| (a) HHSC denies a CLASS Program service or CFC service
on an individual's IPC, based on a review described in §259.69
of this chapter (relating to HHSC's Review of a Proposed Enrollment
IPC), §259.79 of this chapter (relating to Renewal and Revision
of an IPC), or §259.83 of this chapter (relating to Utilization
Review of an IPC by HHSC), if HHSC determines that the CLASS Program
service or CFC service does not meet the requirements described in §259.65(a)(1)(E)(iii)
or (iv) and §259.65(b) of this chapter (relating to Development
of an Enrollment IPC).
(b) If HHSC denies a CLASS Program service or CFC service
on an individual's IPC, HHSC modifies the IPC and notifies the individual's
CMA, in writing, of the denial.
(c) If a CMA receives a written notice from HHSC denying
a CLASS Program service or CFC service, the CMA must:
(1) send a copy of the modified IPC to the DSA and,
if the individual receives a service through the CDS option, to the
FMSA;
(2) in accordance with the Community
Living Assistance and Support Services Provider Manual, send
written notice to the individual or LAR of the denial of the service,
copying the individual's DSA and, if the individual receives a service
through the CDS option, the FMSA; and
(3) include in the 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).
(d) A CMA and DSA must:
(1) electronically access MESAV to determine if the
information on the modified IPC is consistent with the information
in MESAV;
(2) if the information on the modified IPC is inconsistent
with the information in MESAV, notify HHSC of the inconsistency; and
(3) implement the modified IPC.
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