Section 441.153.57. Reduction, denial, or termination of benefits.

The member’s state payment program benefits may be denied, terminated, or reduced according to the provisions of the approved county management plan of the member’s county of residence.

       153.57(1) Termination of eligibility. A member shall remain eligible until:

        a.           Reimbursement for episodic commitment costs has been made to the county if the member was enrolled for commitment costs only;

        b.           The CPC in the county of residence notifies the state payment program manager that the member is no longer eligible;

        c.           No services have been reported for the member for six months; or

        d.           The member is disenrolled pursuant to subrule 153.57(2).

       153.57(2) Disenrollment. If instituting a waiting list does not adequately address the funding shortfall, the department shall begin disenrollment of members.

        a.           Members who are enrolled and receiving services being reimbursed by the state and who are not under court-ordered involuntary commitment shall be disenrolled beginning with the highest payment slot number first.

        b.           The department shall notify the member and the CPC when a member is to be disenrolled. The department shall give the member at least ten days’ notice of disenrollment pursuant to rule 441—7.7(17A). The department shall give a member receiving any residential service 30 days’ notice of disenrollment from the program consistent with department of inspections and appeals’ rule 481—57.36(135C).

        c.           Any member who is disenrolled shall be placed on the waiting list as provided in subrule 153.54(5).

[ARC 8486B, IAB 1/13/10, effective 1/1/10; ARC 8612B, IAB 3/10/10, effective 4/14/10]