An individual or LAR must comply with the following mandatory
participation requirements:
(1) completing and submitting an application for Medicaid
financial eligibility to HHSC no later than 30 calendar days after
the case manager's initial in-person visit described in §259.61(a)(2)
of this chapter (relating to Process for Enrollment of an Individual)
or within another time frame permitted by §259.61(c) of this
chapter;
(2) participating on the service planning team to:
(A) develop an enrollment IPC and an enrollment IPP,
as described in §259.65 of this chapter (relating to Development
of an Enrollment IPC) and §259.67 of this chapter (relating to
Development of IPPs); and
(B) develop renewal and revised IPC and IPPs, as described
in §259.79 of this chapter (relating to Renewal and Revision
of an IPC);
(3) reviewing, agreeing to, signing, and dating an
IPC and IPPs in accordance with §259.65 of this chapter, §259.67(c)
of this chapter, and §259.79 of this chapter;
(4) cooperating with the CMA and DSA in the delivery
of CLASS Program services or CFC services listed on the individual's
IPC, including:
(A) working with the CMA and DSA to schedule meetings;
(B) attending a scheduled meeting with the case manager
or a service provider;
(C) being available to receive CLASS Program services
and CFC services;
(D) notifying the CMA or DSA in advance if the individual
or LAR is unable to attend a scheduled meeting or is unavailable to
receive services in the individual's residence; and
(E) admitting CMA and DSA representatives to the individual's
residence for a scheduled meeting or to receive CLASS Program services
or CFC services;
(5) cooperating with the DSA's service providers to
ensure progress toward achieving the goals and outcomes described
in the IPP for each CLASS Program service or CFC service listed on
the IPC;
(6) if found by HHSC to be financially eligible for
CLASS Program services based on the special institutional income limit,
paying the required co-payment in a timely manner;
(7) notifying the CMA and DSA if the individual receives
notice from HHSC of a change in the status of the individual's financial
eligibility for Medicaid;
(8) not engaging in criminal behavior in the presence
of the case manager or a service provider;
(9) not permitting a person present in the individual's
residence to engage in criminal behavior in the presence of a service
provider or the case manager;
(10) not engaging in a pattern of harassment of the
case manager or a service provider that interferes with the ability
to provide CLASS Program services or CFC services;
(11) not acting in a manner that is threatening to
the health and safety of the case manager or a service provider;
(12) not permitting a person present in the individual's
residence to:
(A) engage in a pattern of harassment of the case manager
or a service provider that interferes with the ability to provide
CLASS Program services or CFC services; or
(B) act in a manner that is threatening to the health
and safety of the case manager or a service provider;
(13) in accordance with §259.167 of this chapter
(relating to Termination of CLASS Program Services and CFC Services
Without Advance Notice Because of Behavior Causing Immediate Jeopardy),
not exhibiting behavior or permitting a person present in the individual's
residence to exhibit behavior that places the health and safety of
the case manager or a service provider in immediate jeopardy;
(14) not initiating or participating in fraudulent
health care practices;
(15) not engaging in behavior that endangers the individual's
health or safety; and
(16) not permitting a person present in the individual's
residence to engage in behavior that endangers the individual's health
or safety.
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