| (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.
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