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Texas Statutes (Last Updated: January 4, 2014) |
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HEALTH AND SAFETY CODE |
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Title 2. HEALTH |
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Subtitle C. PROGRAMS PROVIDING HEALTH CARE BENEFITS AND SERVICES |
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Chapter 62. CHILD HEALTH PLAN FOR CERTAIN LOW-INCOME CHILDREN |
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Subchapter D. CHILD HEALTH PLAN |
Sec. 62.151. CHILD HEALTH PLAN COVERAGE
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(a) The child health plan must comply with this chapter and the coverage requirements prescribed by 42 U.S.C. Section 1397cc, as amended, and any other applicable law or regulations.
(b) In developing the covered benefits, the commission shall consider the health care needs of healthy children and children with special health care needs.
(c) In developing the plan, the commission shall ensure that primary and preventive health benefits do not include reproductive services, other than prenatal care and care related to diseases, illnesses, or abnormalities related to the reproductive system.
(d) The child health plan must allow an enrolled child with a chronic, disabling, or life-threatening illness to select an appropriate specialist as a primary care physician.
(e) In developing the covered benefits, the commission shall seek input from the Public Assistance Health Benefit Review and Design Committee established under Section 531.067, Government Code.
(f) The commission, if it determines the policy to be cost-effective, may ensure that an enrolled child does not, unless authorized by the commission in consultation with the child's attending physician or advanced practice nurse, receive under the child health plan:
(1) more than four different outpatient brand-name prescription drugs during a month; or
(2) more than a 34-day supply of a brand-name prescription drug at any one time.