| (a) Because budgetary limitations exist, all program
providers shall offer at least the following priority services:
(1) diagnosis and treatment;
(2) emergency medical services;
(3) family planning services;
(4) preventive health services;
(5) health education; and
(6) laboratory, x-ray, nuclear medicine, or other appropriate
diagnostic services.
(b) The department, through approved providers, shall
provide for the delivery of primary health care services to those
populations that demonstrate unmet needs due to the inaccessibility
and/or unavailability of primary health care services. Unmet needs
may be determined by, but are not limited to, the following criteria:
(1) geographic area;
(2) demography;
(3) socioeconomic conditions;
(4) key health indicators identified by the department
with the assistance of the community; and
(5) health resources available in the community.
(c) The department may deliver services directly to
eligible individuals if existing private or public providers or other
resources in the service area are unavailable or unable to provide
those services, as evidenced by the applications received during the
Request for Proposals process. The department shall make determinations
that providers or resources are unavailable or unable to provide services
in accordance with Health and Safety Code, §31.005.
(d) Individuals eligible for prescription drug benefits
under Medicare, Part D, who reside in areas of the state served by
program providers that offer prescription drugs as a primary health
care service shall receive prescription drug benefits according to
Medicare regulations and procedures. Individuals who are not eligible
for prescription drug benefits under Medicare, Part D, who reside
in areas of the state served by program providers that offer prescription
drugs as a primary health care service shall receive covered prescription
drugs dispensed by pharmacy providers according to this chapter.
|
| Source Note: The provisions of this §364.5 adopted to be effective May 28, 2006, 31 TexReg 4218; amended to be effective September 1, 2013, 38 TexReg 5505; transferred effective March 1, 2022, as published in the Texas Register February 11, 2022, 47 TexReg 674 |
