Current through Register Vol. 48, No. 12, March 22, 2024
a) A CCP participant may be allowed access to
CCP adult day services in a service area in which the participant does not
reside (outlying service area) under the following circumstances:
1) the CCU has determined the needs of the
participant may best be served by a provider in an outlying service
area;
2) either:
A) the geographic area in which the
participant resides does not have a provider of the needed services;
or
B) the participant may be
provided services more conveniently/appropriately by a CCP provider in an
outlying service area for the following reasons:
i) the authorized CCP providers in the
participant's service area have reached the maximum capacity and have approval
to not accept new participants and/or is unable to provide a service without
delay and/or interruption;
ii)
optional service components required by the participant are unavailable from
the CCP authorized provider in the participant's service area but are available
from a CCP authorized provider in another service area;
iii) transportation can be more conveniently
arranged to a CCP authorized provider in another service area (adult day
service only); or
iv) special needs
of the participant (e.g., language-appropriate workers) can only be met by a
CCP authorized provider in another service area; and
3) The CCP authorized provider in
the outlying service area agrees to provide the service required without
delay/interruptions to the referred participant.
b) A CCP in-home care participant may be
allowed access to CCP in-home care services in a service area in which the
participant does not reside (outlying service area) upon receipt of written
approval to the CCU from the Department under the following circumstances:
1) The CCU has determined that the special
needs of the participant (e.g., language specific workers) can only be met by a
CCP authorized provider in another service area; and
2) The CCP authorized provider in the
outlying area agrees to provide the service required without
delays/interruptions to the referred participant; and
3) The CCP authorized providers in the
participant's area of residence are unable to meet the special needs of the
participant without delays/interruptions.
c) A request by a participant to receive CCP
services from a provider in an outlying service area is inappropriate if the
participant refuses to accept CCP services deemed appropriate by the CCU in the
participant's service area. In this instance, service will be denied or
terminated as appropriate.
d) If a
provider's contract period is extended in writing by the Department, approval
of the service availability expansion is also extended for the same effective
period.
