Texas Register, Volume 15, Number 94, (Volume I), Pages [7233-7360], December 18, 1990 Page: 7,250
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(5) Other services. The follow-
ing list provides a brief description of other
services available through the CIDC Pro-
gram.
(A) Transportation. The
CIDC Program may provide transportation
for the client and, if needed, a responsible
adult, to the nearest medically appropriate
facility. The lowest cost appropriate con-
veyance should be used. The CIDC Pro-
gram shall not assist if transportation can be
obtained through Medicaid.
(B) Meals and lodging. The
CIDC Program may provide meals and
lodging to enable a parent to obtain inpa-
tient or outpatient care for a child at a
facility located away from their home. The
reason for the inpatient or outpatient visit
must be directly related to a condition cov-
ered by the CIDC Program.
(C) Transportation of de-
ceased. The CIDC Program may provide
the following services:
(i) transportation cost for
the remains of a client who expires in a
CIDC approved facility while receiving
CIDC Program services if the client was not
in the family's city of residence in Texas,
and the transportation cost of a parent or
other person accompanying the remains;
(ii) embalming of the de-
ceased, if required for transportation;
(iii) a coffin meeting min-
imum requirements if required for transpor-
tation; and
(iv) any other necessary
expenses directly related to the care and
return of the client's remains.
(D) Payment of insurance
premiums, coinsurance, and/or deductibles.
The CIDC Program may pay health insur-
ance premiums, coinsurance, and/or deduct-
ibles to maintain or acquire other third party
coverage for the client, if the parent/guard-
ian/conservator is financially unable to do
so, and if paying for such health insurance
can reasonably be expected to be cost effec-
tive for the CIDC Program.
(E) Social Security Income
(SSI) purchase of service. The CIDC Pro-
gram may operate a purchase of service
program for individuals who are determined
to be SSI recipients.
(c) Services not covered. There are
services which are not covered by the CIDC
Program even though they may be related
to a CIDC Program approved condition.
Examples of noncovered services are:
(1) solid organ transplants;(2) custodial care;
(3) treatments which are con-
sidered experimental; and
(4) psychiatric care.
(d) Limitations. Upon board ap-
proval, the CIDC Program may limit or
restrict services to remain within available
funding and to provide effective and effi-
cient administration in accordance with sub-
section (b)(3) of this section. If cutbacks in
services are required and notification is not
published, clients and providers directly af-
fected will be given a minimum of 30 days
notice.
(e) Service authorization. Authori-
zation is the CIDC Program's method of
approving the reimbursement of selected
services for clients.
(1) Providers responsibility. It
is the provider's responsibility to request
services in specific terms on department
prepared forms so that an authorization may
be issued and sufficient monies encumbered
to cover the cost of the service. If a service
is authorized, payment is guaranteed to the
provider as long as the service is not cov-
ered by a third party resource, and all bil-
ling requirements are met.
(2) Required pre-authorization
for selected services. At the CIDC Pro-
gram's option, selected services must be
authorized prior to the delivery of services
for payment to be made.
(3) Use of other benefits. Under
the Chronically Ill and Disabled Children's
Services Act, any health insurance or other
benefits available to the client must be uti-
lized prior to the use of CIDC Program
funds. Clients who are covered by commer-
cial insurance, health maintenance organiza-
tions, preferred provider organizations,
CHAMPUS, or Medicaid will not be con-
sidered for an authorization for services un-
til the CIDC Program receives an
explanation of benefits for that service from
the third party resource.
(f) Pilot projects. The CIDC Pro-
gram may initiate and participate in pilot
projects to determine the fiscal impact of
changes in eligibility criteria and the types
of services provided. New projects are pos-
sible only if funds are available in the cur-
rent fiscal year. All pilot projects are
limited to no more than 10% of the fiscal
year appropriation.
38.5. Rights and Responsibilities of Par-
ents/Guardian/Conservator or the Adult
Client.
(a) Rights. The parent/guard-
ian/conservator or the adult client shall have
the right to:
(1) apply for eligibility determi-
nation;
(2) choose providers within theChronically Ill and Disabled Children's Ser-
vices (CIDC) Program limitations;(3) be notified of modification,
suspension, or termination of service;
(4) refuse entry into the home
to any employee, agent, or representative of
the Texas Department of Health (depart-
ment);
(5) appeal CIDC Program deci-
sions and receive a response within the
CIDC Program specified deadline as de-
scribed in section 38.16 of this title (relat-
ing to Right of Appeal); and
(6) have all client files and other
information maintained in a confidential
manner to the extent authorized by law.
(b) Responsibilities. The par-
ent/guardian/conservator or adult client
shall have the responsibility to:
(1) notify all providers of CIDC
Program coverage prior to delivery of ser-
vices;
(2) provide the CIDC Program
with accurate information regarding any
change of circumstance which might affect
eligibility, within 30 days of such change;
(3) receive and utilize services
as close to the home community as possi-
ble, except when CIDC Program contracts,
policies, or appropriate physician referral
require the use of specific facilities or spe-
cialty centers;
(4) reimburse the CIDC Pro-
gram if payments from health insurance or
other benefits are made directly to the client
or parent/guardian/conservator for services
or equipment purchased by the CIDC Pro.
gram;
(5) consult with the provider re-
garding authorization of service from the
CIDC Program prior to service delivery;
(6) utilize provided services ap-
propriately, especially to keep appointments
and to use supplies and equipment judi-
ciously;
(7) utilize health insurance,
other benefits and assets, and to inform
service providers of same;
(8) notify the CIDC Program of
any other benefits, as defined in 38.2 of
this title (relating to Definitions), available
to the client at the time of application or
thereafter, including any lawsuit arising out
of the cause for the medical condition paid
for by the CIDC Program; and
(9) bear a portion of the expense
of medical or dental care if deemed finan-
cially able by the CIDC Program. Items of
routine daily living are not covered by the
CIDC Program.
(c) Non-discrimination. The depart-
ment, operates in compliance with Title VI,
Civil Rights Act of 1964 (Public Law
88-352) and Title 45, Code of Federal Reg-
ulations, Part 80, so that no person will be
excluded from participation in, or otherwisesubjected to discrimination on the grounds
of race, color, or national origin.15 TexReg 7250 December 18, 1990 Texas Register *
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Texas. Secretary of State. Texas Register, Volume 15, Number 94, (Volume I), Pages [7233-7360], December 18, 1990, periodical, December 18, 1990; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth201791/m1/18/: accessed May 1, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.