1. (a) Introduction. The department provides personal health services directly or through contractors at public health clinics throughout Texas. This section establishes a schedule of fees covering such services.

2. (b) Schedule of fees.

   1. (1) The department shall base the calculation of fees upon the federal poverty guidelines published annually by the U.S. Department of Health and Human Services. The commissioner of health shall adjust the income guidelines annually to determine the schedule of fees for clinical health services. The Income Guidelines and Schedule of Charges shall be published in the Texas Register not later than 30 days after adoption by the commissioner of health and shall be available for public inspection in the offices of the Bureau of Community Oriented Public Health.
   2. (2) The following schedule of fees lists the fees covering clinical health services provided at public health clinics. Local health department contractors may use the following schedule or their own schedule. Public health regions shall use the following schedule.
      Attached Graphic
      
   3. (3) No recipient or client eligible for Medicaid shall be charged a fee in addition to the amount reimbursable by Medicaid.
   4. (4) The clinic shall determine if a person is able to pay in accordance with the appropriate schedule; however, the clinic shall not deny services because of a person's inability to pay.
   5. (5) Patients or clients whose incomes are above the 200% + poverty level shall be referred to the private sector for care unless extenuating circumstances exist. Such circumstances include provision of immunization services, prevention and control of communicable diseases, unusually high medical expenses or the unavailability of specific care needed. Such exceptions may receive care at the public health clinic in accordance with the schedule of fees.
   6. (6) A clinic may not charge a fee which exceeds the cost to the clinic of providing service or if prohibited by federal funding requirements.
   7. (7) The clinic shall make a reasonable effort to collect the fees, but the clinic may waive collection if the administrative cost of collection will exceed the fee to be collected.
   8. (8) The clinics covered by this section are those operated by public health regions and local health departments.
   9. (9) Fees collected by local health department clinics shall be retained by those departments and be accounted for and expended under the rules relating to program income.
   10. (10) Fees collected by public health region clinics shall be deposited in the state treasury to a special fee fund to be entitled Texas Department of Health services fees fund.

3. (c) Modification, suspension, or termination of services.

   1. (1) The department may modify, suspend, or terminate services to a person determined able to pay for nonpayment of fees after notice to the person and opportunity for hearing. The criteria upon which the department will take such action is when the person fraudulently or deliberately misrepresents a material fact about his or her eligibility, ability to pay, or the application of the schedule of fees to him/her.
   2. (2) The department shall conduct the hearing in accordance with §§1.51-1.55 of this title (relating to Fair Hearing Procedures).

Source Note:The provisions of this §1.91 adopted to be effective June 25, 1985, 10 TexReg 1975; amended to be effective October 16, 1986, 11 TexReg 4154; amended to be effective February 20, 1987, 12 TexReg 1607; amended to be effective April 1, 1988, 13 TexReg 1328; amended to be effective April 1, 1990, 15 TexReg 2033; amended to be effective July 19, 1994, 19 TexReg 5169; amended to be effective August 15, 1999, 24 TexReg 6075.