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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 §45.405Reduction of a CLASS Program Service or CFC Service

(a) HHSC reduces a CLASS Program service or CFC service on an individual's IPC, based on a review described in §45.223 of this chapter (relating to Renewal and Revision of an IPC) or §45.225 of this chapter (relating to Utilization Review of an IPC by HHSC), if HHSC determines that the CLASS Program service or CFC service on the IPC does not meet the requirements described in §45.214(a)(1)(E)(iii) or (iv) and §45.214(b) of this chapter (relating to Development of Enrollment IPC).

(b) If HHSC proposes to reduce a CLASS Program service or CFC service on the individual's IPC, HHSC modifies the IPC and notifies the individual's CMA, in writing, of the proposed reduction.

(c) Upon receipt of a written notice from HHSC proposing to reduce a CLASS Program service or CFC service, the CMA must:

  (1) send a copy of the modified IPC to the DSA and, if the individual receives a service through the CDS option, to the FMSA;

  (2) in accordance with the CLASS Provider Manual, send written notice to the individual or LAR of the proposal to reduce the service, copying the individual's DSA and, if selected, FMSA; and

  (3) 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).

(d) If the individual or LAR requests a fair hearing before the effective date of the reduction of a CLASS Program service or CFC service, as specified in the written notice, the modified IPC described in subsection (b) of this section may not be implemented and the DSA must provide the service to the individual in the amount authorized in the prior IPC while the appeal is pending.

(e) If the individual or LAR does not request a fair hearing before the effective date of the reduction of a CLASS Program service or CFC service, a CMA and DSA must:

  (1) electronically access MESAV to determine if the information on the modified IPC is consistent with the information in MESAV;

  (2) if the information on the modified IPC is inconsistent with the information in MESAV, notify HHSC of the inconsistency; and

  (3) implement the modified IPC.


Source Note: The provisions of this §45.405 adopted to be effective March 21, 2011, 36 TexReg 1840; amended to be effective December 1, 2011, 36 TexReg 8049; amended to be effective November 15, 2015, 40 TexReg 7883; amended to be effective March 20, 2016, 41 TexReg 1952; amended to be effective October 1, 2019, 44 TexReg 5118

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