Texas Administrative Code
Title 26 - HEALTH AND HUMAN SERVICES
Part 1 - HEALTH AND HUMAN SERVICES COMMISSION
Chapter 364 - PRIMARY HEALTH CARE SERVICES PROGRAM
Subchapter A - PRIMARY HEALTH CARE SERVICES PROGRAM
Section 364.9 - Eligibility Requirements and Provision of Services to Recipients

(a) Individuals covered under the Primary Health Care Services Program are those who are not eligible for other benefits. Individuals eligible for prescription drug benefits under Medicare, Part D, who reside in areas of the state served by program providers that offer prescription drugs as a primary health care service may be eligible for other program services, and for prescription drugs not covered by Medicare, Part D.

(b) Nothing in this section shall preclude a system of integrated eligibility with the commission.

(c) In accordance with program policy, providers shall assure that each individual is:

(d) In accordance with program policy, providers:

(e) Subsection (d)(4) of this section notwithstanding, no otherwise eligible individual unable to pay a co-payment may be denied services.

(f) If funds are available, the program may pay co-payments required under federal regulations for eligible individuals receiving prescription drug benefits under Medicare, Part D, if the eligible individual resides in an area of the state served by a program provider that offers prescription drugs as a benefit under the primary health care service program.

(g) No eligible individual or person legally responsible for an eligible individual shall be required to make a pre-treatment payment.

(h) An individual found ineligible for program services may reapply at any time.