reglab/statecodes huggingface dataset:
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 361 - GUARDIANSHIP SERVICES › Subchapter C - CONTRACTOR REQUIREMENTS › Section 361.73 - Roles and Responsibilities of Case Managers

Current through Reg. 49, No. 28; July 12, 2024
(a) Upon receipt of a referral from DADS, a
				  case manager monitors the filing of legal documents, accountings, reports,
				  notifications, and taxes as required by state law.
(b) A case manager performs the following
				  duties in accordance with the other duties and responsibilities outlined in the
				  order granting guardianship:
(1) locates,
				  secures, and manages a ward's estate;
(2) ensures that a ward has access to
				  adequate care, protection, and services based upon identified needs and the
				  service plan;
(3) makes decisions
				  on medical issues such as major surgery, life-threatening illness, treatment
				  options, and, if guardian of the estate, makes decisions regarding the ward's
				  estate other than routine expenditures for maintenance and education;
(4) monitors to ensure inventory,
				  appraisement, list of claims, and annual accountings have been
				  completed;
(5) completes annual
				  reports of the guardian of the person;
(6) hires professionals, including
				  accountants, providers, repair persons, or realtors, with the funds of a ward's
				  estate to perform services for the ward;
(7) resolves issues or problems that affect a
				  ward;
(8) as much as possible,
				  considers a ward's wishes and choices when decisions are being made about the
				  ward;
(9) maintains documentation
				  of face-to-face visits;
(10)
				  informs the appropriate DADS and contractor staff concerning major issues
				  involving a ward and documents all actions in the ward's record; and
(11) ensures that cases that are closed or
				  Transferred, or if the guardianship is transferred to another case manager, has
				  documentation that is complete and up-to-date .
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 361 - GUARDIANSHIP SERVICES › Subchapter C - CONTRACTOR REQUIREMENTS › Section 361.75 - Reporting of Abuse, Neglect, or Exploitation

Current through Reg. 49, No. 28; July 12, 2024
(a) A contractor must report an allegation of
				  abuse, neglect, or exploitation of a ward to DFPS within 24 hours of discovery
				  of the alleged abuse, neglect, or exploitation.
(b) If the investigating authority is an
				  entity other than DFPS, a contractor must report an allegation of abuse,
				  neglect, or exploitation of a ward within 24 hours of discovery of the alleged
				  abuse, neglect, or exploitation.
(c) A contractor must report an allegation of
				  abuse, neglect, or exploitation of a ward to the DADS guardianship supervisor
				  in the contractor's designated DADS region within 24 hours or by the next
				  working day, whichever is later. The contractor must notify the DADS
				  guardianship supervisor of the specific suspected abuse, neglect, or
				  exploitation when it is reported to the investigating authority. The contractor
				  must also report what actions have been taken to ensure the health and safety
				  of the ward.
(d) If the alleged
				  perpetrator is a contractor's employee, the contractor must remove the employee
				  from working with any DADS wards until all allegations have been investigated.
				  If an allegation of abuse, neglect, or exploitation is found to be valid, the
				  contractor must take appropriate action. If the perpetrator has the right to
				  appeal and if the appeal process determines the employee was not the
				  perpetrator, the agency must document the findings and reorient the employee
				  before working again with DADS wards.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 361 - GUARDIANSHIP SERVICES › Subchapter C - CONTRACTOR REQUIREMENTS › Section 361.77 - Compliance with Probate Court Local Rules in Service Area

Current through Reg. 49, No. 28; July 12, 2024
A contractor must comply with all requirements of Texas
					 Estates Code, Title 3 . In addition, if a court with probate jurisdiction
					 within a contractor's service area has specific local rules in addition to the
					 requirements of the Texas Estates Code, the contractor must comply with those
					 rules to the best of its ability, to the extent that the court's local rules do
					 not conflict with provisions of the Texas Estates Code.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 361 - GUARDIANSHIP SERVICES › Subchapter C - CONTRACTOR REQUIREMENTS › Section 361.79 - Responsibilities of the Guardian of the Person

Current through Reg. 49, No. 28; July 12, 2024
(a) A contractor, rather than the
				  contractor's employee or volunteer, is appointed by the court as guardian. A
				  contractor must assign a primary case manager who meets the requirements
				  described in § 361.59(a)(2) of this subchapter, to each ward served under
				  its contract with DADS. To ensure the ability to respond in a timely fashion in
				  the event of an emergency, a contractor must assign back-up staff for when the
				  primary case manager is unavailable.
(b) If a contractor is appointed guardian of
				  the person, the contractor must manage the ward's person according to the order
				  appointing guardian of the person. This responsibility may include:
(1) having physical possession of the
				  ward;
(2) caring for, supervising,
				  and protecting the ward;
(3)
				  providing food, clothing, and shelter to the extent permitted by the ward's
				  estate or government benefits;
(4)
				  consenting to medical, surgical, and psychiatric care, except for in-patient
				  psychiatric commitment;
(5)
				  developing an annual service plan that ensures appropriate habilitation and
				  rehabilitation services, including therapy, counseling, education, and training
				  to the extent permitted by the ward's estate;
(6) encouraging the ward to participate in
				  the development of the service plan to the extent that the ward is
				  capable;
(7) building an adequate
				  support system for the ward, including family, friends, and other appropriate
				  collaterals;
(8) ensuring monthly
				  status contacts with the ward as described in subsection (d) of this
				  section;
(9) consulting with
				  service providers periodically;
(10) documenting case actions in files
				  maintained for each ward; and
(11)
				  complying with all of the requirements of Texas Estates Code, Title 3,
				  regarding guardianship of the person.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 361 - GUARDIANSHIP SERVICES › Subchapter C - CONTRACTOR REQUIREMENTS › Section 361.81 - Responsibilities of Guardian of the Estate

Current through Reg. 49, No. 28; July 12, 2024
(a) If a contractor is appointed as permanent
				  guardian of the estate, the contractor must manage the ward's finances and
				  assets according to the order appointing guardian of the estate. This
				  responsibility may include:
(1) locating and
				  taking possession of the ward's assets;
(2) securing the ward's property;
(3) preparing the initial inventory,
				  appraisement, and list of claims;
(4) paying the ward's bills;
(5) investing any money not needed for the
				  care and maintenance of the ward;
(6) ensuring that the ward is receiving all
				  the income and benefits to which the ward is entitled;
(7) selling the ward's property if it is in
				  the ward's best interests;
(8)
				  filing annual accountings to courts and to government agencies administering
				  benefits;
(9) filing tax returns;
				  and
(10) complying with all
				  requirements of Texas Estates Code, Title 3 , regarding guardianship of the
				  estate.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 361 - GUARDIANSHIP SERVICES › Subchapter C - CONTRACTOR REQUIREMENTS › Section 361.83 - Service Plans for Wards

Current through Reg. 49, No. 28; July 12, 2024
(a) A
				  contractor must develop and update at least annually a service plan for each
				  ward for which it is appointed as guardian of the person. The service plan
				  establishes a structured and systematic approach for delivery of services to a
				  ward that maximizes quality of care, quality of life, and overall functioning
				  of the ward.
(b) A contractor must
				  develop the initial service plan within three months after taking and filing
				  the oath of guardianship and must update the service plan annually by the due
				  date of the annual report required by the court.
(c) A contractor may develop its own format
				  for the service plan or may use a format provided by DADS. The service plan
				  must include at least the following information:
(1) a brief description of the current status
				  of the ward;
(2) a description of
				  the needs of the ward in each of the following areas:
(A) living arrangements and basic
				  care;
(B) medical, dental, vision,
				  mental health, and intellectual disability services;
(C) family, social, and recreational
				  needs;
(D) financial and legal
				  services; and
(E) diet and clothing
				  preferences;
(3) the
				  plan or strategy for meeting the needs of the ward in the areas listed in
				  paragraph (2) of this subsection; and
(4) actions taken to date to accomplish the
				  plan.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 361 - GUARDIANSHIP SERVICES › Subchapter D - RECORDS MANAGEMENT › Section 361.151 - Confidentiality of Records

Current through Reg. 49, No. 28; July 12, 2024
(a) A
				  contractor must not disclose information from the case record on a ward served
				  under the contract with the DADS Guardianship Services Program in a manner that
				  identifies the ward unless the disclosure is necessary to carry out the duties
				  of the contractor, as described in subsection (b) of this section. Texas Human
				  Resources Code, §
										161.111
				  makes information about a DADS guardianship case confidential, and this extends
				  to the case record of DADS wards served through contracts with DADS. All
				  records, reports, or working papers related to the case are confidential and
				  are exempt from public disclosure under the Texas Open Records Act (Chapter
				  552, Government Code). DFPS Adult Protective Services Division records are also
				  confidential under Texas Human Resources Code, §
										48.101.
(b) Examples of situations that might require
				  pertinent case information to be disclosed include:
(1) arranging for the provision of
				  services;
(2) facilitating
				  involuntary mental health or intellectual disability commitment;
(3) cooperating with law enforcement during
				  the criminal investigation of abuse, neglect, or exploitation; and
(4) responding to a court order for
				  disclosure.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 361 - GUARDIANSHIP SERVICES › Subchapter D - RECORDS MANAGEMENT › Section 361.153 - Documentation Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) A
				  contractor must maintain all financial and contract-related records:
(1) according to recognized fiscal and
				  accounting practices; and
(2) in
				  accordance with DADS contract requirements.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 361 - GUARDIANSHIP SERVICES › Subchapter D - RECORDS MANAGEMENT › Section 361.155 - Maintenance of Records

Current through Reg. 49, No. 28; July 12, 2024
(a) A
				  contractor must maintain all records until the later of the following occurs:
(1) seven years elapse from the expiration or
				  termination date of the records; or
(2) all litigation, claims, and audit
				  findings involving the records are resolved.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 361 - GUARDIANSHIP SERVICES › Subchapter E - CONTRACT MONITORING AND COMPLIANCE › Section 361.201 - Monitoring Reviews

Current through Reg. 49, No. 28; July 12, 2024
(a) When a
				  contractor accepts funds, it also accepts the authority of federal and state
				  governments, including DADS as an agency of a state government, to perform
				  reviews and audits and to have access to records.
(b) DADS conducts monitoring reviews of a
				  contractor's services to determine if the contractor is in compliance with the
				  contract and program rules and requirements. A monitoring review is conducted
				  at the location where the contractor is providing the services unless DADS
				  specifies a different location.
(c)
				  At the conclusion of the review, DADS determines the level of compliance on
				  each guardianship principle reviewed. Guardianship principles are set forth in
				  the DADS guardianship provider handbook. If DADS considers the contractor
				  substantially out of compliance with the contract and with the program rules
				  and requirements, the contractor is subject to corrective action and may be
				  subject to sanctions.
(d) During
				  the monitoring review, the contractor must provide:
(1) adequate working space for reviewing the
				  records; and
(2) all records DADS
				  requests for review.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 361 - GUARDIANSHIP SERVICES › Subchapter E - CONTRACT MONITORING AND COMPLIANCE › Section 361.203 - Complaint Investigations

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  DADS conducts a complaint investigation of a contractor's services if DADS
				  receives complaints that relate to program rules or procedures, or the
				  contractor's employees or volunteers.
(b) DADS may conduct a complaint
				  investigation at any time without notice to the contractor.
(c) DADS does not disclose the name of the
				  individual who made the complaint unless specifically ordered to by a court of
				  law or requested by law enforcement to disclose to law enforcement.
(d) During the complaint investigation, the
				  contractor must provide:
(1) adequate working
				  space for reviewing the records; and
(2) all records DADS requests for the
				  review.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 361 - GUARDIANSHIP SERVICES › Subchapter E - CONTRACT MONITORING AND COMPLIANCE › Section 361.205 - Fiscal Monitoring

Current through Reg. 49, No. 28; July 12, 2024
(a) Fiscal
				  monitoring is the review of documentation that supports the contractor's
				  billings as it exists at the time DADS staff arrive to conduct the review. DADS
				  may recoup payment if the service delivery documentation does not support the
				  contractor's billing.
(b) DADS may
				  conduct a fiscal monitoring review:
(1) in
				  conjunction with a monitoring review;
(2) independently of a monitoring
				  review;
(3) when a contract is
				  terminated; or
(4) as a result of
				  conducting a complaint investigation.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 361 - GUARDIANSHIP SERVICES › Subchapter E - CONTRACT MONITORING AND COMPLIANCE › Section 361.207 - Sanctions

Current through Reg. 49, No. 28; July 12, 2024
(a) DADS may impose
				  a sanction if DADS determines that the contractor failed to follow the terms of
				  the contract or the contractor failed to comply with program rules, policies,
				  and procedures. Examples of these failures include:
(1) jeopardizing a ward's health and
				  safety;
(2) failing to comply with
				  a plan of correction ;
(3) failing
				  to follow an agreed-upon audit resolution payment plan;
(4) failing to provide services according to
				  the contract or program requirements; or
(5) a validated report of abuse, neglect, or
				  exploitation when the perpetrator is an owner, employee, or volunteer who has
				  contact with a ward or with the estate or benefits of a ward.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 361 - GUARDIANSHIP SERVICES › Subchapter E - CONTRACT MONITORING AND COMPLIANCE › Section 361.209 - Administrative Review

Current through Reg. 49, No. 28; July 12, 2024
(a) A contractor
				  may request an administrative review of the review team's methodology if the
				  contractor suspects a formal compliance monitoring may not have been conducted
				  according to established rules and procedures.
(b) A contractor's request for an
				  administrative review must:
(1) be in
				  writing;
(2) identify the rules and
				  procedures the contractor believes DADS failed to follow;
(3) state the basis for believing the review
				  was not conducted according to established rules and procedures; and
(4) be received by DADS within 10 calendar
				  days after the contractor's receipt of the written review findings.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 363 - COUNTY INDIGENT HEALTH CARE PROGRAM › Subchapter A - PROGRAM ADMINISTRATION › Section 363.1 - State Assistance Fund

Current through Reg. 49, No. 28; July 12, 2024
(a) The Department
				  of State Health Services (department) is responsible for distributing state
				  assistance to eligible counties to the extent appropriated state funds are
				  available.
(b) The department
				  establishes the eligibility requirements and internal procedures for a county
				  applying for state assistance.
(c)
				  The department determines a county's eligibility for state
				  assistance.
(d) The department
				  distributes funds to eligible counties based on a maximum annual allocation.
(1) The maximum annual allocation will be
				  based on such factors as spending history, population, and the number of
				  residents living below the Federal Poverty Guideline.
(2) The department-established allocation of
				  the state assistance funds will distinguish the amount of funds allocated
				  between the counties that actually were eligible and received state assistance
				  funds the prior state fiscal year and other potentially eligible
				  counties.
(3) Up to the
				  legislatively-mandated or department-established appropriated state assistance
				  funds for each county, the department may reallocate the unspent funds to
				  eligible counties.
(4) No county
				  can be approved for more than the legislatively-mandated or
				  department-established percent of the appropriated state assistance fund within
				  a state fiscal year.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 363 - COUNTY INDIGENT HEALTH CARE PROGRAM › Subchapter A - PROGRAM ADMINISTRATION › Section 363.3 - Eligibility Dispute

Current through Reg. 49, No. 28; July 12, 2024
(a) If a provider
				  of assistance and a governmental entity or hospital district cannot agree on a
				  household's eligibility for assistance, the provider or the governmental entity
				  or hospital district may submit the matter to the department not later than the
				  90th day after the eligibility determination was issued.
(b) The provider of assistance and the
				  governmental entity or hospital shall submit all relevant information to the
				  department in accordance with the internal procedures established by the
				  department.
(c) From the
				  information submitted, the department shall determine the household's
				  eligibility for assistance.
(d) Not
				  later than the 45th day after the receipt of the matter, the department shall
				  notify each governmental entity or hospital district and the provider of
				  assistance of the decision and the reasons for the decision.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 363 - COUNTY INDIGENT HEALTH CARE PROGRAM › Subchapter B - DETERMINING ELIGIBILITY › Section 363.51 - Application Processing

Current through Reg. 49, No. 28; July 12, 2024
(a) An
				  identifiable application is an application that minimally contains the
				  applicant's name, address, signature, and the date signed.
(b) The application file date is the date the
				  county first receives an identifiable application.
(c) A complete application is an application
				  with at least the following information provided by the applicant:
(1) the applicant's full name and
				  address;
(2) the applicant's social
				  security number, if available;
(3)
				  the names of all other household members and their relationship to the
				  applicant;
(4) the applicant's
				  county of residence;
(5)
				  information about any medical insurance and hospital or health care benefits
				  for which the household members are eligible;
(6) any transfer of title of a countable
				  resource, including real property, that the applicant has made within three
				  months before application or any time after certification;
(7) the gross monthly income of each
				  household member, excluding the income of any household member receiving
				  Temporary Assistance for Needy Families (TANF), Supplemental Security Income
				  (SSI), or Medicaid benefits;
(8)
				  the amount of liquid assets, the fair market value of vehicles, and the equity
				  value of real property that the household members own;
(9) the applicant's signature and the date
				  the form is filled out; and
(10)
				  all needed verifications.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 363 - COUNTY INDIGENT HEALTH CARE PROGRAM › Subchapter B - DETERMINING ELIGIBILITY › Section 363.53 - Residence

Current through Reg. 49, No. 28; July 12, 2024
(a) A person must
				  live in the Texas county to which he applies for assistance.
(b) No time limit is placed on a person's
				  absence from the county. If a person proves county residency at application,
				  the person remains a county resident until factual evidence proves
				  otherwise.
(c) There are no
				  durational requirements for residency.
(d) Even if a minor student lives in the
				  county, the minor student primarily supported by his parents, whose home
				  residence is in another county or state, is not considered a county
				  resident.
(e) A person cannot
				  qualify for county health care assistance from more than one county
				  simultaneously.
(f) A person is not
				  required to have a permanent dwelling or a fixed residence.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 363 - COUNTY INDIGENT HEALTH CARE PROGRAM › Subchapter B - DETERMINING ELIGIBILITY › Section 363.55 - Household

Current through Reg. 49, No. 28; July 12, 2024
(a) A county health
				  care assistance household is a person living alone, or two or more persons
				  living together, who are legally responsible for the support of the other
				  person(s). Disqualified persons are not household members regardless of their
				  legal responsibility for support.
(b) An inmate in a county jail qualifies as a
				  household if the inmate meets all other eligibility criteria.
(c) A non-TANF foster care child qualifies as
				  a household if the child meets all other eligibility criteria. A foster child
				  in the managing conservatorship of a licensed, privately-funded 24-hour child
				  care facility does not qualify for county health care assistance.
(d) A person appealing a social security
				  disability denial qualifies as a household if the person meets all other
				  eligibility criteria.
(e) Legal
				  responsibility for support exists between persons who are legally married, a
				  legal parent and a minor child, or a managing conservator and a minor
				  child.
(f) Non-household members
				  are defined as individuals who cohabitate without legal
				  responsibility.
(g) A minor child
				  is a person under 18 years of age who is not, or has not been, married and has
				  not had the disabilities of minority removed for general purposes.
(h) An adult is a person at least 18 years of
				  age, or a younger person, who is or has been married or had the disabilities of
				  minority removed for general purposes.
(i) The following persons are disqualified
				  from inclusion in the household:
(1) a person
				  who receives or is categorically eligible to receive Medicaid;
(2) a person who receives TANF or SSI
				  benefits; and
(3) a Medicaid
				  recipient who has exhausted a part or all of that recipient's Medicaid
				  benefit.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 363 - COUNTY INDIGENT HEALTH CARE PROGRAM › Subchapter B - DETERMINING ELIGIBILITY › Section 363.57 - Income

Current through Reg. 49, No. 28; July 12, 2024
(a) Definitions.
				  The following words and terms when used within this chapter shall have the
				  following meanings, unless the context clearly indicates otherwise.
(1) Income--Any type of payment that is of
				  gain or benefit to the household. As established by the department, income is
				  either countable or exempt under the department-established budgeting
				  process.
(2) Earned income--Income
				  related to employment and entitles the household to deductions not allowed for
				  unearned income.
(3) Unearned
				  income--Payments received without performing work-related activities. It
				  includes benefits from other programs.
(4) Sponsored alien--A person who has been
				  lawfully admitted to the United States for permanent residence under the
				  Immigration and Nationality Act (8 U.S.C.
				  §1101 et seq.) and who, as a condition
				  of admission, was sponsored by a person who executed an affidavit of support on
				  behalf of the person.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 363 - COUNTY INDIGENT HEALTH CARE PROGRAM › Subchapter B - DETERMINING ELIGIBILITY › Section 363.59 - Resources

Current through Reg. 49, No. 28; July 12, 2024
(a) Definitions.
				  The following words and terms when used within this chapter shall have the
				  following meanings, unless the context clearly indicates otherwise.
(1) Assets--All items of monetary value owned
				  by an individual, excluding personal possessions.
(2) Resources--Both liquid and non-liquid
				  assets a person can convert to meet his immediate needs. As established by the
				  department, resources are either countable or exempt.
(A) Liquid resources are resources that are
				  readily negotiable, such as cash, checking or savings accounts, savings
				  certificates, stocks, or bonds.
(B)
				  Non-liquid resources include vehicles, buildings, land, or certain other
				  property.
(3) Accessible
				  resource--A resource that is legally available to the household.
(4) Inaccessible resource--A resource that is
				  not legally available to the household.
(5) Personal possessions--Furniture,
				  appliances, jewelry, clothing, livestock, farm equipment, and other items if
				  the household uses them to meet personal needs essential for daily
				  living.
(6) Real property--Land and
				  any improvements on it.
(7) Fair
				  market value--The amount of money an item would bring if sold in the current
				  local market.
(8) Equity--The fair
				  market value of an item minus all money owed on it and the cost associated with
				  its sale or transfer.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 363 - COUNTY INDIGENT HEALTH CARE PROGRAM › Subchapter C - PROVIDING SERVICES › Section 363.101 - Basic and Optional Services

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  Except as specified in the department-established service exclusions and
				  limitations, counties are required to provide the following basic health care
				  services to eligible households by reimbursing providers of services who meet
				  the requirements of this chapter and the responsible county.
(1) Inpatient hospital services. Services
				  must be medically necessary and:
(A) provided
				  in an acute care hospital;
(B)
				  provided to hospital inpatients;
(C) provided by or under the direction of a
				  physician; and
(D) provided for the
				  care and treatment of patients.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 364 - PRIMARY HEALTH CARE SERVICES PROGRAM › Subchapter A - PRIMARY HEALTH CARE SERVICES PROGRAM › Section 364.1 - Introduction

Current through Reg. 49, No. 28; July 12, 2024
(a) The purpose of
				  this subchapter is to establish a system of primary health care services for
				  eligible individuals as prescribed by Health and Safety Code, Chapter 31. The
				  rules in this subchapter do not apply to any subsequent subchapter.
(b) The Department of State Health Services
				  seeks to fund local projects that utilize early intervention and prevention of
				  health problems with emphasis on primary and preventive services to women.
				  Access to appropriate levels of health care can reduce health expenditures,
				  mortality, morbidity, and improve individual productivity, health status, and
				  economic growth.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 364 - PRIMARY HEALTH CARE SERVICES PROGRAM › Subchapter A - PRIMARY HEALTH CARE SERVICES PROGRAM › Section 364.3 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this subchapter
					 shall have the following meanings, unless the context clearly indicates
					 otherwise.
(1) Act--The Texas Primary
				  Health Care Services Act, Health and Safety Code, Chapter 31.
(2) Applicant--An individual and/or family
				  applying to receive primary health care services.
(3) Commission--The Texas Health and Human
				  Services Commission.
(4)
				  Commissioner--The Commissioner of Health.
(5) Department--The Department of State
				  Health Services.
(6) Eligible
				  individual--An eligible recipient of primary health care services under the
				  Act.
(7) Other benefit--A benefit,
				  other than a benefit provided under the Act, to which an individual is entitled
				  for payment of the costs of primary health care services, including:
(A) benefits available from:
(i) an insurance policy, group health plan,
				  or prepaid medical care plan;
(ii)
				  Title XVIII or Title XIX of the Social Security Act;
(iii) the Veterans Administration;
(iv) the Civilian Health and Medical Program
				  of the Uniformed Services; and
(v)
				  workers compensation or any other compulsory employer's insurance
				  program.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 364 - PRIMARY HEALTH CARE SERVICES PROGRAM › Subchapter A - PRIMARY HEALTH CARE SERVICES PROGRAM › Section 364.5 - General Program Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  Because budgetary limitations exist, all program providers shall offer at least
				  the following priority services:
(1)
				  diagnosis and treatment;
(2)
				  emergency medical services;
(3)
				  family planning services;
(4)
				  preventive health services;
(5)
				  health education; and
(6)
				  laboratory, x-ray, nuclear medicine, or other appropriate diagnostic
				  services.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 364 - PRIMARY HEALTH CARE SERVICES PROGRAM › Subchapter A - PRIMARY HEALTH CARE SERVICES PROGRAM › Section 364.7 - Provider Reimbursement for Primary Health Care Services

Current through Reg. 49, No. 28; July 12, 2024
(a) The department
				  will reimburse providers for services rendered in accordance with the contracts
				  between the providers and the department. The department shall pay only valid
				  claims submitted according to the terms of the providers' contracts.
(b) Except for prescription drugs covered
				  under Medicare, Part D, primary health care providers will be reimbursed for
				  services delivered to presumptively eligible clients.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 364 - PRIMARY HEALTH CARE SERVICES PROGRAM › Subchapter A - PRIMARY HEALTH CARE SERVICES PROGRAM › Section 364.9 - Eligibility Requirements and Provision of Services to Recipients

Current through Reg. 49, No. 28; July 12, 2024
(a) Individuals
				  covered under the Primary Health Care Services Program are those who are not
				  eligible for other benefits. Individuals eligible for prescription drug
				  benefits under Medicare, Part D, who reside in areas of the state served by
				  program providers that offer prescription drugs as a primary health care
				  service may be eligible for other program services, and for prescription drugs
				  not covered by Medicare, Part D.
(b) Nothing in this section shall preclude a
				  system of integrated eligibility with the commission.
(c) In accordance with program policy,
				  providers shall assure that each individual is:
(1) in financial need based on a family
				  income that does not exceed 200% of the current Federal Poverty Level
				  guidelines; and
(2) a Texas
				  resident.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 364 - PRIMARY HEALTH CARE SERVICES PROGRAM › Subchapter A - PRIMARY HEALTH CARE SERVICES PROGRAM › Section 364.11 - Maintaining Eligibility

Current through Reg. 49, No. 28; July 12, 2024
To maintain eligibility for program benefits, the recipient
					 must continue to reside in Texas, be in financial need as defined by this
					 subchapter, and inform the provider in writing or by telephone within 30 days
					 of changes in the following:
(1)
				  permanent home address;
(2) health
				  insurance coverage;
(3)
				  employment;
(4) other income;
				  or
(5) family
				  composition.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 364 - PRIMARY HEALTH CARE SERVICES PROGRAM › Subchapter A - PRIMARY HEALTH CARE SERVICES PROGRAM › Section 364.13 - Coordination of Benefits

Current through Reg. 49, No. 28; July 12, 2024
(a) An
				  individual is not eligible to receive services delivered under the Primary
				  Health Care Services Program when the individual, or a person with a legal
				  obligation to support the individual, is eligible for some other benefit that
				  would pay for all or part of the services, unless coverage for those services
				  has been denied.
(b) An individual
				  who applies for or receives primary health care services shall inform the
				  provider at the time of application or at the time the individual receives
				  services of any other benefit to which the individual or person who has a legal
				  obligation to support the individual may be entitled.
(c) The commissioner, or the manager of the
				  department unit having responsibility for oversight of the primary health care
				  services program, if so authorized by the commissioner, may waive enforcement
				  of this section concerning individual applicants if enforcement of this section
				  would deny services to a class of otherwise eligible individuals because of
				  conflicting federal, state, or local laws or regulations.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 364 - PRIMARY HEALTH CARE SERVICES PROGRAM › Subchapter A - PRIMARY HEALTH CARE SERVICES PROGRAM › Section 364.15 - Denial/Modification/Suspension/Termination of Services

Current through Reg. 49, No. 28; July 12, 2024
The contractor may deny, modify, suspend, or terminate
					 services to an applicant or recipient after written notice if:
(1) the applicant has provided intentionally
				  false or incomplete information on the applications form; or
(2) the recipient is no longer
				  eligible.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 364 - PRIMARY HEALTH CARE SERVICES PROGRAM › Subchapter A - PRIMARY HEALTH CARE SERVICES PROGRAM › Section 364.17 - Appeals

Current through Reg. 49, No. 28; July 12, 2024
(a) A recipient or
				  applicant aggrieved by the denial, modification, suspension or termination of
				  services may appeal the program's decision according to the procedures in
				  §§
										1.51-
				  1.55 of this
				  title (relating to Fair Hearing Procedures). If an aggrieved recipient requests
				  a hearing, the department shall not terminate services to the recipient until a
				  final decision is rendered.
(b) An
				  applicant or recipient may not appeal a denial, modification, suspension, or
				  termination of program services by the department if the department has
				  restricted program services according to priorities established by §
										39.3(b)
				  of this title (relating to General Program Requirements) and/or program funds
				  are reduced or curtailed.
(c) Upon
				  final determination that benefits will be denied, modified, suspended, or
				  terminated, the department will notify the recipient in writing.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 364 - PRIMARY HEALTH CARE SERVICES PROGRAM › Subchapter A - PRIMARY HEALTH CARE SERVICES PROGRAM › Section 364.19 - Program Review

Current through Reg. 49, No. 28; July 12, 2024
(a) Program review
				  activities will be accomplished through monitoring systems developed to ensure
				  the delivery of appropriate services.
(b) At least annually, the department shall
				  review and determine the continued need for the services it provides directly
				  in accordance with the methods and procedures used to make the initial
				  determination prescribed by the Act and these sections.
(c) The department will require providers to
				  report information on service delivery as required by Health and Safety Code,
				  Chapter 31, and the Primary Health Care Services Policy Manual.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 364 - PRIMARY HEALTH CARE SERVICES PROGRAM › Subchapter D - CLEARINGHOUSE FOR PRIMARY CARE PROVIDERS SEEKING COLLABORATIVE PRACTICE › Section 364.51 - Purpose and Authority

Current through Reg. 49, No. 28; July 12, 2024
(a) Purpose.
				  These sections provide the criteria and procedures the department uses to
				  determine the health professionals to include in the Health Professions
				  Resource Center's primary care provider clearinghouse.
(b) Authority. These sections are authorized
				  by Health and Safety Code, §
										105.007, which
				  requires the council to develop and establish a clearinghouse for health
				  professionals seeking collaborative practice. The department assists the
				  council in performing the council's duties and functions as authorized by the
				  Health and Safety Code, §
										104.014, under these
				  rules.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 364 - PRIMARY HEALTH CARE SERVICES PROGRAM › Subchapter D - CLEARINGHOUSE FOR PRIMARY CARE PROVIDERS SEEKING COLLABORATIVE PRACTICE › Section 364.53 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
Terms used in this section have the following meanings,
					 unless the context clearly indicates otherwise. Terms not defined have their
					 common meanings.
(1) Board--The Texas
				  Board of Health.
(2)
				  Clearinghouse--The Internet accessible registry maintained by the Health
				  Professions Resource Center listing primary care providers seeking
				  opportunities to serve on a primary care team in settings such as rural health
				  clinics, federally qualified health centers, or private group
				  practices.
(3) Council--The
				  Statewide Health Coordinating Council.
(4) Department--The Texas Department of
				  Health.
(5) Federally qualified
				  health centers--Has the meaning given the term in
				  42
				  U.S.C.
				  §1395x(aa)(4).
(6) Health Professions Resource Center--The
				  center established by Health and Safety Code, Chapter 105, for the collection
				  and analysis of educational and employment trends for health professions in the
				  state.
(7) Primary care
				  provider--Primary care providers include the following:
(A) a physician with an unrestricted, active
				  license issued by the Texas State Board of Medical Examiners who practices or
				  plans to practice in the following specialty areas:
(i) family/general practice;
(ii) general pediatrics;
(iii) general internal medicine; or
(iv) obstetrics/gynecology;
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 364 - PRIMARY HEALTH CARE SERVICES PROGRAM › Subchapter D - CLEARINGHOUSE FOR PRIMARY CARE PROVIDERS SEEKING COLLABORATIVE PRACTICE › Section 364.55 - Provider Registration

Current through Reg. 49, No. 28; July 12, 2024
A primary care provider may register with the clearinghouse
					 by completing and submitting a paper form to the clearinghouse, or by accessing
					 and completing the electronic Candidate Interview Forms available online using
					 the department's Internet site at
http://www.tdh.state.tx.us/dpa/clrhouse.htm
or
http://www.texaspracticesites.org/
.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 364 - PRIMARY HEALTH CARE SERVICES PROGRAM › Subchapter D - CLEARINGHOUSE FOR PRIMARY CARE PROVIDERS SEEKING COLLABORATIVE PRACTICE › Section 364.57 - Duties of the Department

Current through Reg. 49, No. 28; July 12, 2024
(a) The
				  department will develop, maintain, and encourage the use of the clearinghouse
				  as an effective and efficient tool for primary care providers to establish
				  collaborative practice opportunities.
(b) The department will collect name, mailing
				  address, phone number, electronic mail address, primary specialty information,
				  preferred practice setting, preferred practice location, and other information
				  relevant to establishing an effective clearinghouse for primary care
				  providers.
(c) The department will
				  give a provider either written or electronic notice of the status of the
				  provider's registration. Only registrations with all required fields completed
				  and accepted will be included in the registry.
(d) A provider whose registration is not
				  approved for inclusion in the registry for any reason other than for incomplete
				  information may request informal reconsideration of the determination by
				  submitting a written request to Manager, Health Professions Resource Center,
				  Center for Health Statistics, Texas Department of Health, 1100 West 49th
				  Street, Austin, Texas 78756. Written requests for reconsideration must be made
				  within 10 days from the date the department sent an electronic notice or within
				  10 working days of the postmarked date of the department's written notice.
				  Denials based on failure to meet the licensing requirements of the appropriate
				  licensing authority are not appealable to the department.
(e) A provider will be included in the
				  clearinghouse registry for four months, unless the provider requests to be
				  deleted. A provider must reapply every four months to remain in the registry.
				  The department will provide electronic or written notices to registrants whose
				  names will be deleted if the provider does not re-register.
(f) The department will update the registry
				  only during the first week of each month. Information received during the
				  second through fourth weeks of the month regarding additions, changes, or
				  deletions to the registry will be processed during the first week of the
				  following month.
(g) The department
				  will notify providers and registrants when the opportunity for a successful
				  collaboration occurs, and work with each party to follow through on
				  opportunities.
(h) There are no
				  fees for using the services provided by the clearinghouse.
(i) Information provided to the department
				  for inclusion in the clearinghouse is subject to Government Code, §
										552.001, et
				  seq.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 365 - KIDNEY HEALTH CARE › Section 365.1 - General

Current through Reg. 49, No. 28; July 12, 2024
(a) Purpose. The
				purpose of this subchapter is to establish rules for the Kidney Health Care
				(KHC) program. The authority for these rules is granted in the Texas Health and
				Safety Code, Chapter 42.
(b)
				Confidentiality of Information.
(1) All
				information submitted, as required by this subchapter, may be verified at the
				discretion of the Department of State Health Services (department) with or
				without notice to applicants, clients, authorized entities, or providers of
				program benefits or services. This information is confidential to the extent
				authorized by law.
(2) Information
				may be disclosed in summary, statistical, or other forms that do not identify
				particular individuals.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 365 - KIDNEY HEALTH CARE › Section 365.3 - Client Eligibility Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) A person must meet all of the following
				requirements to be eligible for program benefits:
(1) have a diagnosis of ESRD; and
(A) require a regular course of chronic renal
				dialysis treatments; or
(B) have
				received a kidney transplant;