| (a) A person shall meet all of the following requirements
to be eligible for Epilepsy Program benefits:
(1) have a diagnosis of epilepsy certified by a licensed
physician, or be suspected of having epilepsy;
(2) if younger than 21 years of age, be determined
not eligible for benefits from the Children With Special Health Care
Needs Program (CSHCN) or be currently on the CSHCN waiting list for
services;
(3) be a resident of Texas as determined in §37.213
of this title (relating to Residency and Residency Documentation Requirements);
and not be:
(A) incarcerated in city, county, state, or federal
jail, or prison;
(B) a ward of the state; or
(C) a Medicaid-eligible nursing home recipient.
(4) submit an application for benefits through a contracted
provider; and
(5) meet, or the person(s) who has a legal obligation
to support the applicant meet, the financial guidelines as outlined
in §37.215 of this title (relating to Financial Criteria);
(b) If an applicant meets all eligibility requirements
as outlined in subsection (a) of this section except for the financial
guidelines outlined in subsection (a)(5) of this section, the applicant
is eligible only for support services as outlined in §37.216
of this title (relating to Limitations and Benefits Provided).
(c) A recipient may have all Epilepsy Program benefits
modified, suspended, or terminated for any of the following reasons:
(1) failure to maintain Texas residency or, upon demand,
furnish evidence of such using the criteria in §37.213 of this
title (relating to Residency and Residency Documentation Requirements);
(2) failure to provide income verification as requested
by the contracted provider to determine continued Epilepsy Program
eligibility;
(3) recipient is incarcerated in a city, county, state,
or federal jail, or prison;
(4) recipient becomes a ward of the state;
(5) the contracted provider determines that the recipient
has made a material mis-statement or misrepresentation on their application
or any document required to support their application;
(6) failure to continue premium payments on individual
or group insurance, prepaid medical plan, and health insurance plans
under the Social Security Act, Title XVIII, as amended, where such
plans provide benefits for the care and treatment of persons who have
epilepsy and the person's eligibility for benefits under the plans(s)
was effective prior to eligibility for the Epilepsy Program, or provide
a statement on the application form outlining the reason(s) why such
insurance cannot be maintained; or
(7) failure to receive services through a contracted
provider.
(d) In order to requalify for Epilepsy Program benefits,
an applicant shall reapply and requalify for Epilepsy Program benefits
when eligibility for program benefits is terminated.
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| Source Note: The provisions of this §355.3 adopted to be effective March 17, 2002, 27 TexReg 1791; amended to be effective October 8, 2006, 31 TexReg 8237; amended to be effective November 4, 2010, 35 TexReg 9738; amended to be effective July 2, 2015, 40 TexReg 4215; transferred effective March 15, 2022, as published in the February 25, 2022 issue of the Texas Register, 47 TexReg 981 |
