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 21:16:45 GMT
(a) Any person applying for or eligible for health care benefits from the program shall be notified in writing if the program proposes to deny, modify, suspend, or terminate such health care benefits because:(1) the application or other requested information is intentionally erroneous or falsified;(2) the applicant or family does not meet financial eligibility requirements;(3) the person does not meet Texas residency requirements;(4) information, including the receipt for a purchased family support service, was not provided when requested;(5) behavioral or emotional condition(s) exist, but no physical or developmental condition(s);(6) the client has received third party or liability payments and has failed to reimburse the department for services provided to the client;(7) the client attains the age of 21, except for adults with cystic fibrosis;(8) utilization review indicates inappropriate use of program services and the client and family fail to adhere to a plan established to direct or supervise the use of program services;(9) program funds are reduced or curtailed; or(10) the client is placed on a waiting list for program health care benefits.(b) The program will notify the parents, foster parents, guardian, managing conservator, adult applicant, or adult client in writing of the action, the reasons for the action, and the right of appeal in accordance with §38.13 of this title (relating to Right of Appeal).