1. (a) Required notification. A provider must provide written notification to the case manager if:

   1. (1) an individual complains of pain;
   2. (2) an individual requests that services end;
   3. (3) an individual is temporarily admitted to an institution;

   4. (4) an individual abuses the service by activating:

      1. (A) four false alarms within a six-month period that result in a response by the fire department, police, sheriff, or ambulance; or
      2. (B) 20 false alarms of any kind within a six-month period;
   5. (5) a provider makes three unsuccessful attempts for three consecutive months to contact an individual for a monthly system check;
   6. (6) an individual or someone in an individual's home engages in illegal discrimination against a provider staff or DADS employee; or

   7. (7) an individual or someone in an individual's home exhibits reckless behavior, which may result in imminent danger to the health and safety of the individual, provider staff, or another person. If this occurs, the provider must immediately notify:

      1. (A) the Department of Family and Protective Services or other appropriate protective services agency;
      2. (B) local law enforcement, if appropriate; and
      3. (C) the case manager.

2. (b) Method and due date. A provider must notify the case manager orally or by fax no later than one working day after becoming aware of a circumstance detailed in subsection (a) of this section. If the provider's first notification is oral, the provider must send written notification to the case manager within five working days of the oral notification. Written notification must include:

   1. (1) the date the provider became aware of a circumstance detailed in subsection (a) of this section; and
   2. (2) the reason for the written notification.

3. (c) Allowed payment. A provider may continue to receive payment when the provider is unable to conduct a monthly system check for the reasons outlined in subsection (a) of this section for three consecutive months. In order to receive payment, the provider must:

   1. (1) comply with the requirements of §52.407(b) of this chapter (relating to System Checks); and
   2. (2) convene an IDT meeting, as described in §52.413 of this chapter (relating to Interdisciplinary Team) to address subsection (a)(5) and (6) of this section.

Source Note:The provisions of this §279.97 adopted to be effective March 1, 2006, 31 TexReg 1307; transferred effective July 1, 2021, as published in the June 11, 2021 issue of the Texas Register, 46 TexReg 3617.