Part 15.
TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 353.
MEDICAID MANAGED CARE
Subchapter A. GENERAL PROVISIONS
1 TAC §353.5
The Texas Health and Human Services Commission (HHSC) proposes §353.5,
concerning Internet Posting of Sanctions Imposed For Contractual Violations.
The rule outlines the authority of HHSC to impose sanctions when it is determined
that a Medicaid Managed Care Organization (MCO) has failed to comply with
the terms of its contract with HHSC. The rule also explains when and how HHSC
will post MCO sanction information on its Internet website.
Background and Justification
The proposed new rule is required by S.B. 1188, Section 6, 79th Legislature,
Regular Session, 2005, Internet Posting of Sanctions Imposed for Contractual
Violations. This rule requires that HHSC prepare and maintain a record of
each enforcement action initiated by HHSC that results in a sanction, including
a penalty, imposed against an MCO.
Section-by-Section Summary
Section 353.5 describes HHSC's authority to determine when an MCO has failed
to comply with the terms of a contract to provide health care services to
clients. The proposed new rule also states that HHSC will be responsible for
identifying and investigating contract deficiencies and violations, and taking
corrective action to remedy contract deficiencies and violations of an MCO.
HHSC will give written notice to the MCO that describes the contract violation.
In addition, MCO sanctions that are not under administrative appeal or judicial
review will be posted to the HHSC website.
Fiscal Note
Thomas M. Suehs, Deputy Executive Commissioner for Financial Services,
has determined that during the first five-year period the rule is in effect
there will be no fiscal impact to state government. The proposed rule will
not result in any fiscal implications for local health and human services
agencies. Local governments will not incur additional costs.
Small and Micro-business Impact Analysis
Mr. Suehs has also determined that there will be no effect on small businesses
or micro businesses to comply with the rule as it will not be required to
alter their business practices as a result of the rule. There are no anticipated
economic costs to persons who are required to comply with the proposed rule.
There is no anticipated negative impact on local employment.
Public Benefit
Chris Traylor, Associate Commissioner for Medicaid and CHIP, has determined
that for each year of the first five years the proposed new rule is in effect,
the public will benefit from the adoption of the rule. The anticipated public
benefit of enforcing the proposed rule will be improved access to and quality
of health care services.
Regulatory Analysis
HHSC has determined that this proposal is not a "major environmental rule"
as defined by §2001.0225 of the Texas Government Code. "Major environmental
rule" is defined to mean a rule the specific intent of which is to protect
the environment or reduce risk to human health from environmental exposure
and that may adversely affect, in a material way, the economy, a sector of
the economy, productivity, competition, jobs, the environment or the public
health and safety of a state or a sector of the state. This proposal is not
specifically intended to protect the environment or reduce risks to human
health from environmental exposure.
Takings Impact Assessment
HHSC has determined that this proposal does not restrict or limit an owner's
right to his or her property that would otherwise exist in the absence of
government action and, therefore, does not constitute a taking under §2007.043
of the Government Code.
Public Comment
Written comments on the proposed rule may be submitted to Gilbert Estrada,
Policy Analyst in the Medicaid/CHIP Division, Texas Health and Human Services
Commission, P.O. Box 85200, MC-H600; Austin, Texas 78708-5200; by fax to (512)
491-1953, or by e-mail to gilbert.estrada@hhsc.state.tx.us within 30 days
of publication of this proposal in the
Texas Register
.
Public Hearing
A public hearing is scheduled for January 24, 2007 from 1:30 p.m. to 2:30
p.m. in the HHSC Lone Star Conference Room at 11209 Metric Boulevard, Austin,
Texas. Persons requiring further information, special assistance, or accommodations
should contact Meisha Spencer at (512) 491-1453.
Statutory Authority
The new rule is proposed under the Texas Government Code, §531.033,
which provides the Executive Commissioner of HHSC with broad rulemaking authority;
the Human Resources Code, §32.021 and the Texas Government Code, §531.021(a),
which provide HHSC with the authority to administer the federal medical assistance
(Medicaid) program in Texas.
The proposed new rule affects the Human Resources Code, Chapter 32, and
the Texas Government Code, Chapter 531. No other statutes, articles, or codes
are affected by this proposal.
§353.5.Internet Posting of Sanctions Imposed For Contractual Violations.
(a)
This section pertains to a Managed Care Organization (MCO)
which the Health and Human Services Commission (HHSC) determines has failed
to comply with the terms of a contract to provide health care services to
clients through a managed care plan issued by the MCO.
(b)
HHSC is responsible for identifying and investigating contract
deficiencies and violations, and taking corrective action to remedy contract
deficiencies and violations of an MCO. Corrective actions may include assessment
of liquidated damages, contract termination, and/or any other sanction or
remedy available under the terms and conditions of the contract or state and
federal law and regulations.
(c)
If HHSC finds that performance issues, problems, or deficiencies
exist with an MCO, as those issues pertain or relate to certain deliverable
services, HHSC may investigate a claim of contract violation and determine
whether a contract violation has occurred or currently exists.
(d)
If HHSC determines that a contract violation has occurred
or currently exists, HHSC will decide on the appropriate contract sanction
or remedy to be imposed.
(e)
If required by contract, HHSC will give written notice
to the MCO, describing the contract violation, the contract sanction or remedy
to be imposed, the method by which reimbursement (if applicable) to HHSC will
be made, and the time frame for resolution of the issue.
(f)
When a contract violation has been determined and a sanction
imposed, HHSC will post the following information on HHSC's Internet website:
(1)
The name and address of the MCO;
(2)
A description of the contractual obligation the MCO failed
to meet;
(3)
The date of determination of noncompliance;
(4)
The date the sanction was imposed;
(5)
The maximum sanction that may be imposed under the contract
for the violation; and
(6)
The actual sanction imposed against the MCO.
(g)
HHSC shall post and maintain the records required by this
section on HHSC's Internet website in English and Spanish. HHSC shall update
the list of records on the website at least quarterly.
(h)
The information posted on the website will be displayed
for twelve months (12) from the date of posting, or for twelve months after
completion of the contract remedy, whichever is later.
(i)
HHSC will not post information on HHSC's Internet website
that relates to a sanction while the sanction is the subject of an administrative
appeal or judicial review. Nothing in this subsection creates or enlarges
a right to an administrative appeal or judicial review of a contract sanction
or remedy.
(j)
For purposes of this section, a sanction includes assessment
or imposition of one or more of the following contract remedies:
(1)
assessment of a penalty;
(2)
assessment of liquidated damages;
(3)
assessment of consequential damages;
(4)
imposition of a corrective action plan;
(5)
debarment;
(6)
involuntary suspension of a contract or portion of a contract;
and/or
(7)
involuntary termination of a contract or portion of a contract.
(k)
For purposes of this section, a sanction is not considered
to include:
(1)
a vendor hold or similar temporary delay in payment; or
(2)
an agreed temporary remedial measure intended to facilitate
contract compliance.
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 December 21, 2006.
TRD-200606865
Steve Aragón
General Counsel
Texas Health and Human Services Commission
Earliest possible date of adoption: February 4, 2007
For further information, please call: (512) 424-6576
Subchapter A. PURCHASED HEALTH SERVICES
11.
GENERAL ADMINISTRATION
1 TAC §354.1186
The Texas Health and Human Services Commission (HHSC) proposes
new §354.1186, Requirements for the Health Passport. This rule defines
the "Health Passport" and describes the minimum requirements of the health
passport as required by Senate Bill (S.B.) 6, 79th Legislature, Regular Session,
2005, codified at §266.006, Family Code, relating to the health passport.
Background and Justification
S.B. 6 requires that HHSC, in coordination with the Department of Family &
Protective Services (DFPS), develop a comprehensive healthcare services delivery
model for Texas children in substitute (foster) care. The model will include
a "Health Passport" for children in DFPS conservatorship. The Health Passport
is an electronic medical record that will contain portions of the child's
medical information and can be used to document medical services provided
to the child. The Health Passport is intended to ensure continuity of healthcare
for children in DFPS conservatorship. S.B. 6 requires that HHSC develop rules
specifying the information to be included in the Health Passport.
Section-by-Section Summary
Section 354.1186, Requirements for the Health Passport, identifies information
that must be included in the Health Passport, including identifying information
on the child and the child's providers, identification of the child's known
health problems, a record of provider visits and immunizations, and information
on prescriptions. The proposed new rule requires that the Health Passport
system must be secure and must comply with the security and privacy requirements
of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
The proposed new rule also establishes to whom the information on the Health
Passport will be available when the child is discharged from foster care.
Fiscal Note
Thomas M. Suehs, Deputy Commissioner for Financial Services, has determined
that for the first five years the proposed new rule is in effect there will
be a cost to the state. For state fiscal year 2007, the state will incur a
cost of $500,000, a federal cost of $500,000 and total cost of $1,000,000.
For fiscal years 2008 - 2011, the cost to maintain the Health Passport is
estimated to be $250,000 state funds and $250,000 federal funds annually,
for a total cost of $500,000 per year, or $3,000,000 total for the time period.
Local governments will not incur additional costs. The proposed amendment
will not have an affect on the local health and human service agencies.
Small and Micro-business Impact Analysis
Mr. Suehs has also determined that there will be no effect on small businesses
or micro-businesses to comply with the new rule, as they will not be required
to alter their business practices as a result of the rule. There are no anticipated
economic costs to persons who are required to comply with the proposed rule.
There is no anticipated negative impact on a local economy.
Public Benefit
Chris Traylor, Associate Commissioner for Medicaid and CHIP, has determined
that for the period the proposed new rule is in effect, the public will benefit
from the adoption of the rule. The anticipated public benefit of enforcing
the proposed new rule will be improved access to and quality of health care
services for children in foster care.
Regulatory Analysis
HHSC has determined that this proposal is not a "major environmental rule"
as defined by §2001.0225 of the Texas Government Code. "Major environmental
rule" is defined to mean a rule the specific intent of which is to protect
the environment or reduce risk to human health from environmental exposure
and that may adversely affect, in a material way, the economy, a sector of
the economy, productivity, competition, jobs, the environment or the public
health and safety of a state or a sector of the state. This proposal is not
specifically intended to protect the environment or reduce risks to human
health from environmental exposure.
Takings Impact Assessment
HHSC has determined that this proposal does not restrict or limit an owner's
right to his or her property that would otherwise exist in the absence of
government action and, therefore, does not constitute a taking under §2007.043
of the Government Code.
Public Comment
Written comments on the proposed amendment to the rule may be submitted
to Deborah Norris, Policy Analyst in the Medicaid/CHIP Division, Texas Health
and Human Services Commission, P.O. Box 85200, MC-H600; Austin, Texas 78708-5200;
by fax to (512) 491-1953; or by e-mail to deborah.norris@hhsc.state.tx.us
within 30 days of publication of this proposal in the
Texas Register
.
Public Hearing
A public hearing is scheduled for January 24, 2007 from 9:30 a.m. to 10:30
a.m. in the HHSC Lone Star Conference Room at 11209 Metric Boulevard, Austin,
Texas. Persons requiring further information, special assistance, or accommodations
should contact Meisha Spencer at (512) 491-1453.
Statutory Authority
The new rule is proposed under the Texas Government Code, §531.033,
which provides the Executive Commissioner of HHSC with broad rulemaking authority;
the Human Resources Code, §32.021, and the Texas Government Code, §531.021(a),
which provide HHSC with the authority to administer the federal medical assistance
(Medicaid) program in Texas; and the Texas Family Code, §266.006, which
requires the Executive Commissioner to adopt rules implementing the health
passport program.
The new rule affects the Human Resources Code, Chapter 32; the Texas Government
Code, Chapter 531; and the Texas Family Code, §266.003 and §266.006.
No other statutes, articles, or codes are affected by this proposal.
§354.1186.Requirements for the Health Passport.
(a)
The Health Passport is an electronic medical record used
to document healthcare services provided to clients who receive services through
the comprehensive foster care healthcare delivery system, mandated by the
Texas Family Code, § 266.003 and §266.006, and other Medicaid clients
as may be designated by the Health and Human Services Commission (HHSC).
(b)
The contents of the Health Passport must include, but are
not limited to:
(1)
Client's name, birthdate, address of record, and Medicaid
ID number;
(2)
Name and address of each of the client's physicians and
health care providers;
(3)
A record of each visit to a physician or other healthcare
provider, including routine checkups conducted in accordance with the Texas
Health Steps program;
(4)
A record of immunizations;
(5)
Identification of the client's known health problems; and
(6)
Information on all client prescriptions.
(c)
The electronic Health Passport system must be secure and
maintain the confidentiality of the client's health records in compliance
with security and privacy rules adopted by the U.S. Department of Health and
Human Services under the Health Insurance Portability and Accountability Act
of 1996 (HIPAA), 45 C.F.R. §§164.302 - 164.318 and §§164.500
- 164.534.
(d)
If the client is in foster care, the Health Passport information
shall be available in printed and electronic formats to the following individuals
when the client is discharged from foster care:
(1)
The client's legal guardian, managing conservator, or parent;
or
(2)
The client, if the client is at least 18 years of age or
has been awarded the legal rights of an adult through the removal of the disabilities
of minority, as defined in the Texas Family Code, Title 2, Chapter 31.
(e)
The administrator of the electronic Health Passport system
shall be determined by HHSC. The administrator shall be responsible for meeting
all requirements of the Health Passport.
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 December 21, 2006.
TRD-200606866
Steve Aragón
General Counsel
Texas Health and Human Services Commission
Earliest possible date of adoption: February 4, 2007
For further information, please call: (512) 424-6576
1 TAC §§354.2510, 354.2512 - 354.2518
The Texas Health and Human Services Commission (HHSC) proposes
to add a new Subchapter M, Women's Health Program, to its Medicaid Health
Services chapter, §§354.2510 and 354.2512 - 354.2518.
Background and Justification
Section 32.0248 of the Human Resource Code, added by Acts 2005 by the 79th
Texas Legislature during its regular session, and Rider 71 of the Appropriations
Act, authorizes the Texas Health and Human Services Commission (HHSC) to implement
a program to expand access to preventative health and family planning services
through the medical assistance program for women between the ages of eighteen
and forty-four. To implement this program, HHSC proposes to amend its Medicaid
Health Services chapter by adding Subchapter M to Title 1, Chapter 354 of
the Texas Administrative Code to create the Women's Health Program. The proposed
rules set out the guidelines for determining and certifying eligibility and
procedures related to the application process.
Section-by-Section Summary
Section 354.2510, Definitions, provides definitions of terms used in new
Subchapter M. The requirements for applying and providing information are
set out in §354.2513 Financial Eligibility requirements related to countable
income and deductions are contained in §354.2514. The non-financial eligibility
requirements related to citizenship, immigration status, age, residence, social
security number, Third Party Resource, and identity are found in §354.2515.
Medicaid eligibility effective dates are discussed in §354.2516. Section
354.2517 sets out the only change that must be reported by the participant.
Finally, §354.2518 contains the information regarding the applicants
right to appeal a determination.
Fiscal Note
Tom Suehs, Deputy Commissioner for Financial Services, has determined that
during the first five-year period the proposed rule is in effect there will
be a savings to the state of $268.1 million. Local Governments operating health
facilities could experience additional flexibility in Family Planning funding
sources provided by the Department of State Health Services, as a portion
of their patients begin receiving Women Health Plan services. Local government
operated public hospitals could experience a short-term change in the number
of deliveries as clients receive these Family Planning Services. Long-term
changes are not significant to these hospitals.
Small and Micro-business Impact Analysis
Mr. Suehs has also determined that there will be no effect on small businesses
or micro businesses to comply with the proposal as they will not be required
to alter their business practices as a result of the rule. There are no anticipated
economic costs to persons who are required to comply with the proposed rule.
There is no anticipated negative impact on local employment.
Public Benefit
Linda Franco, Associate Commissioner for Family Services, has determined
that for each year of the first five years the proposed rules are in effect,
the public will benefit from the adoption of the section. The anticipated
public benefit, as a result of enforcing the section, will be the expansion
of medical assistance to a population of women who are not currently eligible
to receive benefits due to income limits, age, and household composition policies
of other programs. It is anticipated that the expansion of services will also
reduce the number of unintended pregnancies among low-income women unable
to afford counseling, contraception, and health care services.
Regulatory Analysis
HHSC has determined that this proposal is not a "major environmental rule"
as defined by §2001.0225 of the Texas Government Code. "Major environmental
rule" is defined to mean a rule the specific intent of which is to protect
the environment or reduce risk to human health from environmental exposure
and that may adversely affect, in a material way, the economy, a sector of
the economy, productivity, competition, jobs, the environment or the public
health and safety of a state or a sector of the state. This proposal is not
specifically intended to protect the environment or reduce risks to human
health from environmental exposure.
Takings Impact Assessment
HHSC has determined that this proposal does not restrict or limit an owner's
right to his or her property that would otherwise exist in the absence of
government action and, therefore, does not constitute a taking under §2007.043
of the Government Code.
Public Comment
Written comments on the proposal may be submitted to Regina Perez at P.O.
Box 12668, Austin, Texas 78711-2668, by fax to (512) 206-5061, or by e-mail
to gina.perez@hhsc.state.tx.us within 30 days of publication of this proposal
in the
Texas Register
.
Statutory Authority
The new rules are proposed under the Texas Government Code §531.033,
which provides the Commissioner of HHSC with broad rulemaking authority; the
Human Resources Code §32.021 and the Texas Government Code §531.021(a),
which provide HHSC with the authority to administer the federal medical assistance
(Medicaid) program in Texas and by §23.0248 of the Texas Human Resources
Code which directs HHSC to establish this Women's Health Program.
The proposed new rules affect the Human Resources Code, Chapter 32, and
the Texas Government Code, Chapter 531. No other statutes, articles, or codes
are affected by this proposal.
§354.2510.Definitions.
The words and terms used in this subchapter have the following meanings,
unless the context clearly indicates otherwise. The definitions apply to the
Women's Health Program (WHP).
(1)
Adjunctive Eligibility--Term used when a person's financial
eligibility for the program is deemed because her inclusion in a group where
at least one of the members receives services under another program such as
food stamps or Medicaid.
(2)
Budget Group--Members of a household whose needs, income,
resources, and medical expenses are considered in determining eligibility
for medical assistance programs. The budget group may include both members
who are eligible for the medical assistance program and those who are not.
(3)
CMA--Children's Medical Assistance
(4)
FPIL--Federal Poverty Income Limit
(5)
HHSC--Health and Human Services Commission
(6)
TANF--Temporary Assistance for Needy Families
(7)
WHP--Women's Health Program
(8)
WIC--Woman, Infant and Children supplemental nutrition
program
(9)
File Date--the date the application is received by HHSC.
§354.2512.Participation Requirements.
To receive benefits under the Women's Health Program, an applicant
must be
(1)
a female, age of 18 through 44
(2)
not otherwise receiving benefits under Medicaid, CHIP,
or Medicare services, and
(3)
have countable income, as provided in §354.2514 of
this subchapter relating to Financial Eligibility Requirements of this section,
less than or equal to the 185% of the Federal Poverty Income Limit (FPIL).
§354.2513.Application Procedures.
An applicant may apply by submitting a one-page Women's Health Program
application. The application will not be used to apply for any other programs.
(1)
The Texas Health and Human Services Commission (HHSC) processes
Women's Health Program applications using the application rules of the Temporary
Assistance for Needy Families Program, as detailed in Chapter 372 of this
title (relating to Texas Works), except as follows:
(A)
HHSC also processes applications and renewals received
via mail or fax;
(B)
HHSC does not require a face-to-face or telephone interview
at an initial or renewal application. The applicant may request an interview;
(C)
HHSC may conduct a face-to-face interview with an applicant
if HHSC has received conflicting information related to the household membership
and income that affects eligibility and the information cannot be verified
through other means;
(D)
HHSC may conduct a face-to-face interview for renewals
of Women's Health Program eligibility when there is no associated case record
for TANF, food stamps or Medicaid coverage, and HHSC has received conflicting
information related to household membership or income that affects eligibility
and the information cannot be verified through other means;
(E)
HHSC allows any office of a state Health and Human Services
agency to accept an initial or renewal application; and
(F)
HHSC contracts with third parties to accept applications
from hospital districts (including state-owned teaching hospitals), federally
qualified health centers, and county health departments.
(2)
There are no conditions limiting the designation of an
authorized representative.
§354.2514.Financial Eligibility Requirements.
An applicant for the Women's Health Program must meet the income eligibility
rules under the Temporary Assistance for Needy Families Program, as detailed
in Chapter 372 of this title (relating to Texas Works - Eligibility), except
as follows:
(1)
HHSC will verify an applicant's countable income by obtaining
documents such as the following:
(A)
copies of one or more paycheck stubs issued within 60-days
prior to the file date;
(B)
a copy of the most recent federal income tax return;
(C)
a copy of the most recent Social Security Award Letter;
(D)
copies of one or more child support check within 60-days
prior to the file date; or
(E)
written confirmation from an employer of the employee's
income.
(2)
HHSC will verify an applicant's income deductions by obtaining
documents such as the following:
(A)
a copy of a paycheck stub showing garnishment of wages
for a child support deduction if the paycheck clearly indicates the deduction
is for child support; or
(B)
Office of the Attorney General (OAG) data or other documents
HHSC considers reliable.
(3)
HHSC will count TANF payments as income.
(4)
HHSC will use the standard TANF work-related expense deductions
and dependent care deductions, but not the other TANF earned income deductions.
(5)
Increased income does not cause the denial of a participant's
ongoing eligibility for the Women's Health Program.
(6)
Applicants are considered adjunctively eligible at an initial
or renewal application, and therefore, financially eligible, if:
(A)
a member in her budget group receives WIC benefits,
(B)
she is a member of a certified food stamp household, or
(C)
she is in a Medicaid budget group for someone receiving
Medicaid.
§354.2515.Non-Financial Eligibility Requirements.
To be eligible for the Women's Health Program (WHP), an applicant must
meet the following eligibility criteria, in addition to the criteria detailed
in §354.2514 of this title (relating to Financial Eligibility Requirements):
(1)
Citizenship. Applicants must be U.S. citizens, as required
by Children's Medical Assistance rules in Chapter 354 of this title.
(2)
Legal Permanent Residents. Applicants must be aliens with
approved Bureau of Citizenship and Immigration Services status, as required
by the Temporary Assistance for Needy Families (TANF) rules found in Chapter
372, Subchapter B, Division 3 of this title (relating to Citizenship). However,
certain eligible aliens who were admitted to the United States on or after
August 22, 1996, are eligible for Medicaid for a seven-year period following
entry to the country as specified in 8 United States Code §1612(b)(2)(A)(i),
instead of the five-year period of eligibility for TANF.
(3)
Resources. Resources are not requested or verified for
the Women's Health Program.
(4)
Age. Applicants must be at least age 18 and less than 45
years old to receive benefits. The applicant is considered 18 years of age
the month of her 18th birthday and 44 years old through the month of her 45th
birthday. Women are ineligible for WHP if an application is received the month
prior to her 18th birthday or the month after she turns 45 years of age.
(5)
Residence. The applicant must be a Texas resident.
(6)
Social Security Number (SSN). Applicants must provide or
apply for an SSN as required by Medically Needy program rules detailed in
Chapter 354, Subchapter E of this title (relating to SSN) except that HHSC
requests, but does not require, budget group members who are not eligible
for Medicaid to provide or apply for an SSN.
(7)
Third-party resources. Applicants and recipients must comply
with third-party resources requirements, as detailed in the Human Resources
Code, §32.033.
(8)
Identity. Applicants must verify their identity at initial
certification.
§354.2516.Medicaid Eligibility Effective Dates.
The Texas Health and Human Services Commission (HHSC) determines eligibility
dates for the Women's Program Health program applicants as follows:
(1)
The application must be processed by the 45th day from
the file date.
(2)
Program coverage begins on the 1st day of the application
month on which the applicant met all eligibility criteria.
(A)
An applicant is ineligible due to age if she submits an
application the month before her 18th birthday or the month after her 45th
birthday.
(B)
Eligibility cannot be determined on a date earlier than
the date the Women's Health Program was implemented.
(3)
Applicants whose applications and renewals are certified
receive a 12-month continuous period of eligibility.
(4)
The Women's Health Program does not provide for retroactive
Medicaid coverage under the WHP program. A person receiving WHP may apply
for and receive 3-months prior Medicaid under another Medicaid program before
or during their WHP eligibility period.
(5)
The applicant's certification will end prior to the end
of their 12-month continuous eligibility if the following occurs:
(A)
the death of the recipient,
(B)
applicant moves out-of-state, or
(C)
she voluntarily withdrawals.
§354.2517.Requirement to Report Changes.
Women's Health Program recipients are only required to report moving
out of the state.
§354.2518.Right to Appeal.
(a)
Women's Health Program applicants and recipients have the
right to appeal eligibility decisions made by the Health and Human Services
Commission. Appeals are governed by HHSC fair hearing rules contained in Chapter
357 of this title (relating to Medical Fair Hearings).
(b)
HHSC provides an action notice regarding an HHSC decision
to Medicaid applicants and recipients. The action notice includes information
about how to file an appeal and the availability of free legal representation.
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 December 21, 2006.
TRD-200606867
Steve Aragón
General Counsel
Texas Health and Human Services Commission
Earliest possible date of adoption: February 4, 2007
For further information, please call: (512) 424-6576
Subchapter G. APPLICATION FOR MEDICAID
Chapter 354.
MEDICAID HEALTH SERVICES
Subchapter M. WOMEN'S HEALTH PROGRAM
Chapter 358.
MEDICAID ELIGIBILITY