(a) The family's cost share amount is the lesser of the:
  (1) HHSC fee schedule amount; or
  (2) applicable deductible, copayment, and coinsurance amounts when the family has insurance that covers the ABA services.
(b) If the parent disagrees with the contractor's determination of the family's ability to pay the cost share, the parent can:
  (1) request a review by the contractor's manager or program director;
  (2) file an informal or formal complaint with the contractor;
  (3) contact the HHS Office of the Ombudsman at 1-877-787-8999, for help resolving a problem or concern with the contractor; and
  (4) file a formal complaint with HHSC as noted in §105.509 of this chapter (relating to Complaint Process).

Source Note: The provisions of this §358.605 adopted to be effective December 22, 2015, 40 TexReg 9307; amended to be effective September 4, 2018, 43 TexReg 5683; transferred effective August 1, 2021, as published in the July 9, 2021 issue of the Texas Register, 46 TexReg 4173