Aging and Disability Services Council Sharon Swift Butterworth ...

(c) If the [begin addition] DADS [end addition] [begin addition] DHS [end deletion] case
manager determines the documentation supports [begin addition] the termination of CBA
services [end addition] [begin deletion] initiation of denial [end deletion], the [begin addition]
DADS [end addition] case manager provides written notice of the termination of CBA services
[end addition] [begin deletion] notification of denial [end deletion] to the [begin addition]
individual [end addition] [begin deletion] participant [end deletion] [begin addition] with a copy
to the [end addition] [begin deletion] and [end deletion] CBA provider [begin deletion] agency
[end deletion] within two [begin addition] DADS [end addition] [begin deletion] DHS [end
deletion] workdays [begin addition] after receiving the documentation described in subsection
(b) of this section [end addition]. The written [begin addition] notice [end addition] [begin
deletion] notification [end deletion] must specify:
[begin addition] (1) [end addition] the reason for [begin addition] termination; [end
addition] [begin deletion] denial, [end deletion]
[begin addition] (2 [end addition]) the effective date of [begin addition] termination; [end
addition] [begin deletion] denial, [end deletion]
[begin addition] (3) [end addition] the regulatory reference, and
[begin addition] (4) information regarding the individual's right to request a fair hearing in
accordance with §48.6010 of this subchapter (relating to Individual's Right to Appeal) [end
addition] [begin deletion] provide written notice of the right to appeal [end deletion].
(d) If the [begin addition] individual submits a request for a fair hearing before the effective
date of the termination specified in the written notice [end addition] [begin deletion] participant
appeals the notification of denial within 10 days of written notification [end deletion], the CBA
provider [agency] continues CBA services [begin addition] at the current authorized level while
the appeal is pending [end addition] [begin deletion] until notification of the decision by the
DHS hearing officer. The CBA provider agency must not reduce waiver services until the
outcome of the appeal is known [end deletion].
§48.6100. Circumstances Requiring [begin addition] Termination [end addition] [begin
addition] Denial [end deletion] of Services and Medicaid Eligibility Without Advance
Notice.
(a) If one or more circumstances specified in paragraphs (1) through (6) of this subsection
occur, the [begin addition] DADS [end addition] [begin deletion] Texas Department of Human
Services (DHS) [end deletion] case manager [begin addition] terminates CBA [end addition]
[begin deletion] is required to deny Community Based Alternatives (CBA) [end deletion]
services without advance notice.
(1) [begin addition] DADS [end addition] [begin deletion] the operating agency [end
deletion] or its designee has factual information confirming the death of the individual;[;]
(2) [begin addition] DADS [end addition] [begin deletion] the operating agency [end
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