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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 GADDITIONAL CMA REQUIREMENTS
RULE §45.702Protection of Individual, Initial and Annual Explanations, and Offering Access to Other Services

(a) A CMA must have and implement written policies and procedures that safeguard an individual against:

  (1) infectious and communicable diseases;

  (2) conflicts of interest with a staff person, volunteer, or controlling person of the CMA;

  (3) abuse, neglect, and exploitation;

  (4) acts of financial impropriety by a staff person, volunteer, or controlling person of the CMA; and

  (5) deliberate damage of personal possessions by a staff person, volunteer, or controlling person of the CMA.

(b) A case manager must, at least annually:

  (1) provide an oral and written explanation of the topics described in §45.212(a)(2)(A)(i) - (x) of this chapter (relating to Process for Enrollment of an Individual) to the individual and LAR or person actively involved with the individual; and

  (2) educate the individual and LAR or person actively involved with the individual about protecting the individual from abuse, neglect, and exploitation.

(c) After an individual is enrolled in the CLASS Program, a CMA must:

  (1) do the following regarding transfers:

    (A) at least annually, provide an oral explanation to the individual and LAR or person actively involved with the individual that the individual may transfer to a different CMA or DSA; and

    (B) if the individual or LAR expresses a desire for the individual to transfer to a different CMA or DSA:

      (i) give the individual and LAR or person actively involved with the individual a written list of CMAs and DSAs serving the catchment area in which the individual resides;

      (ii) have the individual or LAR select a CMA and DSA by completing a Selection Determination form as described in the CLASS Provider Manual; and

      (iii) coordinate the individual's transfer in accordance with §45.401 of this chapter (relating to Coordination of Transfers), if the individual or LAR selects a different DSA or CMA on the Selection Determination form; and

  (2) at least annually:

    (A) give the individual or LAR or person actively involved with the individual a written list of CMAs and DSAs serving the catchment area in which the individual resides;

    (B) have the individual or LAR select a CMA and DSA by completing a Selection Determination form as described in the CLASS Provider Manual;

    (C) obtain the signature of the individual or LAR on a Waiver Program Verification of Freedom of Choice form documenting the individual's or LAR's choice of the CLASS Program over the ICF/IID Program; and

    (D) provide an oral explanation to the individual or LAR that the individual or LAR may request:

      (i) that the DSA provide habilitation, out-of-home respite in a camp described in §45.806(b)(2)(D) of this chapter (relating to Respite and Dental Treatment), adaptive aids, nursing, or CFC PAS/HAB while the individual is temporarily staying at a location outside the catchment area in which the individual resides but within the state of Texas during a period of no more than 60 consecutive days; and

      (ii) that the DSA provide habilitation, out-of-home respite in a camp, adaptive aids, nursing, or CFC PAS/HAB as described in clause (i) of this subparagraph more than once during an IPC period.

(d) If the CMA is notified by the DSA that the individual is receiving habilitation, out-of-home respite in a camp described in §45.806(b)(2)(D) of this chapter, adaptive aids, nursing, or CFC PAS/HAB outside the catchment area in which the individual resides in accordance with §45.805(g)(1) of this chapter (relating to DSA: Service Delivery), the CMA must:

  (1) if the individual receives habilitation, out-of-home respite in a camp, adaptive aids, nursing, or CFC PAS/HAB outside the catchment area, 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) to ensure the continued provision of habilitation, out-of-home respite in a camp, adaptive aids, nursing, or CFC PAS/HAB, the individual must do one of the following before the 61st day:

      (i) transfer to a DSA contract for the catchment area in which the individual is receiving habilitation, 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 habilitation, 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 habilitation, out-of-home respite in a camp, adaptive aids, nursing, or CFC PAS/HAB outside the catchment area; and

  (2) 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 habilitation, out-of-home respite in a camp, adaptive aids, nursing, or CFC PAS/HAB:

    (A) give the individual and LAR or person actively involved with the individual a written list of CMAs and DSAs serving the catchment area in which the individual is receiving habilitation, 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 a Selection Determination form as described in the CLASS Provider Manual; and

    (C) coordinate the individual's transfer in accordance with §45.401 of this chapter (relating to Coordination of Transfers).

(e) 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 §45.805(h)(1)(B) of this chapter, the case manager must:

  (1) convene the meeting to review the reasons the DSA declined the request that was submitted by the DSA; and

  (2) facilitate a discussion between the individual or LAR and DSA during the meeting regarding the reasons the DSA declined the request.

(f) If an individual's CLASS Program services and CFC services are terminated in accordance with Subchapter D of this chapter (relating to Transfer, Denial, Suspension, Reduction, and Termination of Services), the CMA must ensure that the case manager informs the individual of:

  (1) alternative long-term services and supports in the community, including CFC services through a managed care organization; and

  (2) institutional services.

(g) A CMA must have documentation that it provided the oral explanation and information as required under subsections (b), (c)(1)(A), (c)(2) and (3), and (d)(1) of this section and convened a meeting as required under subsection (e) of this section.

(h) A CMA, in accordance with the CLASS Provider Manual, must report critical incidents to HHSC and the DSA using the CLASS/DBMD Notification of Critical Incidents form.

(i) A CMA must ensure that a program director who receives a copy of an HHSC initial intake report or a final investigative report from an FMSA, in accordance with §41.702 of this title (relating to Requirements Related to HHSC Investigations When an Alleged Perpetrator is a Service Provider) or §41.703 of this title (relating to Requirements Related to HHSC Investigations When an Alleged Perpetrator is a Staff Person or a Controlling Person of an FMSA), gives a copy of the report to the individual's case manager.


Source Note: The provisions of this §45.702 adopted to be effective March 21, 2011, 36 TexReg 1840; amended to be effective October 1, 2013, 38 TexReg 6619; amended to be effective July 1, 2015, 40 TexReg 2768; amemded to be effective March 20, 2016, 41 TexReg 1952; amended to be effective October 1, 2019, 44 TexReg 5118

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