26 Tex. Admin. Code § 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).
Notes
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