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TITLE 40SOCIAL SERVICES AND ASSISTANCE
PART 1DEPARTMENT OF AGING AND DISABILITY SERVICES
CHAPTER 45COMMUNITY LIVING ASSISTANCE AND SUPPORT SERVICES AND COMMUNITY FIRST CHOICE (CFC) SERVICES
SUBCHAPTER CRIGHTS AND RESPONSIBILITIES OF AN INDIVIDUAL
RULE §45.302Mandatory Participation Requirements of an Individual

An individual, or an LAR on behalf of the individual, must comply with the following mandatory participation requirements:

  (1) completing and submitting an application for Medicaid financial eligibility to HHSC within 30 calendar days after the case manager's initial face-to-face, in-home visit as described in §45.212(a)(2) of this chapter (relating to Process for Enrollment of an Individual) or within another time frame permitted by §45.212(c) of this chapter;

  (2) participating on the service planning team to:

    (A) develop an enrollment IPC as described in §45.214 of this chapter (relating to Development of Enrollment IPC); and

    (B) renew and revise the IPC and IPPs as described in §45.223 of this chapter (relating to Renewal and Revision of IPC);

  (3) reviewing, agreeing to, signing, and dating an IPC and IPPs in accordance with §45.214 of this chapter, §45.215(b) of this chapter (relating to Development of IPPs), and §45.223 of this chapter;

  (4) cooperating with the CMA and DSA in the delivery of CLASS Program services or CFC services listed on the individual's IPC, including:

    (A) working with the CMA and DSA in scheduling meetings;

    (B) attending scheduled meetings with the case manager or service provider;

    (C) being available to receive the CLASS Program services or CFC services;

    (D) notifying the CMA or DSA in advance if the individual or LAR is unable to attend a scheduled meeting or is unavailable to receive services in the individual's own or family home; and

    (E) admitting CMA and DSA representatives to the individual's own home or family home for a scheduled meeting or to receive CLASS Program services or CFC services;

  (5) cooperating with the DSA's service providers to ensure progress toward achieving the goals and objectives described in the IPP for each CLASS Program service or CFC service listed on the IPC;

  (6) if found by HHSC to be financially eligible for CLASS Program services based on the special institutional income limit, paying the required co-payment in a timely manner;

  (7) notifying the CMA and DSA if the individual receives notice from HHSC of a change in the status of the individual's financial eligibility for Medicaid;

  (8) not engaging in criminal behavior in the presence of the case manager or service provider;

  (9) not permitting a person present in the individual's own or family home to engage in criminal behavior in the presence of the service provider or case manager;

  (10) not engaging in a pattern of harassment of the case manager or service provider that interferes with the ability to provide CLASS Program services or CFC services or acting in a manner that is threatening to the health and safety of the case manager or service provider;

  (11) not permitting a person present in the individual's own or family home to:

    (A) engage in a pattern of harassment of the case manager or service provider that interferes with the ability to provide CLASS Program services or CFC services; or

    (B) act in a manner that is threatening to the health and safety of the case manager or service provider;

  (12) in accordance with §45.409 of this chapter (relating to Termination of CLASS Program Services and CFC Services Without Advance Notice Because of Behavior Causing Immediate Jeopardy), not exhibiting behavior or permitting a person present in the individual's residence to exhibit behavior that places the health and safety of the case manager or service provider in immediate jeopardy;

  (13) not initiating or participating in fraudulent health care practices;

  (14) not engaging in behavior that endangers the individual's health or safety; and

  (15) not permitting a person present in the individual's own home or family home to engage in behavior that endangers the individual's health or safety.


Source Note: The provisions of this §45.302 adopted to be effective March 21, 2011, 36 TexReg 1840; amended to be effective March 20, 2016, 41 TexReg 1952

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