(a) Determining medical need. A provider must obtain and submit a complete Practitioner's Statement of Medical Need form to HHSC for review, as described in §47.45 of this subchapter, (relating to Pre-Initiation Activities) for:
  (1) an individual whom HHSC refers to the provider, unless the individual requests and is to receive FC Program services;
  (2) an individual currently receiving FC Program services whom HHSC refers to the provider for the PHC Program or CAS Program; and
  (3) an individual currently receiving services whom HHSC refers to the provider to have medical need reassessed, as requested by the case worker, such as when the initial medical need was established for a limited time.
(b) Submitting a Practitioner's Statement of Medical Need form. A provider must submit a complete form to:
  (1) the case worker for the PHC Program; and
  (2) the regional nurse for the CAS Program.
(c) Reinstatement of services after termination. If HHSC notifies a provider that services are terminated, all pre-initiation activities, including medical need determination, must be completed before services are reinstated.
(d) Mental illness and intellectual disability. An individual diagnosed with a mental illness, an intellectual disability, or both, is not considered to have established medical need based solely on such diagnoses, but may establish medical need through a related diagnosis that results in a functional limitation.

Source Note: The provisions of this §277.47 adopted to be effective June 1, 2004, 29 TexReg 5113; amended to be effective June 1, 2009, 34 TexReg 2802; amended to be effective October 1, 2019, 44 TexReg 5138; transferred effective July 1, 2024, as published in the June 14, 2024, issue of the Texas Register, 49 TexReg 4436