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TITLE 25HEALTH SERVICES
PART 1DEPARTMENT OF STATE HEALTH SERVICES
CHAPTER 38CHILDREN WITH SPECIAL HEALTH CARE NEEDS SERVICES PROGRAM
RULE §38.5Rights and Responsibilities of a Client's Parent(s), Foster Parent(s), Guardian, or Managing Conservator, or an Adult Client

(a) Rights. A client's parent(s), foster parent(s), guardian, or managing conservator, or an adult client has the right to:

  (1) apply for eligibility determination;

  (2) choose providers subject to program limitations;

  (3) be notified of modification, suspension, or termination of service;

  (4) refuse entry into the home to any employee, agent, or representative of the commission or the department;

  (5) appeal program decisions and receive a response within the deadline as described in §38.13 of this title (relating to Right of Appeal); and

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

(b) Responsibilities. A client's parent(s), foster parent(s), guardian, or managing conservator, or an adult client has the responsibility to:

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

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

  (3) receive and utilize services as close to the client's home community as possible, unless program contracts, policies, or a referral by a program provider requires the use of specific facilities or specialty centers;

  (4) reimburse the program if payments from health insurance or other benefits are made directly to the client or parent, guardian, or managing conservator for services or equipment purchased by the program;

  (5) consult with the provider regarding authorization of service from the program prior to service delivery;

  (6) utilize services provided by the program appropriately including keeping appointments and using supplies and equipment judiciously;

  (7) utilize health insurance (following all plan guidelines and paying required co-payments), other benefits, and assets and to inform service providers of same;

  (8) notify the program of any other benefits, as defined in §38.2 of this title (relating to Definitions), available to the client at the time of application or thereafter and any lawsuit(s) contemplated or filed concerning the cause of the medical condition for which the program has paid for services; and

  (9) bear a portion of the expense of medical or dental care if deemed financially able by the program. Items of routine daily living are not covered by the program.

(c) Nondiscrimination. The department operates in compliance with Title VI, Civil Rights Act of 1964 (Public Law 88-352) and 45 Code of Federal Regulations, Part 80, so that no person will be excluded from participation in or otherwise subjected to discrimination on the grounds of race, color, or national origin.


Source Note: The provisions of this §38.5 adopted to be effective July 1, 2001, 26 TexReg 2979; amended to be effective June 1, 2006, 31 TexReg 4200; amended to be effective October 3, 2010, 35 TexReg 8921; amended to be effective April 21, 2013, 38 TexReg 2362

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