Current through Reg. 49, No. 38; September 20, 2024
(a) HHSC terminates
an individual's CLASS Program services and CFC services if:
(1) the individual does not meet the
eligibility criteria described in §
259.51 of this chapter (relating
to Eligibility Criteria for CLASS Program Services and CFC Services);
(2) the individual is admitted to
one of the facilities listed in §
259.157(a)(1) of
this subchapter (relating to Suspension of CLASS Program Services or CFC
Services) for more than 180 consecutive calendar days or beyond an extension of
the individual's suspension that HHSC approved in accordance with §
259.157(f) of
this subchapter;
(3) the individual
leaves the state for more than 180 consecutive calendar days and HHSC has not
extended the individual's suspension in accordance with §
259.157(f) of
this subchapter; or
(4) the DSAs
serving the catchment area in which the individual resides are not willing to
provide CLASS Program services or CFC services to the individual because they
have determined that they cannot ensure the individual's health and safety.
(b) No later than two
business days after a CMA becomes aware that a situation described in
subsection (a) of this section exists, the CMA must:
(1) send a written request to HHSC to
terminate CLASS Program services and CFC services for the individual;
(2) send written supporting
documentation with the request; and
(3) if the reason for the requested
termination of services is for the reason described in subsection (a)(4) of
this section, include in the written supporting documentation the specific
reasons the DSAs have determined that they cannot ensure the individual's
health and safety.
(c)
Except as provided in subsection (e) of this section, HHSC notifies the
individual's CMA, in writing, of whether it authorizes the proposed termination
of CLASS program services and CFC services.
(d) After receiving a written notice from
HHSC authorizing the proposed termination of CLASS Program services and CFC
services, a CMA must, in accordance with the Community Living
Assistance and Support Services Provider Manual:
(1) send written notice of the proposed
termination of services to the individual or LAR within two business days,
copying the individual's DSA and, if the individual is receiving a service
through the CDS option, to the FMSA; and
(2) include in the written notice the
individual's right to request a fair hearing in accordance with §
259.101 of this chapter (relating
to Individual's Right to a Fair Hearing).
(e) If the reason for the proposed
termination of CLASS Program services and CFC services is based on an
individual not meeting the eligibility criteria described in §
259.51(a)(4) of
this chapter and HHSC approves the proposed termination, HHSC:
(1) sends written notice to the individual or
LAR of the proposal to terminate CLASS Program services and CFC services,
copying the written notice to the individual's DSA, CMA, and, if the individual
is receiving a service through the CDS option, to the FMSA;
(2) includes in the notice the individual's
right to request a fair hearing in accordance with §
259.101 of this chapter; and
(3) sends a copy of the written
notice to the individual's DSA, CMA, and, if the individual is receiving a
service through the CDS option, to the FMSA.
(f) If an individual or LAR requests a fair
hearing before the effective date of the termination of CLASS Program services
and CFC services, as specified in the written notice, the DSA must provide
services to the individual in the amounts authorized in the IPC while the
appeal is pending.
