Texas Register, Volume 10, Number 44, Pages 1807-1878, June 7, 1985 Page: 1,851
1807-1878 p. ; 28 cm.View a full description of this periodical.
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(iii) other reports as pre-
scribed by the department;
(iv) changes in the facility's
Medicare assignment policy and/or Medi-
care reimbursement rates as they occur;
(v) quarterly verification re-
ports, which are forwarded by the depart-
ment to each facility, for verification of re-
cipients who are being treated by the facil-
ity and for whom benefits have been sought
from or paid by the department;
(6) the facility submits false or
misleading information to the department
and the information is material to the de-
partment's determination that the facility is:
(A) approved to participate in
the program;
(B) in compliance with the pro-
visions of the Texas Kidney Health Care Act
and the program rules; or
(C) in compliance with the pro-
visions of the contract between the facility
and the department;
(7) the facility fails to reimburse
the program when overpayments have been
made;
(8) the facility fails to reimburse
the program where primary liability for pay-
ment of recipient claims has not been satis-
fied;
(9) the facility files false claims.
(b) Procedures for the denial,
modification, suspension, or termination of
program facility approval.
(1) The program shall notify the
administrator by certified mail of its intent
to deny, modify, suspend, or terminate pro-
gram approval.
(2) Within 30 days after receiving
this notice, the facility must respond to the
program's notice with a written response to
the program. The response must be by cer-
tified mail to the following address: Kidney
Health Care Program, Texas Departmentof Health, 1100 West 49th Street, Austin,
Texas 78756. Failure to respond will be
deemed a waiver of both the opportunity
to respond and of the opportunity for a
hearing, and the proposed action will be-
come final.
(3) Upon receipt of the facility's
written response, the program will affirm
or reverse its proposed action in writing to
the facility administrator by certified mail,
giving the reason(s) for the decision.
(4) A facility aggrieved by the pro-
gram's decision is entitled to appeal the
decision to the Texas Department of
Health. The appeal process will be the same
as that set forth in 61.7 of this title (relating
to Denial of Application, Modification,
Suspension, or Termination of Patient Ben-
efits).
(c) Vendor hold. If the department
has reasonable cause to believe that a reason
for the modification, suspension, or ter-
mination of facility approval exists, the
department may, without notice to the af-
fected facility, withhold payments to the
facility during the pendency of the admin-
istrative hearing and appeal process set
forth in subsection (b) of this section.
61.10. Patient Reimbursement Obliga-
tion.
(a) Although there is no means test
for receiving benefits through the program,
the Texas Kidney Health Care Act, 3, does
authorize the Texas Board of Health to de-
termine financial standards for the eligibility
of recipients to receive program benefits.
Under this authority the Texas Board of
Health requires that any recipient who has
received benefits from the program must
pay back to the program either:
(1) an amount not to exceed 5.0%
of the recipient's adjusted gross income (or
the adjusted gross income of those respon-
sible for the recipient's debts, e.g., spouse,
parent) plus the proceeds of insurance,
group health plan or prepaid medical care
plan, if the proceeds are paid to the recip-
ient or to those responsible for the reci-
pient's debts and if the department has paid
for the services upon which the claims for
the proceeds are based; minus the follow-
ing deductions:
(A) $1,000 (standard deduc-
tion); and
(B) the yearly premiums paid by
the recipient or the person or persons who
have a legal obligation to support the recip-
ient for insurance, group health insurance
plan, or prepaid medical care plan which
provides benefits to pay the cost or part of
the cost of the services required by the re-
cipient because of end-stage renal disease;
or
(2) an amount equal to the benefits
received from the program, whichever is the
smaller amount.
(b) For the purposes of the reim-
bursement obligation, the program will use
the adjusted gross income (AGI) of the re-
cipient and of the person or persons whohave a legal obligation to support the recip-
ient as shown on his or her federal income
tax return, Forms 1040, 1040A, or 1040EZ.
The person or persons who have a legal
obligation to support the recipient will be
determined by the applicable law.
61.12. Nondiscrimination Statement.
The department operates in compliance
with Title VI, Civil Rights Act of 1964
(Public Law 88-352) and Part 80 of Title 45,
Code of Federal Regulations, so that no
person will be excluded for participation in,
be denied benefits, or otherwise subjected
to discrimination on the grounds of race,
color, or national origin, sex, creed, hand-
icap or age.
61.13. Forms. Forms which have been
developed by the department for use in the
program will be provided to applicants, par-
ticipating facilities, and providers, as neces-
sary.
This agency hereby certifies that the pro-
posal has been reviewed by legal counsel
and found to be within the agency's au-
thority to adopt.
Issued in Austin, Texas, on June 3, 1985.TRD-854862
Robert A. MacLean
Deputy Commissioner
Professional Services
Texas Department of
HealthProposed date of adoption:
July 20, 1985
For further information, please call
(512) 465-2654.Chapter 73. Laboratories
Serologic Testing
*25 TAC 73.11
The Texas Department of Health pro-
poses new 73.11, concerning serologic
testing for antibodies to human T-cell
lymphotropic virus, type III (HTLV-III).
The new section will authorize the
department's laboratory to provide sero-
logic testing for the detection of an-
tibodies to HTLV-III, the virus which may
cause Acquired Immunodeficiency Syn-
drome (AIDS). The new section also will
authorize the department to charge fees
for the testing, depending on the cost of
the reagents. This section is intended to
be a permanent replacement of depart-
ment emergency 73.11, upon its expira-
tion. Emergency 73.11 concerns the
same subject and became effective on
March 18, 1985.
Stephen Seale, chief accountant III, has
determined that there will be fiscal im-
plications as a result of enforcing or ad-
ministering the rule. The anticipated ef-
fect on state government is an estimated
additional cost of $144,000 each year in
1986-1990-and an increase in revenue of4 Proposed Rules June 7, 198S 10 TexReg 1851
4P Proposed Rules June 7, 1985
10 TexReg 1851
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Texas. Secretary of State. Texas Register, Volume 10, Number 44, Pages 1807-1878, June 7, 1985, periodical, June 7, 1985; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth243695/m1/47/: accessed July 17, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.