(a) Medicaid, Children's Health Insurance Program (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.
|
Source Note: The provisions of this §350.1425 adopted to be effective May 1, 2014, 39 TexReg 3449; amended to be effective June 30, 2019, 44 TexReg 3280; transferred effective March 1, 2021, as published in the Texas Register February 5, 2021, 46 TexReg 941; amended to be effective March 17, 2022, 47 TexReg 1277 |