| (a) HHSC suspends an individual's CLASS Program services
or CFC services if the individual:
(1) is admitted to one of the following facilities:
(A) an ICF/IID, unless the individual is receiving
out-of-home respite in the facility in accordance with §259.361
of this chapter (relating to Respite and Dental Treatment);
(B) a nursing facility, unless the individual is receiving
out-of-home respite in the facility in accordance with §259.361
of this chapter;
(C) an ALF;
(D) a residential child-care facility, unless it is
an agency foster home;
(E) a hospital;
(F) a mental health facility;
(G) an inpatient chemical dependency treatment facility;
(H) a residential facility operated by the Texas Workforce
Commission;
(I) a residential facility operated by the Texas Juvenile
Justice Department;
(J) a jail; or
(K) a prison; or
(2) leaves the state.
(b) HHSC suspends services during the time that an
individual is admitted to a facility or that the individual spends
outside the state but is limited to 180 consecutive calendar days,
unless HHSC approves an extension in accordance with subsection (g)
of this section.
(c) Within two business days after a CMA becomes aware
that an individual has been admitted to a facility or has left the
state as described in subsection (a) of this section, the CMA must
submit a written request that HHSC suspend the individual's services.
(d) If HHSC suspends an individual's services, HHSC
sends a written notice to the CMA that includes the effective date
of the suspension and 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) Within two business days after a CMA receives a
notice described in subsection (d) of this section, the CMA must send
the notice to the individual or LAR and, if applicable, to the FMSA.
(f) HHSC may approve one or more 30-calendar-day extensions
of a suspension if extenuating circumstances exist and the individual
anticipates resuming participation in the CLASS Program during the
extension.
(g) To request an extension described in subsection
(f) of this section, a CMA must:
(1) submit the request in writing to HHSC; and
(2) include documentation of the extenuating circumstances.
(h) During the time HHSC suspends an individual's services,
as described in subsection (b) of this section, the individual is
not considered to be residing in a facility listed in subsection (a)(1)
of this section or out of the state.
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