Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES
Subchapter B - PRESUMPTIVE MEDICAID FOR PREGNANT WOMEN PROGRAM
Division 4 - OVERSIGHT
Section 366.261 - Oversight of Qualified Hospitals and Qualified Entities
Current through Reg. 49, No. 38; September 20, 2024
(a) HHSC establishes, in accordance with RSA 435.1102 (b)(3), oversight mechanisms to ensure that qualified hospitals and qualified entities are making presumptive eligibility determinations consistent with statute and regulations.
(b) HHSC establishes, in accordance with RSA 435.1110 (d)(1), standards for qualified hospitals making presumptive Medicaid eligibility determinations related to the proportion of individuals determined presumptively eligible for Medicaid by the hospital who:
(c) HHSC monitors qualified hospitals to determine if the hospitals are meeting the standards set by HHSC and approved in the Texas State Plan for Medical Assistance.
(d) HHSC takes action, including disqualification of a hospital from the Presumptive Medicaid Program if HHSC determines that the hospital is not:
(e) Prior to disqualifying a hospital, HHSC provides additional training or takes other reasonable corrective action measures to address the issue.
(f) HHSC cancels the qualified provider status of qualified entities, in accordance with RSA 435.1102 (b)(3), or qualified hospitals, in accordance with 42 C.F.R. §1110 (d)(2), that intentionally misrepresent program eligibility requirements or are negligent in determining eligibility.
