1. (a) A person may request an appeal of any decision that denies, reduces, or ends the person's benefits. The effective date of the action depends on the situation, as shown in the following table.
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2. (b) A client is entitled to be notified 10 calendar days before any reduction or termination of services, or to have the notification mailed 12 calendar days before the date of reduction or termination. If a client threatened the client's own health or safety or that of others, purchased services may be terminated without advance notice.

3. (c) A client is not eligible for Community Care Services Eligibility (CCSE) services or programs when the client:

   1. (1) dies;
   2. (2) is admitted to an institution;
   3. (3) has a physician who requests service termination, Medicaid services only;
   4. (4) requests service termination or repeatedly refuses to accept help, except in an involuntary protective services case; or
   5. (5) refuses to comply with the service plan.

4. (d) The client is not eligible for Emergency Response Services if the client:

   1. (1) abuses the service by activating:

      1. (A) four false alarms which result in a response by fire department, police, sheriff, or ambulance personnel within a six-month period; or
      2. (B) 20 false alarms of any kind within a six-month period;
   2. (2) is admitted to a skilled institution, personal care home, foster care setting, or any other setting where 24-hour supervision is available;

   3. (3) in the caseworker's judgment, is no longer mentally alert enough to operate the equipment properly, situations include:

      1. (A) damage to the equipment;
      2. (B) the equipment is disconnected and the client received two warnings that are documented in the case record;
      3. (C) refusal to participate in the monthly system checks; or
   4. (4) is away from the home or is unable to participate in the service delivery for three consecutive months or more.
5. (e) The client is not eligible for Residential Care if the client is required to contribute to the cost of the client's care but refuses to do so.
6. (f) If the client repeatedly and directly or knowingly and passively condones the behavior of someone in the client's home and thus, refuses, more than three times, to comply with service delivery provisions, the caseworker may terminate services. Refusal to comply with service delivery provisions includes actions by the client or someone in the client's home that prevent determining eligibility, carrying out the service plan, and monitoring the services. Before services are terminated, the client is entitled to receive written notification that services will end if the client does not comply with service delivery provisions or if the client continues to condone someone's behavior that results in non-compliance with service delivery provisions. Also, before services are terminated, the caseworker must make a referral to Texas Department of Family and Protective Services if the caseworker suspects or knows that the client is being abused, neglected, or exploited by the person who prevents delivery provisions. Services continue pending the outcome of the APS investigation. If an applicant's services were terminated in the past due to the applicant's failure to comply with a service plan, the applicant must agree to cooperate with HHSC staff to facilitate service delivery.

Source Note:The provisions of this §271.155 adopted to be effective February 1, 1989, 13 TexReg 5751; amended to be effective April 15, 1990, 15 TexReg 205; amended to be effective June 1, 1991, 16 TexReg 2053; amended to be effective October 1, 1992, 17 TexReg 6374; amended to be effective November 15, 1992, 17 TexReg 7241; amended to be effective March 15, 1993, 18 TexReg 1170; amended to be effective March 1, 1994, 19 TexReg 272; amended to be effective January 1, 1996, 20 TexReg 9748; transferred effective September 15, 2023, as published in the August 18, 2023, issue of the Texas Register, 48 TexReg 4523; amended to be effective September 10, 2025, 50 TexReg 5936.