This is a clone of the Texas Administrative Code (TAC) for educational purposes. It is not the official version and should not be used for legal purposes. Site created Wed, 21 May 2025 21:16:34 GMT

Back to Sitemap

Title 1 - Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION

Chapter 351 - COORDINATED PLANNING AND DELIVERY OF HEALTH AND HUMAN SERVICES

Subchapter A - GENERAL PROVISIONS

351.1 - Health and Human Services Commission Review of Component Agency Rules
351.2 - Petition for the Adoption of a Rule
351.3 - Recognition of Out-of-State License of Military Service Members and Military Spouses
351.4 - Health and Human Services Commission Executive Council
351.5 - Charges for Public Records
351.6 - Alternative Licensing for Military Service Members, Military Spouses, and Military Veterans
351.7 - Agency Submission of Strategic Plans and Legislative Appropriations Requests to Health and Human Services Commission
351.11 - Reports on Efforts to Streamline and Simplify Delivery of Services
351.13 - Substitute Care Provider Outcome Standards
351.15 - Information Regarding Community-based Services
351.17 - Right to Correct Incorrect Personal Information
351.19 - Requesting a Correction of Personal Information
351.20 - Use of Certified Promotoras in Medicaid
351.21 - Where to Send a Request for Correction of Personal Information
351.23 - Review of Requests for Correction of Personal Information
351.101 - Leasing Department Real Property
351.501 - Definitions relating to child abuse, neglect, and exploitation
351.503 - Minimum Standards for Investigations
351.504 - Caseload Reduction Plan for Adult Protective Services
351.505 - Information Collection; Uniform Data Collection Procedures
351.507 - Adverse Licensing, Listing, or Registration Decisions by Health and Human Services Agencies
351.701 - Unrelated Donor Umbilical Cord Blood Bank Program
351.703 - Grant Program for Regional and Local Health Care Programs
351.751 - Integrated eligibility services call centers

Subchapter B - ADVISORY COMMITTEES

351.801 - Authority and General Provisions
351.803 - Medical Care Advisory Committee
351.805 - State Medicaid Managed Care Advisory Committee
351.807 - Behavioral Health Advisory Committee
351.809 - Drug Utilization Review Board
351.811 - Intellectual and Developmental Disability System Redesign Advisory Committee
351.813 - Perinatal Advisory Council
351.815 - Policy Council for Children and Families
351.817 - Texas Council on Consumer Direction
351.821 - Value-Based Payment and Quality Improvement Advisory Committee
351.823 - e-Health Advisory Committee
351.825 - Texas Brain Injury Advisory Council
351.827 - Palliative Care Interdisciplinary Advisory Council
351.833 - STAR Kids Managed Care Advisory Committee
351.837 - Texas Autism Council
351.838 - Nursing Facility Administrators Advisory Committee
351.839 - Nursing Facility Payment Methodology Advisory Committee
351.841 - Joint Committee on Access and Forensic Services
351.843 - Early Childhood Intervention Advisory Committee
351.847 - Aging Texas Well Advisory Committee
351.849 - Texas Respite Advisory Committee
351.1201 - Purpose
351.1203 - Legal Authority
351.1205 - Definitions
351.1207 - Substantive Rules
351.1209 - Duration of BEI Advisory Board

Chapter 352 - MEDICAID AND CHILDREN'S HEALTH INSURANCE PROGRAM PROVIDER ENROLLMENT

352.1 - Purpose
352.3 - Definitions
352.5 - Provider Enrollment Requirements
352.7 - Applying for Enrollment
352.9 - Screening Levels
352.11 - Provider Enrollment Determinations
352.13 - Medicare Certification or Enrollment in Medicare
352.15 - Surety Bond Requirements
352.17 - Out-of-State Medicaid Provider Eligibility
352.19 - Temporary Moratoria
352.21 - Duty to Report Changes

Chapter 353 - MEDICAID MANAGED CARE

Subchapter A - GENERAL PROVISIONS

353.1 - Purpose
353.2 - Definitions
353.3 - Experience Rebate in the Managed Care Program
353.4 - Managed Care Organization Requirements Concerning Out-of-Network Providers
353.5 - Internet Posting of Sanctions Imposed For Contractual Violations
353.6 - Audit of Managed Care Organizations
353.7 - Continuity of Care with Out-of-Network Specialty Providers
353.8 - Certification of Managed Care Organizations Prior to Contract Awards

Subchapter B - PROVIDER AND MEMBER EDUCATION PROGRAMS

353.101 - Purpose
353.102 - Provider and Member Education Programs Generally
353.104 - Member Education Program
353.105 - Provider Education Program

Subchapter C - MEMBER BILL OF RIGHTS AND RESPONSIBILITIES

353.201 - Purpose
353.202 - Member Bill of Rights
353.203 - Member Bill of Responsibilities

Subchapter E - STANDARDS FOR MEDICAID MANAGED CARE

353.403 - Enrollment and Disenrollment
353.405 - Marketing
353.407 - Requirements of Managed Care Plans
353.409 - Scope of Services
353.411 - Accessibility of Services
353.413 - Managed Care Benefits and Services for Children Under 21 Years of Age
353.415 - Member Complaint and Appeal Procedures
353.417 - Quality Assessment and Performance Improvement
353.419 - Financial Standards
353.421 - Special Disease Management for a Health Care Managed Care Organization
353.423 - Expedited Credentialing
353.425 - MCO Processing of Prior Authorization Requests Received with Incomplete or Insufficient Documentation
353.427 - Accessibility of Information Regarding Medicaid Prior Authorization Requirements

Subchapter F - SPECIAL INVESTIGATIVE UNITS

353.501 - Purpose
353.502 - Managed Care Organization's Plans and Responsibilities in Preventing and Reducing Waste, Abuse, and Fraud
353.503 - Managed Care Organization's Contracts
353.504 - Review of Managed Care Organization's Records
353.505 - Recovery of Funds

Subchapter G - STAR+PLUS

353.601 - General Provisions
353.603 - Member Participation
353.605 - Participating Providers
353.607 - STAR+PLUS Handbook
353.608 - Minimum Payment Amounts to Qualified Nursing Facilities
353.609 - Service Coordination
353.610 - Minimum Performance Standards for Nursing Facilities that Participate in the STAR+PLUS Program

Subchapter H - STAR HEALTH

353.701 - General Provisions
353.702 - Member Participation

Subchapter I - STAR

353.801 - General Provisions
353.802 - Member Participation

Subchapter J - OUTPATIENT PHARMACY SERVICES

353.901 - Purpose
353.903 - Definitions
353.905 - Managed Care Organization Requirements
353.907 - Prior Authorization Requirements
353.909 - Participating Pharmacy Providers
353.911 - Members
353.913 - Managed Care Organization Requirements Concerning Out-of-Network Outpatient Pharmacy Services
353.915 - Access to Network Pharmacies

Subchapter K - CHILDREN'S MEDICAID DENTAL SERVICES

353.1001 - General Provisions
353.1003 - Member Participation

Subchapter L - TEXAS DUAL ELIGIBLES INTEGRATED CARE DEMONSTRATION PROJECT

353.1101 - Purpose
353.1103 - General Provisions
353.1105 - Eligibility
353.1107 - Member Enrollment and Disenrollment
353.1109 - Participating Providers
353.1111 - Benefits
353.1113 - Appeals and Fair Hearings
353.1115 - Network Adequacy for Certain Service Providers

Subchapter M - HOME AND COMMUNITY BASED SERVICES IN MANAGED CARE

353.1151 - General Provisions
353.1153 - STAR+PLUS Home and Community Based Services (HCBS) Program
353.1155 - Medically Dependent Children Program

Subchapter N - STAR KIDS

353.1201 - General Provisions
353.1203 - Member Participation
353.1205 - Service Coordination
353.1207 - Participating Providers
353.1209 - STAR Kids Handbook

Subchapter O - DELIVERY SYSTEM AND PROVIDER PAYMENT INITIATIVES

353.1301 - General Provisions
353.1302 - Quality Incentive Payment Program for Nursing Facilities on or after September 1, 2019
353.1303 - Quality Incentive Payment Program for Nursing Facilities before September 1, 2019
353.1304 - Quality Metrics for the Quality Incentive Payment Program for Nursing Facilities on or after September 1, 2019
353.1305 - Uniform Hospital Rate Increase Program
353.1306 - Comprehensive Hospital Increase Reimbursement Program for Program Periods on or after September 1, 2021
353.1307 - Quality Metrics for the Comprehensive Hospital Increase Reimbursement Program
353.1309 - Texas Incentives for Physicians and Professional Services
353.1311 - Quality Metrics for the Texas Incentives for Physicians and Professional Services Program
353.1315 - Rural Access to Primary and Preventive Services Program
353.1317 - Quality Metrics for Rural Access to Primary and Preventive Services Program
353.1320 - Directed Payment Program for Behavioral Health Services
353.1322 - Quality Metrics for the Directed Payment Program for Behavioral Health Services

Subchapter P - MENTAL HEALTH TARGETED CASE MANAGEMENT AND MENTAL HEALTH REHABILITATION

353.1401 - Purpose
353.1403 - Definitions
353.1405 - Managed Care Organization Responsibilities
353.1407 - Information Systems and Medical Records Systems
353.1409 - Patient Safety, Rights, and Protections
353.1411 - Access to Mental Health Services
353.1413 - Staff Member Competency
353.1415 - Staff Member Credentialing
353.1417 - Comprehensive Provider Agency Requirements for Staff Member Credentialing and Appeals
353.1419 - Supervision Requirements

Subchapter Q - PROCESS TO RECOUP CERTAIN OVERPAYMENTS

353.1451 - Purpose and Authority
353.1452 - Definitions
353.1453 - Due Process Procedures to Recoup an Overpayment Related to an EVV Visit Transaction that is not Fraud or Abuse and Limitation on Audit Period
353.1454 - Due Process Procedures to Recoup an Overpayment Because of a Discovery of Fraud or Abuse

Subchapter R - TELECOMMUNICATIONS IN MANAGED CARE SERVICE COORDINATION AND ASSESSMENTS

353.1501 - Purpose
353.1502 - Definitions
353.1503 - Use of Telecommunications in Assessments
353.1504 - Use of Telecommunications in Service Coordination and Service Management
353.1505 - Additional Requirements for Assessments and Service Coordination in STAR+PLUS and STAR Kids
353.1506 - Additional Requirements for Assessments and Service Management in STAR Health

Chapter 354 - MEDICAID HEALTH SERVICES

Subchapter A - PURCHASED HEALTH SERVICES

354.1001 - Claim Information Requirements
354.1002 - Compliance with Civil Rights Act
354.1003 - Time Limits for Submitted Claims
354.1004 - Retention of Records
354.1005 - Unauthorized Charges
354.1015 - Benefits and Limitations
354.1017 - Specifications for Eyewear
354.1021 - Additional Claims Information Requirements
354.1023 - Optometric Services Provider
354.1025 - Competitive Procurement of Vision Care Services
354.1031 - General
354.1033 - Provider Participation Requirements
354.1035 - Recipient Qualifications for Home Health Services
354.1037 - Written Plan of Care
354.1039 - Benefits and Limitations of Home Health Services
354.1040 - Requirements for Wheeled Mobility Systems
354.1041 - Benefits for Medicare/Medicaid Recipients
354.1042 - Supplies Provided by a Pharmacy
354.1043 - Competitive Procurement of Durable Medical Equipment (DME) and Supplies
354.1051 - Additional Claim Information Requirements
354.1052 - Authorized Chiropractic Services
354.1060 - Definitions
354.1061 - Additional Claim Information Requirements
354.1062 - Authorized Physician Services
354.1063 - Preventable Adverse Events
354.1064 - Anesthesiologist Assistant Conditions of Participation
354.1065 - Anesthesiologist Assistant Benefits and Limitations
354.1066 - Physician Assistant Conditions of Participation
354.1067 - Physician Assistant Benefits and Limitations
354.1069 - Sign Language Interpreter Services
354.1070 - Definitions
354.1071 - Additional Claim Information Requirements
354.1072 - Authorized Inpatient Hospital Services
354.1073 - Authorized Outpatient Hospital Services
354.1075 - Hospitalization (Dental Care Only) for Individuals under Age 21 Years
354.1077 - Provider Participation Requirements
354.1091 - Additional Claim Information Requirements
354.1092 - Authorized Services
354.1101 - Additional Claim Information Requirements
354.1102 - Authorized Podiatry Services
354.1111 - Definitions
354.1113 - Additional Claim Information Requirements
354.1115 - Authorized Ambulance Services
354.1121 - Definitions
354.1131 - Payments to Eligible Providers
354.1133 - Parental Accompaniment Requirement
354.1135 - Claims Procedures
354.1137 - Review of Questionable Claims
354.1139 - Verification of Cost Data
354.1141 - Notification to Eligible Providers
354.1143 - Coordination of Medicaid with Medicare Parts A, B, and C
354.1145 - Nonliability
354.1147 - Medicaid Fee Schedule
354.1149 - Exclusions and Limitations
354.1151 - Freedom of Choice
354.1153 - Subrogation
354.1155 - Confidentiality of Information
354.1157 - Potential Fraud, Program Abuse, and Other Misutilization
354.1159 - Utilization Review
354.1161 - Provider Re-enrollment or Provider Contract or Agreement Modification
354.1163 - Fair Hearings
354.1165 - Free Services for Recipients
354.1167 - Reimbursement for Abortions
354.1169 - Ectopic Pregnancy
354.1171 - Use of Drugs or Devices to Prevent Implantation of the Fertilized Ovum
354.1175 - Organ Transplants
354.1181 - Provider Compliance with the Clinical Laboratory Improvement Amendments of 1988
354.1183 - Provider Compliance with the Mammography Quality Standards Act of 1992
354.1185 - Provider Compliance with Durable Medical Equipment (DME) Certification Requirements
354.1186 - Requirements for the Health Passport
354.1187 - Responsibilities of Third-Party Billing Vendors
354.1189 - Acute Care Medicaid Billing Coordination System
354.1190 - Medicaid Provider Database
354.1201 - Authorized Services by Rural Health Clinics
354.1202 - Conditions for Payments to Rural Health Clinics
354.1203 - Relationship of Recipient's Treating Physician to Rural Health Clinics
354.1211 - Conditions for Participation
354.1212 - Services and Limitations
354.1221 - Authorized Dentists' Services
354.1231 - Benefits and Limitations
354.1233 - Requirements for Hearing Aid Services
354.1235 - Requirements for Provider Participation
354.1251 - Benefits and Limitations
354.1252 - Certified Nurse Midwife: Conditions for Participation
354.1253 - Licensed Midwife: Conditions for Participation
354.1261 - Benefits and Limitations
354.1262 - Conditions for Participation
354.1271 - Benefits and Limitations
354.1272 - Conditions for Participation
354.1275 - Monitoring
354.1281 - Benefits and Limitations
354.1282 - Conditions of Participation
354.1291 - Benefits and Limitations
354.1292 - Conditions for Participation
354.1301 - Benefits and Limitations
354.1302 - Conditions for Participation
354.1311 - Benefits and Limitations
354.1312 - Conditions for Participation
354.1321 - Benefits and Limitations
354.1322 - Provider Participation Requirements
354.1323 - Reviews/Appeals
354.1331 - Benefits and Limitations
354.1332 - Conditions for Participation
354.1341 - Benefits and Limitations
354.1342 - Conditions for Participation
354.1351 - Coordinated Care Pilot Project
354.1360 - Purpose
354.1361 - Definitions
354.1362 - Eligibility
354.1363 - Assessment
354.1364 - Services and Limitations
354.1365 - Provider Qualifications
354.1366 - Consumer Directed Services and Service Responsibility Option
354.1367 - Person-Centered Service Plan
354.1368 - Fair Hearing
354.1369 - Attendant Base Wage
354.1371 - Tuberculosis Clinic Benefits and Limitations
354.1381 - Benefits and Limitations
354.1382 - Conditions for Participation
354.1391 - In-home Total Parenteral Hyperalimentation Services
354.1401 - In-home Respiratory Therapy Services for Ventilator-Dependent Persons
354.1415 - Vendor Requirements and Conditions for Participation
354.1416 - Eligibility Criteria
354.1417 - Definitions for Wellness Services
354.1430 - Definitions
354.1432 - Telemedicine and Telehealth Benefits and Limitations
354.1434 - Home Telemonitoring Benefits and Limitations
354.1435 - Provision of Behavioral Health Services through an Audio-Only Platform
354.1436 - Provision of Non-behavioral Health Services Using an Audio-only Platform
354.1440 - Medical Care or Services Provided to Medicaid Recipients Outside of Texas
354.1445 - Potentially Preventable Readmissions
354.1446 - Potentially Preventable Complications

Subchapter B - GENERAL PROVISIONS

354.1450 - Audits of Medicaid Providers
354.1451 - Medicaid Recovery Audit Contractor Program
354.1452 - Provider Marketing

Subchapter D - TEXAS HEALTHCARE TRANSFORMATION AND QUALITY IMPROVEMENT PROGRAM

354.1601 - Introduction
354.1602 - Definitions
354.1611 - Organization
354.1612 - Anchors
354.1613 - Participants
354.1621 - RHP Plan
354.1622 - RHP Plan Assessment
354.1623 - RHP Plan Modifications and the Addition of Three-Year DSRIP Projects
354.1624 - Independent Assessment of DSRIP Projects
354.1631 - DSRIP Categories
354.1632 - DSRIP Requirements for Regional Healthcare Partnerships
354.1633 - DSRIP Requirements for Performers
354.1634 - Waiver Pool Allocation
354.1635 - DSRIP Project Valuation
354.1636 - Payment for DSRIP Performance
354.1637 - DSRIP Project Termination and Payment Recoupment
354.1641 - Definitions
354.1643 - Medicaid and Low-income or Uninsured (MLIU) Quantifiable Patient Impact (QPI)
354.1645 - Electing to Continue a DSRIP Project in the Waiver Extension Period
354.1647 - Requests for Adjustments to Certain DSRIP Projects
354.1649 - Certain Requirements for the Planned Transition Year and their Exceptions
354.1661 - Definitions
354.1663 - Medicaid and Low-income or Uninsured (MLIU) Quantifiable Patient Impact (QPI)
354.1665 - Demonstration Year 6 DSRIP Pool Funding and Distribution
354.1667 - Requirements for Continuing DSRIP Projects
354.1669 - Requirements for Combining Certain DSRIP Projects
354.1671 - DSRIP Requirements for Uncompensated Care Hospitals
354.1673 - Remaining DSRIP Funds
354.1675 - Anchor Requirements
354.1691 - Definitions
354.1693 - Regional Healthcare Partnerships (RHPs)
354.1695 - Participants
354.1697 - RHP Plan Update
354.1699 - RHP Plan Update Review
354.1701 - RHP Plan Update Modifications
354.1703 - Independent Assessor
354.1705 - Categories
354.1707 - Performer Valuations
354.1709 - Category A Requirements for Performers
354.1711 - Category B Requirements for Performers
354.1713 - Category C Requirements for Performers
354.1715 - Category D Requirements for Performers
354.1717 - Uncompensated Care (UC) Hospital Requirements
354.1719 - Disbursement of Funds
354.1721 - Remaining Funds for Demonstration Years (DYs) 7-8
354.1729 - Definitions
354.1731 - Medicaid and Low-income or Uninsured Patient Population by Provider
354.1733 - Regional Healthcare Partnerships (RHPs)
354.1735 - Participants
354.1737 - RHP Plan Update for DY9-10
354.1739 - RHP Plan Update Review
354.1741 - RHP Plan Update Modifications
354.1743 - Independent Assessor
354.1745 - Categories
354.1747 - Performer Valuations
354.1749 - Category A Requirements for Performers
354.1751 - Category B Requirements for Performers
354.1753 - Category C Requirements for Performers
354.1755 - Category D Requirements for Performers
354.1757 - Disbursement of Funds

Subchapter F - PHARMACY SERVICES

354.1801 - Requirements for Participation
354.1803 - Confidentiality
354.1805 - Nondiscrimination
354.1807 - Access to Records
354.1809 - Denial or Termination of Participation
354.1811 - Sanctions
354.1813 - Placing a Pharmacy Provider on Vendor Hold
354.1831 - Covered Drugs
354.1832 - Prior Authorization Procedures
354.1833 - Pharmacy Services
354.1835 - Prescriber Identification Numbers
354.1837 - Evidence of Eligibility
354.1851 - Substitution of One Drug for Another in a Prescription
354.1853 - Specialty Drugs
354.1861 - Availability of Funds
354.1863 - Prescription Requirements
354.1867 - Refills
354.1868 - Exceptions in Disasters
354.1871 - Advertising
354.1873 - Freedom of Choice
354.1875 - Limitations on Provider Charges to Recipients
354.1877 - Quantity Limitations
354.1891 - Vendor Drug Providers Subject to Audit
354.1892 - Exception Notification
354.1901 - Pharmacy Claims
354.1905 - Claim Adjustments
354.1907 - Unacknowledged Claims
354.1909 - Submittal of Special Claims
354.1911 - Electronic Data Transmission Vendors (Switches)
354.1921 - Addition of Drugs to the Texas Drug Code Index
354.1923 - Review and Evaluation
354.1924 - Preferred Drug List
354.1925 - Resubmittal of a Denied Request
354.1927 - Retention and Deletion of Drugs
354.1941 - Drug Utilization Review Board
354.1942 - Conflict of Interest Policy

Subchapter I - MEDICAID PROGRAM APPEALS PROCEDURES

354.2201 - Definitions
354.2203 - Recipients with Special Needs or Disabilities
354.2211 - Recipient Notice and Fair Hearing Request
354.2213 - Maintaining Benefits or Services
354.2215 - Fair Hearing
354.2217 - Provider Appeals and Reviews

Subchapter J - MEDICAID THIRD PARTY RECOVERY

354.2301 - Basis and Purpose
354.2302 - Definitions
354.2311 - Applicant and Recipient Assignment of Rights
354.2313 - Duty of Applicant or Recipient to Inform and Cooperate
354.2315 - Duty of Attorney or Representative of a Recipient
354.2321 - Provider Billing and Recovery From Third Party Resources
354.2322 - Provider Billing and Recovery from Other Liable Third Parties
354.2331 - Requests for Information
354.2332 - Distribution of Recoveries
354.2333 - Waiver Authority of the Executive Commissioner
354.2334 - Notices and Payments
354.2341 - Third Party Health Insurer Payment and Information Requirements
354.2343 - Administrative Penalties for Failure to Provide Information
354.2344 - Notice and Appeal of Administrative Penalty
354.2354 - Billing Medicare Intermediaries
354.2355 - Long Term Care Providers
354.2356 - Provider Requirements to Bill Third Party Health Coverage
354.2361 - Medicaid Health Insurance Premium Payment Program

Subchapter K - MEDICAID RECIPIENT UTILIZATION REVIEW AND CONTROL

354.2401 - Definitions
354.2403 - Monitoring and Review
354.2405 - Utilization Control
354.2407 - Recipient Rights

Subchapter L - QUALITY IMPROVEMENT PROCESS FOR CLINICAL INITIATIVES

354.2501 - Definitions
354.2503 - Clinical Initiative Evaluation Process
354.2505 - Action on Approved Clinical Initiatives
354.2507 - Internet Website

Subchapter M - MENTAL HEALTH TARGETED CASE MANAGEMENT AND MENTAL HEALTH REHABILITATION

354.2601 - Purpose and Applicability
354.2603 - Definitions
354.2605 - Fair Hearings and Appeal Processes
354.2607 - Assessment and Service Authorization
354.2609 - Recovery/Treatment Planning, Recovery/Treatment Plan Review, and Discharge Summary
354.2611 - Pharmacological Management, Psychiatric Diagnostic Evaluations, and Psychotherapy
354.2613 - Criminal History Background Checks
354.2651 - Eligible Individuals
354.2653 - Continued Eligibility
354.2655 - Mental Health Targeted Case Management Services
354.2657 - Documentation Requirements
354.2659 - Exclusions
354.2701 - Eligible Individuals
354.2703 - Continued Eligibility
354.2705 - Mental Health Rehabilitative Services
354.2707 - Crisis Intervention Services
354.2709 - Medication Training and Support Services
354.2711 - Psychosocial Rehabilitative Services
354.2713 - Skills Training and Development Services
354.2715 - Day Programs for Acute Needs
354.2717 - Exclusions

Subchapter N - PEER SPECIALIST SERVICES

354.3001 - Purpose and Applicability
354.3003 - Definitions
354.3011 - Eligibility to Receive Services
354.3013 - Services Provided
354.3015 - Medicaid Reimbursement
354.3051 - Minimum Qualifications
354.3053 - Scope of Work
354.3055 - Ethical Responsibilities
354.3101 - Requirements
354.3103 - Supervision of Peer Specialists
354.3105 - Peer Specialist Supervisor Minimum Qualifications
354.3151 - Training Entity Minimum Requirements
354.3153 - Instructor Requirements
354.3155 - Orientation and Self-Assessment
354.3157 - Application for Training
354.3159 - Core and Supplemental Training
354.3161 - Peer Specialist Certification Renewal Training
354.3163 - Supervisor Training
354.3165 - Peer Specialist Supervisor Certification Renewal Training
354.3201 - Criminal History and Registry Checks
354.3203 - Procedures for Peer Specialist Certification
354.3205 - Initial Peer Specialist Certification
354.3207 - Peer Specialist Certification Renewal
354.3209 - Procedures for Peer Specialist Supervisor Certification
354.3211 - Peer Specialist Supervisor Certification Renewal
354.3251 - Certification Entity Minimum Requirements
354.3253 - Certification Entity Application Process
354.3255 - Certification Entity Ongoing Requirements
354.3301 - Recipient Complaints
354.3303 - Peer Specialist or Peer Specialist Supervisor: Denial, Suspension, or Revocation of Certification or Renewal
354.3305 - Training Entity: Denial, Suspension, or Revocation of Certification
354.3307 - Certification Entity: Denial, Suspension, or Revocation of Approval

Subchapter O - ELECTRONIC VISIT VERIFICATION

354.4001 - Purpose and Authority
354.4003 - Definitions
354.4005 - Personal Care Services that Require the Use of EVV
354.4006 - Home Health Care Services that Require the Use of EVV
354.4007 - EVV System
354.4009 - EVV Visit Transaction and EVV Claim
354.4011 - Visit Maintenance
354.4013 - HHSC and MCO Compliance Reviews and Enforcement Actions
354.4015 - EVV Training Requirements
354.4017 - Process to Request Approval of a Proposed EVV Proprietary System and Additional Requirements for a PSO
354.4019 - Access to EVV System and EVV Documentation
354.4021 - Additional Requirements
354.4023 - Sanctions
354.4025 - Administrative Hearing

Subchapter P - AUTISM SERVICES

354.5001 - Purpose and Applicability
354.5003 - Definitions
354.5011 - Providers of Applied Behavior Analysis (ABA) Services
354.5021 - Service Description, Requirements, and Limitations for Providing Applied Behavior Analysis (ABA) Services
354.5023 - Additional Medicaid Reimbursement Limitations and Exclusions Specific to Applied Behavior Analysis (ABA) Services

Chapter 355 - REIMBURSEMENT RATES

Subchapter A - COST DETERMINATION PROCESS

355.101 - Introduction
355.102 - General Principles of Allowable and Unallowable Costs
355.103 - Specifications for Allowable and Unallowable Costs
355.104 - Revenues
355.105 - General Reporting and Documentation Requirements, Methods, and Procedures
355.106 - Basic Objectives and Criteria for Audit and Desk Review of Cost Reports
355.107 - Notification of Exclusions and Adjustments
355.108 - Determination of Inflation Indices
355.109 - Adjusting Reimbursement When New Legislation, Regulations, or Economic Factors Affect Costs
355.110 - Informal Reviews and Formal Appeals
355.111 - Administrative Contract Violations
355.112 - Attendant Compensation Rate Enhancement
355.114 - Consumer Directed Services Payment Option

Subchapter B - ESTABLISHMENT AND ADJUSTMENT OF REIMBURSEMENT RATES FOR MEDICAID

355.201 - Establishment and Adjustment of Reimbursement Rates for Medicaid
355.205 - Rule for Emergency Temporary Reimbursement Rate Increases and Limitations on Use of Emergency Temporary Funds for Medicaid in Response to Novel Coronavirus (COVID-19)
355.207 - American Rescue Plan Act Home and Community-Based Services Provider Retention Payments

Subchapter C - REIMBURSEMENT METHODOLOGY FOR NURSING FACILITIES

355.304 - Direct Care Staff Spending Requirement on or after September 1, 2023
355.306 - Cost Finding Methodology before September 1, 2025
355.307 - Reimbursement Setting Methodology before September 1, 2025
355.308 - Direct Care Staff Rate Component before September 1, 2025
355.310 - Reimbursement Methodology for Customized Equipment
355.311 - Medicaid Reimbursement Rates for State Veterans Homes
355.312 - Reimbursement Setting Methodology--Liability Insurance Costs
355.313 - Reimbursement Methodology for Rehabilitative and Specialized Services
355.315 - Reimbursement Methodology for Preadmission Screening and Resident Review (PASRR) Specialized Services
355.316 - Reimbursement Methodology for Pediatric Care Facilities
355.318 - Reimbursement Setting Methodology for Nursing Facilities on or after September 1, 2025
355.320 - Nursing Care Staff Rate Enhancement Program for Nursing Facilities on or after September 1, 2025
355.403 - Vendor Hold

Subchapter D - REIMBURSEMENT METHODOLOGY FOR INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONS (ICF/IID)

355.455 - Payments to Non-State Operated Facilities
355.456 - Reimbursement Methodology
355.457 - Cost Finding Methodology
355.458 - Supplemental Payments to Non-State Government-Owned Facilities

Subchapter E - COMMUNITY CARE FOR AGED AND DISABLED

355.501 - Reimbursement Methodology for Program for All-Inclusive Care for the Elderly (PACE)
355.502 - Reimbursement Methodology for Common Services in Home and Community-Based Services Waivers
355.503 - Reimbursement Methodology for the Community-Based Alternatives Waiver Program and the Integrated Care Management-Home and Community Support Services and Assisted Living/Residential Care Programs
355.505 - Reimbursement Methodology for the Community Living Assistance and Support Services Waiver Program
355.507 - Reimbursement Methodology for the Medically Dependent Children Program
355.509 - Reimbursement Methodology for Residential Care
355.510 - Reimbursement Methodology for Emergency Response Services (ERS)
355.511 - Reimbursement Methodology for Home-Delivered Meals
355.513 - Reimbursement Methodology for the Deaf-Blind with Multiple Disabilities Waiver Program

Subchapter F - REIMBURSEMENT METHODOLOGY FOR PROGRAMS SERVING PERSONS WITH MENTAL ILLNESS OR INTELLECTUAL OR DEVELOPMENTAL DISABILITY

355.722 - Reporting Costs by Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Providers
355.723 - Reimbursement Methodology for Home and Community-Based Services and Texas Home Living Programs
355.725 - Reimbursement Methodology for Common Waiver Services in Home and Community-based Services (HCS) and Texas Home Living (TxHmL)
355.743 - Reimbursement Methodology for Mental Health Case Management
355.746 - Reimbursement Methodology for Mental Retardation Service Coordination
355.748 - Reimbursement Methodology for Preadmission Screening and Resident Review (PASRR) Level II Evaluations
355.761 - Reimbursement Methodology for Institutions for Mental Diseases (IMD)
355.781 - Rehabilitative Services Reimbursement Methodology

Subchapter G - ADVANCED TELECOMMUNICATIONS SERVICES AND OTHER COMMUNITY-BASED SERVICES

355.5902 - Reimbursement Methodology for Primary Home Care
355.6907 - Reimbursement Methodology for Day Activity and Health Services
355.7001 - Reimbursement Methodology for Telemedicine, Telehealth, and Home Telemonitoring Services

Subchapter H - BASE WAGE REQUIREMENTS FOR PERSONAL ATTENDANTS

355.7051 - Base Wage for a Personal Attendant

Subchapter I - REPORTING

355.7201 - Novel Coronavirus (COVID-19) Fund Reporting

Subchapter J - PURCHASED HEALTH SERVICES

355.8001 - Reimbursement for Vision Care Services
355.8021 - Reimbursement Methodology for Home Health Services
355.8023 - Reimbursement Methodology for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)
355.8041 - Recipient-Initiated Second Opinions
355.8052 - Inpatient Hospital Reimbursement
355.8056 - State-Owned Teaching Hospital Reimbursement Methodology
355.8058 - Inpatient Direct Graduate Medical Education (GME) Reimbursement
355.8060 - Reimbursement Methodology for Freestanding Psychiatric Facilities
355.8061 - Outpatient Hospital Reimbursement
355.8065 - Disproportionate Share Hospital Reimbursement Methodology
355.8066 - State Payment Cap and Hospital-Specific Limit Methodology
355.8070 - Hospital Augmented Reimbursement Program
355.8085 - Reimbursement Methodology for Physicians and Other Practitioners
355.8087 - In-Home Total Parenteral Hyperalimentation Services
355.8089 - In-home Respiratory Therapy Services for Ventilator-Dependent Persons
355.8091 - Reimbursement to Licensed Professional Counselors, Licensed Clinical Social Workers, and Licensed Marriage and Family Therapists
355.8093 - Reimbursement Methodology for Physician Assistants
355.8095 - Medicaid Administrative Claiming Program
355.8097 - Reimbursement Methodology for Physical, Occupational, and Speech Therapy Services
355.8101 - Rural Health Clinics Reimbursement
355.8121 - Reimbursement to Ambulatory Surgical Centers
355.8141 - Reimbursement for Hearing Aid Services
355.8161 - Reimbursement Methodology for Midwife Services
355.8181 - Birthing Center Reimbursement
355.8200 - Retained Funds for the Uncompensated Care Program
355.8201 - Waiver Payments to Hospitals for Uncompensated Care
355.8202 - Waiver Payments to Physician Group Practices for Uncompensated Care
355.8203 - Delivery System Reform Incentive Payments
355.8204 - Funding for DSRIP Monitoring Program
355.8205 - Delivery System Reform Incentive Payments for Demonstration Years 7-8
355.8206 - Funding for DSRIP Monitoring Program for Demonstration Years 7-8
355.8208 - Waiver Payments to Publicly-Owned Dental Providers for Uncompensated Charity Care
355.8210 - Waiver Payments to Governmental Ambulance Providers for Uncompensated Charity Care
355.8212 - Waiver Payments to Hospitals for Uncompensated Charity Care
355.8214 - Waiver Payments to Physician Group Practices for Uncompensated Charity Care
355.8215 - Public Health Provider - Charity Care Program (PHP-CCP)
355.8216 - Delivery System Reform Incentive Payments for Demonstration Years 9-10
355.8217 - Payments to Public Health Providers for Charity Care
355.8218 - Funding for DSRIP Monitoring Program for Demonstration Years 9-10
355.8221 - Reimbursement Methodology
355.8241 - Reimbursement Methodology for Chemical Dependency Treatment Facilities
355.8261 - Federally Qualified Health Center Services Reimbursement
355.8281 - Reimbursement Methodology for Nurse Practitioners and Clinical Nurse Specialists
355.8321 - LoneSTAR Select Contracting Process for Inpatient Hospital Services
355.8361 - Rates and Payment Structures
355.8401 - Reimbursement Methodology for Case Management for Children and Pregnant Women
355.8421 - Reimbursement for Case Management Services for Infants and Toddlers with Developmental Disabilities
355.8422 - Reimbursement for Specialized Rehabilitation Services for Infants and Toddlers with Developmental Disabilities
355.8441 - Reimbursement Methodologies for Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services
355.8443 - Reimbursement Methodology for School Health and Related Services (SHARS)
355.8445 - Reimbursement for Environmental Lead Investigations
355.8461 - Reimbursement
355.8541 - Legend and Nonlegend Medications
355.8542 - Drug Price Effective Date
355.8543 - Nonlegend Drug Restrictions
355.8544 - Usual and Customary Prices
355.8546 - Brand-Name Drugs
355.8547 - Reimbursement for Compound Prescriptions
355.8548 - 340B Covered Entities
355.8549 - Reimbursement to Hospitals and Physicians Who Dispense Drugs
355.8550 - Third-Party Resources
355.8551 - Professional Dispensing Fee
355.8561 - Billing
355.8581 - Reimbursement Methodology for Family Planning Services
355.8600 - Reimbursement Methodology for Ambulance Services
355.8610 - Reimbursement for Clinical Laboratory Services
355.8620 - Reimbursement Methodology for Services Provided in Indian Health Service and Tribal Facilities
355.8641 - Reimbursement Methodology for the Women's Health Program
355.8660 - Renal Dialysis Reimbursement

Subchapter L - LOCAL FUNDS MONITORING

355.8701 - Purpose
355.8702 - Definitions
355.8703 - Applicability
355.8704 - Reporting and Monitoring
355.8705 - Post-Determination Review
355.8706 - State and Federal Reporting
355.8707 - Notification Requirements for the Creation of a Local Provider Participation Fund (LPPF)

Subchapter M - MISCELLANEOUS PROGRAMS

355.9040 - Reimbursement Methodology for Comprehensive Rehabilitation Services Program
355.9060 - Reimbursement Methodology for the Youth Empowerment Services Waiver Program
355.9070 - Reimbursement Methodology for Home and Community-Based Services - Adult Mental Health Program
355.9080 - Reimbursement Methodology for Prescribed Pediatric Extended Care Centers
355.9090 - Reimbursement Methodology for Community First Choice

Chapter 356 - MEDICAID AND CHIP ELECTRONIC HEALTH INFORMATION

Subchapter A - MEDICAID ELECTRONIC HEALTH RECORD

356.101 - Data for the Medicaid Eligibility and Health Information System

Subchapter B - MEDICAID ELECTRONIC HEALTH RECORD INCENTIVE PAYMENT PROGRAM

356.201 - General Provisions
356.202 - Audit Review and Recoupment

Chapter 357 - HEARINGS

Subchapter A - UNIFORM FAIR HEARING RULES

357.1 - Definitions
357.3 - Authority and Right to Appeal
357.5 - Hearings Officer Responsibilities
357.7 - Agency and Designee Responsibilities
357.9 - Burden of Proof in a Fair Hearing
357.11 - Notice and Continued Benefits
357.13 - Appellant Rights and Responsibilities
357.15 - Scheduling Hearings and Notice Requirements
357.17 - Types of Hearings
357.19 - Other Procedures
357.21 - Interpreters in Fair Hearings
357.23 - Hearings Officer Decision and Actions
357.25 - Records and Confidential Information

Subchapter I - HEARINGS UNDER THE ADMINISTRATIVE PROCEDURE ACT

357.481 - Application of this Subchapter
357.482 - Definitions
357.483 - Powers and Duties of the Judge
357.484 - Request for a Hearing
357.485 - Venue
357.486 - Computation of Time
357.487 - Representation of Parties
357.488 - Filing and Service of Documents
357.489 - Notice of Hearing
357.490 - Pre-hearing Conference
357.491 - Motions
357.492 - Discovery and Subpoenas
357.493 - Conduct of Hearing
357.494 - Evidence
357.495 - Default and dismissal
357.496 - Summary disposition
357.497 - Proposals for Decision, Exceptions, and Replies
357.498 - Final Orders and Rehearing

Subchapter J - MEDICAID THIRD-PARTY RECOVERY

357.501 - Basis and Purpose
357.502 - Definitions
357.503 - Distribution of Recoveries
357.504 - Waiver Authority of the Commissioner

Subchapter K - ADMINISTRATIVE FRAUD DISQUALIFICATION HEARINGS

357.521 - Introduction and Legal Basis
357.522 - Designation of Hearing Officer
357.523 - Disqualification of Hearing Officer
357.524 - Hearing Officer's Powers and Duties
357.525 - Scheduling the Hearing
357.526 - Advance Notice of Hearing
357.527 - Participation While Hearing is Pending
357.528 - Conduct of Hearing
357.529 - Attendance at Hearing
357.530 - Household Member's Rights during Hearing
357.531 - Consideration of the Case by the Hearing Officer
357.532 - Failure of Household Member To Appear
357.533 - Postponements
357.534 - Recessing the Hearing
357.535 - Findings of the Hearing Officer
357.536 - The Hearing Record and Decision
357.537 - Effect of an Administrative Determination of Intentional Program Violation
357.538 - Notification of Hearing Decision and the Effect on Remaining Household Members
357.539 - Court Actions in Relation to Administrative Disqualification
357.540 - Presentation of the Texas Department of Human Services' (DHS's) Case
357.541 - Effect of Nondetermination of Intentional Program Violation
357.542 - Consolidation of Administrative Disqualification Hearings and Fair Hearings

Subchapter L - FRAUD INVOLVING RECIPIENTS

357.561 - Terms and General Policy
357.562 - Determination and Disposition of Intentional Program Violations
357.563 - Eligibility during Investigation
357.564 - Appeals
357.565 - Referral of Food Stamp and Temporary Assistance for Needy Families (TANF) Intentional Program Violation Claims to Administrative Disqualification Hearing Officer
357.566 - Collection Action on Food Stamp and Temporary Assistance for Needy Families (TANF) Intentional Program Violation Claims

Subchapter M - FRAUD OR ABUSE INVOLVING MEDICAL PROVIDERS

357.581 - Department Responsibility
357.582 - Confidentiality of Fraud or Abuse Investigation Records
357.583 - Statutory Bases
357.584 - Department Responsibilities in Relation to Provider Fraud and Abuse
357.585 - Grounds for Fraud Referral and Administrative Sanction
357.586 - Administrative Sanctions/Actions, Restitution, and Recoupment
357.587 - Definitions
357.588 - Administrative Sanctions and Actions
357.589 - Scope of Sanction
357.590 - Imposing a Sanction
357.591 - Notice of Adverse Action
357.592 - Informing Other Interested Parties
357.593 - Provider Education
357.594 - Request for Reinstatement
357.595 - Obligation of Health Care Practitioners and Providers

Subchapter N - FRAUD OR ABUSE INVOLVING PROVIDERS (EXCEPT MEDICAL)

357.601 - Responsibilities of the Department In Relation to Provider Fraud
357.602 - Statutory Bases for Prosecution

Subchapter O - RECOVERY OF BENEFITS WRONGFULLY RECEIVED

357.621 - Department Responsibility
357.622 - Recovery from Providers
357.623 - Recovery When Fraud Is Involved

Subchapter P - CIVIL MONETARY PENALTIES

357.641 - Definitions
357.642 - Liability
357.643 - Maximum Amount
357.644 - Exemptions
357.645 - Determining the Amount
357.646 - Assessment of a Civil Monetary Penalty
357.647 - Payment of a Civil Monetary Penalty
357.648 - Prohibited Use of Civil Monetary Penalties in Cost Reports or Claims

Subchapter Q - REIMBURSEMENT RATES FOR PROSECUTION OF INTENTIONAL PROGRAM VIOLATIONS

357.661 - Rates of Reimbursement

Subchapter R - JUDICIAL AND ADMINISTRATIVE REVIEW OF HEARINGS

357.701 - Purpose and Application
357.702 - Definitions
357.703 - Process and Timeframes

Chapter 358 - MEDICAID ELIGIBILITY FOR THE ELDERLY AND PEOPLE WITH DISABILITIES

Subchapter A - GENERAL INFORMATION

358.101 - Purpose and Scope
358.103 - Definitions
358.105 - General Medicaid Eligibility Requirements
358.107 - Coverage Groups

Subchapter B - NONFINANCIAL REQUIREMENTS

358.201 - Purpose and Scope
358.203 - Citizenship and Qualified Alien Status
358.205 - Alien Status for Treatment of an Emergency Medical Condition
358.207 - Residence
358.209 - Social Security Number
358.211 - Aged, Blind, or Disabled
358.213 - Resident of an Institution for Mental Diseases
358.215 - Inmates of Public Institutions
358.217 - Application for Other Benefits
358.219 - Third-party Resources

Subchapter C - FINANCIAL REQUIREMENTS

358.301 - Purpose and Scope
358.321 - General Treatment of Resources
358.322 - Conversion of Resources
358.323 - Resource Limits
358.324 - Deeming of Resources
358.325 - Ownership Interest and Legal Right to Access a Resource
358.326 - Unknown Assets
358.327 - Transactions Involving Agents
358.331 - General Exclusions from Resources
358.333 - Treatment of Employment-and Retirement-Related Annuities
358.334 - Treatment of a Nonemployment-Related Annuity with a Purchase or Transaction Date before February 8, 2006
358.335 - Treatment of Annuities with a Purchase or Transaction Date on or after February 8, 2006
358.336 - Treatment of Testamentary or Inter Vivos Trusts
358.337 - Treatment of a Medicaid-qualifying Trust
358.338 - Treatment of a Trust Established with Zebley v. Sullivan Settlement Funds
358.339 - Treatment of Trusts on and after August 11, 1993
358.345 - Entrance Fees for Continuous Care Retirement Communities
358.346 - Funds Held in Financial Institution Accounts
358.347 - Nonliquid Resources
358.348 - Exclusion of a Home
358.349 - Exceptions to Treatment of Excess Real Property
358.350 - Life Estates and Remainder Interest
358.351 - Mineral Rights
358.352 - Burial Spaces
358.353 - Term and Burial Insurance
358.354 - Automobiles
358.355 - Qualified Long-Term Care Partnership Program Insurance Policies
358.357 - Achieving a Better Life Experience Program
358.358 - School-Based Savings Program
358.371 - Treatment of Other Resources
358.381 - General Treatment of Income
358.382 - Variable Monthly Income
358.383 - Deeming of Income
358.384 - Temporary Absence
358.385 - Cafeteria Plan Benefits
358.386 - Reduction of Pension and Benefit Checks for Recoupment of Overpayments
358.387 - Income Exclusions
358.388 - Tuition Savings Programs
358.389 - Achieving a Better Life Experience Program
358.390 - School-Based Savings Program
358.391 - Treatment of Other Income
358.401 - Transfer of Assets on or after February 8, 2006
358.402 - Transfer of Assets before February 8, 2006
358.411 - Purpose and Application
358.412 - Definitions
358.413 - Spousal Impoverishment Treatment of Income and Resources
358.414 - Assessment of Resources to Determine a Spousal Protected Resource Amount
358.415 - Calculation of the Spousal Protected Resource Amount
358.416 - Initial Application and the Spousal Protected Resource Amount
358.417 - Treatment of Resources of the Institutionalized Spouse after the Initial Eligibility Period
358.418 - Refusal of a Community Spouse to Cooperate
358.419 - Separation to Circumvent Medicaid Policy
358.420 - Expanding the Spousal Protected Resource Amount
358.421 - Treatment of Income for Eligibility and Co-payment
358.422 - Notice and Fair Hearing
358.423 - Transfer of Assets and Spousal Impoverishment
358.431 - Definitions
358.432 - Eligibility Budgets
358.433 - Special Income Limit
358.434 - Budget Types for a Noninstitutional Setting
358.435 - Noninstitutional Eligibility Budgets
358.436 - Budget Types for an Institutional Setting
358.437 - Institutional Eligibility Budgets
358.438 - Determination of Co-payment
358.439 - Guardianship Fee
358.440 - Dependent Allowance
358.441 - Payroll Deductions

Subchapter D - APPLICATION AND ELIGIBILITY DETERMINATION

358.501 - Purpose and Scope
358.505 - Application Process Overview
358.510 - Authorized Representative
358.515 - Application Requirements
358.520 - Date of Application
358.525 - Previously Completed Application for Assistance
358.530 - Eligibility Determination
358.535 - Notice of Eligibility Determination
358.540 - Medical Effective Date
358.545 - Eligibility Redetermination

Subchapter E - RIGHTS AND RESPONSIBILITIES OF APPLICANTS AND RECIPIENTS

358.601 - Rights
358.602 - Disclosure of Official Records and Information
358.603 - Release of Medical Information
358.604 - Responsibility To Provide Information and Report Changes
358.605 - Fraud Referral and Restitution
358.356 - Tuition Savings Programs

Chapter 359 - MEDICARE SAVINGS PROGRAM

359.101 - Purpose and Scope
359.103 - Qualified Medicare Beneficiary Program
359.105 - Specified Low-Income Medicare Beneficiary Program
359.107 - Qualifying Individual Program
359.109 - Qualified Disabled and Working Individual Program

Chapter 360 - MEDICAID BUY-IN PROGRAM

360.101 - Overview and Purpose
360.103 - Applying and Providing Information
360.105 - Citizenship, Immigration Status, and Residency
360.107 - Disability
360.109 - Work
360.111 - Income
360.113 - Resources
360.115 - Deeming of Income and Resources
360.117 - Cost Sharing
360.119 - Medical Effective Date

Chapter 361 - MEDICAID BUY-IN FOR CHILDREN PROGRAM

361.101 - Overview and Purpose
361.103 - Definitions
361.105 - Applying and Providing Information
361.107 - Nonfinancial Requirements
361.109 - Third-party Resources
361.111 - Income
361.113 - Employer-sponsored Health Insurance
361.115 - Cost Sharing
361.117 - Notice of Eligibility Determination and Right to Appeal
361.119 - Medical Effective Date

Chapter 363 - TEXAS HEALTH STEPS COMPREHENSIVE CARE PROGRAM

Subchapter B - PRESCRIBED PEDIATRIC EXTENDED CARE CENTER SERVICES

363.201 - Purpose
363.203 - Definitions
363.205 - Provider Participation Requirements
363.207 - Participant Eligibility Criteria
363.209 - Benefits and Limitations
363.211 - Service Authorization
363.212 - Documentation Requirements for Services Other Than Transportation Services
363.213 - Ordering Physician Responsibilities
363.215 - Termination, Reduction, or Denial of Authorization for Prescribed Pediatric Extended Care Center Services

Subchapter C - PRIVATE DUTY NURSING SERVICES

363.301 - Purpose
363.303 - Definitions
363.305 - Provider Participation Requirements
363.307 - Medical Necessity
363.309 - Benefits and Limitations
363.311 - Prior Authorization Requirements
363.313 - Plan of Care

Subchapter D - DENTAL SERVICES

363.401 - Eligibility for TH Steps Dental Services

Subchapter E - EPSDT EYEGLASS PROGRAM

363.501 - Definitions
363.502 - Benefits and Limitations
363.503 - Specifications for Eyewear
363.504 - Claims Information Requirements

Subchapter F - PERSONAL CARE SERVICES

363.601 - Purpose
363.602 - Definitions
363.603 - Provider Participation Requirements
363.605 - Benefits and Limitations
363.607 - Place of Service

Chapter 366 - MEDICAID ELIGIBILITY FOR WOMEN, CHILDREN, YOUTH, AND NEEDY FAMILIES

Subchapter B - PRESUMPTIVE MEDICAID PROGRAM

366.201 - Purpose and Scope
366.203 - Definitions
366.211 - General Eligibility Requirements
366.213 - Eligible Group
366.215 - Application Requirements and Processing
366.217 - Citizenship
366.219 - Social Security Number
366.221 - Residence
366.223 - Income Limits
366.225 - Determination of Household Composition
366.227 - Calculation of Household Income
366.229 - Third-party Resources
366.231 - Medicaid Eligibility Effective Date
366.233 - Resident of an Institution for Mental Diseases
366.235 - Inmates of Public Institutions
366.237 - Right to Appeal
366.251 - Qualified Hospital and Qualified Entity Eligibility Requirements
366.261 - Oversight of Qualified Hospitals and Qualified Entities
366.263 - HHSC Responsibilities to Qualified Hospitals and Qualified Entities

Subchapter C - PREGNANT WOMEN'S MEDICAID

366.301 - Purpose and Scope
366.303 - Definitions
366.305 - General Eligibility Requirements
366.307 - Eligible Group
366.309 - Application Requirements
366.311 - Application Processing
366.313 - Citizenship
366.315 - Social Security Number
366.317 - Residence
366.319 - Child Support and Medical Support
366.321 - Income Levels
366.323 - Third-Party Resources
366.325 - Medical Eligibility Effective Date
366.327 - Resident of an Institution for Mental Diseases
366.329 - Inmates of Public Institutions
366.331 - Information from Other Agencies
366.333 - Requirement to Report Changes
366.335 - Right to Appeal

Subchapter D - MEDICAID FOR BREAST AND CERVICAL CANCER

366.401 - Purpose and Scope
366.403 - Definitions
366.405 - Eligible Group
366.407 - Eligibility Requirements
366.409 - Application Requirements and Processing
366.411 - Medicaid Eligibility Effective Date
366.413 - Inmates of Public Institutions
366.415 - Eligibility Renewal
366.417 - Information from Other Agencies
366.419 - Requirement to Report Changes
366.421 - Right to Appeal

Subchapter E - CHILDREN'S MEDICAID

366.501 - Purpose and Scope
366.503 - Definitions
366.505 - General Eligibility Requirements
366.507 - Eligible Groups
366.509 - Application Requirements
366.511 - Application Processing
366.513 - Citizenship
366.515 - Social Security Number
366.517 - Residence
366.519 - Relationship and Domicile
366.521 - Child Support and Medical Support
366.523 - Income Limits
366.525 - Third-Party Resources
366.527 - Medicaid Eligibility Effective Date
366.529 - Resident of an Institution for Mental Diseases
366.531 - Inmates of Public Institutions
366.533 - Eligibility Renewal
366.535 - Comprehensive Health Care Requirements
366.537 - Information from Other Agencies
366.539 - Requirement to Report Changes
366.541 - Right to Appeal

Subchapter F - MEDICAID FOR TRANSITIONING FOSTER CARE YOUTH

366.601 - Purpose and Scope
366.603 - Definitions
366.605 - Program Administration
366.607 - Legal Basis
366.609 - General Eligibility Requirements
366.611 - Eligible Group
366.613 - Application Requirements
366.615 - Application Processing
366.617 - Citizenship
366.619 - Social Security Number
366.621 - Residence
366.623 - Income Limits
366.625 - Medicaid Eligibility Effective Dates
366.627 - Resident of an Institution for Mental Diseases
366.629 - Inmates of Public Institutions
366.631 - Eligibility Renewal
366.633 - Information from Other Agencies
366.635 - Requirement to Report Changes
366.637 - Right to Appeal

Subchapter G - MEDICAID FOR PARENTS AND CARETAKER RELATIVES PROGRAM

366.701 - Purpose and Scope
366.703 - Definitions
366.705 - General Eligibility Requirements
366.707 - Eligible Group
366.709 - Application Requirements
366.711 - Application Processing
366.713 - Citizenship
366.715 - Social Security Number
366.717 - Residence
366.719 - Relationship and Domicile
366.721 - Medical Support
366.723 - Income Eligibility
366.725 - Third-Party Resources
366.727 - Medicaid Eligibility Effective Date
366.729 - Resident of an Institution for Mental Diseases
366.731 - Inmates of Public Institutions
366.733 - Retroactive Coverage
366.735 - Four Months Post-Medicaid Eligibility
366.737 - Twelve-Month Transitional Medicaid
366.739 - Eligibility Renewal
366.741 - Information from Other Agencies
366.743 - Requirement to Report Changes
366.745 - Right to Appeal

Subchapter H - MEDICALLY NEEDY PROGRAM

366.801 - Purpose and Scope
366.803 - Definitions
366.805 - General Eligibility Requirements
366.807 - Eligible Groups
366.809 - Application Requirements
366.811 - Application Processing
366.813 - Citizenship
366.815 - Social Security Number
366.817 - Residence
366.819 - Relationship and Domicile
366.821 - Child Support and Medical Support
366.823 - Income Limits
366.825 - Third-Party Resources
366.827 - Medicaid Eligibility Effective Date
366.829 - Resident of an Institution for Mental Diseases
366.831 - Inmates of Public Institutions
366.833 - Exemption for Newborns
366.835 - Comprehensive Health Care Requirements
366.837 - Information from Other Agencies
366.839 - Requirement to Report Changes
366.841 - Right to Appeal
366.843 - Resources
366.845 - Vehicles
366.847 - Exempt Resources

Subchapter I - EMERGENCY MEDICAL SERVICES FOR ALIENS INELIGIBLE FOR REGULAR MEDICAID

366.901 - Legal Basis
366.903 - Application and Eligibility Requirements

Subchapter J - FORMER FOSTER CARE CHILDREN'S PROGRAM

366.1001 - Purpose and Scope
366.1003 - Definitions
366.1005 - Program Administration
366.1007 - Legal Basis
366.1009 - General Eligibility Requirements
366.1011 - Eligible Group
366.1013 - Application Requirements
366.1015 - Application Processing
366.1017 - Citizenship
366.1019 - Social Security Number
366.1021 - Residence
366.1023 - Third-Party Resources
366.1025 - Medicaid Eligibility Effective Dates
366.1027 - Resident of an Institution for Mental Diseases
366.1029 - Inmates of Public Institutions
366.1031 - Eligibility Renewal
366.1033 - Information from Other Agencies
366.1035 - Requirement to Report Changes
366.1037 - Right to Appeal

Subchapter K - MODIFIED ADJUSTED GROSS INCOME METHODOLOGY

366.1101 - Purpose and Scope
366.1103 - Definitions
366.1105 - Methodology
366.1107 - Determination of Household Composition
366.1109 - Calculation of Individual Income
366.1111 - Determination Regarding Inclusion of Individual Income in the Household Income
366.1113 - Calculation of Household Income
366.1115 - Modification

Subchapter L - MEDICAID FOR YOUTH UNDER THE INTERSTATE COMPACT ON THE PLACEMENT OF CHILDREN

366.1201 - Purpose and Eligibility

Chapter 370 - STATE CHILDREN'S HEALTH INSURANCE PROGRAM

Subchapter A - PROGRAM ADMINISTRATION

370.1 - Purpose
370.4 - Definitions
370.10 - Duties and Responsibilities of HHSC
370.12 - Maternal Depression Screening

Subchapter B - APPLICATION SCREENING, REFERRAL, PROCESSING, RENEWAL, AND DISENROLLMENT

370.20 - Application Availability and File Date
370.21 - Application Assistance
370.22 - Completion of Telephone Applications
370.25 - Missing Information
370.30 - Applicant Rights and Responsibilities
370.42 - Age Limits
370.43 - Citizenship and Residency
370.44 - Income and Assets
370.45 - Medicaid Eligibility
370.46 - Waiting Period
370.47 - Social Security Number
370.49 - Pregnant CHIP Members
370.50 - Matters Subject to Review
370.51 - Deadline and Method for Requesting Review
370.52 - Disposition of a Request for Review
370.54 - Temporary Enrollment Pending Disposition of Review or Reconsideration
370.60 - Renewal
370.70 - Income Eligibility Check in 6th Month of Coverage
370.71 - Review and Reconsideration of Disenrollment Determination

Subchapter C - ENROLLMENT, RENEWAL, DISENROLLMENT, AND COST SHARING

370.301 - CHIP Enrollment Packet
370.303 - Completion of Enrollment
370.305 - Enrollment of Children with Special Health Care Needs (CSHCN)
370.307 - Continuous Enrollment Period
370.309 - Incomplete or Missing Information
370.311 - Disenrollment
370.321 - Requirements and Exemptions
370.325 - Cost-Sharing Cap

Subchapter D - ELIGIBILITY FOR UNBORN CHILDREN

370.401 - Perinates

Subchapter E - PROVIDER REQUIREMENTS

370.452 - Significant Traditional Provider
370.453 - Balance Billing
370.454 - Experience Rebate in the Children's Health Insurance Program
370.455 - Provider Complaints and Appeals Processes

Subchapter F - SPECIAL INVESTIGATIVE UNITS

370.501 - Purpose
370.502 - Managed Care Organization's Plans and Responsibilities in Preventing and Reducing Waste, Abuse, and Fraud
370.503 - Managed Care Organization's Contracts
370.504 - Review of Managed Care Organization's Records
370.505 - Recovery of Funds

Subchapter G - STANDARDS FOR CHIP MANAGED CARE

370.601 - Applicability of Medicaid Managed Care Standards to CHIP
370.602 - Member Complaints and Appeals
370.604 - Managed Care Organization Requirements Concerning Out-of-Network Providers

Subchapter H - OUTPATIENT PHARMACY SERVICES

370.701 - Applicability of Medicaid Managed Care Standards for Outpatient Pharmacy Services to CHIP

Subchapter I - MODIFIED ADJUSTED GROSS INCOME METHODOLOGY

370.801 - Purpose and Scope
370.803 - Definitions
370.805 - Methodology
370.807 - Determination of Household Composition
370.809 - Calculation of Individual Income
370.811 - Determination Regarding Inclusion of Individual Income in the Household Income
370.813 - Calculation of Household Income
370.815 - Modification

Chapter 371 - MEDICAID AND OTHER HEALTH AND HUMAN SERVICES FRAUD AND ABUSE PROGRAM INTEGRITY

Subchapter B - OFFICE OF INSPECTOR GENERAL

371.1 - Definitions
371.3 - Purpose and Authority
371.11 - Scope
371.17 - Detection
371.23 - Surety Bond
371.25 - Injunction to Prevent Disposing of Assets and Application to Debts
371.27 - Prohibition against Solicitation of Medicaid or CHIP Recipients
371.29 - Random Prepayment Review
371.31 - Federal Felony Match
371.33 - On-Site Reviews of Prospective Providers
371.35 - Use of Statistical Sampling and Extrapolation
371.37 - Audit of Managed Care Organizations

Subchapter C - UTILIZATION REVIEW

371.200 - Inpatient Hospital Utilization Review Program
371.201 - Case Selection Process
371.203 - TMRP Review Process
371.204 - Hospital Screening Criteria for TMRP, TEFRA, and Facility-Specific Per Diem Methodology Reviews
371.206 - Denials and Recoupments for TMRP, TEFRA Hospitals, and Facility-Specific Per Diem Methodology Reviews
371.208 - Appeals Related to Utilization Review Department Review Decisions
371.210 - Inpatient Utilization Review for Hospitals Reimbursed Under TMRP and TEFRA Principles of Reimbursement and Facility-Specific Per Diem Methodology Reviews
371.212 - Utilization Review of Nursing Facilities
371.214 - HHSC-Approved Online RUG or Other HHSC-Required Training Course
371.216 - Nursing Facility Clinical Records
371.218 - Onsite and Desk Utilization Reviews of Nursing Facilities
371.220 - Exit Conferences
371.222 - Reconsideration of Utilization Review Results
371.224 - Appeals of Reconsideration Results
371.226 - Calculation of Overpayments and Underpayments
371.228 - Recoveries
371.230 - Waiver of Extrapolation

Subchapter E - PROVIDER DISCLOSURE AND SCREENING

371.1001 - Applicability
371.1005 - Disclosure Requirements
371.1007 - Screening Levels
371.1009 - Verifications Required for Each Screening Level
371.1011 - Recommendation Criteria
371.1013 - Provider Enrollment Recommendations
371.1015 - Types of Provider Enrollment Recommendations

Subchapter F - INVESTIGATIONS

371.1301 - Purpose
371.1305 - Preliminary Investigation
371.1307 - Full Investigation
371.1309 - Training of Investigators
371.1311 - Role of the OIG and SIUs
371.1312 - Recipient Investigations

Subchapter G - ADMINISTRATIVE ACTIONS AND SANCTIONS

371.1601 - Applicability
371.1603 - Legal Basis and Scope
371.1605 - Provider Responsibility
371.1609 - Notice and Service
371.1611 - Due Process
371.1613 - Informal Resolution Process
371.1615 - Appeals
371.1617 - Finality and Collections
371.1619 - Award for Reporting Medicaid Fraud, Abuse, or Overcharges
371.1651 - Provider Eligibility
371.1653 - Claims and Billing
371.1655 - Program Compliance
371.1657 - Unallowable Fiscal Gain
371.1659 - Compliance with Health Care Standards
371.1661 - Convictions and Prohibited Acts
371.1663 - Managed Care
371.1665 - Cost Report Violations
371.1667 - Records and Documentation
371.1669 - Self-Dealing
371.1701 - Administrative Actions
371.1703 - Termination of Enrollment or Cancellation of Contract
371.1705 - Mandatory Exclusion
371.1707 - Permissive Exclusion
371.1709 - Payment Hold
371.1711 - Recoupment of Overpayments and Debts
371.1715 - Damages and Penalties
371.1717 - Reinstatement
371.1719 - Recoupment of Overpayments Identified by Audit
371.1721 - Recoupment of Overpayments Identified by Inspection
371.1723 - Recoupment of Overpayments Identified by Retrospective Payment Review

Chapter 372 - TEMPORARY ASSISTANCE FOR NEEDY FAMILIES AND SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAMS

Subchapter A - OVERVIEW AND PURPOSE

372.1 - Purpose and Scope
372.2 - Definitions
372.3 - Legal Basis
372.4 - Purpose of TANF and SNAP
372.5 - Funding for TANF and SNAP
372.6 - TANF and SNAP Administrator

Subchapter B - ELIGIBILITY

372.101 - Receiving TANF Benefits
372.102 - Caretaker
372.103 - Composition of a TANF Certified Group
372.104 - Required TANF Certified Group Members
372.105 - Eligibility for a Stepparent
372.106 - Eligibility for the Spouse of a Caretaker
372.107 - Excluded TANF Certified Group Members
372.108 - Relationship Requirement
372.151 - Receiving SNAP Benefits
372.152 - Required SNAP Household Members
372.153 - Determining SNAP Household Eligibility
372.201 - TANF Citizenship Requirements
372.202 - Verifying Citizenship for TANF
372.203 - SNAP Citizenship Requirements
372.204 - Verifying Citizenship for SNAP
372.205 - Reporting Undocumented Alien Applicants
372.251 - Residency Requirements for TANF
372.252 - Residency Requirements for SNAP
372.301 - Domicile Requirements for TANF
372.351 - Overview of Resources
372.352 - Resource Eligibility Requirements
372.353 - Determining the Value of a Non-Cash Resource
372.354 - Treatment of Resources in TANF
372.355 - Treatment of Resources in SNAP
372.356 - Consequences of Transferring Resources
372.401 - Overview of Income
372.402 - Income Eligibility Requirements
372.403 - Determining Whose Income Counts in TANF
372.404 - Countable and Excluded Income in TANF
372.405 - Determining Whose Income Counts in SNAP
372.406 - Countable and Excluded Income in SNAP
372.407 - Consequences for Failure to Pursue Other Income
372.408 - Determining Income Eligibility
372.409 - Allowable Deductions from Countable Income in TANF
372.410 - Allowable Deductions from Countable Income in SNAP
372.411 - Projecting Future Household Income
372.451 - Time Limits
372.452 - TANF Time Limit Exemptions
372.453 - Requesting a TANF Time Limit Exemption
372.454 - 60-Month Lifetime TANF Cash Limit
372.455 - Continuing Eligibility Beyond the 60-Month Lifetime TANF Cash Limit
372.456 - SNAP Time Limit Exemptions
372.457 - Regaining SNAP Eligibility After a Time Limit Disqualification
372.501 - Disqualifications Due to Criminal Activity

Subchapter C - ASSOCIATED PROGRAMS

372.601 - SNAP Benefits for Disaster Victims
372.651 - Overview of SNAP-CAP
372.652 - SNAP-CAP Eligibility Requirements
372.653 - SNAP-CAP Application Process
372.654 - SNAP-CAP Certification Process
372.655 - Reporting Changes
372.701 - Overview of the TANF Non-Cash Program
372.702 - TANF Non-Cash Eligibility Requirements
372.751 - Overview of the TANF State Program
372.752 - TANF-State Program Eligibility Requirements
372.753 - Determining Eligibility and Benefits
372.801 - Overview of One-Time TANF
372.802 - One-Time TANF Eligibility Requirements

Subchapter D - APPLICATION PROCESS

372.901 - Applying for TANF or SNAP
372.902 - Incomplete Applications
372.903 - Application File Date
372.904 - Application Processing Time Frame
372.905 - Designation of an Authorized Representative
372.906 - Choosing to Apply for TANF Benefits
372.951 - Interview Requirements
372.952 - Interview Scheduling
372.953 - Interview Content
372.954 - Action Taken After an Interview
372.955 - Delayed Eligibility Decisions
372.956 - Expedited SNAP Application Process
372.957 - Periodic Eligibility Review
372.958 - Renewal Notification
372.1001 - Notification of Final Eligibility Decision
372.1002 - Appeal of Eligibility Decision
372.1003 - Reopening a Denied Application

Subchapter E - PARTICIPATION REQUIREMENTS

372.1101 - Social Security Number Requirements
372.1151 - Purpose and Scope of the Personal Responsibility Agreement
372.1152 - Consequence of Not Signing a Personal Responsibility Agreement
372.1153 - Personal Responsibility Agreement Requirements
372.1154 - Cooperating with Personal Responsibility Agreement Requirements
372.1155 - Consequence for Noncooperation with Personal Responsibility Agreement Requirements
372.1156 - Good Cause for Noncooperation with Personal Responsibility Agreement Requirements
372.1251 - TANF Workforce Orientation Requirement
372.1252 - TANF Workforce Orientation Exemption
372.1253 - Consequence for Noncompliance With TANF Workforce Orientation Requirements
372.1301 - Overview of Third-party Resources
372.1302 - Third-party Resource Requirements
372.1303 - Consequence for Noncompliance with Third-party Resource Requirements
372.1351 - SNAP Work Requirements
372.1352 - Consequence for Noncompliance with SNAP Work Requirements
372.1353 - Consequence for a TANF Parent on Strike
372.1401 - Changes a TANF Household Must Report
372.1402 - Changes a SNAP Household Must Report
372.1403 - Time Frame to Report a Change
372.1404 - Time Frame for Action on a Reported Change

Subchapter F - BENEFITS

372.1501 - Definitions
372.1502 - Maximum Benefit Amounts
372.1503 - Minimum Benefit Amounts
372.1504 - SNAP Benefit Allotment Amounts
372.1505 - Determining Monthly Benefits
372.1506 - Benefit Time Frames
372.1507 - TANF Supplemental Relative Payment
372.1508 - Eligibility for Benefits if a Household Member Dies or Leaves the Home
372.1509 - Appropriate Use of Benefits
372.1510 - Issuance of and Access to Benefits
372.1511 - Using an EBT Card
372.1512 - Required Authorized Representative
372.1513 - Availability of Monthly Benefits
372.1514 - Cash Back from a SNAP Account Purchase
372.1515 - Transaction Charges on a TANF Account
372.1516 - Using Benefits after Moving from Texas
372.1517 - Alternate Benefit Issuance Methods during a Disaster
372.1518 - Reporting and Replacing a Lost or Stolen EBT Card
372.1519 - Reporting and Replacing Lost or Stolen Benefits
372.1520 - Action Taken on Non-accessed Benefits
372.1521 - Account Balance and Transaction Errors
372.1551 - TANF Overpayments
372.1552 - SNAP Overpayments
372.1601 - Restoring TANF and SNAP Benefits

Subchapter G - RETAILER REQUIREMENTS

372.1701 - Definitions
372.1702 - EBT System Participation Requirements
372.1703 - Point-of-Sale Terminal Requirements
372.1704 - Point-of-Sale Terminal Requirements to Redeem SNAP Benefits
372.1705 - Manual Voucher Transaction Requirements
372.1706 - Electronic Manual Voucher Transaction Requirements
372.1707 - Liability Implications for Manual Transactions
372.1708 - Store-and-Forward as an Alternative to Manual Transaction
372.1709 - Liability Implications for Store-and-Forward Transactions
372.1710 - Third-Party Processor Requirements
372.1711 - Reimbursement for Electronic Benefit Transfer Transactions
372.1712 - Account Discrepancies
372.1713 - Transaction Disputes
372.1714 - Transaction Dispute Resolution
372.1715 - Appeal of Transaction Dispute Resolution
372.1716 - Out-of-State Transactions of Texas-issued Benefits

Chapter 373 - MEDICAID ESTATE RECOVERY PROGRAM

Subchapter A - GENERAL

373.101 - Purpose
373.103 - Applicability
373.105 - Definitions

Subchapter B - RECOVERY CLAIMS

373.201 - Basis for Claims
373.203 - Claims Procedures
373.205 - Medicaid Estate Recovery Program (MERP) Claim
373.207 - Exemptions from Claims
373.209 - Undue Hardship Waivers
373.211 - Right to a Review of an Undue Hardship Waiver Denial
373.213 - Deduction Allowed for Expenses for Home Maintenance and Costs of Care
373.215 - Recovery Not Cost-Effective
373.217 - Claim Amount
373.219 - Claim Payments

Subchapter C - NOTICE

373.301 - Notice Upon Application
373.303 - Additional Application Notice Provision to Recipients and Others
373.305 - Medicaid Application Estate Recovery Notice Contents
373.307 - Notice of Intent to File A Claim upon the Death of a Medicaid Recipient

Chapter 375 - REFUGEE CASH ASSISTANCE AND MEDICAL ASSISTANCE PROGRAMS

Subchapter G - LOCAL RESETTLEMENT AGENCY REQUIREMENTS

375.701 - Local Governmental and Community Input

Chapter 376 - REFUGEE SOCIAL SERVICES

Subchapter J - LOCAL RESETTLEMENT AGENCY REQUIREMENTS

376.1001 - Local Governmental and Community Input

Chapter 377 - CHILDREN'S ADVOCACY PROGRAMS

Subchapter A - GENERAL

377.1 - Definitions

Subchapter B - STANDARDS OF OPERATION FOR LOCAL COURT-APPOINTED VOLUNTEER ADVOCATE PROGRAMS

377.101 - Purpose and Definitions
377.103 - Legal Authorization
377.105 - Applicability
377.107 - Contract with Statewide Volunteer Advocate Organization
377.109 - Contracts with Local Volunteer Advocate Programs
377.111 - Scale of State Financial Support
377.113 - Local Volunteer Advocate Program Administration
377.115 - Local Volunteer Advocate Program Personnel
377.117 - Local Volunteer Advocate Program Personnel Background Checks

Subchapter C - STANDARDS OF OPERATION FOR LOCAL CHILDREN'S ADVOCACY CENTERS

377.201 - Purpose and Definitions
377.203 - Legal Authorization
377.205 - Applicability
377.207 - Contract with Statewide Children's Advocacy Center Organization
377.209 - Contracts with Local Children's Advocacy Centers
377.211 - Operation of Local Children's Advocacy Center and Program

Chapter 380 - MEDICAL TRANSPORTATION PROGRAM

Subchapter A - PROGRAM OVERVIEW

380.101 - Definitions of Terms

Subchapter B - ELIGIBILITY, PROGRAM SERVICES, PROCESSES, ADDITIONAL TRANSPORTATION CONNECTED WITH AN AUTHORIZED TRIP, LIMITATIONS, AND EXCLUSIONS

380.201 - Eligibility
380.202 - Program Services
380.203 - Program Requirements
380.205 - Program Processes
380.207 - Program Limitations
380.209 - Program Exclusions

Subchapter C - CLIENT RIGHTS

380.301 - Client Rights and Responsibilities

Subchapter D - INDIVIDUAL TRANSPORTATION PARTICIPATION

380.401 - Individual Transportation Participant Requirements

Subchapter E - REGIONAL CONTRACTED BROKERS AND MANAGED TRANSPORTATION ORGANIZATIONS

380.501 - Standards for Motor Vehicles
380.502 - Standards for Motor Vehicle Operators

Chapter 381 - GUARDIANSHIP SERVICES

Subchapter A - PURPOSE AND DEFINITIONS

381.1 - Purpose
381.2 - Definitions

Subchapter B - GUARDIANSHIP ADVISORY BOARD

381.101 - Duties
381.102 - Membership and Eligibility
381.103 - Officers and Meetings

Subchapter C - GRANTS FOR LOCAL GUARDIANSHIP PROGRAMS

381.201 - Eligible Projects
381.202 - Eligible Applicants
381.203 - Application and Selection Process
381.204 - Grant Period
381.205 - Continuation Funding Policy
381.206 - Grant Amounts
381.207 - Notification of Award
381.208 - Request for Reconsideration
381.209 - Contract
381.210 - Progress Reports

Subchapter D - STANDARDS FOR GUARDIANSHIP PROGRAMS

381.301 - Purpose
381.303 - Applicability of Standards to Guardianship Programs
381.305 - Ineligibility of Non-compliant Programs
381.315 - Form of Entity
381.317 - Fiscal Responsibility
381.319 - Budget
381.321 - Insurance
381.323 - Fees for Services
381.325 - Guardianship Bonds
381.331 - Guardianship Accountability
381.333 - Service Provider Employee Screening
381.335 - Confidentiality
381.337 - Supervision of Employees and Volunteers
381.339 - Community Involvement
381.345 - Less Restrictive Alternatives to Guardianship
381.347 - Guardianship Program Service Levels
381.349 - Role of Volunteers
381.351 - Staffing Requirements
381.353 - Training Requirements
381.355 - Conflicts of Interest
381.357 - Referral, Intake, and Assessments
381.359 - Prioritization of Potential Clients on Waiting Lists
381.361 - Responsibility for Burial or Cremation
381.363 - Evaluation and Monitoring of Caseloads
381.365 - Personal Care Plans for Guardianship Clients
381.367 - Financial Care Plans for Guardianship Clients

Chapter 382 - WOMEN'S HEALTH SERVICES

Subchapter A - HEALTHY TEXAS WOMEN

382.1 - Introduction
382.5 - Definitions
382.7 - Client Eligibility
382.9 - Initial Application and Renewal Procedures
382.13 - Denial, Suspension, or Termination of Services and Client Appeals
382.15 - Covered and Non-covered Services
382.17 - HTW Providers
382.19 - Prohibition of Abortion
382.21 - Reimbursement
382.23 - Health-Care Provider's Request for Review of Claim Denial
382.25 - Confidentiality and Consent
382.27 - Audits and Reports
382.29 - Severability

Subchapter B - FAMILY PLANNING PROGRAM

382.101 - Introduction
382.103 - Non-entitlement and Availability
382.105 - Definitions
382.107 - Client Eligibility
382.109 - Financial Eligibility Requirements
382.111 - Denial, Suspension, or Termination of Services and Client Appeals
382.113 - Covered and Non-covered Services
382.115 - Family Planning Program Providers
382.117 - Prohibition of Abortion
382.119 - Reimbursement
382.121 - Provider's Request for Review of Claim Denial
382.123 - Record Retention
382.125 - Confidentiality and Consent
382.127 - FPP Services for Minors
382.129 - Severability

Chapter 386 - DISASTER ASSISTANCE PROGRAM

Subchapter A - GENERAL INFORMATION

386.101 - What does this chapter cover?
386.102 - Are the Individual and Family Grant Program and Temporary Housing Program still available?
386.103 - How are the terms in this chapter defined?
386.104 - Who funds and administers the assistance within the Federal Assistance to Individuals and Households Program?
386.105 - Does this chapter cover Housing Assistance (HA)?
386.106 - What is Other Needs Assistance (ONA)?
386.107 - Can Other Needs Assistance (ONA) funds be used for housing repair or replacement?
386.108 - What is the maximum grant amount I can receive?
386.109 - Who is responsible for helping me apply for a grant?

Subchapter B - ELIGIBILITY CRITERIA FOR OTHER NEEDS ASSISTANCE (ONA) GRANTS

386.201 - Under what circumstances may I apply for disaster assistance?
386.202 - Must I be a citizen to qualify for an Other Needs Assistance grant?
386.203 - What types of losses are eligible for me to receive an Other Needs Assistance (ONA) grant?
386.204 - What are the Other Needs Assistance (ONA) grant categories?
386.205 - What types of personal property are eligible for grant assistance?
386.206 - What types of disaster-related transportation expenses are covered?
386.207 - Are disaster-related medical or dental expenses covered?
386.208 - Are disaster-related funeral expenses covered?
386.209 - What types of moving and storage expenses are covered?
386.210 - Can I receive a grant to purchase flood insurance?
386.211 - What types of losses are ineligible for an Other Needs Assistance (ONA) grant?
386.212 - Are any other categories of assistance covered under an Other Needs Assistance (ONA) grant?
386.213 - Must I file a claim with my insurance company(ies) if my expenses are eligible for an Other Needs Assistance (ONA) grant?
386.214 - Must I apply for assistance from the U.S. Small Business Administration (SBA) before I can receive an Other Needs Assistance (ONA) grant?
386.215 - Am I eligible for an Other Needs Assistance (ONA) grant if the U.S. Small Business Administration (SBA) will not provide assistance?
386.216 - Can I get an Other Needs Assistance grant even if I receive assistance from another source?
386.217 - Are there any exceptions to federal regulations regarding the duplication of benefits?
386.218 - Do I have to accept assistance from other sources if I am eligible for an Other Needs Assistance grant?
386.219 - May I keep the Other Needs Assistance (ONA) grant money if I receive other assistance?
386.220 - Why would Other Needs Assistance (ONA) deny my grant application?
386.221 - Am I eligible for a grant if the U.S. Small Business Administration (SBA) denies my application for failure to maintain flood insurance required as a condition of a previous loan?
386.222 - Are there any additional restrictions on receiving a grant if flooding damaged my residence?

Subchapter C - APPLYING FOR AN OTHER NEEDS ASSISTANCE GRANT

386.301 - How do I apply for an Other Needs Assistance grant?
386.302 - Do I need identification?
386.303 - How much time do I have to apply for a grant?
386.304 - What if I cannot apply within 60 days of the disaster declaration?
386.305 - What does FEMA consider extenuating circumstances if I miss the 60-day application deadline?
386.306 - Do I have the right to withdraw my application for a grant?
386.307 - What happens if I withdraw my application?
386.308 - How will I be notified of the grant decision on my application?
386.309 - What do I do if my grant warrant is lost or stolen?
386.310 - Why would I have to return grant funds?
386.311 - Can I receive additional funds after the initial grant decision?

Subchapter D - RECONSIDERATION AND APPEALS

386.401 - What do I do if I disagree with the grant decision?
386.402 - What happens if I miss the 60-day deadline?
386.403 - What is good cause?
386.404 - Where do I send my request for reconsideration?
386.405 - What happens when I request reconsideration of the decision?
386.406 - How long does it take to respond to my request for reconsideration?
386.407 - Do I have the right to appeal the reconsideration decision?
386.408 - How do I appeal the reconsideration decision?
386.409 - What steps does the Other Needs Assistance (ONA) staff take when I request a hearing?
386.410 - When will DHS schedule my hearing?
386.411 - Who decides my appeal?
386.412 - Will I be able to see the records DHS has regarding my claim?
386.413 - What documents must the DHS office administering Other Needs Assistance (ONA) send to the DHS Hearings Department when a disaster is declared and the ONA state administrative plan is approved?
386.414 - Do DHS attorneys across the state have access to disaster-related documents?
386.415 - How will I learn the decision on my appeal?
386.416 - What happens if I decide to withdraw my appeal?
386.417 - What DHS rules apply to my appeal?
386.418 - What records does DHS keep of my hearing?

Subchapter E - NATIONAL FLOOD INSURANCE PROGRAM (NFIP)

386.501 - Am I required to purchase and maintain flood insurance as a condition of receiving an Other Needs Assistance (ONA) grant?
386.502 - How is a Group Flood Insurance Policy (GFIP) administered?
386.503 - How much is the Group Flood Insurance Policy coverage?
386.504 - Are there any restrictions on future disaster assistance if I receive a grant that includes a flood insurance premium?
386.505 - What must I do when I receive the Group Flood Insurance Policy (GFIP)?
386.506 - How long must I maintain flood insurance on my home?
386.507 - If I am a renter, how long must I maintain flood insurance?
386.508 - What happens if I fail to maintain my flood insurance policy on flood-damaged property?
386.509 - Could I be eligible for a Group Flood Insurance Policy if I live in a community that does not participate in or is sanctioned by the National Flood Insurance Program (NFIP)?
386.510 - What grants am I eligible to receive if I live in a community that does not participate or is sanctioned by the National Flood Insurance Program (NFIP)?
386.511 - Will my application be accepted if my community's petition to FEMA to join the National Flood Insurance Program (NFIP) delays the process?

Chapter 390 - INFORMATION PRACTICES

Subchapter A - STANDARDS RELATING TO THE ELECTRONIC EXCHANGE OF HEALTH INFORMATION

390.1 - Definitions
390.2 - Standards

Chapter 391 - PURCHASE OF GOODS AND SERVICES BY THE TEXAS HEALTH AND HUMAN SERVICES COMMISSION

Subchapter A - GENERAL PROVISIONS

391.101 - Purpose
391.103 - Authority
391.105 - Exceptions
391.107 - Definitions

Subchapter B - PROCUREMENT AND SPECIAL CONTRACTING METHODS

391.201 - Procurement Methods
391.203 - Spot Purchases
391.205 - Competitive Bidding through Informal Bidding
391.207 - Competitive Sealed Bidding through Invitation for Bids
391.209 - Request for Proposals
391.211 - Request for Qualifications
391.213 - Request for Offers
391.215 - Proprietary Purchases
391.217 - Emergency Purchases
391.219 - Award Notification
391.241 - Contracting and Delivery Procedures for Construction
391.243 - Buy America Requirements for Iron and Steel Used in Construction Contracts
391.245 - Group Purchasing Organizations Program
391.247 - Direct Contract Award

Subchapter C - PROTESTS

391.301 - Purpose
391.303 - Applicability
391.305 - Filing of a Protest
391.307 - Review and Disposition of Protests
391.309 - Contract Awards During Protest

Subchapter D - STANDARDS OF CONDUCT FOR VENDORS

391.401 - Purpose
391.403 - Respondent Responsibility During Discussions and Negotiations
391.405 - Responsibilities of Vendors

Subchapter E - HISTORICALLY UNDERUTILIZED BUSINESSES

391.501 - Historically Underutilized Business Program
391.503 - Mandatory Review of Historically Underutilized Business Subcontracting Plan

Subchapter F - CONTRACTS

391.601 - Open Enrollment Contracts
391.603 - Contract Monitoring Roles and Responsibilities
391.605 - Enhanced Contract Monitoring

Subchapter G - NEGOTIATION AND MEDIATION OF CERTAIN CONTRACT CLAIMS AGAINST HHSC

391.701 - Purpose
391.703 - Applicability
391.705 - Definitions
391.721 - Notice of Claim of Breach of Contract
391.723 - HHSC Counterclaim
391.725 - Request for Voluntary Disclosure of Additional Information
391.727 - Duty to Negotiate
391.729 - Conduct of Negotiation
391.731 - Settlement Approval Procedures
391.733 - Settlement Agreement
391.735 - Costs of Negotiation
391.737 - Request for Contested Case Hearing
391.751 - Mediation Timetable
391.753 - Conduct of Mediation
391.755 - Agreement to Mediate
391.757 - Qualifications and Immunity of the Mediator
391.759 - Confidentiality of Mediation and Final Settlement
391.761 - Costs of Mediation
391.763 - Settlement Approval Procedures
391.765 - Initial Settlement Agreement
391.767 - Final Settlement Agreement
391.769 - Referral to the State Office of Administrative Hearings (SOAH)

Chapter 392 - PURCHASE OF GOODS AND SERVICES FOR SPECIFIC HEALTH AND HUMAN SERVICES COMMISSION PROGRAMS

Subchapter A - PURPOSE AND APPLICABILITY

392.1 - Purpose and Applicability

Subchapter B - EARLY CHILDHOOD INTERVENTION (ECI) SERVICES

392.101 - Purpose
392.103 - Definitions
392.105 - Application and Program Requirements for Early Childhood Intervention Services
392.107 - Contract
392.109 - Transition of Contractors
392.111 - Data Collection and Reporting

Subchapter C - AUTISM PROGRAM

392.201 - Definitions
392.203 - Staff Qualifications
392.205 - Criminal Background Checks
392.207 - Safety

Subchapter D - DARS CONTRACT MANAGEMENT REQUIREMENT

392.301 - Purpose and Applicability
392.303 - Definitions
392.305 - General Requirements for Contracting
392.307 - Complaints
392.309 - Record Requirements
392.311 - Access to Contractor Facilities and Records
392.313 - Contract Monitoring
392.315 - Corrective Action Plan
392.317 - Adverse Actions
392.319 - Debarment and Suspension of Current and Potential Contractor Rights
392.321 - Causes and Conditions of Debarment
392.323 - Causes and Conditions of Suspension
392.325 - Evidence for Debarment or Suspension
392.327 - Notice for Debarment or Suspension
392.329 - Appeals
392.331 - Request for Reconsideration

Subchapter E - CONTRACT MANAGEMENT FOR DSHS FACILITIES AND CENTRAL OFFICE

392.401 - Purpose and Applicability
392.403 - Definitions
392.405 - Accountability
392.407 - Provisions for Certain Contracts
392.409 - Performance Contracts and Ownership of Goods

Subchapter F - CONTRACT MANAGEMENT FOR SUBSTANCE ABUSE PROGRAMS

392.501 - Purpose
392.503 - Definitions
392.505 - Allocation of Funds
392.507 - Competitive Procurement of Client Services
392.509 - Eligibility Criteria
392.511 - Policy and Procedures Manuals

Subchapter G - CONTRACTING WITH PROVIDERS FOR CERTAIN DSHS PROGRAMS

392.601 - Provision of Contracts for Primary Health Care Services
392.603 - Provider Application and Contract to Provide FFS Oral Health Treatment Services
392.605 - Kidney Health Care Provider Requirements and Effective Dates
392.607 - Breast and Cervical Cancer Services Provider Applicant Requirements

Subchapter I - DARS CONTRACTS FOR DEAF AND HARD OF HEARING

392.801 - Contracts for Deaf and Hard of Hearing Services

Subchapter J - INDEPENDENT LIVING SERVICES PROGRAM CONTRACTS

392.901 - Independent Living Services Program Contracts

Chapter 393 - INFORMAL DISPUTE RESOLUTION AND INFORMAL RECONSIDERATION

393.1 - Informal Dispute Resolution for Nursing Facilities and Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID)
393.2 - Informal Dispute Resolution for Assisted Living Facilities
393.3 - Informal Dispute Resolution for Texas Home Living and Home and Community-based Service Providers

Chapter 394 - MEDIATION AND NEGOTIATED RULEMAKING

394.1 - Definitions
394.2 - Policy
394.3 - Circumstances in Which Mediation is Offered
394.4 - Dispute Resolution Administrator
394.5 - Dispute Resolution Coordinators
394.6 - Mediation Process
394.7 - Negotiated Rulemaking

Chapter 395 - CIVIL RIGHTS

Subchapter A - GENERAL PROVISIONS

395.1 - Purpose
395.2 - Definitions

Subchapter B - RESPONSIBILITIES OF HEALTH AND HUMAN SERVICES AGENCIES

395.11 - HHS Agency Responsibilities
395.12 - Role of the HHSC Civil Rights Office

Subchapter C - COMPLAINTS

395.21 - Complaints and Complaint Procedures
395.22 - Complaint Records

Subchapter D - COMPLIANCE MONITORING

395.31 - HHS Agency Compliance
395.32 - Contractor Compliance

Subchapter E - EMPLOYMENT PRACTICES

395.41 - Employment Practices

Chapter 396 - EMPLOYEE TRAINING AND EDUCATION

396.1 - Purpose and Applicability
396.2 - Educational and Training Assistance