Section 354.1005 - Unauthorized Charges(a) An eligible provider must certify that no charges beyond reimbursement paid under the Texas Medicaid Program for a covered service or any function incidental to the provision of a covered service, have been, or will be, billed to an eligible recipient.(b) Within the provisions cited in § RSA 354.1131 of this chapter (relating to Payments to Eligible Providers), an eligible provider may not bill or take other recourse against an eligible recipient for claims denied as a result of an error attributed to the provider.(c) For purposes of subsection (a) of this section, functions incidental to the provision of a covered service include: (1) signing, completing, or providing a copy of a health assessment form, such as a physical examination form required for the eligible recipient's enrollment in school or participation in school or other activities;(2) providing a copy of a medical record requested: (A) by or on behalf of any health care practitioner for purposes of medical care or treatment of the eligible recipient;(B) under Texas Health and Safety Code § RSA 161.202;(C) as a supplement to a form described in paragraph (1) of this subsection; or(D) by an eligible recipient, for any reason, for the first time in a one-year period; and(3) providing a copy of any subsequent amendment, supplement, or correction to a medical record under paragraph (2) of this subsection.(d) An eligible provider may bill or otherwise charge an eligible recipient for providing a copy of a medical record not described in subsection (c)(2) of this section if the: (1) eligible provider provided one copy of the medical record at no charge to the eligible recipient within one year before the request for an additional copy;(2) medical record described in paragraph (1) of this subsection has not been amended, supplemented, changed, or corrected and contains the same documentation as the medical record requested under this subsection; and(3) provider complies with state and federal law, including 22 TAC § RSA 165.2(relating to Medical Record Release and Charges) and RSA 164.524.(e) For purposes of this section, "medical record" includes a record with the elements described in 22 TAC § RSA 165.1(a) (relating to Medical Records). The term also includes a copy of a medical record created by another health care practitioner and in the possession of the eligible provider to whom a request for release of records has been made.1 Tex. Admin. Code § 354.1005
The provisions of this §354.1005 adopted to be effective May 30, 1977, 2 TexReg 1929; Amended to be effective October 26, 1984, 9 TexReg 5270; transferred effective September 1, 1993, as published in the Texas Register September 7, 1993, 18 TexReg 5978; transferred effective September 1, 2001, as published in the Texas Register May 24, 2002, 27 TexReg 4561; Amended to be effective November 24, 2013, 38 TexReg 8187; Amended by Texas Register, Volume 40, Number 09, February 27, 2015, TexReg 917, eff. 3/8/2015