Appendix IX, Notification/Effective Date of Decision

Printer-friendly version

Revision 18-1; Effective June 15, 2018

Case Action	Date Form Is Mailed/Given to Individual	Effective Date to be Entered on Form 2065-A, Notification of Community Care Services
If application is denied, includes denied one service that was requested but granted another service:	Within two workdays of denial.	Not applicable for denials.
If application is certified:	Within two workdays 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 individual is determined eligible for Emergency Care, enter the date the individual was determined eligible.
If a verbal referral is necessary:	Within two workdays 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 individual's request, a change to priority status, a decrease in copayment, or addition of a service;	Within two workdays of the decision.	The date the action is completed is the date the change goes into effect.
If there is an increase in units or priority level:	Within two workdays of the decision.	The date must be within seven days after the date on Form 2101, Authorization for Community Care Services.
If the individual 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 or caregiver which performs all of the previously purchased tasks; individual becoming financially ineligible; loss of unmet need; or individual requesting that service(s) be terminated;	12 full days before the date services are reduced, terminated or transferred, unless the individual loses Medicaid.	12 full days following the date Form 2065-A is mailed. If Day 12 falls on a weekend or holiday, the effective date is the following workday.
If services are reduced/terminated because: an individual loses CAS eligibility for financial reasons and is not transferred to FC;	Within two workdays of the date the case worker learns of the denial.	The last day of the final month of CAS eligibility as determined by the Medicaid for the Elderly and People with Disabilities (MEPD) case specialist.
an interest list individual withdraws;	Not applicable.	No notice is sent in this situation.
a DAHS facility-initiated individual does not want to have the initial paperwork processed for continued DAHS services;	12 full days before the case is closed.	12 full calendar days following the date Form 2065-A is mailed. If Day 12 falls on a weekend or holiday, the effective date is the following workday.
changes in federal law or state regulations require that services be reduced or terminated for an entire categorical individual group;	Prior to the date of action.	Services continue only through the termination date of the categorical individual group, even if appealed.
of functional ineligibility for personal attendant services (PAS) or loss of the need for six hours of PAS;	12 full days before the case is closed (only at annual review).	12 full calendar days following the date Form 2065-A is mailed. If Day 12 falls on a weekend or holiday, the effective date is the following workday.
an individual moves to a skilled or intermediate care facility, or any other facility where 24-hour supervision is available;	Within two workdays of the date the case worker receives the information that a nursing facility stay is permanent or notification of the effective date.	The date the individual entered the facility.
an individual threatens the health or safety of himself or others; an individual or someone in his home threatens the department	Within two workdays of the date the case worker receives the information.	The date the case worker becomes aware of the action. Services are not reinstated prior to the outcome of the appeal hearing.
an individual loses Medicaid and does not qualify for FC;	Within two workdays of the date the case worker receives the information.	The last date of eligibility for Medicaid.
the Texas Health and Human Services Commission has facts confirming the death of the individual;	Not applicable.	Not applicable.
If services are reduced/terminated for any reason not given above:	at least 12 full days before services are reduced or terminated.	12 full calendar days following the date Form 2065-A is mailed, unless the individual: requests that services end, or gains a resource that affects unmet need. Note: When the individual signs the front of Form 2065-A to verify that he has orally requested his services be reduced or terminated, document the individual’s reason in the comments section. The effective date of the adverse action is the date that Form 2065-A is dated and given to the individual. In some cases, the individual might request a specific effective date. If Day 12 falls on a weekend or holiday, the effective date is the following workday. For denied services, Day 12 is the last day the individual has the right to appeal and is the last day the individual will receive services. For reduced services, Day 12 is the last day the individual has the right to appeal and Day 13 is the first day the individual will receive the reduced number in service hours.

Refer to the instructions for Form 2065-A for the procedures to follow when an individual 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 an individual’s forwarding address is unknown, such as situations when the post office sends notification that the individual left no forwarding address.
Send Form 2065-A when an individual is transferring from one service to another, regardless of whether the change is considered to be positive or negative.