Aging and Disability Services Council Sharon Swift Butterworth ...

y the health and human services agencies, including DADS; Texas Human Resources Code,
§161.021, which provides that the Aging and Disability Services Council shall study and make
recommendations to the HHSC executive commissioner and the DADS commissioner regarding
rules governing the delivery of services to persons who are served or regulated by DADS; and
Texas Government Code, §531.021, which provides HHSC with the authority to administer
federal funds and plan and direct the Medicaid program in each agency that operates a portion of
the Medicaid program.
The amendments affect Texas Government Code, §531.0055 and §531.021, and Texas Human
Resources Code, §161.021.
§45.403. Denial of a CLASS Program Service.
(a) DADS denies a CLASS Program service on an individual's IPC, based on a review
described in §45.216 of this chapter (relating to DADS Review of an Enrollment IPC), §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 DADS), if:
[begin addition] (1) [end addition] DADS determines that the IPC does not meet:
[begin addition] (A) [end addition] the requirements described in §45.214(b) of this chapter
(relating to Development of Enrollment IPC); or
[begin addition] (B) [end addition] the requirements described in Subchapter F of this chapter
(relating to Adaptive Aids and Minor Home Modifications);[.]
[begin addition] (2) the service is transition assistance services and the service limit described in
§45.218(c) of this division (relating to Service Limits) is exceeded; or
(3) DADS denies a request for an exception to the service limit of a service described in
§45.218(b) of this division submitted in accordance with §45.219(c) of this chapter (relating to
Exception to Service Limits). [end addition]
(b) DADS notifies the CMA selected by the individual, in writing, if DADS denies a CLASS
Program service on the individual's IPC. DADS sends a copy of the modified IPC to the CMA.
(c) Upon receipt of DADS written notice of denial of a CLASS Program service, the CMA
must:
(1) in accordance with the CLASS Provider Manual, send written notice to the individual
or LAR of the denial of the service, copying the individual's DSA and, if selected, CDSA;
(2) 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); and
(3) coordinate the implementation of the modified IPC described in subsection (b) of this
- 46 -