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RULE §358.309Enrollment

(a) The contractor must:

  (1) enroll eligible children in HHSC Focused ABA services in accordance with the eligibility criteria in §105.307 of this subchapter (relating to Eligibility);

  (2) provide written information to families regarding the estimated maximum monthly cost of service and the estimated amount of cost share that will be required for payment of services based on the fee schedule and any applicable insurance deductible, co-insurance and co-pay described in Subchapter F of this chapter (relating to Cost Share);

  (3) verify benefits for all children identified with potential third-party payer coverage for services provided in the Autism Program and maintain related documentation on file; and

  (4) provide written notification of rights of the child and parents or guardians noted in Subchapter E of this chapter (relating to Autism Program Rights).

(b) An offer of enrollment into HHSC Focused ABA services is based on the continued availability of funding and the contractor's ability to serve more children.

  (1) When a contractor is not immediately able to accept an eligible child into the HHSC Children's Autism Program, and the family is interested in enrolling in services, the contractor places the family on an interest list. The interest list is reviewed every six months to determine if families are still eligible and interested in services.

  (2) Children are removed from the interest list when an opening for services is available, the child is no longer eligible for the HHSC Children's Autism Program, or when the family indicates they are no longer interested.

  (3) Children who have received Focused Applied Behavior Analysis (ABA) Services and have remaining months of eligibility are given priority over children on the interest list who have not previously received services when they apply for additional Focused ABA Services if they continue to meet eligibility criteria and funds and staff capacity are available.

Source Note: The provisions of this §358.309 adopted to be effective September 1, 2014, 39 TexReg 6680; amended to be effective December 22, 2015, 40 TexReg 9307; amended to be effective September 4, 2018, 43 TexReg 5683; transferred effective August 1, 2021, as published in the July 9, 2021 issue of the Texas Register, 46 TexReg 4173

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