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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 DTRANSFER, DENIAL, SUSPENSION, REDUCTION, AND TERMINATION OF SERVICES
RULE §45.406Termination of CLASS Program Services and CFC Services With Advance Notice Because of Ineligibility or Leave from the State or Because DSAs Cannot Ensure Health and Safety

(a) HHSC terminates an individual's CLASS Program services and CFC services if:

  (1) the individual does not meet the eligibility criteria described in §45.201 of this chapter (relating to Eligibility Criteria for CLASS Program Services and CFC Services);

  (2) the individual is admitted for more than 180 consecutive calendar days to one of the facilities listed in §45.404(a)(1) of this subchapter (relating to Suspension of CLASS Program Services or CFC Services) and HHSC has not extended the individual's suspension in accordance with §45.404(d) 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 §45.404(d) 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) If a CMA becomes aware that a situation described in subsection (a) of this section exists, the CMA must request, in writing, that HHSC terminate CLASS Program services and CFC services for the individual. Within two business days after the CMA becomes aware of the situation, the CMA must send the written request with written supporting documentation to HHSC.

(c) If the reason for the requested termination of services is subsection (a)(4) of this section, the CMA must include in the written documentation the specific reasons the DSAs have determined that they cannot ensure the individual's health and safety.

(d) Except as provided in subsection (f) 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.

(e) Upon receipt of a written notice from HHSC authorizing the proposed termination of CLASS Program services, the CMA must, in accordance with the CLASS Provider Manual, send written notice to the individual or LAR of the proposal to terminate CLASS Program services and CFC services, copying the individual's DSA and, if selected, FMSA. The CMA must include in the notice the individual's right to request a fair hearing in accordance with §45.301 of this chapter (relating to Individual's Right to a Fair Hearing).

(f) If the reason for the proposed termination of CLASS Program services and CFC services is based on the requirement in §45.201(a)(4) of this chapter and HHSC authorizes the proposed termination, HHSC sends written notice to the individual or LAR of the proposal to terminate CLASS Program services and CFC services and includes in the notice the individual's right to request a fair hearing in accordance with §45.301 of this chapter. HHSC sends a copy of the written notice to the individual's DSA, CMA, and, if selected, FMSA.

(g) If the 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.


Source Note: The provisions of this §45.406 adopted to be effective March 21, 2011, 36 TexReg 1840; amended to be effective March 20, 2016, 41 TexReg 1952; amended to be effective October 1, 2019, 44 TexReg 5118

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