§ 4.7. Enrollment.
(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.
(f) Notification of discharge from HIP. The Division will notify a client or authorized representative in writing of its decision to terminate the client’s participation in HIP. The notice will include the reason for the decision and will advise of appeal rights.
(g) Grandfather clause. Clients who are receiving rehabilitation services as of August 27, 2001 are eligible for the maximum enrollment period, beginning on August 27, 2001. Clients who are receiving only case management services as of August 27, 2001 are eligible for the maximum transition period.
Cross References This section cited in 28 Pa. Code § 4.15 (relating to administrative review).
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