SECTION 365.4. Applications

Persons meeting the eligibility requirements set forth in §61.3(a) - (c) of this title (relating to Client Eligibility Requirements) must submit an application packet for benefits.

(1) A complete application packet must be submitted by an authorized entity and include all of the following:

(A) a completed, signed and dated program application;

(B) a copy of the completed, signed and dated Centers for Medicare and Medicaid Services (CMS) End-Stage Renal Disease Medical Evidence Report or, with program approval, the Kidney Health Care Physician Assessment Form;

(C) documentation of Texas residency as required by §61.3 of this title;

(D) a copy of the applicant's social security card issued by the Social Security Administration (SSA), or an allowable substitute, as follows:

(i) a copy of a SSA document which verifies the social security number; or

(ii) a copy of a valid Medicare card, if the Medicare account is established in the applicant's own social security number and the social security number is printed on the Medicare card; and

(E) applicant's financial data. The applicant or the person(s) legally obligated to support the applicant must verify income by providing one of the following:

(i) a copy of the first page of the federal individual income tax return for the most recent tax year, if self-employed; or

(ii) a statement of estimated or declared income for the current tax year, and supporting documentation.

(2) Incomplete application. An application which does not meet all of the requirements of paragraph (1) of this section is incomplete. Incomplete applications may be returned to the submitting person or entity for correction or completion.

(3) The program eligibility date is the date the program receives a complete application packet; if approved, the client receives an effective date.

(4) If program benefits are terminated, the eligibility date for any subsequent benefit period is the date the program receives a subsequent complete application packet for program benefits.

(5) An applicant whose eligibility for benefits is denied may appeal under §61.11 of this title (relating to Rights of Appeal).

Source Note: The provisions of this §365.4 adopted to be effective February 18, 2010, 35 TexReg 1220; amended to be effective March 27, 2016, 41 TexReg 2170; transferred effective January 15, 2022, as published in the December 31, 2021 issue of the Texas Register, 46 TexReg 9421