SECTION 259.161. Termination of CLASS Program Services and CFC Services with Advance Notice for Reasons Other Than Non-compliance with Mandatory Participation Requirements

(a) HHSC terminates an individual's CLASS Program services and CFC services if:

(1) the individual does not meet the eligibility criteria described in §259.51 of this chapter (relating to Eligibility Criteria for CLASS Program Services and CFC Services);

(2) the individual is admitted to one of the facilities listed in §259.157(a)(1) of this subchapter (relating to Suspension of CLASS Program Services or CFC Services) for more than 180 consecutive calendar days or beyond an extension of the individual's suspension that HHSC approved in accordance with §259.157(f) of this subchapter;

(3) the individual leaves the state for more than 180 consecutive calendar days and HHSC has not extended the individual's suspension in accordance with §259.157(f) of this subchapter; or

(4) the DSAs serving the catchment area in which the individual resides are not willing to provide CLASS Program services or CFC services to the individual because they have determined that they cannot ensure the individual's health and safety.

(b) No later than two business days after a CMA becomes aware that a situation described in subsection (a) of this section exists, the CMA must:

(1) send a written request to HHSC to terminate CLASS Program services and CFC services for the individual;

(2) send written supporting documentation with the request; and

(3) if the reason for the requested termination of services is for the reason described in subsection (a)(4) of this section, include in the written supporting documentation the specific reasons the DSAs have determined that they cannot ensure the individual's health and safety.

(c) Except as provided in subsection (e) of this section, HHSC notifies the individual's CMA, in writing, of whether it authorizes the proposed termination of CLASS program services and CFC services.

(d) After receiving a written notice from HHSC authorizing the proposed termination of CLASS Program services and CFC services, a CMA must, in accordance with the Community Living Assistance and Support Services Provider Manual:

(1) send written notice of the proposed termination of services to the individual or LAR within two business days, copying the individual's DSA and, if the individual is receiving a service through the CDS option, to the FMSA; and

(2) include in 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).

(e) If the reason for the proposed termination of CLASS Program services and CFC services is based on an individual not meeting the eligibility criteria described in §259.51(a)(4) of this chapter and HHSC approves the proposed termination, HHSC:

(1) sends written notice to the individual or LAR of the proposal to terminate CLASS Program services and CFC services, copying the written notice to the individual's DSA, CMA, and, if the individual is receiving a service through the CDS option, to the FMSA;

(2) includes in the notice the individual's right to request a fair hearing in accordance with §259.101 of this chapter; and

(3) sends a copy of the written notice to the individual's DSA, CMA, and, if the individual is receiving a service through the CDS option, to the FMSA.

(f) If an individual or LAR requests a fair hearing before the effective date of the termination of CLASS Program services and CFC services, as specified in the written notice, the DSA must provide services to the individual in the amounts authorized in the IPC while the appeal is pending.

Source Note: The provisions of this §259.161 adopted to be effective January 30, 2023, 48 TexReg 362