§9.561: Lapsed Level of Care (LOC)

(a) To reinstate authorization for payment for days when services were delivered to an individual without a current LOC determination, an MRA must electronically submit to DADS an MR/RC Assessment for each period of time for which there was a lapsed LOC according to DADS procedures.

(b) The MRA must maintain in the individual's record:

(1) a copy of the individual's most recent MR/RC Assessment approved by DADS; and

(2) an MR/RC Assessment identical to that submitted in accordance with subsection (a) of this section for each period of time for which there was a lapsed LOC.

(c) DADS does not grant a request for reinstatement of an LOC determination:

(1) to establish program eligibility;

(2) to renew an LOC determination;

(3) to obtain an LOC determination for a period of time for which an LOC has been denied;

(4) to revise an LON; or

(5) for a period of time for which an individual's IPC is or was not current.

Comments

Source Note: The provisions of this §9.561 adopted to be effective January 5, 2003, 27 TexReg 12254; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; amended to be effective March 1, 2007, 32 TexReg 544