Denial, reduction, and termination of services - Appeal

1. The department or its designee shall inform an individual who is determined to be ineligible for covered services or who becomes ineligible while receiving services in writing of the denial, termination, or reduction, the reasons for the denial, termination, or reduction, the right to appeal, and the appeal process as provided in chapter 75-01-03. 2. An eligible individual must receive ten calendar days' written notice before termination of services occurs. The ten-day notice is not required if: a. The eligible individual enters a basic care facility or a nursing facility; b. The termination is due to changes in federal or state law; c. The eligible individual requests termination of services; or d. The eligible individual moves from the service area. 3. An applicant denied services or an eligible individual terminated from services should be given an appropriate referral to other public or private service providers and should be assisted in finding other resources. 4. The department shall deny or terminate SPED program and Medicaid waiver program services when service to the eligible individual presents an immediate threat to the health or safety of the eligible individual, the provider of services, or others or when services that are available are not adequate to prevent a threat to the health or safety of the eligible individual, the provider of services, or others. Examples of health and safety threats include physical abuse of the provider by the eligible individual, eligible individual self-neglect, an unsafe living environment for the eligible individual, or contraindicated practices, like smoking while using oxygen.