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TITLE 25HEALTH SERVICES
PART 1DEPARTMENT OF STATE HEALTH SERVICES
CHAPTER 61CHRONIC DISEASES
SUBCHAPTER CBREAST AND CERVICAL CANCER SERVICES
RULE §61.33Providers

(a) Health care providers must be eligible to participate in the Texas Women's Health Program (TWHP) in order to apply as providers for and be reimbursed for services provided in the Breast and Cervical Cancer Services (BCCS) Program, except in very limited circumstances. Providers that are eligible to apply also include providers that do not provide the required TWHP service package but are otherwise eligible to participate in the TWHP. Healthcare providers must ensure compliance with the requirements set out in Subchapter B, §39.33 of this title (relating to Definitions) and §39.38 of this title (relating to Health-Care Providers).

(b) Exempted Providers. If the BCCS Program is unable to locate a sufficient number of TWHP eligible providers in a certain region, the BCCS Program may compensate other local providers for the provision of breast and cervical cancer screening and diagnostic services. Methodologies for determining if a certain region has a sufficient number of TWHP eligible providers may include, but are not limited to the:

  (1) estimated number of clients in need;

  (2) amount of funds available for allocation;

  (3) service capacity of the proposed provider for the provision of breast and cervical cancer screening and diagnostic services; and

  (4) distance and/or time clients must travel to receive services.

(c) Compliance Information. Upon request, BCCS providers must provide the department or its designees with all information the department or its designees require to determine the provider's compliance with the program requirements.

(d) Provider Disqualification. If, after the effective date of this section, the department or its designee determines that a BCCS provider fails to comply with this section, the department or its designee will disqualify the provider from BCCS.

(e) Recoupment. If a BCCS provider is disqualified, the department or its designee will take appropriate action to:

  (1) assist a BCCS client to find an alternative provider; and

  (2) recoup any funds paid to the disqualified provider for BCCS services performed during the period of disqualification.


Source Note: The provisions of this §61.33 adopted to be effective July 1, 1992, 17 TexReg 3983; amended to be effective May 23, 2002, 27 TexReg 4355; amended to be effective June 27, 2007, 32 TexReg 3847; amended to be effective September 1, 2016, 41 TexReg 6500

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