SECTION 351.12. Denial, Modification, Suspension, or Termination of Program Eligibility or Eligibility for Health Care Benefits

(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).

Source Note: The provisions of this §351.12 adopted to be effective July 1, 2001, 26 TexReg 2979; amended to be effective October 11, 2001, 26 TexReg 7870; amended to be effective March 27, 2003, 28 TexReg 2523; amended to be effective June 1, 2006, 31 TexReg 4200; amended to be effective October 3, 2010, 35 TexReg 8921; amended to be effective April 21, 2013, 38 TexReg 2362; transferred effective March 15, 2022, as published in the February 25, 2022 issue of the Texas Register, 47 TexReg 982