Closures, Denials, Terminations, and Reductions in Services 525-05-40

(Revised 4/1/12 ML #3325)

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1. Closures

If a client (both, new or current client) does not utilize the services authorized in the care plan within a 30-day period of time, the case should close and an SFN 474, Closure/Transfer form, should be forwarded to HCBS Program Administration.  

1. If services were to be implemented within a few days after the 30th day, contact the HCBS Program Administrator for written approval.

County social service boards must notify HCBS Program Administration of HCBS closures using the SFN 474, Closure/Transfer form, this includes all HCBS programs. The Notification is to be submitted within 3 days of closing the case.

10-day Notice Not Required

Either because the client has taken action that results in the termination of services or it is a change in benefits that is not appealable, a 10-day notice is not required.  The county is required to inform the client of the action taken to close their case.  The notice may be a letter stating the effective date of the closure and the specific reason.  

Note:  If the case closure is due to death and the County has factual information confirming the client’s death, a letter is not required to be forwarded to the client’s estate.  The source of the information should be documented in the case file.

Any of the reasons below do not require a 10-day notice:

1. County has factual information confirming the death of the client.
2. The county has received in writing the client’s decision to terminate services
3. Client has been admitted to a basic care facility or nursing facility.
4. Client’s whereabouts are unknown.
5. Special allowance granted for a specific period is terminated.
6. State or federal government initiates a mass change which uniformly and similarly affects all similarly situated applicants, recipients, and households.
7. Determined the client has moved from the area.

2. Reduction/Denial/Termination Notice

The applicant/client must be informed in writing of the reason(s) for the denial/termination/reduction.  Complete SFN 1647 or if allowable send a letter with all applicable information to the client or applicant or their legal decision maker. The citation used to complete the SFN 1647 must be obtained from a HCBS Program Administrator or the Assistant Director of Medical Services.

• Reduction in services may include reducing the number of units or reducing the tasks in a specific category. A written reduction note SFN 1647 is required (the client agreeing with the reduction is not sufficient).
• Termination of a service is discontinuing the service. The client must be informed in writing of the Termination by providing the client with a completed SFN 1647 or the client may provide a written statement indicating they no longer want the service.
• Denial of a service may include denying the service to a new applicant or denying the number of units a current client requests.

• When denying units the client has requested, the client must be informed in writing of the Denial by providing the client a completed SFN 1647.
• When a home visit is completed to assess or inform an applicant about services, an application for service is implied by the client and a completed SFN 1647 must be provided informing the client of the Denial or the client can provide a written statement indicating they do not want the service.
• When a client contacts the HCBS Case Manager per phone for general information about the service, the applicant must be made aware that a formal determination of eligibility for the service cannot be made by phone. The client must be offered the option to complete an Application for Services SFN 1047. Upon receipt of the completed SFN 1047 a home visit would be scheduled to determine eligibility.

• After the SFN 1047 is received and a formal assessment is completed  the client must be informed in writing of the Denial by providing the client with a completed SFN 1647 or the client may provide a written statement indicating they do not want the service.

The Notice of Denial/Termination/Reduction is dated the date of mailing.  contact the HCBS Program Administrator to obtain the legal reference required at ”as set forth . . ." The legal reference must be based on federal law, state law and/or administrative code; reliance on policy and procedures manual reference is not sufficient.

When the client is no longer eligible for the HCBS funding, the County must terminate services under this funding source.  Even if services continue under another funding source, the client must be informed in writing of the reasons s/he is no longer eligible under this Service Chapter.

The client must be notified in writing at least 10 days (it may be more) prior to the date of terminating services UNLESS it is for one of the reasons stated in this section. The date entered on the line, the effective date field, is 10 calendar days from the date of mailing the Notice or the next working day if it is a Saturday, Sunday, or legal holiday.

The county may send a cover letter with the Notice identifying other public and/or private service providers or agencies that may be able to meet the denied/terminated applicant/client’s needs.

3. Former SPED or ExSPED Clients

A former SPED or Expanded SPED Program recipient can be reinstated without going through the SPED or Expanded SPED Program Pool if services are re-established within two calendar months from the month of closure. However, the HCBS Case Manager must determine that the former client is still eligible and what the current service needs are.  

For the SPED program, forward the SPED Program Pool Data form and the MMIS form SFN 676 to HCBS Program Administration. The MMIS form should indicate the date the individual returned to services in the field “Medical Appr. Date.”

For the ExSPED program, forward the ExSPED Program Pool Data form and the MMIS form SFN 677 to the HCBS Program Administration. The MMIS form should indicate the date the individual returned to services in the field “Medical Appr. Date.”

The Transfer to Another County section of SFN 474 is to be used when an open case is transferred to another county. This section of the form is used when the client remains eligible for services but will not continue to reside in this county. Case information should be forwarded to the new county of physical residence.

For the Medicaid Waiver programs, in addition to submitting the SFN 474, the case manager must also submit the SFN 1288. In lieu of a closing date for Medicaid Waiver cases, the HCBS case manager must submit to Medical Services an end date for the level-of-care screening on the SFN 1288 when services will no longer be provided to the client. Whether the case is closed due to death or by issuance of a termination notice, submit an “end date” for the level-of-care to Medical Services and a copy to HCBS Program Administration.

Submitting an “end date” is required in order for the Department to have accurate data when submitting federal reports. A change will automatically be made in the screening information when a client enters a nursing facility or swing-bed unit.