Persons meeting the eligibility requirements set forth in §61.3(a)
- (c) of this title (relating to Client Eligibility Requirements)
must submit an application packet for benefits.
(1) A complete application packet must be submitted
by an authorized entity and include all of the following:
(A) a completed, signed and dated program application;
(B) a copy of the completed, signed and dated Centers
for Medicare and Medicaid Services (CMS) End-Stage Renal Disease Medical
Evidence Report or, with program approval, the Kidney Health Care
Physician Assessment Form;
(C) documentation of Texas residency as required by §61.3
of this title;
(D) a copy of the applicant's social security card
issued by the Social Security Administration (SSA), or an allowable
substitute, as follows:
(i) a copy of a SSA document which verifies the social
security number; or
(ii) a copy of a valid Medicare card, if the Medicare
account is established in the applicant's own social security number
and the social security number is printed on the Medicare card; and
(E) applicant's financial data. The applicant or the
person(s) legally obligated to support the applicant must verify income
by providing one of the following:
(i) a copy of the first page of the federal individual
income tax return for the most recent tax year, if self-employed;
(ii) a statement of estimated or declared income for
the current tax year, and supporting documentation.
(2) Incomplete application. An application which does
not meet all of the requirements of paragraph (1) of this section
is incomplete. Incomplete applications may be returned to the submitting
person or entity for correction or completion.
(3) The program eligibility date is the date the program
receives a complete application packet; if approved, the client receives
an effective date.
(4) If program benefits are terminated, the eligibility
date for any subsequent benefit period is the date the program receives
a subsequent complete application packet for program benefits.
(5) An applicant whose eligibility for benefits is
denied may appeal under §61.11 of this title (relating to Rights
|Source Note: The provisions of this §365.4 adopted to be effective February 18, 2010, 35 TexReg 1220; amended to be effective March 27, 2016, 41 TexReg 2170; transferred effective January 15, 2022, as published in the December 31, 2021 issue of the Texas Register, 46 TexReg 9421