Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 98 - TEXAS HIV MEDICATION PROGRAM › Subchapter C - TEXAS HIV MEDICATION PROGRAM › Division 1 - GENERAL PROVISIONS › Section 98.105 - Eligibility Determination Process

Current through Reg. 49, No. 28; July 12, 2024
(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.