Providers must notify the district when certain patients need emergency services, and the district must decide eligibility within 14 days.
Sec. 1114.116. NOTIFICATION OF PROVISION OF EMERGENCY SERVICES. (a) If a patient who is eligible for assistance under this chapter requires emergency services from a nonmandated provider, the provider must notify the district as provided by this section. (b) A provider delivering emergency services to a patient who the provider suspects might be eligible for assistance under this chapter shall notify the district that emergency services have been or will be provided to the patient. The provider must notify the district: (1) by telephone, as soon as possible after the provider determines that the patient resides in the district; and (2) by mail postmarked not later than the third working day after the date on which the provider determines that the patient resides in the district. (c) A provider shall attempt to determine if a patient resides in the district at the time the patient first receives services. (d) The provider, the patient, and the patient's family shall cooperate with the district in determining if the patient is an eligible resident of the district. (e) Not later than the 14th day after the date on which the district receives sufficient information to determine eligibility, the district shall determine if the patient is eligible for assistance. If the district does not determine the patient's eligibility within that period, the patient is considered to be eligible. The district shall notify the provider of the district's decision. (f) A provider that delivers emergency services to a patient who is eligible for assistance under this chapter and fails to comply with this section is not eligible for payment for the services from the district. Added by Acts 2013, 83rd Leg., R.S., Ch. 112 (S.B. 1026), Sec. 1.01, eff. April 1, 2015.