Part 1.
TEXAS DEPARTMENT OF HEALTH
Chapter 14.
COUNTY INDIGENT HEALTH CARE PROGRAM
The Texas Department of Health (department) proposes amendments to §§14.1,
14.2, 14.102, 14.103, 14.104, 14.105, 14.107, 14.201, 14.202, 14.203, 14.204
and new §14.109 concerning the County Indigent Health Care Program (CIHCP).
The proposed amendment to §14.1 will comply with state law, simplify
program administration, and make minor clarifications. To comply with state
law, §14.1 clarifies the distribution of state assistance funds to eligible
counties based on a maximum annual allocation. To simplify program administration,
word changes have been made concerning a county's submission of their General
Revenue Tax Levy (GRTL) report and the loss of eligibility for state assistance
funds if their GRTL report is not received timely by the State Property Tax
Board.
Proposed §14.2 simplifies program administration concerning eligibility
disputes.
The proposed amendments to §§14.102, 14.103, 14.104, and 14.105
will comply with state law, be analogous with the Temporary Assistance for
Needy Families (TANF) program, and correct minor spelling, grammar, and punctuation
errors. Specifically, the proposed amendment to §14.104, which is a result
of House Bill 2602 passed by the 77th Legislature, 2001, maintains the current
net monthly income limit of 21% of the Federal Poverty Income Limit (FPIL).
The proposed amendment to §14.105 makes wording changes concerning the
resource value of prepaid burial insurance policies and real property to be
analogous with the TANF program.
In §14.107, changes have been proposed to simplify program administration
concerning appeal hearings and fraud hearings.
The proposed amendment to §14.201, which is a result of House Bill
2446, passed by the 77th Legislature, 2001, allows counties to choose emergency
medical services as an optional service.
Proposed amendments to §§14.202, 14.203, and 14.204 include wording
changes and minor punctuation, capitalization, and acronym changes to make
minor clarifications.
The department proposes new §14.109 concerning employment services.
These rules are proposed to comply with state law. Specifically the new section
covers the county option to implement an employment services program, guidelines
to be used if a county implements an employment services program, the allowable
exemptions, and the disqualification periods for non-compliance.
Neva Klotz, Budget Director, has determined that for each year of the first
five-year period the sections are in effect, there will be no fiscal implications
on state or local government as a result of enforcing or administering the
sections as proposed.
Ms. Klotz has also determined that for the first five years the sections
are in effect, the public benefit anticipated will be simplified administration
of the program and compliance with state law. There will be no impact on small
businesses or micro-businesses to comply with these sections as described.
This was determined by interpretation of the rules that small businesses and
micro-businesses will not be required to alter their business practices in
order to comply with the rules as proposed. There are no anticipated economic
costs to persons who are required to comply with the sections as proposed.
There is no anticipated impact on local employment.
A public hearing on the proposed sections will be held at 10:00 a.m. on
September 21, 2001, in the Public Hearing Room, Texas Department of Health,
12555 Riata Vista Circle, Austin, Texas to accept comments on the proposal.
Comments on the proposed sections may be submitted to Kathy McCormick,
Program Specialist, Indigent Health Care Division, Texas Department of Health,
Mail Code Y-990, 1100 West 49th Street, Austin, Texas 78756-6405, within 30
days of publication in the
Texas Register
.
Subchapter A. COUNTY PROGRAM ADMINISTRATION
25 TAC §14.1, §14.2
The sections are proposed under Health and Safety Code Chapter
61 and Human Resources Code Chapters 22 and 32. The department has rule making
authority for CIHCP under Health and Safety Code Chapter 61.
The proposed sections affect the Health and Safety Code, Chapter 61, Human
Resources Code Chapters 22 and 32.
§14.1.County Program Administration.
(a) - (b)
(No change.)
(c)
General administrative requirements. Each county required
to administer a program must:
(1)
provide public notice and make a reasonable effort to notify
the public,
not later than
[
(2) - (13)
(No change.)
(d)
(No change.)
(e)
State assistance fund.
(1) - (3)
(No change.)
(4)
The department distributes funds to eligible counties based
on a maximum annual allocation [
(A)
The maximum annual allocations will be
based on such factors as spending history, population, and the number of residents
living below the Federal Poverty Income Limit.
(B)
The maximum annual allocations will be
recomputed at least every six months.
(C)
85% of the state assistance fund will
be allocated to the counties that actually were eligible and received state
assistance funds the prior state fiscal year.
(D)
The remaining amount will be held in reserve
for other potentially eligible counties.
(E)
The department may reallocate the reserve
of money to eligible counties.
(F)
No county can be approved for more than
40% of available state assistance funds within a state fiscal year.
(G)
No county can be approved for more than
5.0% of the available state assistance funds in any given month.
(f)
Eligibility requirements for counties applying for state
assistance.
(1)
Each county that plans to credit expenditures
toward
[
(A) - (I)
(No change.)
(J)
report the county's GRTL, as shown in county records on
July 31 of each year, to the State Property Tax Board
not
[
(2)
Counties may not credit payments for the following
toward
[
(A) - (F)
(No change.)
(3)
Counties may also credit toward eligibility for
the
state assistance
fund
the value of health care services
credited or paid in a state fiscal year and provided to county residents eligible
under the eligibility and payment standards established by the department
in Subchapters B, C, and D of this chapter (relating to Determining Eligibility,
Providing Services, and
Case
[
(A) - (B)
(No change.)
(g)
Determining county eligibility for state assistance.
(1)
Within 30 days from the date the department receives written
notification that the county expended 6.0% of its GRTL for basic and department
approved optional services for eligible residents, the department must:
(A) - (B)
(No change.)
(C)
provide information relevant to a department audit of the
county's
[
(2)
(No change.)
(h)
(No change.)
(i)
The department administration of state assistance funds.
The following procedures are established to assist the department in its administration
of state assistance funds and to assist counties in the management of their
programs.
(1)
(No change.)
(2)
After a county reaches the 8.0% expenditure level, the
county must contact the department by telephone to encumber available state
assistance funds to match expenditures that the commissioners court will be
asked to authorize.
(A)
(No change.)
(B)
The county must complete the State of Texas purchase voucher
form, enter "For reimbursement from the state assistance fund provided under
the County Indigent Health Care Program (the Health and Safety Code, Chapter
61). The payee agrees to repay any funds paid in error and acknowledges the
state's authority to collect any funds paid in error." and the approval code
number for the encumbered funds on the voucher, and submit the voucher to
the department within 30 days after the commissioner's court authorizes the
expenditures. The county judge must sign and date the purchase voucher and
enter his or her telephone number. If the county does not submit the purchase
voucher within the 30-day period, the encumbered state assistance funds become
unencumbered
and are reallocated to the remaining counties
.
(3)
The department prepares a weekly report on the status of
the state assistance fund after
75%
[
(4) - (5)
(No change.)
§14.2.Eligibility Disputes [
(a) - (e)
(No change.)
[(f)
If a county discovers that a household
intentionally misrepresented information to receive benefits, the county may
recover the funds through household restitution or court action. Counties
may consult with the county attorney to develop a procedure for administering
suspected fraud cases.]
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of
the Secretary of State, on August 20, 2001.
TRD-200104843
Susan Steeg
General Counsel
Texas Department of Health
Earliest possible date of adoption: September 30, 2001
For further information, please call: (512) 458-7236
25 TAC §§14.102 - 14.105, 14.107, 14.109
The sections are proposed under Health and Safety Code Chapter
61 and Human Resources Code Chapters 22 and 32. The department has rule making
authority for CIHCP under Health and Safety Code Chapter 61.
The proposed sections affect the Health and Safety Code, Chapter 61, Human
Resources Code Chapters 22 and 32.
§14.102.Residency.
(a) - (d)
(No change.)
(e)
A person cannot qualify for county health care assistance
from more than one county
simultaneously
[
(f) - (g)
(No change.)
§14.103.Household Determinations.
(a)
(No change.)
(b)
An inmate in a county jail or a
non-TANF
[
(c) - (k)
(No change.)
§14.104.Income.
(a) - (b)
(No change.)
(c)
Types of Income. Eligibility staff must count or exempt
types of income as follows:
(1)
Temporary Assistance to Needy Families (TANF) benefits.
These benefits are
exempt
[
(2)
(No change.)
(3)
Cash contributions. Cash contributions are counted as unearned
income, but are
exempt
[
(4)
(No change.)
(5)
Child's earned income. A child's earned income is
exempt
[
(6) - (7)
(No change.)
(8)
Disqualified household member's earned and unearned income.
This income is
exempt
[
(9)
(No change.)
(10)
Educational assistance. This assistance is
exempt
[
(11)
Energy assistance. Energy assistance from
federally-
funded
[
(12)
Foster care payments. These payments are
exempt
[
(13)
(No change.)
(14)
In-kind income. In-kind income (any gain or benefit that
is not in the form of money payable directly to the household) is
exempt
[
(15)
(No change.)
(16)
Job training. Payments made under the Workforce Investment
Act (WIA) are
exempt
[
(17) - (19)
(No change.)
(20)
Other supplemental job training and training allowance
payments. Job training and training allowance payments from agencies that
are for training-related expenses are
exempt
[
(21) - (24)
(No change.)
(25)
Supplemental
Security Income
[
(26) - (27)
(No change.)
(28)
Third-party payments. These payments are
exempt
[
(29) - (30)
(No change.)
(31)
Vendor payments. These payments are
exempt
[
(32)
Veterans Administration (VA) benefits. These benefits
are counted as unearned income. Benefits that meet a special need are
exempt
[
(33) - (34)
(No change.)
(35)
Unusual types of benefits/payments. Benefits/payments
from the following programs are
exempt
[
(A) - (I)
(No change.)
(d)
Net income test and deductions. The net income test is
used to determine eligibility.
(1)
Net income test. Net monthly income is gross monthly income
minus allowable deductions. A household is eligible if its net monthly income,
after rounding down cents, is not more than [
(2)
(No change.)
(e) - (f)
(No change.)
§14.105.Resources.
(a) - (c)
(No change.)
(d)
Types of resources. The following resources are countable
or exempt. Eligibility staff must count the equity value of any resource not
specifically
exempt
[
(1)
Burial plots are
exempt
[
(2)
A household's homestead is
exempt
[
(3)
Inaccessible resources are
exempt
[
(4)
Jointly-owned
[
(A) - (B)
(No change.)
(5)
Trust funds are
exempt
[
(6) - (7)
(No change.)
(8)
Keogh plans are counted as a resource. If there is a penalty
for early withdrawal, eligibility staff must deduct the early withdrawal penalty
and count the remainder as a resource. Exception: Do not count
Keogh
[
(9)
Life insurance is
exempt
[
(10) - (11)
(No change.)
(12)
Personal possessions are
exempt
[
(13)
Up to $1,500 cash value of a prepaid
[
(14)
Exempt real property if the household is making a
good faith effort to sell it.
[
(15) - (18)
(No change.)
(19)
Resources of disqualified persons are
exempt
[
(20)
(No change.)
(e)-(g)
(No change.)
Appeal and Fraud Hearings.
[
(1)
[
(2)
Counties shall establish written procedures
for appeal hearings, which shall provide for appropriate due process.
(b)
Fraud Hearing.
(1)
Counties shall establish written procedures for fraud hearings,
which shall provide for appropriate due process.
(2)
If it is determined that the household intentionally misrepresented
information to receive benefits, counties may impose fraud disqualifications
as contained in the county's written procedures.
[(b)
Counties may adapt, for use in their
program, the Texas Department of Health (department) fair hearings and notifications
procedures contained in the department's Fair Hearings, Fraud, and Civil Rights
Handbook, or develop their own rules and procedures for fair hearings and
notifications.]
§14.109.Employment Services.
(a)
Employment Services. Counties have the option of implementing
an employment services program.
(b)
The following are guidelines to be used if a county implements
an employment services program.
(1)
Notify all CIHCP eligible residents and those with pending
applications of the program requirements at least 30 days before the program
begins.
(2)
Allow an exemption from employment services if applicants
or CIHCP eligible residents meet one of the following criteria:
(A)
receive food stamp benefits;
(B)
receive unemployoment insurance benefits or have applied
but not yet been notified of eligibility (both food stamp and unemployment
insurance benefits require recipients to register for work with the Texas
Workforce Commission (TWC) and report for job interviews and accept suitable
offers of employment);
(C)
physically or mentally unfit for employment. The county
may require proof, such as a doctor's statement, before allowing this exemption;
(D)
undocumented alien (because an undocumented alien cannot
legally register for work with TWC);
(E)
distance from the applicant's or CIHCP eligible resident's
home to available employment or training resources is too remote. Too remote
means that the distance from the applicant's or CIHCP eligible resident's
home to the job or training requires commuting time of more than two hours
a day (not including taking a child to and from a child care facility); or
prohibits walking, and transportation is not available;
(F)
age 15 or younger;
(G)
age 16, 17, or 18 and attending elementary, secondary,
vocational, or technical school full time;
(H)
age 60 or older;
(I)
a parent or other household member who personally provides
care for a child under age 6 or a disabled person of any age living with the
CIHCP household;
(J)
employed or self employed at least 30 hours per week, or
receive earnings equal to 30 hours per week multiplied by the federal minimum
wage;
(K)
migrant or seasonal farm worker under contract or similar
agreement with employer or crew chief to begin work within 30 days;
(L)
full-time volunteer for the Volunteers In Service To America
(VISTA) program; or
(M)
pregnant.
(3)
An applicant or CIHCP eligible resident is considered non-exempt
if he or she does not meet one of the above-listed exemptions. A non-exempt
applicant or CIHCP eligible resident must register for work with TWC and may
be required to report for job interviews and accept an offer of suitable employment.
In order to track job search activities (reporting for interviews and accepting
an offer of suitable employment), individual contracts or agreements may be
necessary between the local TWC office and the county.
(4)
If a non-exempt applicant or CIHCP eligible resident fails
without good cause to comply with employment services requirements, disqualify
him or her from CIHCP benefits:
(A)
for one month or until her or she agrees to comply, whichever
is later, for the first non-compliance;
(B)
for three consecutive months or until he or she agrees
to comply,whichever is later, for the second non-compliance;
(C)
for six consecutive months or until he or she agrees to
comply, whichever is later, for the third or subsequent non-compliance;
(5)
Counties, who wish to set up an optional employment services
program, should contact their local TWC office to determine how to set up
their program and negotiate what type of information can be provided.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed
with the Office of the Secretary of State, on August 20, 2001.
TRD-200104844
Susan Steeg
General Counsel
Texas Department of Health
Earliest possible date of adoption: September 30, 2001
For further information, please call: (512) 458-7236
25 TAC §§14.201 - 14.204
The sections are proposed under Health and Safety Code Chapter
61 and Human Resources Code Chapters 22 and 32. The department has rule making
authority for CIHCP under Health and Safety Code Chapter 61.
The proposed sections affect the Health and Safety Code, Chapter 61, Human
Resources Code Chapters 22 and 32.
§14.201.Required and Optional Services, and Their Definitions.
(a)
(No change.)
(b)
The following services are optional services. A county
must notify the department of the county's intent to provide any of the following
services prior to the beginning of a state fiscal year. If the services are
approved by the department or if the department fails to notify the county
of the department's disapproval before the 31st day after the date the department
receives the county's request, the county may credit the services toward eligibility
for state assistance for the state fiscal year following the date of the request.
A county must notify the department in writing if they decide to discontinue
providing any of the optional services that were department approved. (For
state fiscal year 2000 only, a county must notify the department of the county's
intent to provide any of the following services within 45 days of the final
adoption of these rules. If approved by the department, the county may credit
these services toward eligibility for state assistance the month following
the date of the approval.)
(1) - (13)
(No change.)
(14)
Emergency Medical Services. When the
client's condition is life-threatening and requires the use of special equipment,
life support systems, and close monitoring by trained attendants while en
route to the nearest appropriate facility, ground ambulance transport is an
emergency service.
§14.202.Exclusions and Limitations.
(a) - (b)
(No change.)
(c)
Specific exclusions. The following specific services or
supplies are excluded from basic and department approved optional services:
(1) - (5)
(No change.)
(6)
prosthetic or
orthotic
[
(7) - (15)
(No change.)
(16)
hearing aids
;
[
(17)
chiropractors.
(d) - (g)
(No change.)
§14.203.Payments for Basic and Department Approved Optional Services.
(a) - (b)
(No change.)
(c)
The payment standards for the individual basic and department
approved optional services are as follows:
(1)
(No change.)
(2)
Physician,
family planning,
laboratory, and
x-ray services. The payment standard for the procedures the department identifies
as the most-commonly [
(A) - (B)
(No change.)
(3)
Prescribed drugs. The reimbursement rate is the
Redbook
[
[(4)
Family planning clinic services. The
reimbursement rate is the fee established by the department for the Medicaid
Family Planning Program.]
(4)
[
(5)
[
(6)
[
(d)
(No change.)
§14.204.Services and Payment Liability, Limitations, and Options.
(a) - (g)
(No change.)
(h)
Only counties not fully served by a public hospital or
hospital district may submit claims for Texas Medicaid or Vendor Drug Program
reimbursement to the department for basic and department approved optional
services provided to an otherwise eligible SSI/SSDI appellant if the services
are furnished by a Title XIX-enrolled provider; if the SSI/SSDI appellant
is later determined to be retroactively eligible for SSI/Medicaid; and the
appellant and the provider assign reimbursement rights by completing the appellant/provider
assignment form.
(1) - (2)
(No change.)
(3)
The county determines the Medicaid eligibility status of
all eligible residents who are also SSI/SSDI appellants by using the [
(A)
To use
the automated inquiry system
[
(B)
The automated inquiry system
[
(C)
The county must follow all procedures established by the
department for CIHCP counties accessing
the automated inquiry system
[
(4) - (5)
(No change.)
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed
with the Office of the Secretary of State, on August 20, 2001.
TRD-200104845
Susan Steeg
General Counsel
Texas Department of Health
Earliest possible date of adoption: September 30, 2001
For further information, please call: (512) 458-7236
Subchapter B. IMMUNIZATION REQUIREMENTS IN TEXAS ELEMENTARY AND SECONDARY SCHOOLS AND INSTITUTIONS OF HIGHER EDUCATION
25 TAC §97.63
The Texas Department of Health (department) proposes an amendment
to §97.63, concerning immunization requirements for Texas child-care
facilities, elementary and secondary schools and institutions of higher education.
Specifically, this amendment requires hepatitis A vaccination for children
in child-care facilities, pre-kindergarten, kindergarten and first grade in
geographic areas when the incidence rate of hepatitis A during a representative
period of time of no less than 180 days has reached a rate at least twice
the national average, as recommended by the Centers for Disease Control and
Prevention's Advisory Committee on Immunization Practices.
Linda S. Linville, M.S., R.N., Chief, Bureau Immunization and Pharmacy
Support, has determined that the department requires greater flexibility to
respond to increased incidence rates of hepatitis A disease in geographic
areas specified by the department as those rates increase to a minimum of
twice the national average, as recommended by the Centers for Disease Control
and Prevention's Advisory Committee on Immunization Practices. In addition,
Senate Bill 1 General Appropriations Act, Article II, Rider 49, titled "Hepatitis
A Immunization in Counties of High Incidence" was enacted by the 77th Legislature
mandating Hepatitis A vaccination in the following high incidence counties:
Bailey, Bee, Bexar, Brown, Cochran, Comal, Dallam, Dallas, Dawson, Deaf Smith,
Ector, Gaines, Glasscock, Grayson, Hale, Harris, Hidalgo, Hood, Karnes, Knox,
Lamb, Maverick, Medina, Moore, Nueces, Oldham, Potter, Roberts, Runnels, Terry,
Travis, Upton, Ward, and Yoakum.
Ms. Linville has determined that for the first five-year period that the
section will be in effect there will be fiscal implications as a result of
enforcing and administering the section as proposed. The total cost to state
government of immunizing the cohort of children susceptible to hepatitis A
who are expected to attend child-care facilities and schools in counties that
currently qualify under the proposed requirement will be approximately $400,000
per fiscal year. Currently there are at least 34 counties at or near the threshold
for incidence rates that would require vaccination. Much of the cost of vaccinating
children against hepatitis A in many of the qualifying counties is already
being expended in voluntary local vaccination programs. Cost to local government
should not be substantial, with most new costs originating in the increased
operating expenses required to serve a larger number of children. School districts
and private schools will be required to monitor their student populations
for compliance with the new requirement without absorbing any significant
fiscal impact.
Ms. Linville has also determined that for each year of the first five years
that the section is in effect the public benefits anticipated as a result
of enforcing and administering the section as proposed will emerge as fewer
outbreaks of hepatitis A occur. Public benefits will continue to accrue since
greater protection levels translate into lower incidence rates for hepatitis
A and reduced treatment costs for hepatitis A infection. No costs to small
business or micro-business are expected. No impact on local employment is
expected. Health benefit plans will be affected by this proposed rule, which
increases the number of vaccines and vaccinations for which they are required
to provide first-dollar coverage. Health-care providers who administer uncompensated
vaccination and private-pay parents will experience increased costs for vaccine
and vaccine administration. These visits are estimated to cost $90 on average.
Comments on the proposal may be submitted to Janie Garcia, Immunization
Division, Texas Department of Health, 1100 West 49th Street, Austin, Texas
78756, (512) 458-7284, or (800) 252-9152. Comments will be accepted for 30
days following publication of this proposal in the
Texas Register
.
This amendment is proposed under Health and Safety Code §81.023,
which requires the Board of Health (board) to develop immunization requirements
for children; Education Code §38.001, which allows the board to develop
immunization requirements for admission to any elementary or secondary school;
Education Code §51.933, which allows the board to develop immunization
requirements for students at any institution of higher education who are pursuing
a course of study in a health profession; Texas Human Resources Code, §42.043,
which requires the department to make rules regarding the immunization of
children admitted to child-care facilities; and Health and Safety Code §12.001,
which provides the board with the authority to adopt rules for the performance
of every duty imposed by law on the board, the department and the commissioner
of health.
This section affects Health and Safety Code §81.023; Texas Education
Code, §§38.001, 51.933; and Human Resources Code §42.043.
§97.63.Required Immunizations
(a) - (b)
(No change.)
(c)
The following immunizations are required in the respective
age groupings. A child or student must meet all the immunization requirements
specific to an age group upon first entering the age group. Implementation
of requirements for hepatitis B vaccine for adolescents and varicella vaccine
and hepatitis A for all ages is contingent upon the appropriation of funds
to the department for these purposes. By July 1 of each odd-numbered year,
the department will publish a statement on whether or not these vaccines have
been funded and are required as specified.
(1)
Children less than five years of age: polio vaccine; diphtheria-tetanus-pertussis
(DTP) or diphtheria-tetanus-acellular pertussis (DTaP) vaccine; measles, mumps,
and rubella vaccine (MMR); Haemophilus influenzae type b conjugate vaccine
(HibCV), hepatitis A, and varicella vaccine.
(A) - (E)
(No change.)
(F)
Children 15 months of age, but not yet five years of age
(15 months through four years of age):
(i) - (v)
(No change.)
(vi)
no later then August 1, 2000, children subject to these
requirements as described in §97.61 (relating to Children and Students
Included in Requirements) must comply with the following requirement for hepatitis
A vaccine if the facility, school or institution attended is located in any
of the following counties: Brewster, Brooks, Cameron, Crockett, Culberson,
Dimmitt, Duval, Edwards, El Paso, Frio, Hidalgo, Hudspeth, Jeff Davis, Jim
Hogg, Kenedy, Kinney, La Salle, Maverick, McMullen, Pecos, Presidio, Real,
Reeves, Starr, Sutton, Terrell, Uvalde, Val Verde, Webb, Willacy, Zapata,
and Zavala. Serologic confirmation of immunity to hepatitis A or serologic
evidence of infection is acceptable in lieu of vaccine.
In addition to
the above hepatitis A vaccine requirements, the Texas Department of Health
(department) pursuant to the requirements of Health and Safety Code §81.023
shall require hepatitis A vaccine for children residing in other geographic
areas specified by the department when the incidence rate of hepatitis A during
a representative period of time of no less than 180 days has reached the rate
at least twice the national average, as recommended by the Centers for Disease
Control and Prevention's Advisory Committee on Immunization Practices. Serologic
confirmation of immunity to hepatitis A or serologic evidence of infection
is acceptable in lieu of vaccine.
For further information, see §97.67
of this title. Doses of hepatitis A vaccine are required as follows:
(I) -(II)
(No change.)
(2)
Children and students five years of age or older.
(A) - (G)
(No change.)
(H)
Hepatitis A. Effective August 1, 1999, children subject
to these requirements as described in §97.61 of this title (relating
to Children and Students Included in Requirements) must comply with the following
requirement for hepatitis A vaccine if the facility, school or institution
attended is located in any of the following counties: Brewster, Brooks, Cameron,
Crockett, Culberson, Dimmitt, Duval, Edwards, El Paso, Frio, Hidalgo, Hudspeth,
Jeff Davis, Jim Hogg, Kenedy, Kinney, La Salle, Maverick, McMullen, Pecos,
Presidio, Real, Reeves, Starr, Sutton, Terrell, Uvalde, Val Verde, Webb, Willacy,
Zapata, and Zavala. Serologic confirmation of immunity to hepatitis A or serologic
evidence of infection is acceptable in lieu of vaccine.
In addition to
the above hepatitis A vaccine requirements, the department pursuant to the
requirements of Health and Safety Code §81.023 shall require hepatitis
A vaccine for children residing in other geographic areas specified by the
department when the incidence rate of hepatitis A during a representative
period of time of no less than 180 days has reached the rate at least twice
the national average, as recommended by the Centers for Disease Control and
Prevention's Advisory Committee on Immunization Practices. Serologic confirmation
of immunity to hepatitis A or serologic evidence of infection is acceptable
in lieu of vaccine.
For further information, see §97.67 of this
title. Children and students born on or after September 2, 1992, will be required
to have received two doses of hepatitis A vaccine administered on or after
their second birthday.
(3)
(No change.)
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of
the Secretary of State, on August 17, 2001.
TRD-200104833
Susan Steeg
General Counsel
Texas Department of Health
Earliest possible date of adoption: September 30, 2001
For further information, please call: (512) 458-7236
Chapter 415.
PROVIDER CLINICAL RESPONSIBILITIES
Subchapter C. USE AND MAINTENANCE OF TDMHMR DRUG FORMULARY
at
] the beginning of the
state's fiscal year, of the county's eligibility standards, and the county's
application, documentation, and verification procedures and the verification
and documentation procedures that applicants must comply with to establish
eligibility;
for each county potentially eligible
for state assistance
], subject to funding. [
The maximum annual
allocation for each county will be based on such factors as spending history,
population, and the number of residents living below the Federal Poverty Income
Limit. The maximum annual allocation will be recomputed at least every six
months. The minimum annual allocation, subject to funding, will be no less
than the average of what a county would have received in state fiscal years
1997, 1998, 1999 at the 8.0% GRTL threshold with a 90% state match. At the
end of the state fiscal year the department may reallocate the distribution
of money to eligible counties.
]
towards
] eligibility for the state assistance fund must:
no
] later than October 1 of the same year. If part of the county is
served by a hospital district, request the county appraisal district to determine
the GRTL of county
property located
[
propertylocated
]
outside the area served by a hospital district.
If this report is not
received by the State Property Tax Board by December 1 of the same year, a
county may not be eligible for state assistance funds that state fiscal year.
towards
] eligibility for
the
state assistance
fund
:
Care
] Management) under
the following types of contracts:
country's
] financial accounting system.
50%
] of the fund
is expended, and the department sends the report to counties that reported
reaching the 6.0% expenditure level.
and Fraud ].
Subchapter B. DETERMINING ELIGIBILITY
imultaneously
].
non-AFDC
] foster care child qualifies as a household if the inmate or
the child meets all other eligibility criteria. A foster child in the managing
conservatorship of a licensed privately funded 24-hour child care facility
does not qualify for county health care assistance.
exempted
].
exempted
] if they are irregular
and unpredictable.
exempted
] if the child is a full-time student or
a part-time student employed less than 30 hours a week.
exempted
].
exempted
]. These payments include aid from the United States
Office of Education for undergraduate, vocational, or education courses. Some
examples of the most common forms of educational assistance are Pell grants,
Stafford Loan Program, Parent Loans for Students, Supplemental Educational
Opportunity Grants, College Work Study, and Carl D. Perkins Loans. Exempt
educational assistance including loans (regardless of the source).
federally funded
], state-administered programs (HEAP),
weatherization, energy crisis intervention) is
exempt
[
exempted
]. Utility supplement payments from the Department of Housing and Urban
Development (HUD) or local housing authorities, whether they are in the form
of vendor payments, in-kind income, or cash payments, are
exempt
[
exempted
]. Energy assistance from private, nonprofit, or government
agencies that make payments based on need is
exempt
[
exempted
]. If an energy assistance payment is combined with other payments,
only the energy assistance portion of the payment is
exempt
[
exempted
].
exempted
].
exempted
].
exempted
], except On The Job (OJT)
payments funded under Title II, Section 204(#) of the WIA are earned income
and counted for adults. OJT payments are exempt if received by a child who
is under 19 and under parental control of another household member.
exempted
].
security
income
] (SSI) payments. These payments are
exempt
[
exempted
].
exempted
] if the money is intended and used for the maintenance
of a nonmember. If a single payment is received for more than one beneficiary,
the amount actually used for the nonmember up to the nonmember's identifiable
portion or prorated portion, if the portion is not identifiable, is excluded.
exempted
] if made by a person or organization outside the household
directly to the household's creditor or person providing the service.
exempted
].
exempted
]:
17% FPIL until 12-31-2000,
] 21% FPIL [
1-1-2001 until 12-31-2001, and 25% FPIL beginning 1-1-2002
] for the household's size. All households must pass the net income
test.
exempted
] in this subsection.
exempted
].
exempted
]. A homestead is the household's usual residence and surrounding property
which is not separated by property owned by others. The exemption remains
in effect if the surrounding property is separated from the home by public
rights of way. If the household intends to return, eligibility staff must
exempt a homestead temporarily unoccupied because of employment, training
or future employment, illness, casualty, or natural disaster. Real property
outside of Texas cannot be claimed as a homestead. Households which currently
do not own a home, but own or are purchasing a lot on which they intend to
build or are building a permanent home, receive an exemption for the lot and,
if partially completed, for the home. Eligibility staff must count money remaining
from the sale of a homestead as a resource.
exempted
].
Jointly owned
] property
is
exempt
[
exempted
] if the property is jointly owned
by the household and other owners and the household provides proof that:
exempted
].
keogh
] plans as resources if there is a contractual withdrawal
agreement with other people who are not household members and who share the
same fund. This type of
Keogh
[
keogh
] plan is considered
an inaccessible resource.
exempted
].
exempted
].
Prepaid
] burial insurance
policy
[
policies
], funeral
plan
[
plans
], or funeral
agreement
[
agreements
up to $1,500 (one per
]
for
each certified
member
[
member)
]
is exempt
[
are exempted
].
Real property is counted unless
the household is making a good faith effort to sell it. At the county's option,
eligibility staff may exempt the household's real property if the household
agrees to a legally enforceable obligation to reimburse the county for all
or part of the services received. The county and household must negotiate
the terms of the obligation.
]
exempted
].
Notification and Appeals.
]
(a)
Appeal Hearing
.
(a)
] Individuals have the right
to appeal denial of their application or eligibility.
Subchapter C. PROVIDING SERVICES
orthodontic
]
devices;
.
]
most commonly
] performed procedures in the
Medicaid program is the Texas Medicaid payment for the procedure.
redbook
] wholesale price minus 10%, plus the basic dispensing
fee established by the department
in accordance with Human Resources
Code Chapter 32
.
(5)
] Skilled nursing facility care.
The reimbursement rate is the skilled facility daily rate established by the
department for the Medicaid program.
(6)
] Rural health clinic (RHC) services.
The reimbursement rate is the fee established by the department for the Medicaid
program.
(7)
] Payments for department approved
optional services will be based on Texas Medicaid Program rates.
National Heritage Insurance Company (NHIC)
] automated inquiry system
established by the state
[
(NAIS)
] at least once a month.
NAIS
], the county requests a telephone access code number from the department
in writing. Upon receipt of the county's written request, the department sends
the county the access code number and instructions for using the
automated
inquiry system
[
NAIS
] toll-free number from a touch-tone telephone.
NAIS
]
provides the county with information about the SSI/SSDI appellant's current
Medicaid eligibility.
NAIS
].
Chapter 97.
COMMUNICABLE DISEASES
Part 2.
TEXAS DEPARTMENT OF MENTAL HEALTH AND MENTAL RETARDATION