Section 370.321 - Requirements and ExemptionsCost-sharing requirements are based on a household's percentage of the Federal Poverty Level (FPL). Except for costs associated with unauthorized, non-emergency services provided to a member by out-of-network providers, the co-payments identified in this section are the only amounts a provider may collect from an applicant in regard to services provided to a member.
(1) An applicant may be required to pay any of the following costs of CHIP coverage for a member: (A) an enrollment fee; and(2) HHSC determines the cost sharing amounts for enrollment in and services provided through CHIP. When determining cost sharing charges, HHSC will solicit public input by publishing proposed cost-sharing amounts and requesting comments. Cost sharing may be determined based on the maximum levels authorized under federal law and applied to income levels so as to minimize administrative costs.(3) A member who is an American Indian/Alaska Native, as defined in RSA 457.10, is exempt from cost-sharing.(4) HHSC or its designee notifies each MCO which of its members are exempt from cost-sharing.(5) Co-payments do not apply, at any income level, to preventive health services, such as well-child or well-baby care visits and immunizations.(6) A member's exemption from cost sharing is noted on the member's MCO Member Identification Card.1 Tex. Admin. Code § 370.321
The provisions of this §370.321 adopted to be effective September 1, 2003, 28 TexReg 7337; Amended to be effective January 1, 2006, 30 TexReg 8674; Amended to be effective March 1, 2012, 37 TexReg 1301; Amended to be effective January 1, 2014, 38 TexReg 9477