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) Except as specified in the Health and Human Services Commission-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.(2) Outpatient hospital services. Services must be medically necessary and:(A) provided in an acute care hospital or hospital-based ambulatory surgical center;(B) provided to hospital outpatients;(C) provided by or under the direction of a physician; and(D) are diagnostic, therapeutic, or rehabilitative.(3) Physician services. Services must be medically necessary and provided by a physician in the doctor's office, a hospital, a skilled nursing facility, or elsewhere.(4) Up to three prescriptions for drugs per recipient per month. New and refilled prescriptions count equally toward this total prescription limit. Drugs must be prescribed by a physician or other practitioner within the scope of practice under law. The quantity of drugs prescribed depends on the prescribing practice of the physician or other practitioner and the needs of the patient.(5) Skilled nursing facility services (SNF). Services must be medically necessary, ordered by a physician, and provided in a SNF that provides daily services on an inpatient basis.(6) Rural health clinic services. Rural health clinic services must be provided in a rural health clinic by a physician, a physician assistant (PA), an advanced practice registered nurse (APRN) licensed by the Texas Board of Nursing, such as a certified nurse practitioner, a certified nurse midwife, or other specialized nurse practitioner.(7) Family planning services. These are preventive health and medical services that assist an individual in controlling fertility and achieving optimal reproductive and general health.(8) Laboratory and x-ray services. These are technical laboratory and radiological services ordered and provided by, or under the direction of, a physician in an office or a similar facility other than a hospital outpatient department or clinic.(9) Immunizations. These are given when appropriate.(10) Medical screening services. These medical services include blood pressure, blood sugar, and cholesterol screening.(11) Annual physical examinations. These are examinations provided once per calendar year by a physician or a PA. Associated testing, such as mammograms, can be covered with a physician's referral. These services may also be provided by an APRN if the services are within the scope of practice of the APRN in accordance with the standards established by the Texas Board of Nursing in