Section R9-21-314. Modification or Termination of Plans

A.       Requests for modifications or termination of an ISP or any portion of an ISP may be initiated at the ISP review or at any other time by:

1.        The client;

2.        Any designated representative and/or guardian;

3.        A service provider; or

4.        Any member of the clinical team.

B.       A request for modification or termination of an ISP shall be directed to the case manager.

C.       The case manager shall give the client, the client’s guardian and designated representative, appropriate service providers, and the client’s clinical team written notice of any request for modification or termination of the ISP.

D.       An ISP may be modified in order to more appropriately meet the client’s needs, goals, and objectives. An ISP shall be modi- fied where:

1.        The client withdraws consent to the ISP or any portion of the ISP;

2.        The client consents to services recommended as more suitable but previously refused by the client;

3.        The needs of the client have changed due to progress or lack of progress in meeting the client’s goals and objec- tives;

4.        The proposed change will permit the client to receive ser- vices which are more consistent with the client’s needs, less restrictive of the client’s freedom, more integrated in the community, or more likely to maximize the client’s ability to live independently;

5.        The client wants to change the long-term view and the focus of the ISP or no longer needs a service or services; or

6.        The client is no longer eligible for services according to R9-21-303.

E.       The clinical team shall:

1.        Be notified by a service provider of any proposed termi- nation or modification of services in the ISP as soon as possible and always prior to its implementation;

2.        Promptly inform the client and any designated represen- tative and/or guardian of the requested modification and seek the client’s consent to implement such modification or termination; and

3.        Within 20 days of any request for modification or termi- nation of an ISP, approve the request only if the request meets the requirements of subsection (D).

4.        Provide written notice of the right to appeal to the client and any designated representative and guardian in accor- dance with R9-21-401(B) whenever service to the client is to be terminated, suspended or reduced.

F.       The case manager shall:

1.        Incorporate the approved modification in the current ISP or prepare a revised ISP, as appropriate.

2.        Within five days of any approval by the clinical team, dis- tribute the modified or revised ISP to the client, any des- ignated representative and/or guardian, the members of the clinical team, and all service providers.

3.        Meet with the client or guardian to explain the modifica- tion or revision and the client’s right to appeal according to R9-21-401.

G.      If the client or any designated representative and/or guardian does not reject or appeal the termination or modification within 30 days of the date the modified ISP is distributed, the client shall be deemed to have accepted the termination or modification.

H.      The client for whom a modification or termination is proposed or any designated representative and/or guardian may appeal a modification or termination according to R9-21-401.

I.         If the clinical team denies the client’s or guardian’s request to modify or terminate an ISP, the client or the designated repre- sentative and/or guardian may appeal the denial according to R9-21-401.

J.        No modification or termination of an ISP shall be made with- out the acceptance of the client or any designated representa- tive and/or guardian, unless a qualified clinician determines that the modification or termination is required to avoid a seri- ous or immediate threat to the health or safety of the client or others.

1.        Except in an emergency, no requested termination of a client from a particular service or provider may be con- sidered unless the standards and procedures set forth in R9-21-210 and the provisions of this rule are satisfied.

2.        The client may not be transferred from one program or location to another while an appeal is pending.

K.       If a qualified clinician determines that the client is no longer eligible for services according to R9-21-303, the qualified cli- nician shall make a determination of non-eligibility, move to terminate services under the ISP and this rule, and notify in writing the client of the non-eligibility determination and of the right to appeal such determination, in accordance with R9- 21-401. When appropriate, referral and provision for further treatment shall be made by the case manager or clinical team.

Historical Note

Adopted under an exemption from A.R.S. Title 41, Chap- ter 6 pursuant to Laws 1992, Ch. 301, § 61, effective October 7, 1992; received in the Office of the Secretary of State October 14, 1992 (Supp. 92-4). Amended under an exemption from A.R.S. Title 41, Chapter 6 pursuant to Laws 1992, Ch. 301, § 61, effective September 30, 1993 (Supp. 93-3). Amended by exempt rulemaking at 9

A.A.R. 3296, effective June 30, 2003 (Supp. 03-2).