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TITLE 40SOCIAL SERVICES AND ASSISTANCE
PART 1DEPARTMENT OF AGING AND DISABILITY SERVICES
CHAPTER 48COMMUNITY CARE FOR AGED AND DISABLED
SUBCHAPTER ICASE MANAGEMENT
RULE §48.3903Denial, Reduction, and Termination of Benefits

(a) An applicant or client may request an appeal of any decision that denies, reduces, or terminates his benefits. The effective date of the action depends on the situation, as shown in the following table.

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(b) A client is entitled to be notified 10 days before any reduction or termination of his services, or to have the notification mailed 12 days before the date of reduction or termination. If a client threatened his own health or safety or that of others, purchased services may be terminated without advance notice.

(c) A client is not eligible for CCAD services when:

  (1) he dies;

  (2) he is admitted to an institution;

  (3) his physician requests service termination (Medicaid services only); or

  (4) he requests service termination or repeatedly refuses to accept help, except in an involuntary protective services case, or he refuses to comply with his service plan.

(d) The client is not eligible for emergency response services if:

  (1) he abuses the service by activating:

    (A) four false alarms which result in a response by fire department, police/sheriff, or ambulance personnel within a six-month period; or

    (B) 20 false alarms of any kind within a six-month period;

  (2) he is admitted to a skilled institution, personal care home, foster care setting, or any other setting where 24-hour supervision is available;

  (3) in the caseworker's judgment, he is no longer mentally alert enough to operate the equipment properly. Situations include, but are not limited to:

    (A) he damages the equipment;

    (B) he disconnects the equipment and has received two warnings that are documented in the case record;

    (C) he refuses to participate in the monthly system checks; or

  (4) he is away from the home or is unable to participate in the service delivery for three consecutive months or more.

(e) The client is not eligible for residential care if he is required to contribute to the cost of his care, but refuses to do so.

(f) If the client repeatedly and directly or knowingly and passively condones the behavior of someone in his home and thus, refuses (more than three times) to comply with service delivery provisions, the caseworker may terminate services. Refusal to comply with service delivery provisions includes actions by the client or someone in the client's home that prevent determining eligibility, carrying out the service plan, and monitoring the services. Before services are terminated, the client is entitled to receive written notification that his services will be terminated if he does not comply with service delivery provisions or if he continues to condone someone's behavior that results in non-compliance with service delivery provisions. Also before services are terminated, a referral to APS is made if the client is abused, neglected, or exploited by the person who prevents delivery provisions. Services continue pending the outcome of the APS investigation. If an applicant's services were terminated in the past due to his failure to comply with his service plan, the applicant must agree to cooperate with DHS staff to facilitate service delivery.


Source Note: The provisions of this §48.3903 adopted to be effective February 1, 1989, 13 TexReg 5751; amended to be effective April 15, 1990, 15 TexReg 205; amended to be effective June 1, 1991, 16 TexReg 2053; amended to be effective October 1, 1992, 17 TexReg 6374; amended to be effective November 15, 1992, 17 TexReg 7241; amended to be effective March 15, 1993, 18 TexReg 1170; amended to be effective March 1, 1994, 19 TexReg 272; amended to be effective January 1, 1996, 20 TexReg 9748

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