| (a) HHSC reduces a CLASS Program service or CFC service
on an individual's IPC, based on a review described in §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 on
the IPC 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 proposes to reduce a CLASS Program service
or CFC service on the individual's IPC, HHSC modifies the IPC and
notifies the individual's CMA, in writing, of the proposed reduction.
(c) After receiving a written notice from HHSC proposing
to reduce a CLASS Program service or CFC service, a CMA must:
(1) in accordance with the Community
Living Assistance and Support Services Provider Manual:
(A) send written notice to the individual or LAR of
the proposal to reduce the service, copying the individual's DSA and,
if the individual receives a service through the CDS option, the FMSA;
(B) include with 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); and
(C) give the individual or LAR 10 calendar days to
respond to the written notice before taking any action to reduce the
service; and
(2) send a copy of the modified IPC to the DSA and,
if the individual receives a service through the CDS option, to the
FMSA.
(d) If the individual or LAR requests a fair hearing
before the effective date of the reduction of a CLASS Program service
or CFC service, as specified in the written notice, the modified IPC
described in subsection (b) of this section may not be implemented
and the DSA must provide the service to the individual in the amount
authorized in the prior IPC while the appeal is pending.
(e) If an individual or LAR does not request a fair
hearing before the effective date of the reduction of a CLASS Program
service or CFC service, 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.
|
