Closures, Denials, Terminations, Reductions, and Transfer of Services 525-05-40

(Revised 5/1/19 ML #3551)

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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 or an exception has not been approved, the case should close and an HCBS Case Closure/Transfer Notice/Provider Termination (SFN 474), SFN 474, should be completed and forwarded to Aging Services/HCBS.

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

HCBS Case Managers must notify HCBS Program Administration of HCBS closures using the SFN 474, this includes all HCBS programs. The Notification is to be submitted to HCBS/Aging Services 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 (i.e. a client indicating, in writing, his/her desire to terminate services; moving out of the area, admitted to a nursing facility, etc.) or it is a change in benefits that is not appealable, a 10-day notice is not required and an HCBS Notice of Reduction, Denial, or Termination (SFN 1647) is not required.  The HCBS Case Manager 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 HCBS Case Manager 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. HCBS Case Manager has factual information confirming the death of the client.
2. The HCBS Case Manager 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.

• 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 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. If a home visit is completed but an assessment wasn’t completed but information was shared, an SFN 1647 is not required.
• When a client contacts the HCBS Case Manager for general information about the service, the applicant must be made aware that a formal determination of eligibility for the service cannot be made without completing a home visit and assessment. 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 HCBS Case Manager 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 by completing a SFN 1647 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 HCBS Case Manager may send a cover letter with the SFN 1647 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.

• If a client will be re-opened for SPED or Ex-SPED, the HCBS Case Manager only needs to complete the Add New Record to MMIS Eligibility File – SPED & Ex-SPED (SFN 676) and submit to Aging Services/HCBS. The SPED Program Pool Data (SFN 1820) nor the Ex-SPED Program Pool Data (SFN 56) need to be completed.

For the SPED and Ex-SPED programs, complete the SFN 676 and forward to the Aging Services/HCBS Program Administration. The MMIS form should indicate the date the individual returned to services in the field “Date of Application.”

4. Transfer to Another County

The Closure/Denial Section of the SFN 474 is to be completed to indicate the funding source and the last day a client will receive services in the county. The closure code “T” (transferring to another county) is to be used.

 

The Transfer Case 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. HCBS Case Managers must contact the receiving Case manager and case information should be forwarded to the new county of physical residence.

 

5. Medicaid Waiver Clients

For the Medicaid Waiver programs, the case manager must include the date of closure of the level of care screening on the SFN 474. Case managers must submit a SFN 474 to Aging Services/HCBS regardless of the reason for the closure i.e. death, going to a nursing home etc.

 

Submitting a “date of closure” is required in order for the Department to have accurate data when submitting federal reports.