| (a) If a CMA is notified by the DSA in accordance with §259.359(g)(2)
of this chapter (relating to DSA: Service Delivery) that an individual
is receiving transportation as a habilitation activity, out-of-home
respite in a camp, adaptive aids, nursing, or CFC PAS/HAB outside
the catchment area in which the individual resides, the CMA must:
(1) provide an oral explanation to the individual or
LAR, on or before the 35th day of the period services have been provided
outside the catchment area, that:
(A) the individual must do one of the following before
the 61st day of the period services have been provided outside the
catchment area to ensure the continued provision of transportation
as a habilitation activity, out-of-home respite in a camp, adaptive
aids, nursing, or CFC PAS/HAB:
(i) transfer to a DSA contract for the catchment area
in which the individual is receiving transportation as a habilitation
activity, out-of-home respite in a camp, adaptive aids, nursing, or
CFC PAS/HAB; or
(ii) return to the catchment area in which the individual
resides; and
(B) if the individual receives transportation as a
habilitation activity, out-of-home respite in a camp, adaptive aids,
nursing, or CFC PAS/HAB outside the catchment area during a period
of 60 consecutive days, the individual must return to the catchment
area in which the individual resides and receive services in that
catchment area before the DSA may accept another request from the
individual or LAR that the DSA provide transportation as a habilitation
activity, out-of-home respite in a camp, adaptive aids, nursing, or
CFC PAS/HAB outside the catchment area;
(2) document that the CMA provided the oral explanation
required by paragraph (1) of this subsection; and
(3) if the individual or LAR expresses a desire for
the individual to transfer to a DSA contract for the catchment area
in which the individual is receiving transportation as a habilitation
activity, out-of-home respite in a camp, adaptive aids, nursing, or
CFC PAS/HAB:
(A) give the individual and LAR or actively involved
person a written list of CMAs and DSAs serving the catchment area
in which the individual is receiving transportation as a habilitation
activity, out-of-home respite in a camp, adaptive aids, nursing, or
CFC PAS/HAB;
(B) have the individual or LAR select a CMA and DSA
by completing an HHSC Selection Determination form, as described in
the Community Living Assistance and Support
Services Provider Manual; and
(C) coordinate the individual's transfer in accordance
with §259.151 of this chapter (relating to Coordination of Transfers).
(b) If an individual requests that the case manager
convene a meeting of the service planning team to discuss the DSA's
reasons for declining a request to allow services to be provided outside
the catchment area, as described in §259.359(h)(1)(B) of this
chapter, the case manager must:
(1) convene a meeting to review the reasons the DSA
declined the request to allow services outside the catchment area;
(2) facilitate a discussion between the individual
or LAR and the DSA during the meeting regarding the reasons the DSA
declined the request; and
(3) document the results of the meeting.
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