SECTION 364.5. General Program Requirements

(a) Because budgetary limitations exist, all program providers shall offer at least the following priority services:

(1) diagnosis and treatment;

(2) emergency medical services;

(3) family planning services;

(4) preventive health services;

(5) health education; and

(6) laboratory, x-ray, nuclear medicine, or other appropriate diagnostic services.

(b) The department, through approved providers, shall provide for the delivery of primary health care services to those populations that demonstrate unmet needs due to the inaccessibility and/or unavailability of primary health care services. Unmet needs may be determined by, but are not limited to, the following criteria:

(1) geographic area;

(2) demography;

(3) socioeconomic conditions;

(4) key health indicators identified by the department with the assistance of the community; and

(5) health resources available in the community.

(c) The department may deliver services directly to eligible individuals if existing private or public providers or other resources in the service area are unavailable or unable to provide those services, as evidenced by the applications received during the Request for Proposals process. The department shall make determinations that providers or resources are unavailable or unable to provide services in accordance with Health and Safety Code, §31.005.

(d) Individuals eligible for prescription drug benefits under Medicare, Part D, who reside in areas of the state served by program providers that offer prescription drugs as a primary health care service shall receive prescription drug benefits according to Medicare regulations and procedures. Individuals who are not eligible for prescription drug benefits under Medicare, Part D, who reside in areas of the state served by program providers that offer prescription drugs as a primary health care service shall receive covered prescription drugs dispensed by pharmacy providers according to this chapter.

Source Note: The provisions of this §364.5 adopted to be effective May 28, 2006, 31 TexReg 4218; amended to be effective September 1, 2013, 38 TexReg 5505; transferred effective March 1, 2022, as published in the Texas Register February 11, 2022, 47 TexReg 674