| (a) A Medicaid provider that wishes to provide services
as a qualified hospital or qualified entity under the Presumptive
Medicaid Program must provide notification in the format prescribed
by HHSC.
(b) As defined in 42 C.F.R. §435.1101, a qualified
entity applicant must:
(1) furnish health care items and services covered
under the approved plan and be eligible to receive payments under
the Texas State Plan for Medical Assistance;
(2) be authorized to determine a child's eligibility
to participate in a Head Start program under the Head Start Act;
(3) be authorized to determine a child's eligibility
to receive child care services for which financial assistance is provided
under the Child Care and Development Block Grant Act of 1990;
(4) be authorized to determine an infant's or child's
eligibility to receive assistance under the special nutrition program
for women, infants, and children (WIC) under section 17 of the Child
Nutrition Act of 1966;
(5) be authorized to determine a child's eligibility
for medical assistance under the Medicaid State plan, or eligibility
of a child for child health assistance under that State Children's
Health Insurance Program;
(6) be an elementary or secondary school, as defined
in section 14101 of the Elementary and Secondary Act of 1965 (20 U.S.C. §8801);
(7) be an elementary or secondary school operated or
supported by the Bureau of Indian Affairs;
(8) be a State or Tribal child support enforcement
agency;
(9) be an organization that:
(A) provides emergency food and shelter under a grant
under the Stewart B. McKinney Homeless Assistance Act;
(B) is a State or Tribal office or entity involved
in enrollment in the program under the following provisions of the
Social Security Act: Title XIX; Part A of Title IV; or Title XXI;
or
(C) determines eligibility for any assistance or benefits
provided under any program of public or assisted housing that receives
federal funds, including the program under section 8 or any other
section of the United States Housing Act of 1937 (42 U.S.C. §1437)
or under the Native American Housing Assistance and Self Determination
Act of 1996 (25 U.S.C. §4101 et seq.); and
(10) Any other entity HHSC so deems, as approved by
the Centers for Medicare and Medicaid Services.
(c) Based on 42 C.F.R. §435.1110(b), a qualified
hospital is a hospital that:
(1) is a Medicaid provider;
(2) assists individuals in completing and submitting
an application for ongoing Medicaid and understanding any documentation
requirements; and
(3) has not been disqualified by HHSC.
(d) A qualified entity or qualified hospital must demonstrate
the capability to make presumptive eligibility determinations and:
(1) receive HHSC approval of the criteria in subsections
(b) and (c) of this section;
(2) complete training as prescribed by HHSC; and
(3) enter into a Memorandum of Understanding as prescribed
by HHSC.
(e) HHSC may verify with a third-party agency that
the qualified hospital or qualified entity applicant meets the criteria
specified in subsections (b) and (c) of this section.
(f) HHSC notifies the qualified hospital or qualified
entity applicant of HHSC's approval or disapproval to make presumptive
eligibility determinations.
(g) The qualified hospital or qualified entity must
adhere to the standards as set forth in §366.261 of this subchapter
(relating to Oversight of Qualified Hospitals and Qualified Entities).
(h) The qualified hospital or qualified entity may
not delegate to another entity the authority to determine presumptive
eligibility.
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