Current through Register Vol. 48, No. 38, September 20, 2024
a)
Any participant whose CCP services are being changed in the following manner
shall be advised of the change by written notice: change of service type;
reduced amount of service; increased amount of services; or termination.
1) The written notice shall be sent to a
participant/authorized representative by mail, email (if consented to), or
given personally.
2) The notice
shall clearly state the reason for the action being taken.
3) The participant/authorized representative
shall be notified of the action being taken no later than 15 calendar days
after the date of assessment or redetermination and the action shall be
effective no sooner than 15 calendar days after the date of the notice if the
action is adverse to the participant. This time frame does not apply to
termination as a result of the non-cooperative act specified in Section
240.355.
4) In instances involving
an automatic, non-discretionary change in eligibility, rates or benefits
required by federal or State statute or regulation, the participant/authorized
representative will be notified of the action being taken at least 15 calendar
days prior to the implementation by the CCU of the change affecting the
participant. The action will be effective no sooner than 15 calendar days after
the date of notice if the action is adverse to the participant.
5) In the event of a death, the termination
shall be effective the date of the participant's death. The form shall be dated
and mailed/hand-delivered upon the Department or the CCU being informed of the
death.
b) CCP services
may be changed, reduced or terminated at the request of the
participant/authorized representative and do not require the 15-calendar day
notice period under the following circumstances:
1) the participant/authorized representative
provides the CCU with a signed statement that the change, reduction or
termination is at their request;
2)
the CCU, participant/authorized representative and provider mutually agree to
the initiation of the change, reduction or termination on the agreed upon date
(which may be less than the required 15 calendar days after the date of the
notice to the participant/authorized representative);
3) a written notice is provided to the
participant/authorized representative prior to the initiation of the change or
reduction. The notice shall indicate the agreed upon effective date;
and
4) the CCU has documented all
of the requirements of this subsection (b) and placed the participant's
statement in the case record.
c) When an assessment or reassessment for
services requires an increase, or no change in service, the
participant/authorized representative and the provider shall be notified in
writing. The notice shall be mailed or emailed within 15 calendar days after
the date of the assessment or reassessment.
