SECTION 259.159. Reduction 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 §259.79 of this chapter (relating to Renewal and Revision of an IPC) or §259.83 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 §259.65(a)(1)(E)(iii) or (iv) and §259.65(b) of this chapter (relating to Development of an 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) After receiving a written notice from HHSC proposing to reduce a CLASS Program service or CFC service, a CMA must:

(1) in accordance with the Community Living Assistance and Support Services Provider Manual:

(A) send written notice to the individual or LAR of the proposal to reduce the service, copying the individual's DSA and, if the individual receives a service through the CDS option, the FMSA;

(B) include with the written notice the individual's right to request a fair hearing in accordance with §259.101 of this chapter (relating to Individual's Right to a Fair Hearing); and

(C) give the individual or LAR 10 calendar days to respond to the written notice before taking any action to reduce the service; and

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

(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 an 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 §259.159 adopted to be effective January 30, 2023, 48 TexReg 362