| (a) Individuals covered under the Primary Health Care
Services Program are those who are not eligible for other benefits.
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 may
be eligible for other program services, and for prescription drugs
not covered by Medicare, Part D.
(b) Nothing in this section shall preclude a system
of integrated eligibility with the commission.
(c) In accordance with program policy, providers shall
assure that each individual is:
(1) in financial need based on a family income that
does not exceed 200% of the current Federal Poverty Level guidelines;
and
(2) a Texas resident.
(d) In accordance with program policy, providers:
(1) shall assist applicants in completing the eligibility
screening process and shall provide coverage if the applicant is potentially
eligible for program services;
(2) may collect co-payments from eligible individuals
who receive primary health care services; and
(3) shall provide services to potentially eligible
individuals who require immediate medical attention on a presumptive
eligibility basis.
(e) Subsection (d)(4) of this section notwithstanding,
no otherwise eligible individual unable to pay a co-payment may be
denied services.
(f) If funds are available, the program may pay co-payments
required under federal regulations for eligible individuals receiving
prescription drug benefits under Medicare, Part D, if the eligible
individual resides in an area of the state served by a program provider
that offers prescription drugs as a benefit under the primary health
care service program.
(g) No eligible individual or person legally responsible
for an eligible individual shall be required to make a pre-treatment
payment.
(h) An individual found ineligible for program services
may reapply at any time.
|
| Source Note: The provisions of this §364.9 adopted to be effective May 28, 2006, 31 TexReg 4218; amended to be effective February 14, 2013, 38 TexReg 645; 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 |
