Texas Administrative Code
Title 26 - HEALTH AND HUMAN SERVICES
Part 1 - HEALTH AND HUMAN SERVICES COMMISSION
Chapter 351 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS SERVICES PROGRAM
Section 351.12 - Denial, Modification, Suspension, or Termination of Program Eligibility or Eligibility for Health Care Benefits
Universal Citation: 26 TX Admin Code ยง 351.12
Current through Reg. 49, No. 38; September 20, 2024
(a) Any person applying for or eligible for health care benefits from the program shall be notified in writing if the program proposes to deny, modify, suspend, or terminate such health care benefits because:
(1) the application or other requested
information is intentionally erroneous or falsified;
(2) the applicant or family does not meet
financial eligibility requirements;
(3) the person does not meet Texas residency
requirements;
(4) information,
including the receipt for a purchased family support service, was not provided
when requested;
(5) behavioral or
emotional condition(s) exist, but no physical or developmental
condition(s);
(6) the client has
received third party or liability payments and has failed to reimburse the
department for services provided to the client;
(7) the client attains the age of 21, except
for adults with cystic fibrosis;
(8) utilization review indicates
inappropriate use of program services and the client and family fail to adhere
to a plan established to direct or supervise the use of program
services;
(9) program funds are
reduced or curtailed; or
(10) the
client is placed on a waiting list for program health care benefits.
(b) The program will notify the parents, foster parents, guardian, managing conservator, adult applicant, or adult client in writing of the action, the reasons for the action, and the right of appeal in accordance with § 351.13 of this title (relating to Right of Appeal).
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