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TITLE 25HEALTH SERVICES
PART 1DEPARTMENT OF STATE HEALTH SERVICES
CHAPTER 37MATERNAL AND INFANT HEALTH SERVICES
SUBCHAPTER FHEMOPHILIA ASSISTANCE PROGRAM
RULE §37.117Rights and Responsibilities

(a) Client Rights. The applicant, client, or legally authorized representative have the right to:

  (1) apply for eligibility determination;

  (2) choose providers subject to program limitations;

  (3) choose a health plan, if applicable, subject to program limitations;

  (4) be notified of program decisions relating to modifications, suspensions, denials, or terminations;

  (5) have all client files and other information maintained in a confidential manner to the extent authorized by law;

  (6) appeal program decisions and receive a response within the deadline as described in §37.119 of this title (relating to Right of Appeal); and

  (7) reapply for the program when eligibility for the program is denied or terminated.

(b) Provider Rights. The provider has the right to:

  (1) apply and enroll as a provider;

  (2) be notified of program decision relating to modifications, suspensions, denials, or terminations;

  (3) have confidentiality of information in the manner and to the extent authorized by law;

  (4) appeal program decisions and receive a response within the deadline as described in §37.119 of this title; and

  (5) reapply for the program when eligibility for the program is denied or terminated.

(c) Client Responsibilities. The applicant, client, or legally authorized representative have the responsibility to:

  (1) provide accurate medical information to providers and notify providers of program eligibility prior to delivery of services;

  (2) provide the program with accurate information regarding any change of circumstance which might affect eligibility and benefits within 30 days following such change; and

  (3) notify the program of any lawsuit(s) contemplated or filed concerning the cause of the medical condition for which the program has made payment.

(d) Provider Responsibilities. The provider has the responsibility to:

  (1) enroll as a program provider and submit a completed application to the program, including all documents requested;

  (2) abide by the program rules and regulations;

  (3) not discriminate against applicants or clients based on source of payment; and

  (4) notify the program of any lawsuit(s) contemplated or filed concerning the cause of the medical condition for which the program has made payment.


Source Note: The provisions of this §37.117 adopted to be effective April 16, 2015, 40 TexReg 2090; amended to be effective March 1, 2017, 42 TexReg 764

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