1. (a) An individual applying for or receiving services from the Newborn Screening Program (program) may have his/her application denied or his/her benefits modified, suspended, or terminated for any of the following reasons.

   1. (1) Services will be denied, modified, suspended, or terminated if:

      1. (A) it is determined that the individual does not have a confirmed diagnosis of a condition for which program services are available;
      2. (B) the individual is not a bona fide resident of the state;
      3. (C) the individual fails or refuses to provide the periodic information regarding residency and financial status when requested by the program;
      4. (D) the individual refuses to reimburse the department after being notified of third-party benefits, financial participation obligations, or other sources of payment for program services;
      5. (E) the individual sells, barters, exchanges, gives away special dietary supplement without the express consent of the program coordinator;
      6. (F) the individual fails or refuses to abide by these sections, including the family financial participation when required;
      7. (G) the individual notifies the program in writing that he or she no longer wants to claim program benefits. Such a statement does not free the individual, or persons with legal obligation to support the individual, of any financial participation obligation owing to the program at the time of withdrawal; or
      8. (H) the individual dies.

   2. (2) Services may be denied, modified, suspended, or terminated if:

      1. (A) the individual submits an application form or any document required in support of the application or continued participation in the program which contains a misstatement of fact which is material to the program administrator's determination that the individual is eligible for program services; or
      2. (B) program funds are curtailed.

2. (b) Procedure for denial, modification, suspension, or termination do not apply to adjustments made by the program in poverty income guidelines to conform to federal poverty income guidelines or to adjustments in the type and amount of program services available when such adjustments are necessary to conform to budgetary limitations as provided in §37.60 of this title (relating to Scope of Newborn Screening Program Services.)

   1. (1) An individual applying for program services will be notified in writing if their application has been denied. The notification will outline the reasons for denial.
   2. (2) An individual receiving program services will be notified if the services are to be modified, suspended, or terminated. Notification will be by certified mail to the most recent address known to the program.
   3. (3) Within 30 days after receiving notice as specified in paragraph (2) of this subsection, the individual or the individual's representative may appeal the program's decision to deny, suspend, modify, or terminate the services to the department and request an administrative hearing before the department. Appeals and request for hearings must be in writing and sent the following address by certified mail: Administrator, Newborn Screening Program, Bureau of Children's Health, Texas Department of Health, 1100 West 49th Street, Austin, Texas 78756-3190. Failure to respond will be deemed a waiver of the appeal and of the opportunity for a hearing.
   4. (4) Appeals and administrative hearings will be conducted in accordance with the department's fair hearing rules, §§1.41, 1.51-1.55 of this title (relating to Fair Hearing Procedures).

Source Note:The provisions of this §37.64 adopted to be effective February 2, 1989, 13 TexReg 6268; amended to be effective May 16, 1994, 19 TexReg 3369; amended to be effective December 17, 2002, 27 TexReg 11744.