Section 354.13 - Rights and Responsibilities(a) Client Rights. The applicant, client, or legally authorized representative have the right to: (1) apply for eligibility determination;(2) choose providers subject to program limitations;(3) choose a health plan, if applicable, subject to program limitations;(4) be notified of program decisions relating to modifications, suspensions, denials, or terminations;(5) have all client files and other information maintained in a confidential manner to the extent authorized by law;(6) appeal program decisions and receive a response within the deadline as described in § 354.17 of this title (relating to Right of Appeal); and(7) reapply for the program when eligibility for the program is denied or terminated.(b) Provider Rights. The provider has the right to:(1) apply and enroll as a provider;(2) be notified of program decision relating to modifications, suspensions, denials, or terminations;(3) have confidentiality of information in the manner and to the extent authorized by law;(4) appeal program decisions and receive a response within the deadline as described in § 354.17 of this title; and(5) reapply for the program when eligibility for the program is denied or terminated.(c) Client Responsibilities. The applicant, client, or legally authorized representative have the responsibility to: (1) provide accurate medical information to providers and notify providers of program eligibility prior to delivery of services;(2) provide the program with accurate information regarding any change of circumstance which might affect eligibility and benefits within 30 days following such change; and(3) notify the program of any lawsuit(s) contemplated or filed concerning the cause of the medical condition for which the program has made payment.(d) Provider Responsibilities. The provider has the responsibility to: (1) enroll as a program provider and submit a completed application to the program, including all documents requested;(2) abide by the program rules and regulations;(3) not discriminate against applicants or clients based on source of payment; and(4) notify the program of any lawsuit(s) contemplated or filed concerning the cause of the medical condition for which the program has made payment.26 Tex. Admin. Code § 354.13
Adopted to be effective December 14, 2008, 33 TexReg 10036; Amended by Texas Register, Volume 40, Number 15, April 10, 2015, TexReg 2091, eff. 4/16/2015; Amended by Texas Register, Volume 42, Number 08, February 24, 2017, TexReg 764, eff. 3/1/2017; Entire chapter transferred from T. 25, Pt. 1, Ch. 37, Subch. F by Texas Register, Volume 47, Number 08, February 25, 2022, TexReg 0981, eff. 3/15/2022