| (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.
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