|(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;
(4) distance and/or time clients must travel to receive
(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;
(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