Aging and Disability Services Council Sharon Swift Butterworth ...

deletion] DHS [end deletion] workdays of [begin addition] the phone [end addition] [begin
deletion] verbal [end deletion] notification.
(d) The [begin addition] DADS [end addition] [begin deletion] DHS [end deletion] case
manager must make a face-to-face visit [begin addition] to the individual [end addition] to
initiate efforts to resolve the situation. If the temporary suspension of services constitutes a threat
to the health and safety of the individual, then community alternatives or placement in an
institutional setting must be offered and facilitated by the [begin addition] DADS [end addition]
case manager.
(e) With prior authorization by [begin addition] DADS [end addition] [begin deletion] DHS
[end deletion], the CBA provider [begin addition] agency [end deletion] may continue providing
services to assist in the resolution of the crisis. This service will be reimbursed as an
administrative expense.
(f) If the crisis is not satisfactorily resolved, the [begin addition] DADS [end addition] [begin
deletion] DHS [end deletion] case manager provides [begin addition] written notice to the
individual with a copy to the CBA provider [end addition] [begin deletion] notification [end
deletion] of [begin addition] the termination [end addition] [begin addition] denial [end deletion]
of services [begin deletion] and offers the right of appeal. Services do not continue during the
appeal process [end deletion]. [begin addition] The written notice must specify:
(1) the reason for termination;
(2) the effective date of termination;
(3) the regulatory reference; and
(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).
(g) If the individual submits a request for a fair hearing, the CBA provider is not required to
continue to provide CBA services to the individual.
§48.6109. Denial of a CBA Program Service.
(a) The DADS case manager denies a request for a CBA service if the DADS case manager
determines, as a result of utilization review, that the service does not meet the requirements
described in §48.6006(d)(1)-(5) (relating to Individual Service Plan).
(b) The DADS case manager provides written notice of the denial to the individual and the
CBA provider agency within two DADS workdays of making the determination. The written
notice must specify:
(1) the reason for denial;
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