1. (a) HHSC suspends an individual's CLASS Program services or CFC services if the individual:

   1. (1) is admitted to one of the following facilities:

      1. (A) an ICF/IID, unless the individual is receiving out-of-home respite in the facility in accordance with §259.361 of this chapter (relating to Respite and Dental Treatment);
      2. (B) a nursing facility, unless the individual is receiving out-of-home respite in the facility in accordance with §259.361 of this chapter;
      3. (C) an ALF;
      4. (D) a residential child-care facility, unless it is an agency foster home;
      5. (E) a hospital;
      6. (F) a mental health facility;
      7. (G) an inpatient chemical dependency treatment facility;
      8. (H) a residential facility operated by the Texas Workforce Commission;
      9. (I) a residential facility operated by the Texas Juvenile Justice Department;
      10. (J) a jail; or
      11. (K) a prison; or
   2. (2) leaves the state.
2. (b) HHSC suspends services during the time that an individual is admitted to a facility or that the individual spends outside the state but is limited to 180 consecutive calendar days, unless HHSC approves an extension in accordance with subsection (g) of this section.
3. (c) Within two business days after a CMA becomes aware that an individual has been admitted to a facility or has left the state as described in subsection (a) of this section, the CMA must submit a written request that HHSC suspend the individual's services.
4. (d) If HHSC suspends an individual's services, HHSC sends a written notice to the CMA that includes the effective date of the suspension and the individual's right to request a fair hearing in accordance with §259.101 of this chapter (relating to Individual's Right to a Fair Hearing).
5. (e) Within two business days after a CMA receives a notice described in subsection (d) of this section, the CMA must send the notice to the individual or LAR and, if applicable, to the FMSA.
6. (f) HHSC may approve one or more 30-calendar-day extensions of a suspension if extenuating circumstances exist and the individual anticipates resuming participation in the CLASS Program during the extension.

7. (g) To request an extension described in subsection (f) of this section, a CMA must:

   1. (1) submit the request in writing to HHSC; and
   2. (2) include documentation of the extenuating circumstances.
8. (h) During the time HHSC suspends an individual's services, as described in subsection (b) of this section, the individual is not considered to be residing in a facility listed in subsection (a)(1) of this section or out of the state.

Source Note:The provisions of this §259.157 adopted to be effective January 30, 2023, 48 TexReg 362.