<<Prev Rule

Texas Administrative Code

Next Rule>>
TITLE 40SOCIAL SERVICES AND ASSISTANCE
PART 2DEPARTMENT OF ASSISTIVE AND REHABILITATIVE SERVICES
CHAPTER 108EARLY CHILDHOOD INTERVENTION SERVICES
SUBCHAPTER NFAMILY COST SHARE SYSTEM
RULE §108.1425Public Benefits and Insurance

(a) Medicaid, CHIP, and TRICARE are public insurance programs.

(b) The contractor must assist the parent to:

  (1) identify and access other available funding sources to pay for a child's early childhood intervention services; and

  (2) enroll a potentially eligible child in Medicaid or CHIP.

(c) The contractor must not require a parent to enroll in public benefits or insurance programs as a condition of receiving early childhood intervention services.

(d) If the child is not already receiving public insurance, the contractor must obtain written parental consent before billing. The contractor must waive the maximum charge while eligibility is being determined, not to exceed 90 days.

(e) The contractor must obtain written parental consent to release personally identifiable information to Medicaid, CHIP, and TRICARE. If the parent does not give consent to release personally identifiable information, the contractor bills the parent up to their maximum charge, based on their placement on the sliding fee scale.

(f) The contractor must not bill the parent if the child is enrolled in Medicaid and the parent gives consent to release personally identifiable information to Medicaid.

(g) If the child is in foster care or kinship care, the contractor must obtain consent to release personally identifiable information to bill Medicaid.

(h) If the child has private insurance in addition to Medicaid, the private insurance is the primary payor. The contractor must bill the private insurance every time before filing a claim with Medicaid for all services other than targeted case management or specialized skills training.

(i) If the child has CHIP or TRICARE and the parent gives consent to release personally identifiable information, the contractor must bill the family for services not paid for by CHIP or TRICARE and for any co-pays, up to the family's maximum charge, based on their placement on the sliding fee scale.

(j) If the child becomes ineligible for Medicaid, CHIP, or TRICARE, the contractor bills the parent up to their maximum charge, based on their placement on the sliding fee scale.

(k) The contractor must not deny or delay a child's services if:

  (1) the family does not have public insurance; or

  (2) the parent does not give consent to release personally identifiable information to their public insurance. If the parent does not give consent, the contractor bills the family up to their maximum charge, based on their placement on the sliding fee scale.

(l) A family with public insurance will not be charged disproportionately more than a family without public or private insurance.

(m) If a child is covered by private insurance only, once the contractor has verified that the private insurance plan will not pay for certain ECI services for a child, the contractor is not required to continue to bill the private insurance plan for those services for that child. The contractor must verify coverage for ECI services with the private insurance plan at least annually.


Source Note: The provisions of this §108.1425 adopted to be effective May 1, 2014, 39 TexReg 3449; amended to be effective June 30, 2019, 44 TexReg 3280

Link to Texas Secretary of State Home Page | link to Texas Register home page | link to Texas Administrative Code home page | link to Open Meetings home page