26 Tex. Admin. Code § 277.47 - Determination of Medical Need
(a) Determining
medical need. A provider must obtain and submit a complete Practitioner's
Statement of Medical Need form to HHSC for review, as described in § 47.45
of this subchapter, (relating to Pre-Initiation Activities) for:
(1) an individual whom HHSC refers to the
provider, unless the individual requests and is to receive FC Program services
;
(2) an individual currently
receiving FC Program services whom HHSC refers to the provider for the PHC
Program or CAS Program; and
(3) an
individual currently receiving services whom HHSC refers to the provider to
have medical need reassessed, as requested by the case worker, such as when the
initial medical need was established for a limited time.
(b) Submitting a Practitioner's Statement of
Medical Need form. A provider must submit a complete form to:
(1) the case worker for the PHC Program;
and
(2) the regional nurse for the
CAS Program.
(c)
Reinstatement of services after termination. If HHSC notifies a provider that
services are terminated, all pre-initiation activities, including medical need
determination, must be completed before services are reinstated.
(d) Mental illness and intellectual
disability. An individual diagnosed with a mental illness, an intellectual
disability, or both, is not considered to have established medical need based
solely on such diagnoses, but may establish medical need through a related
diagnosis that results in a functional limitation.
Notes
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