Current through Register Vol. 48, No. 12, March 22, 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; or termination.
1) The written
notice shall be sent to a participant/authorized representative by certified
mail, return receipt requested, or given personally, in which case the
participant/authorized representative is to provide a signed and dated receipt
for the notice, except for instances involving automatic, non-discretionary
changes in eligibility, rates or benefits required by federal or State statute
or regulation. In these instances, regular mail is acceptable. Also, in the
event of the death of a participant, regular mail is acceptable for
notification purposes.
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 (see Section
240.160 for a
definition of adverse action). This time frame does not apply to termination as
a result of the non-cooperative act specified in Section
240.350(b)(1).
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 his/her 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 (either by certified mail, return receipt
requested, or handed to the participant/authorized representative, with a
receipt provided by the participant/authorized representative for the notice)
prior to the initiation of the change or reduction. The notice shall indicate
the agreed upon effective date;
4)
rights of appeal shall not be denied to a participant/authorized representative
who has requested a change or reduction in CCP services; and
5) 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 shall be notified in
writing. The notice shall be mailed by regular mail to the
participant/authorized representative within 15 calendar days after the date of
the assessment or reassessment.
d)
A copy of any notification mailed/hand-delivered to a participant/authorized
representative shall be mailed/provided to the appropriate provider on the same
date it is mailed/hand-delivered to the participant/authorized
representative.