La. Admin. Code tit. 48 § I-20121

Current through Register Vol. 50, No. 11, November 20, 2024

Section I-20121 - Reasons for Closure and/or Termination [Formerly LAC 67:VII.1127]

A. The following may result in termination of services and/or closure:

1. the participant no longer meets eligibility criteria;

2. the participant intentionally falsified information;

3. the participant has shown consistent failure to cooperate with the service plan and management contractor;

4. the participant is unable to be contacted and/or whereabouts unknown for 90 days or more and no response after an attempted home visit and certified letter;

5. the participant made misrepresentations in the eligibility determination process;

6. the participant made misrepresentations to obtain goods and services;

7. any other reason which is contradictory to policy and procedures for the SPAS Program.

B. The management contractor should issue a "warning" to participants who commit a violation of policy. If the violation is not intentional, written notice of the violation and action to correct the violation is to be given to the participant. A copy of the warning notice to the participant is to be placed in the participants case record. The management contractor shall make a recommendation to the OAAS program manager to terminate a participant who continues to violate the policy and/or procedures of the SPAS Program after a warning has been issued. The decision to terminate will be based on the severity of the violation(s) and/or continued violation(s) and will be made by OAAS.

1. If the violation of policy by the participant was intentional, the management contractor shall immediately notify the OAAS program manager. In the case of an intentional violation of the policy by the participant, a warning does not need to be issued prior to termination from the program.

2. When a participant is terminated from this program the management contractor will send a termination letter to the participant that explains the reason(s) and right to an appeal;

C. Recoupment

1. In lieu of termination, the management contractor can demand that a participant refund the SPAS Program for all benefits received.

2. If the management contractor rules that the participant must repay the amount in question, the management contractor will determine the repayment schedule. Participant can remain eligible as long as recoupment is made and a willingness to comply with policies and procedures set forth in the SPAS Program are shown. The management contractor shall maintain close monitoring of the participant until such time the management contractor determines participant is complying with the policies and procedures.

3. Recoupment is required from fraudulently received benefits as well; however, the participant will not be eligible for further services.

La. Admin. Code tit. 48, § I-20121

Promulgated by the Department of Social Services, Rehabilitation Services, LR 21:1251 (November 1995), amended LR 33:1149 (June 2007), amended by the Department of Health and Hospitals, Office of Aging and Adult Services, LR 41:388 (February 2015).

AUTHORITY NOTE: Promulgated in accordance with R.S. 46:2116.2.