Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part I - General Health › Chapter 4 - HEAD INJURY PROGRAM › Section 4.7 - Enrollment

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Notification of decision
. The Division will notify an
				applicant or authorized representative in writing of its decision regarding an
				application for enrollment within 16 days after receiving from the provider the
				completed assessment and, if applicable, its decision regarding the
				rehabilitation service plan. If the Division determines that the applicant is
				ineligible, the notice will include the reason for that determination and will
				advise of appeal rights.
(b)
Provider determination that applicant is not eligible for
				enrollment
. If, after assessing the applicant the provider determines
				that the applicant does not satisfy the condition and symptom criteria in
				§
									4.6(a)(2) and (3)
				(relating to assessment), lacks the potential to benefit or the need described
				in §
									4.6(b)(2) and (3)
				or manifests ideation or behavior which would render the applicant unfit to
				participate in HIP under §
									4.6(b)(4), the
				provider shall share its findings with the Division and the applicant or
				authorized representative. The Division will provide the applicant or
				authorized representative the opportunity to rebut the provider's findings, and
				then will make a determination as to whether the applicant is eligible for
				enrollment in HIP.
(c)
Overturning provider determinations
. If the Division
				determines that an applicant is eligible for enrollment in HIP despite the
				provider's determination to the contrary, or that a rehabilitation service plan
				is unacceptable, the Division will direct the provider, or another provider at
				the Division's discretion, to develop a rehabilitation service plan for the
				applicant within 14 days of receiving the Division's decision. The Division
				will act on the revised rehabilitation service plan within 16 days after
				receipt.
(d)
Commencement
				of enrollment
. A client's enrollment begins on the first day that a
				client receives rehabilitation services from a provider after the Division
				issues its written notification granting enrollment in HIP.
(e)
Duration of enrollment
.
				The enrollment period of a client shall be specified in the client's
				rehabilitation service plan. It may not exceed 18 consecutive months, comprised
				of a maximum rehabilitation period of 12 consecutive months followed by a
				maximum transition period of 6 consecutive months. A client's enrollment shall
				end prior to the time designated in the client's rehabilitation service plan
				when one of the following occurs:
(1) The
				Division determines that the continuation of HIP services will not enable the
				client to progress to a higher level of functioning and transition to a less
				restrictive environment.
(2) The
				client fails to cooperate or exhibits unmanageable behavior so that HIP cannot
				provide the appropriate services to meet the client's needs under §
				4.6(b)(4).
(3) The maximum funds
				available for allocation to the client under §
										4.12 (relating to funding limits)
				are exhausted.
(4) The client
				becomes eligible for other services offered as a result of the TBI, which
				services will meet the client's needs or duplicate HIP services so that HIP
				services are rendered unnecessary.