Appendix IX, Notification Effective Date of Decision

Revision 22-3; Effective Sept. 1, 2022

Case Action Date Form Is Mailed or Given to Applicant or Recipient Effective Date to be Entered on Form 2065-A, Notification of Community Care Services
If application is denied, includes when the applicant is denied for one service that was requested but granted another service: Within two business days of denial. Not applicable for denials.
If application is certified: Within two business days of certification. The effective date is the date on Form 2064, Eligibility Worksheet, or the negotiated date.

The effective date for Primary Home Care (PHC), Community Attendant Services (CAS) and Title XIX Day Activity and Health Services (DAHS) cases is not applicable. Check the "pending" box to indicate eligibility is contingent on medical approval. For Residential Care (RC) cases in which the applicant is determined eligible for Emergency Care, enter the date the applicant was determined eligible.
If a verbal referral is necessary or priority status is added: Within two business days of certification. The date is negotiated with the provider for PHC and Family Care (FC) or the provider and regional nurse for CAS.
If there is:
  • denial of priority status at the recipient's request,
  • a decrease in copayment, or addition of a service;
 Within two business days of the decision. The date the action is completed is the date the change goes into effect.
If there is an increase in units: Within two business days of the decision. The date must be within seven calendar days after the date on Form 2101, Authorization for Community Care Services.
If the recipient loses PHC eligibility and is transferred to FC, whether or not there is a change in units or if priority status is terminated due to the:
  • loss of a personal care task needed for PHC, CAS or DAHS;
  • addition of a resource from a community or social network, support system or caregiver which performs all of the previously purchased tasks;
  • recipient becomes financially ineligible;
  • loss of unmet need; or
  • recipient requests that service(s) be terminated;
 12 calendar days before the date services are decreased, terminated or transferred, unless the recipient loses Medicaid. 12 calendar days following the date Form 2065-A is mailed. *
If services are decreased or terminated because:
  • a recipient loses CAS eligibility for financial reasons and is not transferred to FC;
 Within two business days of the learned denial date The last day of the final month of CAS eligibility as determined by the Medicaid for the Elderly and People with Disabilities (MEPD) staff.
  • an interest list person withdraws;
 Not applicable. No notice is sent in this situation.
  • a DAHS facility-initiated recipient does not want to have the initial paperwork processed for continued DAHS services;
 12 calendar days before the case is closed. 12 calendar days following the date Form 2065-A is mailed.*
  • changes in federal law or state regulations require that services be decreased or terminated for an entire categorical recipient group;
 Before the date of action. Services continue only through the termination date of the categorical recipient group, even if appealed.
  • of functional ineligibility for personal attendant services (PAS) or loss of the need for six hours of PAS;
 12 calendar days before the case is closed (only at annual review). 12 calendar days following the date Form 2065-A is mailed.*
  • a recipient moves to a skilled or intermediate care facility, or any other facility where 24-hour supervision is available;
 Within two business days of the date information that a nursing facility stay is permanent or notification of the effective date. The date the recipient entered the facility.
  • a recipient threatens their health or safety or others;
  • a recipient or someone in their home threatens the department
 Within two business days of the date information is received. The date CCSE staff become aware of the action. Services are not reinstated before the outcome of the appeal hearing.
  • a recipient loses Medicaid and does not qualify for FC;
 Within two business days of the date information is received. The last date of eligibility for Medicaid.
  • the Texas Health and Human Services Commission has facts confirming the death of the recipient;
 Not applicable. Not applicable.
If services are decreased or terminated for any reason not given above: at least 12 calendar days before services are decreased or terminated. 12 calendar days following the date Form 2065-A is mailed *, unless the recipient:
  • requests that services end, or
  • enrolled in another program equivalent or better.
In some cases, the recipient might request a specific effective date.

For decreased services, day 12 is the last day the recipient has the right to appeal. Day 13 is the first day the recipient will receive the decreased service hours.

For denied services, day 12 is the last day the recipient has the right to appeal and is the last day the recipient will receive services.

Note: When the recipient orally requests their services be decreased or terminated, document the recipient’s reason and obtain their signature in the comments section of Form 2065-A. The effective date of the adverse action is the date that Form 2065-A is dated and given to the recipient.

* If day 12 falls on a weekend or holiday, the effective date is the following business day.

Refer to the instructions for Form 2065-A for the procedures to follow when a recipient requests a hearing in writing or in person.

Notes:

  • For terminations, the effective date on Form 2065-A must be the same as the “End Date” on Form 2101.
  • Do not send Form 2065-A when a recipient’s forwarding address is unknown, such as situations when the post office sends notification that the recipient left no forwarding address.
  • Send Form 2065-A when a recipient is transferring from one service to another, regardless of whether the change is considered to be positive or negative.