Tracking# 2011-00238
FA/E 5/4/12, eff. 7/1/12
(former emergency #2012-00279 
adopted 3/23/12, eff. 3/23/12) 

I:/12022701.rtf
[I:/12022701.doc]

(9 CCR 2503-1)

[Editorial note: statement of basis and purpose has been incorporated into Tracking# 2012-00241 (#12-1-17-1).] 

***************

[Instructions: insert replace lines 2291891 through 2292097.] 
3.740  SPECIAL POPULATIONS-HOME CARE ALLOWANCE (SP-HCA) PROGRAM
3.741  Definitions [Rev. eff. 7/1/12]
The following definitions shall apply to the rules related to SP-HCA: 
“Activities of daily living” means physical transfers, bladder care, bowel care, mobility, dressing, bathing, hygiene, and eating. 
“Authorized representative” means an individual designated by the client, or by the parent or guardian of the client, if appropriate, to assist in acquiring or utilizing SP-HCA services. 
“Care planning” means identifying client goals and choices for the care needed, services needed, appropriate service providers based on the client assessment and knowledge of the client and of community resources. 
“Case management” means the assessment of a client’s long-term care needs, development and implementation of a care plan, coordination and monitoring of the long-term care service delivery, evaluation of service effectiveness, and periodic reassessment of client needs. 
“Client” means any person identified by the State Department as meeting the minimal eligibility criteria to apply for a Special Populations - Home Care Allowance (SP-HCA) program grant as outlined at Section 3.742, A-B, or any person approved for a SP-HCA program grant. 
“Functional Assessment” means a comprehensive evaluation by the case manager with the client and appropriate collaterals (such as family members, friends and/or caregivers) to determine the client's level of functioning, service needs, available resources, and necessity for paid care. 
“Home” means a non-institutional residence. 
“Instrumental activities of daily living” means meal preparation, housework, laundry, and shopping. 
“Non-skilled services” mean activities of daily living, instrumental activities of daily living, and supportive services. 
“Single Entry Point” means the agencies designated by the Colorado Department of Health Care Policy and Financing pursuant to Section 25.5-6-106, C.R.S. 
"Service Plan Authorization Limit" (SPAL) means an annual upper payment limit of total funds available to purchase services to meet the client’s ongoing needs. Purchase of services not subject to the SPAL are in accordance with the Colorado Department of Health Care Policy and Financing rules in Section 8.500.102, B (10 CCR 2505-10). A  specific limit is assigned to each of the six support levels in the HCBS-SLS waiver. The SPAL is determined by the Department based on the annual appropriation for the HCBS-SLS waiver, the number of clients in each level, and projected utilization. 
“Spending Limitation” means an annual maximum limit of funds available to purchase services to meet the client’s needs under the HCBS-CES waiver. 
“State Department” means the Colorado Department of Human Services. 
“Supportive services” means medication, appointment, and money management; accessing resources; and telephoning. 
3.742  Program Overview [Rev. eff. 7/1/12] 
A.  The Special Populations Home Care Allowance (SP-HCA) program was established to allow dual eligibility for a SP-HCA program grant for specific clients enrolled in Home and Community Based Services (HCBS) Supportive Living Services (SLS) or HCBS-Children’s Extensive Support (CES) waivers meeting eligibility criteria established within these rules. 
B.  The SP-HCA grant shall be used for the purpose of securing non-skilled services for a client in his/her home, based on the SEP's functional assessment.  Skilled personal care is not a paid service under the SP-HCA grant. (See HCPF rules, Section 8.489.30 (10 CCR 2505-10) for the definition of skilled personal care). 
C.  The SP-HCA grant shall be paid to the designated care provider and shall not be used to meet ordinary household expenses, including but not limited to, shelter costs, utilities, food, toiletries, clothing, or home furnishings. 
D.  SP-HCA is a non-entitlement program that can only be combined with HCBS-SLS and HCBS-CES.  No other long-term care program, such as other Home and Community Based Services waivers, Home Care Allowance (HCA), or Adult Foster Care (AFC), may be combined with SP-HCA. 
E.  Eligibility for the SP-HCA program shall be based on: 
1.  Basic requirements for public assistance benefits, including residency, citizenship, and lawful presence, as outlined in Section 3.100 et seq., and 3.200, et seq.; 
2.  Financial need; 
3.  The client’s functional capacity score; 
4.  The client’s need for paid care score; 
5.  The client’s receipt of Home Care Allowance (HCA) between September 1, 2011 and December 31, 2011; and, 
6.  The client’s receipt of and relationship to his/her HCBS-SLS SPAL or HCBS-CES Spending Limitation maximum between September 1, 2011 and December 31, 2011, as outlined in Section 3.743, A-B. 
F.  Authorized grants under SP-HCA are subject to the client’s ongoing eligibility and to available appropriations. 
G.  The SP-HCA program sunsets and shall no longer be available after June 30, 2017. 
3.743  Application Process and Eligibility Determination [Rev. eff. 7/1/12] 
A.  Persons identified as potential clients for a SP-HCA grant minimally shall have been: 
1.  Approved for Supplemental Security Income (SSI) benefits and been receiving at least a one dollar ($1.00) SSI payment at least one month between September 2011 and December 2011; or, 
2.  Eligible for a Home Care Allowance (HCA) grant under criteria for the Old Age Pension (OAP) or Aid to the Needy Disabled/Aid to the Blind – State Only (AND/AB-SO) programs as outlined in Sections 3.300, et seq. and 3.400, et seq., at least one month between September 2011 and December 2011; and, 
3.  Receiving a Home Care Allowance (HCA) grant at least one month between September 2011 and December 2011; and, 
4.  Receiving HCBS-SLS or HCBS-CES services at least one month between September 2011 and December 2011; and, 
5.  One thousand dollars ($1,000) or less from the maximum SPAL or Spending Limitation for his/her functional level of need within the HCBS-SLS or HCBS-CES waiver between September 2011 and December 2011. 
B.  Persons identified by the State Department as potential clients by meeting the criteria outlined in Section 3.743, A, through a review of the Colorado Benefits Management System (CBMS), the data system for the Division for Developmental Disabilities, and review of the Single Entry Point (SEP) case file shall be provided a one-time-only opportunity to apply for SP-HCA. 
1.  The application process to determine eligibility for the SP-HCA grant shall be initiated no later than the effective date of the rules for the SP-HCA grant program. 
2.  An application packet for SP-HCA shall be sent to the identified clients. The application packet shall include: 
a.  A cover letter outlining the SP-HCA grant, the application process, and other necessary information; and, 
b.  The application; and, 
c.  Any other forms or documents deemed necessary by the State Department to determine eligibility and process grant payments. 
C.  Clients wishing to apply for an SP-HCA grant shall return the application packet and all supporting documentation so it arrives in the State Department office no later than June 1, 2012. 
1.  Applications may be returned via email, fax, or mail service. 
2.  Clients whose application is received in the State Department office after June 1, 2012 shall be determined permanently ineligible for SP-HCA. An appeal of this decision must be filed no later than thirty (30) calendar days after the denial. 
D.  Each application that was returned timely shall be reviewed within forty five (45) calendar days of receipt of the application to determine eligibility and grant award, to include: 
1.  Completeness of the application. 
a.  Incomplete and/or unsigned applications shall be returned to the client immediately. 
b.  If an incomplete application is received between April 15 and June 1, 2012, the State Department may grant a waiver, at its discretion, for the client to return the completed application after the June 1, 2012 program deadline for application. 
2.  Financial eligibility determination. 
a.  A client receiving at least one dollar ($1.00) in SSI benefits shall be determined financially eligible. 
b.  A client not receiving at least $1.00 in SSI benefits shall meet eligibility under either the OAP or AND-SO program requirements for Home Care Allowance (HCA), as outlined in Sections 3.300, et seq. and 3.400, et seq. to be determined financially eligible. 
1)  A secondary application to collect income and resource information shall be sent to the client immediately. 
2)  The client shall return the completed secondary application along with all verifications of income and resources within twenty (20) working days. 
3)  A phone interview shall be scheduled with the client or authorized representative to review the secondary application and verifications. 
4)  If the client or authorized representative refuses to consent to the interview, fails to return the secondary application, or fails to provide required verification the client shall be permanently ineligible for the SP-HCA program. An appeal of this decision must be filed no later than thirty (30) calendar days after the denial. 
3. Functional eligibility determination. 
a.  If the client’s most recent functional assessment (FA), care plan (CP), and provider agreement (PA) were completed ten (10) or more months prior to the application date, the State Department shall refer the client to the appropriate SEP for a new FA, CP, and PA prior to determining eligibility. 
1)  The SEP shall complete the FA, CP, and PA no later than fifteen (15) working days from the date of referral by the State Department. 
2)  The SEP shall email the State Department with the completed FA, CP, and PA within one (1) working day of completion. 
b.  If the client’s most recent FA, CP, and PA were completed less than ten (10) months prior to the application date, the State Department shall review for functional eligibility. 
4.  SP-HCA special eligibility criteria. 
a.  A client must have received a Home Care Allowance (HCA) payment at least one month between September 2011 and December 2011. 
b.  A client must have received HCBS-SLS or HCBS-CES waiver services at least one month between September 2011 and December 2011. 
c.  A client must have been $1,000 or less from his/her SPAL in HCBS-SLS or Spending Limitation in HCBS-CES at least one month between September 2011 and December 2011. 
d.  All applications will be reviewed for eligibility retroactive to January 2012, provided the client was still a resident of Colorado on January 1, 2012. 
E.  All eligible clients shall be approved for an SP-HCA program grant. 
1.  The SP-HCA program approval shall be retroactive to January 2012 for all months that the client is eligible. 
2.  The client’s grant amount shall be based on the SP-HCA tier of payment as determined by the functional assessment conducted by the SEP. 
3.  Grants shall be for one full month and shall not be prorated based on a partial month of services. 
F.  Notice shall be provided to the client of approval for or denial of an SP-HCA grant no later than ten (10) working days after completing the eligibility determination. 
1.  The notice shall contain the eligibility result and appropriate rule citations; and, 
2. The date when the grant will be effective, if approved; or, 
3.  The date and reason for denial and the appeal process, if denied. 
G.  The initial payment shall be processed within ten (10) working days of approval. Subsequent monthly payments shall be processed no later than the fifth working day of the month. 
1.  The client or authorized representative shall report any changes related to income, resources, functional assessment, HCBS waiver status, or any other change that might affect eligibility to the State Department or SEP within five (5) working days of the change. 
2.  Failure to report a change shall be grounds for discontinuation from the program and any payments made after the change shall be subject to recovery and/or fraud investigation and possible prosecution, as outlined in Section 3.800 et seq. 
H.  The SP-HCA authorized grant amount in each tier is determined by the State Department and is subject to change at any time to ensure the expenditures do not exceed the available appropriation for SP-HCA and/or HCA. An appeal shall not be granted. 
I.  Hardship exceptions outlined in Sections 3.140.173, 3.210.3, 3.622.2, 3.622.3, 3.705.11, 3.810.73, and 3.810.76 shall not apply to SP-HCA grants.
3.744  Functional Assessment, Care Plan, and Provider Agreement [Rev. eff. 7/1/12] 
A.  The Single Entry Point (SEP) agency shall complete a functional assessment for each client as follows: 
1.  Upon referral by the State Department to determine initial eligibility for the SP-HCA program; or, 
2.  Immediately whenever the SEP, during ordinary case management services and in his/her professional opinion, identifies a significant change in the client’s ability to perform activities of daily living; or, 
3.  Immediately whenever the client or authorized representative reports a significant change in the client’s ability to perform activities of daily living; or, 
4.  Annually, at a minimum, the annual functional assessment shall be completed no earlier than forty five (45) calendar days prior to and no later than the client’s reassessment due date.  The assessment shall include, but may not be limited to: 
a.  A new functional assessment during a face-to-face visit at the client's place of residence; 
b.  Evaluation of the appropriateness of services, service effectiveness, and quality of care over the past year; and, 
c.  Completion of an updated care plan and provider agreement. 
B.  The functional assessment shall determine the functional capacity score and the Need for Paid Care score and shall be completed on the State Department required form. 
1.  The client shall meet requirements for both scores to be eligible for a SP-HCA grant. 
2.  A functional capacity score of twenty one (21) or higher and a Need for Paid Care score of one (1) or higher shall be required. 
a.  The functional capacity assessment shall assess the client’s capacity to meet his/her needs in the following areas:  physical transfers, bladder and bowel care, mobility, dressing, bathing and hygiene, eating and meal preparation, housework and laundry, shopping, medication management, money management and accessing resources, and ability to set appointments and use the telephone. 
b.  The scoring guidelines are as follows: 
1)  Independent – Client is able to perform all components of the function with or without an assistive device. Score = 0. 
2)  Little – Client is able to perform all essential components of the function but some impairment of function exists even with an assistive device. The client requires some supervision or physical assistance in some components of the activity. Score = 1. 
3)  Moderate – Client is unable to perform most of the essential components of the function even with an assistive device. Client requires a great deal of assistance or supervision to accomplish the activity. Score = 2. 
4)  Severe – Client is totally unable to perform the function and needs someone to perform the task, or the client requires constant supervision. Score = 3. 
3.  The Need for Paid Care score reflects the frequency of assistance required by the client to perform the functional activities. The need for paid care shall be greater than and differentiated from normal household routine and the normal expectation of assistance by family members living in the home. If the need is not more than or differentiated from normal household routine and the normal expectation of assistance by family members, the client shall not be scored as needing paid care for that service. 
a.  None – Client’s needs are met.  No need for paid care or care is required less than once per week. Score = 0. 
b.  Weekly – Client needs paid care up to once per week. Score = 1. 
c.  Daily – Client needs paid care more than once a week, but no more than once per day for up to seven (7) days per week. Score = 2. 
d.  Twice Daily – Client needs paid care at least twice per day and five (5) days per week. Score = 3. 
4.  For SP-HCA, the SEP shall score children age zero (0) through thirteen (13) years in both functional capacity and need for paid care according to the following age appropriate criteria: 
a.  Toileting: a child age zero (0) to thirty six (36) months shall not be scored for bowel and bladder incontinence. 
b.  Mobility and positioning: a child age 0 to 36 months shall not be scored for mobility and positioning. 
c.  Dressing: a child age zero (0) to sixty (60) months shall not be scored for dressing. 
d.  Bathing and hygiene: a child 0 to 60 months shall not be scored for bathing and hygiene. 
e.  Eating: a child zero (0) to forty eight (48) months shall not be scored for eating. 
f.  Transfers: a child 0 to 48 months shall not be scored for transfers. A child 0 to 60 months shall not be scored for car seat, highchair, or crib transfers. 
5.  The overall score shall determine the maximum grant that shall be authorized for the client. 
a.  A need for paid care score of 1-23 with a functional capacity score of 21 or higher meets the criteria for the low tier grant standard. 
b.  A need for paid care score of 24-37 with a functional capacity score of 21 or higher meets the criteria for the middle tier grant standard. 
c.  A need for paid care score of 38 and over with a functional capacity score of 21 or higher meets the criteria for the high tier grant standard. 
6.  The grant standards shall equal the grant standards for the Home Care Allowance (HCA) program. 
a.  The SP-HCA grant is not taxable income to the client. 
b.  The payment made to the care provider using the SP-HCA grant received by the client is income to the care provider and subject to taxation under State and Federal laws. 
C.  The SEP shall develop a care plan on a State Department approved form for all clients who meet the functional capacity requirements for a SP-HCA grant. 
1.  The care plan shall be completed and shall be signed by all parties no later than ten (10) working days from the date of the functional assessment. 
2.  The care plan shall include, but not be limited to, the following tasks: 
a.  The identification and documentation of care plan goals and client choices; 
b.  The identification and documentation of services, including type, duration, and frequency; 
c. The formalization of the care plan provider agreement, including appropriate signatures, in accordance with program requirements; 
d.  The explanation of complaint procedures to the client as listed on the care plan document; 
e.  The explanation of appeals process to the client, if necessary. 
3.  The care plan shall ensure that there is prudent purchase of services. 
a.  There shall be no service duplication between the client’s HCBS services and approved SP-HCA services and those services that can be received through other paid or unpaid service providers or sources. 
b.  When services are available to the client at no cost from family, friends, volunteers, or others, these services shall be utilized before the purchase of services. 
c.  When public dollars must be used to purchase services, the case manager shall encourage the client to select the lowest cost provider of service when quality of service is comparable. 
d.  The SEP shall meet the client's needs, with consideration of the client's choices, using the most cost effective methods available. 
4.  The SEP shall assist the client in locating a care provider, if needed. 
a.  The SEP shall negotiate with the client or authorized representative and the care provider to arrive at the total number of paid care hours to be provided monthly. 
b.  The client or authorized representative and the provider shall sign the state prescribed provider agreement and each party shall receive a copy of the agreement. 
c.  SP-HCA payments shall be made directly to the client or authorized representative who is responsible for paying the provider monthly for the agreed upon services. 
D.  The SEP shall notify the client in writing of the outcome of the functional assessment no later than ten (10) working days from the date of the functional assessment. The notice shall contain: 
1.  The functional eligibility result and appropriate rule citations. 
2.  The authorized grant amount, if the functional assessment determines the client has a functional need for paid care: 
a.  The authorized grant amount shall be the tier grant standard based on the client’s overall functional capacity and need for paid care score; or, 
b.  An amount less than the tier grant standard based on the client’s overall functional capacity score if the care provider has agreed to provide all services outlined in the care plan for the lesser amount. 
3.  The reason for denial and the appeal process, if denied. 
E.  Upon completion of the functional assessment, care plan, and provider agreement, the SEP shall email or fax the State Department all documentation within one (1) working day of finalizing the care plan agreement. 
F.  The SEP shall monitor the provision of services by the care provider to ensure the care plan is implemented, the care provider is providing services as agreed, the client’s services are appropriate, and to identify any changes in functional need. 
1.  A home visit shall be conducted every six (6) months in conjunction with the HCBS required visit. 
2.  A home visit earlier than six (6) months shall be conducted when the SEP, in its professional opinion, believes the client’s needs may have changed, and/or the client is not receiving or paying for appropriate care as established in the care plan agreement, and/or the client reports concerns regarding the provision of services. 
3.  A client or authorized representative’s refusal to allow a home visit is grounds for discontinuation from the SP-HCA grant program, as outlined in Section 3.746, D-E.
G.  The SEP shall perform all other duties for the SP-HCA program as is required for the HCA program, outlined in Section 3.720.
3.745  Ongoing Determination of Eligibility [Rev. eff. 7/1/12] 
A.  Ongoing review of the client’s eligibility beginning February 2012 and thereafter shall be conducted by in coordination with the SEP, Division for Developmental Disabilities, and State Department. To remain eligible for a SP-HCA grant, the client shall continually: 
1.  Be approved for Supplemental Security Income (SSI) benefits and be receiving at least a one dollar ($1.00) SSI monthly payment; or, meet all eligibility criteria for the Old Age Pension (OAP) or Aid to the Needy Disabled/Aid to the Blind – State Only (AND/AB-SO) programs; and, 
2.  Be receiving HCBS-SLS or HCBS-CES services and SP-HCA; and, 
3.  Remain one thousand dollars ($1,000) or less from the maximum SPAL or Spending Limitation for his/her functional level of need within the HCBS-SLS or HCBS-CES waiver; and, 
4.  Meet the SP-HCA eligible Functional Capacity Score and Need for Paid Care Score as outlined in Section 3.744. 
B.  Annual reassessment and redetermination shall be conducted. 
1.  A new functional assessment shall be conducted by the SEP, as outlined in Section 3.744. 
2.  A new financial and SP-HCA eligibility determination shall be conducted, as outlined in Section 3.743. 
3.  The client or authorized representative shall compete and timely return the redetermination application and any other required documentation required to process the redetermination. 
4.  Notice of continued eligibility and grant amount shall be provided, if the client is determined eligible for SP-HCA. 
D.  If during ongoing review or at the time of annual redetermination the client is no longer eligible for SP-HCA, notice of discontinuation and appeal rights shall be provided within ten (10) working days. 
1.  The notice shall include the reason for the discontinuation, the appropriate rule citations, and information on the appeal process. 
2.  The appeal process shall be as outlined in Section 3.850, with the following exceptions: 
a.  Requirements of the County Department shall be changed to requirements of the State Department and/or SEP and requests for a county level conference shall be a State Department level conference. 
b.  Appeals shall be granted for specific SP-HCA requirements only within thirty (30) days of denial as outlined in Section 3.743, C and D. 
c.  Appeals shall not be granted for specific SP-HCA requirements, as indicated in Section 3.743, H. 
3.746  Denials and Discontinuations [Rev. eff. 7/1/12] 
A.  A client shall meet all eligibility requirements outlined in Section 3.743, D, 2-4, each month to continue to be eligible for the SP-HCA program. 
B.  Clients shall be denied or discontinued from the SP-HCA program if he/she is determined ineligible. The client shall be informed of the adverse action and appeal rights in accordance with rules under Section 3.745. 
C.  Clients that are denied and/or are discontinued from the SP-HCA program are permanently disqualified from the program and shall not be eligible to apply for or be approved for benefits in subsequent months or years. 
D.  The SEP shall notify the client when denied or discontinued from the SP-HCA program for any one or more of the following reasons: 
1.  The client no longer receives services under the HCBS-SLS or HCBS-CES waiver. 
2.  The client’s needs change and his/her level of service need is no longer within $1,000 of the SPAL or Spending Limitation for HCBS-SLS or HCBS-CES. 
3.  The client no longer meets the functional capacity and need for paid care scores necessary to be approved for SP-HCA. 
4.  The client has not received services for thirty (30) or more consecutive days. 
5.  The client or authorized representative has refused to schedule an appointment with the SEP or refuses to allow for a home visit, an initial assessment, six-month review, reassessment, or other review. 
6.  The client or authorized representative has failed to keep two (2) scheduled appointments. 
7.  The client or authorized representative refuses to sign the care plan or other documents and forms required to receive services or in any other way refuses to cooperate with the requirements of the SP-HCA program. 
8.  The client or authorized representative refuses to use the SP-HCA grant to pay for services, uses the grant for services not identified in the care plan and provider agreement, or uses the grant to purchase household expenses, including but not limited to, shelter costs, utilities, food, toiletries, clothing, home furnishings or other items not authorized by the SP-HCA care plan. 
9.  The client is a resident of a nursing facility, hospital, alternative care facility, group home, licensed or unlicensed long-term care facility, or other institution. 
10.  The client enters a hospital or other long-term care facility for treatment or rehabilitation that continues for thirty (30) or more consecutive days. 
a.  SP-HCA benefits shall be temporarily discontinued while the client remains in the hospital or long-term care facility for treatment or rehabilitation. 
b.  SP-HCA benefits shall be permanently discontinued if the client remains in the hospital or long-term care facility for treatment or rehabilitation for one hundred eighty (180) or more consecutive days. 
11.  The client cannot be safely served given the type and/or amount of services available. To support a denial or discontinuation for safety reasons related to service limitations, the SEP shall document the limitations and evidence of safety concerns, when available, including, but not limited to: 
a.  The results of an adult protective services assessment; 
b.  A statement from the client's physician attesting to diminished mental capacity or increased medical or physical care needs; 
c.  Lack of available services and/or providers; 
d.  An assessment score indicating a level of need for services in excess of those available under the SP-HCA program; and/or, 
e.  Other available information or evidence that will support the determination that the client’s safety is at risk. 
12.  The level of service need is not cost effective under the SP-HCA program. To support a denial or discontinuation due to cost effectiveness the SEP shall document the level of service need and more cost effective alternatives. 
13.  The client has moved out of the state or country or has or been out of the state or country for more than thirty (30) consecutive days. Discontinuation shall be effective the day after the date of the move or on day thirty one (31) of the absence from the state or country. 
14.  The client or authorized representative requests withdrawal from the program. 
15.  The client or authorized representative has failed to report a change in circumstances that potentially affects eligibility for SP-HCA, as outlined in Section 4.743, G. 
16.  The client has died. Discontinuation shall be effective the day after the client’s death. No notice of discontinuation shall be sent. 
E.  The State Department shall notify the client when denied or discontinued from the SP-HCA program for any one or more of the following reasons. 
1.  The client no longer meets financial eligibility criteria, as outlined in Section 3.743, D, 2.
2.  The client or authorized representative has refused to schedule an appointment with the State Department or refuses to allow for a home visit, an initial assessment, six-month review, reassessment and redetermination, or other review. 
3.  The client or authorized representative has failed to keep two (2) scheduled appointments. 
4.  The client or authorized representative refuses to sign the application or other documents and forms required to receive services or in any other way refuses to cooperate with the requirements of the SP-HCA program. 
5.  The client or authorized representative refuses to use the SP-HCA grant to pay for services, uses the grant for services not identified in the care plan and provider agreement, or uses the grant to purchase household expenses, including but not limited to, shelter costs, utilities, food, toiletries, clothing, home furnishings or other items not authorized by the SP-HCA care plan. 
6.  The client has moved out of the state or country or has or been out of the state or country for more than thirty (30) consecutive days. Discontinuation shall be effective the day after the date of the move or on day 31 of the absence from the state or country. 
7.  The client or authorized representative requests withdrawal from the program. 
8.  The client or authorized representative has failed to report a change in circumstances that potentially affects eligibility for SP-HCA, as outlined in Section 4.743, G. 
9.  The client has died. Discontinuation shall be effective the day after the client’s death. No notice of discontinuation shall be sent. 
F.  The notice of adverse action shall include the reason for denial or discontinuation, the appropriate rule cite, and appeal rights. 
G.  In the event of denial or discontinuation, the SEP shall: 
1.  Provide appropriate referrals to other community resources, as needed, within one (1) working day of discontinuation. 
2.  Notify all providers on the care plan within one (1) working day of discontinuation. 
3.  Notify the State Department within one (1) working day of discontinuation. 
4.  Attend the appeal hearing to defend the denial or discontinuation. 

**************