A beneficiary may be disenrolled from the CES Waiver under the following circumstances:

1. (1) When the beneficiary or legal guardian refuses to participate in the PCSP or nonclinical treatment plan development;
2. (2) When the beneficiary or legal guardian refuses to permit implementation of the PCSP, nonclinical treatment plan, or any part thereof that is deemed necessary to ensure health and safety;

3. (3) When the beneficiary or legal guardian refuses to permit the on-site entry of:

   1. (A) The PASSE care coordinator to conduct scheduled/required visits;
   2. (B) Direct care staff to provide scheduled care;
   3. (C) The supervisory or management staff of a provider to conduct a scheduled/required visit; or
   4. (D) The Department of Human Services or its authorized representatives acting in their role as oversight authority for compliance or audit purposes;
4. (4) When the beneficiary requires twenty-four-hour nursing care on a continuous basis as prescribed by a physician;
5. (5) When the beneficiary is fully admitted as a resident in a public institution or as an inmate in a federal, state, or local correctional facility;
6. (6) When the beneficiary is deemed ineligible based on assessment or reassessment finding that the beneficiary does not meet ICF/IID institutional level of care; and
7. (7) When the beneficiary is ineligible based on not meeting or not complying with Medicaid eligibility requirements.

Codification Notes: “ICF/IID” means intermediate care facilities for individuals with intellectual disabilities.