Current through Register 1531, September 27, 2024
(1) An ASAP may
suspend a Consumer's Home Care Program Services if the Consumer is temporarily
unavailable to receive such services in his or her home for up to 90 calendar
days. The ASAP may extend the Suspension of Home Care Services to a Consumer
beyond such 90 day period for reasonable cause and shall document such cause in
the Consumer's record. The ASAP shall reassess the Consumer's need for services
when the Consumer becomes available to receive services in his or her
home.
(2) If it appears during such
Suspension period that the Consumer's unavailability will last longer than 90
calendar days and reasonable cause for extension of the suspension is not
present, the ASAP shall forward a Notice of Action to the Consumer to terminate
Home Care Program Services.
(3) If
the Consumer no longer meets the eligibility criteria for the Home Care Program
set forth in
651 CMR 3.04(2), (3),
(4), or (5) the ASAP shall forward a Notice
of Action to the Consumer to terminate Home Care Program Services.
(4)
Notice of Action
Requirements.
(a) For non-Frail
Elder Waiver Consumers, the Notice of Action shall include the date on which
services were suspended; the reason for the Termination; and a statement that
the Consumer's Home Care Services shall be Terminated on the
15th calendar day after the Consumer receives such
Notice of Action unless the Consumer takes either of the following actions
prior to such date:
1. The Consumer notifies
the ASAP within 14 calendar days after receiving such Notice of Action that he
or she is available to receive Home Care Services in his or her home. The
Consumer's need for Home Care Program Services shall be reassessed as soon as
possible after the ASAP is notified that the Consumer is available to receive
such services; or
2. If the
Consumer requests a Review of such Termination of Home Care Services which is
received by the ASAP on or before the 14th calendar
day following the Consumer's receipt of such Notice of Action. If the Consumer
files a timely request for Review, the ASAP shall continue the Suspension or
continue the provision of Home Care Program Services during the Review and
Appeal period. If the Consumer fails to timely notify the ASAP or request a
Review of the Notice of Action Terminating Services as set forth in 651 CMR
3.07, the Consumer's request for reinstatement shall be treated as a new
application for Services.
(b) For Frail Elder Waiver Consumers, the
Notice of Action shall include the date on which a Frail Elder Waiver
Consumer's services were suspended; the reason for the termination; and a
statement that the Consumer's Home Care Services shall be Terminated on the
31st calendar day after the Consumer receives such
Notice of Action unless the Consumer takes either of the following actions
prior to such date:
1. The Consumer notifies
the ASAP within 30 calendar days after receiving such Notice of Action that he
or she is available to receive Home Care Services in his or her home. The
Consumer's need for Home Care Program Services shall be reassessed as soon as
possible after the ASAP is notified that the Consumer is available to receive
such services; or
2. If the
Consumer requests a Review of such Termination of Home Care Services which is
received by the ASAP on or before the 30th calendar
day following the Consumer's receipt of such Notice of Action. If the Consumer
files a timely request for Review, the ASAP shall continue the Suspension or
continue the provision of Home Care Program Services during the Review and
Appeal period. If the Consumer fails to timely notify the ASAP or request a
Review of the Notice of Action Terminating Services as set forth in 651 CMR
3.07, the Consumer's request for reinstatement shall be treated as a new
application for Services.
(5)
Right to Appeal.
(a) An Applicant/Consumer shall be informed
in writing of his or her right to request a Review, where the ASAP makes a
decision to deny, terminate, or reduce Home Care Program Service.
(b) An ASAP shall inform the Consumer when
there has been a change in the source of funding of the Consumer's services but
the type of and amount of such services remain unchanged. The Consumer shall
not have the right to Appeal a decision by the ASAP where there is or has been
a change in the source of funding of his or her services.
(c) The Applicant or Consumer shall also be
informed in writing of his or her right to Appeal a Review decision to Elder
Affairs' Hearings Officer as specified in
651 CMR
1.07: Initiation of Appeal of a
Review Decision. The Appeal shall be conducted in accordance with
801 CMR 1.00: Standard
Adjudicatory Rules of Practice and Procedure and
651 CMR 1.00:
Adjudicatory Rules of Practice and Procedures.
