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.
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