Texas Administrative Code

Texas Administrative Code

TITLE 26	HEALTH AND HUMAN SERVICES
PART 1	HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 351	CHILDREN WITH SPECIAL HEALTH CARE NEEDS SERVICES PROGRAM
RULE §351.15	Third Party Recovery

(a) The program or the program's designee may recover the cost of services provided to a client from any person or entity who does not pay or reimburse the department as required by Health and Safety Code, §35.007.

(b) The program or the program's designee may recover the cost of services provided to a client from any third party who has a legal obligation to pay for the services provided.

(c) The program's right of recovery against a third party liable for the client's condition or injury is limited to the amount paid by the program for all claims submitted by program providers for covered services to treat the client's condition or injury.

(d) The program or the program's designee may agree to waive all or part of the program's right to recover from a liable third party if:

(1) the total of all claims from providers for the cost of services provided to the client exceeds the amount of the available recovery or settlement;

(2) the program or the program's designee finds that enforcement of the program's right of recovery of the cost of services provided would adversely affect the client's long-term health and welfare; or

(3) the program or the program's designee finds that the cost of recovery could exceed the cost of services provided by the program.

Source Note: The provisions of this §351.15 adopted to be effective October 3, 2010, 35 TexReg 8921; amended to be effective April 21, 2013, 38 TexReg 2362; transferred effective March 15, 2022, as published in the February 25, 2022 issue of the Texas Register, 47 TexReg 982