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(a)New applicants to THMP. An individual meeting the
eligibility requirements must submit a complete application for benefits
to THMP, in the format specified by THMP, certifying that the statements
made within the application are factual and true, submitted as instructed,
and accompanied by the required supporting documentation. To request
an application packet, please follow current procedures on THMP's
webpage found at www.dshs.texas.gov/hivstd/meds.
(b)Renewals. An individual must renew enrollment in
THMP according to the procedures established by THMP. An individual
must demonstrate continuing eligibility using THMP's renewal application
and comply with all associated deadlines and requirements for accompanying
documents.
(c)Eligibility Determination.
(1)Approved. If approved, the applicant is eligible
for THMP services.
(2)Incomplete. Any application that does not meet
all requirements of this section is considered incomplete. Incomplete
applications are not processed further, and the applicant is contacted
concerning the insufficiency of the application.
(3)Pending. THMP may, at the time of application and
at any time during enrollment, verify the eligibility status of an
enrolled individual to determine if the individual is continuing to
meet the eligibility criteria of THMP. The individual must furnish
requested documentation to THMP as directed. Until this is completed,
the status of enrollment is considered pending.
(4)Denial, non-renewal, and termination of benefits.
An individual may be denied enrollment, be denied renewal, or have
enrollment in THMP terminated for any of the following reasons:
(A)failure to maintain Texas residency, or upon request,
furnish evidence of such;
(B)failure to continue to meet income requirements
for eligibility or to provide income data as requested, as THMP shall
periodically verify the financial status of an enrolled individual
to determine if the individual continues to meet financial eligibility
criteria;
(C)failure to initially meet or continue to meet the
medical requirements for eligibility;
(D)become eligible for the full-LIS under Medicare
Part D;
(E)become incarcerated in a city, county, state, or
federal jail or prison, in accordance with Ryan White HIV/AIDS Treatment
Extension Act of 2009 (Public Law 111-87), Health Resources and Services
Administration (HRSA) Policy Clarification Notice (PCN) #18-02, and
Texas Code of Criminal Procedure Article §104.002(a);
(F)admitted or committed to a Texas state hospital
or state supported living facility;
(G)determined by THMP that the individual has made
a material misstatement or misrepresentation on the individual's application
or any document required to support the individual's application or
renewal, or on submissions made to comply with subsection (a) or (b)
of this section;
(H)failure to notify THMP of changes to permanent
home address or insurance coverage;
(I)notified THMP in writing that the individual no
longer wants to receive THMP benefits;
(J)failure to request or use services during any period
of six consecutive months; or
(K)exhausted THMP program funds.
(d)Denial, modification, suspension, or termination
of services. An applicant or individual is governed by the procedures
required by §98.106 of this title (relating to Appeal Process
and Exceptions).
The agency certifies that legal counsel has reviewed
the
adoption and found it to be a valid exercise of the agency's legal
authority.
Filed
with the Office of the Secretary of State on October 28, 2022
TRD-202204235 Cynthia Hernandez
General Counsel
Department of State Health Services
Effective date: November 17, 2022
Proposal publication date: June 10, 2022
For further information, please call: (737) 255-4300
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