|(a) Prohibition from denying services. An MRA is prohibited from denying services: (1) to a person because of the person's inability to pay for the services; (2) to a person in crisis, and the denial is because: (A) a financial assessment has not been completed; (B) financial responsibility has not been determined; (C) the person has a past-due account; or (D) the person had services involuntarily reduced or terminated for non-payment under §2.109(d) of this subchapter (relating to Payments, Collections, and Non-payment); or (3) to a person pending resolution of an issue relating solely to payment for services, including failure of the person (or parent) to comply with any requirement in subsection (c), (d), (e), or (g) of this section. (b) Identifying funding sources. An MRA must identify and access available funding sources other than DADS, and assist a person (or parent) in identifying and accessing available funding sources other than DADS, to pay for services. Available funding sources may include third-party coverage, state and/or local governmental agency funds (e.g., crime victims fund), Qualified Medicare Beneficiary (QMB) Program, or a trust that provides for the person's need for community services. (c) Requirement for a parent to enroll a child in income-based public insurance. A parent of a child who may be eligible for Medicaid or the Children's Health Insurance Program (CHIP) must enroll the child in Medicaid or CHIP or provide documentation that the child has been denied Medicaid or CHIP benefits or that the child's Medicaid or CHIP enrollment is pending. An MRA must provide assistance as needed to facilitate the enrollment process. (d) Financial documentation. A person (or parent) must provide the following financial documentation: (1) annual or monthly gross income/earnings, if any; (2) extraordinary expenses (as defined) paid during the past 12 months or projected for the next 12 months; (3) number of family members (as defined); and (4) proof of any third-party coverage. (e) Authorizing third-party coverage payment to the MRA. A person (or parent) with third-party coverage must execute an assignment of benefits authorizing third-party coverage payment to the MRA. (f) Failure to comply. (1) Except as provided by paragraph (2) of this subsection, if the person (or parent) fails to comply with any requirement in subsection (c), (d), (e), or (g) of this section, then the MRA must charge the person (or parent) the standard charge(s) for services. If, within 30 days after the person (or parent) initially failed to comply, the person (or parent) complies with the requirements, then the MRA must adjust the person's account to retroactively reflect compliance. (2) The MRA may not charge the person the standard charge(s) for services if the MRA makes a decision, which is documented and includes input from the person's team, that the person's failure to comply is related to the person's functioning limitations. The decision must be reassessed at least annually. If the MRA decides that a person's failure to comply is related to the person's functioning limitations, then the MRA must develop and implement a plan to reduce or eliminate the barriers related to the person's failure to comply. (g) Requirement for an adult person to apply for Supplemental Security Income (SSI) to become eligible for Medicaid. An adult person who may be eligible for Medicaid must apply for SSI or provide documentation that the person has been denied SSI or that the person's SSI application is pending. The MRA must provide assistance as needed to facilitate all aspects of the application process.
|Source Note: The provisions of this §2.105 adopted to be effective September 1, 2002, 27 TexReg 2041; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; amended to be effective November 1, 2007, 32 TexReg 7494