SECTION 259.103. Mandatory Participation Requirements of an Individual

An individual or LAR must comply with the following mandatory participation requirements:

(1) completing and submitting an application for Medicaid financial eligibility to HHSC no later than 30 calendar days after the case manager's initial in-person visit described in §259.61(a)(2) of this chapter (relating to Process for Enrollment of an Individual) or within another time frame permitted by §259.61(c) of this chapter;

(2) participating on the service planning team to:

(A) develop an enrollment IPC and an enrollment IPP, as described in §259.65 of this chapter (relating to Development of an Enrollment IPC) and §259.67 of this chapter (relating to Development of IPPs); and

(B) develop renewal and revised IPC and IPPs, as described in §259.79 of this chapter (relating to Renewal and Revision of an IPC);

(3) reviewing, agreeing to, signing, and dating an IPC and IPPs in accordance with §259.65 of this chapter, §259.67(c) of this chapter, and §259.79 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 to schedule meetings;

(B) attending a scheduled meeting with the case manager or a service provider;

(C) being available to receive CLASS Program services and 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 residence; and

(E) admitting CMA and DSA representatives to the individual's residence 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 outcomes 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 a service provider;

(9) not permitting a person present in the individual's residence to engage in criminal behavior in the presence of a service provider or the case manager;

(10) not engaging in a pattern of harassment of the case manager or a service provider that interferes with the ability to provide CLASS Program services or CFC services;

(11) not acting in a manner that is threatening to the health and safety of the case manager or a service provider;

(12) not permitting a person present in the individual's residence to:

(A) engage in a pattern of harassment of the case manager or a 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 a service provider;

(13) in accordance with §259.167 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 a service provider in immediate jeopardy;

(14) not initiating or participating in fraudulent health care practices;

(15) not engaging in behavior that endangers the individual's health or safety; and

(16) not permitting a person present in the individual's residence to engage in behavior that endangers the individual's health or safety.

Source Note: The provisions of this §259.103 adopted to be effective January 30, 2023, 48 TexReg 362