SECTION 370.1. Purpose

(a) This chapter implements the State Children's Health Insurance Program (CHIP), authorized under the Texas Health and Safety Code, Chapters 62 (relating to Child Health Plan for Certain Low-Income Children) and 63 (relating to Health Benefits Plan For Certain Children), in a manner that is timely, efficient, fair, and that promotes access to quality and economical health and dental care for eligible children and their families in Texas.

(b) This chapter also defines requirements for CHIP managed care organizations (MCOs). An MCO must comply with this chapter and the terms of its contract with HHSC.

(c) CHIP is a state-designed child health insurance plan authorized under Title XXI of the federal Social Security Act (42 U.S.C. §§1397aa, et seq.), and the Texas Health and Safety Code, Chapters 62 (relating to Child Health Plan For Certain Low-Income Children) and 63 (relating to Health Benefits Plan for Certain Children), which provides access to low-cost preventive and primary health and dental care to children, including children with special health care needs, in certain low-income families of this state.

(d) CHIP is administered, in part, in accordance with the state plan for children's health insurance, filed by HHSC with the federal Secretary of Health and Human Services, which describes the general conditions under which joint federal state child health insurance program funds will be administered in Texas.

(e) The rules in this chapter must be read in conjunction with:

(1) federal and state statutes;

(2) rules relating to CHIP; and

(3) except where otherwise indicated, Texas Department of Insurance rules regarding:

(A) regulation of health maintenance organizations at 28 TAC Chapter 11 (relating to Health Maintenance Organizations); and

(B) exclusive provider benefit plans at 28 TAC Chapter 3, Subchapter KK (relating to Exclusive Provider Benefit Plan).

(f) Nothing in this chapter shall be construed as providing an individual with an entitlement to health or dental insurance benefits or health care or to assistance in obtaining health insurance or health benefits.

Source Note: The provisions of this §370.1 adopted to be effective April 4, 2001, 26 TexReg 2519; amended to be effective January 1, 2006, 30 TexReg 8666; amended to be effective March 1, 2012, 37 TexReg 1301; amended to be effective January 1, 2014, 38 TexReg 9477