Sec. 07.02.19.06. Redetermination, Reconsideration, and Termination

A. Redetermination. The case manager shall redetermine eligibility and level of care:

(1) Within 30 days after the local department obtains information about changes in the resident's circumstances which may affect the resident's eligibility; and

(2) Annually.

B. Reconsideration.

(1) A reconsideration of a resident's case plan shall include:

(a) Reassessment of the resident's needs and goals;

(b) Evaluation of services provided; and

(c) Progress towards meeting the goals set out in the case plan.

(2) The case manager shall reconsider a case plan:

(a) If there is a significant change in the resident's circumstances which may affect the type or amount of service the resident needs; and

(b) Not less frequently than 90 days after placement, and thereafter at least every 6 months.

C. Termination.

(1) The local department shall terminate CARE services when at least one of the following situations exists:

(a) The resident is no longer eligible;

(b) The resident, if competent to make the decision, requests termination or the resident's guardian requests termination;

(c) The resident is unwilling to use available services and the service team can propose no further plan which is acceptable to the resident;

(d) The resident is no longer residing in a CARE home and the local department has no plan to arrange a CARE placement;

(e) The resident's conduct poses a risk to the safety or well-being of self, of the provider, or of other residents in the home;

(f) The provider has requested removal of the resident and the local department is unable to provide another appropriate placement; or

(g) The resident refuses to reimburse the provider for service.

(2) When the local department terminates CARE services, the local department shall:

(a) Refer the resident to the local department's Social Services to Adults (SSTA) program if the resident requests case management services; and

(b) At least 15 days before termination, provide written notice to the resident which shall include the:

(i) Decision to terminate the service;

(ii) Reason for the decision;

(iii) Regulation supporting the decision; and

(iv) Resident's right to appeal the decision and the method of obtaining a fair hearing.

(3) Following termination of CARE services, the case manager shall provide for one month:

(a) Follow-up services; and

(b) Appropriate referrals to other community services including other services within the local department.

D. Immediate Suspension of Services to Resident.

(1) If the conduct of the resident poses a threat to the safety or well-being of the provider or the residents in the home, the local department may, without giving 15 days notice, immediately suspend services to the resident for a period not to exceed 30 days. Within 72 hours of the suspension, the local department shall advise the resident in writing of the:

(a) Grounds for the action taken; and

(b) Resident's right to appeal the suspension.

(2) If the CARE Home Certificate is revoked or the case manager determines that the CARE Provider can no longer meet the needs of the resident and the resident refuses another CARE home placement, then the local department may terminate services to the resident.

(3) At the end of the suspension period, the local department shall either reinstate or terminate services. If the local department terminates services, it shall provide the resident with a notice of the termination at least 15 days before the effective date of termination.