSC, that: (i) includes the recommended LOC; and(ii) is signed and dated in accordance with the instructions for completing the ID/RC Assessment;(B) within three calendar days after sending the completed ID/RC Assessment to HHSC, provide the program provider with a copy of the completed ID/RC Assessment; and(C) submit documentation supporting the ID/RC Assessment to HHSC, as requested by HHSC.(c) Information on an ID/RC Assessment must be supported by current data obtained from standardized evaluations and formal assessments that measure physical, emotional, social, and cognitive factors. A LIDDA must maintain the signed and dated ID/RC Assessment and documentation supporting the recommended LOC in an applicant's or individual's record.(d) When HHSC receives a request for an LOC in accordance with subsection (a) or (b) of this section, HHSC determines if an applicant or individual qualifies for an LOC required by § 262.101(a)(2) of this subchapter (relating to Eligibility Criteria for TxHmL Program Services and CFC Services).(e) HHSC approves an LOC or sends a written notification: (1) to the applicant, individual, or LAR that the applicant or individual is not eligible for TxHmL Program services or CFC services and provides the applicant, individual, or LAR with an opportunity to request a fair hearing in accordance with § 262.601 of this chapter (relating to Fair Hearing);(2) to the LIDDA that the LOC has been denied; and(3) to the program provider using the HHSC data system that the LOC has been denied, if the applicant has selected a program provider or an individual is receiving services from a program provider.(f) An LOC determination is valid for a period of time as described in this subsection. (1) Except as provided in paragraph (2) of this subsection, an LOC determination is valid for a 365-calendar day period starting on the begin date of the ID/RC Assessment.(2) If the begin date of the ID/RC Assessment is March 1 or later in a year before a leap year or January 1 - February 28 of a leap year, the LOC determination is valid for a 366-calendar day period starting on the begin date of the ID/RC Assessment.(g) An ID/RC Assessment submitted in accordance with subsection (b) of this section is effective on the date after the individual's previous ID/RC Assessment expires.26 Tex. Admin. Code § 262.104
Adopted by Texas Register, Volume 48, Number 08, February 24, 2023, TexReg 1066, eff. 3/1/2023