Suspension and Termination

(1) An ASAP may suspend a Consumer's Home Care Program Services if the Consumer is temporarily unavailable to receive such services in his or her home for up to 90 calendar days. The ASAP may extend the Suspension of Home Care Services to a Consumer beyond such 90 day period for reasonable cause and shall document such cause in the Consumer's record. The ASAP shall reassess the Consumer's need for services when the Consumer becomes available to receive services in his or her home. (2) If it appears during such Suspension period that the Consumer's unavailability will last longer than 90 calendar days and reasonable cause for extension of the suspension is not present, the ASAP shall forward a Notice of Action to the Consumer to terminate Home Care Program Services. (3) If the Consumer no longer meets the eligibility criteria for the Home Care Program set forth in 651 CMR 3.04(2), (3), (4), or (5) the ASAP shall forward a Notice of Action to the Consumer to terminate Home Care Program Services. (4) Notice of Action Requirements. (a) For non-Frail Elder Waiver Consumers, the Notice of Action shall include the date on which services were suspended; the reason for the Termination; and a statement that the Consumer's Home Care Services shall be Terminated on the 15th calendar day after the Consumer receives such Notice of Action unless the Consumer takes either of the following actions prior to such date: 1. The Consumer notifies the ASAP within 14 calendar days after receiving such Notice of Action that he or she is available to receive Home Care Services in his or her home. The Consumer's need for Home Care Program Services shall be reassessed as soon as possible after the ASAP is notified that the Consumer is available to receive such services; or 2. If the Consumer requests a Review of such Termination of Home Care Services which is received by the ASAP on or before the 14th calendar day following the Consumer's receipt of such Notice of Action. If the Consumer files a timely request for Review, the ASAP shall continue the Suspension or continue the provision of Home Care Program Services during the Review and Appeal period. If the Consumer fails to timely notify the ASAP or request a Review of the Notice of Action Terminating Services as set forth in 651 CMR 3.07, the Consumer's request for reinstatement shall be treated as a new application for Services. (b) For Frail Elder Waiver Consumers, the Notice of Action shall include the date on which a Frail Elder Waiver Consumer's services were suspended; the reason for the termination; and a statement that the Consumer's Home Care Services shall be Terminated on the 31st calendar day after the Consumer receives such Notice of Action unless the Consumer takes either of the following actions prior to such date: 1. The Consumer notifies the ASAP within 30 calendar days after receiving such Notice of Action that he or she is available to receive Home Care Services in his or her home. The Consumer's need for Home Care Program Services shall be reassessed as soon as possible after the ASAP is notified that the Consumer is available to receive such services; or 2. If the Consumer requests a Review of such Termination of Home Care Services which is received by the ASAP on or before the 30th calendar day following the Consumer's receipt of such Notice of Action. If the Consumer files a timely request for Review, the ASAP shall continue the Suspension or continue the provision of Home Care Program Services during the Review and Appeal period. If the Consumer fails to timely notify the ASAP or request a Review of the Notice of Action Terminating Services as set forth in 651 CMR 3.07, the Consumer's request for reinstatement shall be treated as a new application for Services. (5) Right to Appeal. (a) An Applicant/Consumer shall be informed in writing of his or her right to request a Review, where the ASAP makes a decision to deny, terminate, or reduce Home Care Program Service. (b) An ASAP shall inform the Consumer when there has been a change in the source of funding of the Consumer's services but the type of and amount of such services remain unchanged. The Consumer shall not have the right to Appeal a decision by the ASAP where there is or has been a change in the source of funding of his or her services. (c) The Applicant or Consumer shall also be informed in writing of his or her right to Appeal a Review decision to Elder Affairs' Hearings Officer as specified in 651 CMR 1.07: Initiation of Appeal of a Review Decision. The Appeal shall be conducted in accordance with 801 CMR 1.00: Standard Adjudicatory Rules of Practice and Procedure and 651 CMR 1.00: Adjudicatory Rules of Practice and Procedures.