(a) Prohibition from denying services. Local mental health authorities are prohibited from denying services to a person:
  (1) because of the person's inability to pay for the services;
  (2) in crisis because:
    (A) a financial assessment has not been completed;
    (B) financial responsibility has not been determined;
    (C) the person has a past-due account; or
    (D) the person had his/her services involuntarily reduced or terminated for non-payment under §412.109(d) of this title (relating to Payments, Collections, and Non-payment); or
  (3) pending resolution of an issue relating solely to payment for services, including failure of the person (or parent) to comply with any requirement in subsections (c), (d), (e), and (g) of this section.
(b) Identifying funding sources. Local authorities are responsible for identifying and accessing available funding sources other than the department, and for assisting persons (and parents) in identifying and accessing available funding sources other than the department, to pay for services. Available funding sources may include third-party coverage, state and/or local governmental agency funds (e.g., crime victims fund), Qualified Medicare Beneficiary (QMB) Program, indigent pharmaceutical programs, or a trust that provides for the person's healthcare and rehabilitative needs.
(c) Requirement for parents to enroll their children in income-based public insurance. Parents of children who may be eligible for Medicaid or the Children's Health Insurance Program (CHIP) must enroll their children in Medicaid or CHIP or provide documentation that they have been denied Medicaid or CHIP benefits or that their Medicaid or CHIP enrollment is pending. The LMHA shall provide assistance as needed to facilitate the enrollment process.
(d) Financial documentation. If requested by the LMHA, persons (or parents) must provide the following financial documentation:
  (1) annual or monthly gross income/earnings, if any;
  (2) extraordinary expenses (as defined) paid during the past 12 months or projected for the next 12 months;
  (3) number of family members (as defined); and
  (4) proof of any third-party coverage.
(e) Authorizing third-party coverage payment to the LMHA. Persons (and parents) with third-party coverage must execute an assignment of benefits authorizing third-party coverage payment to the LMHA.
(f) Failure to comply.
  (1) Except as provided by paragraph (2) of this subsection, if the person (or parent) fails to comply with any requirement in subsections (c) - (e) or (h) of this section, then the LMHA will charge the person (or parent) the standard charge(s) for services. If, within 30 days after the person (or parent) initially failed to comply, the person (or parent) complies with the requirements, then the LMHA will adjust the person's account to retroactively reflect compliance.
  (2) The LMHA will not charge the person the standard charge(s) for services if the LMHA makes a decision, based on a clinical determination that is documented and includes input from the person's team, that the person's failure to comply is related to the person's mental illness. The clinical determination must be reassessed at least every three months. If the LMHA decides that a person's failure to comply is related to the person's mental illness, then the LMHA must develop and implement a plan to reduce or eliminate the barriers related to the person's failure to comply.
(g) Requirement for adult persons to apply for SSI to become eligible for Medicaid. Adult persons who may be eligible for Medicaid must apply for Supplemental Security Income (SSI) or provide documentation that they have been denied SSI or that their SSI application is pending. The LMHA shall provide assistance as needed to facilitate all aspects of the application process. If the adult person is unable to act in accordance with the requirement because of the person's mental illness, then the LMHA must develop and implement a plan to reduce or eliminate the barriers related to the person's inability to act in accordance with the requirement.
(h) Requirement for persons to enroll in Medicare Part D prescription drug plan.
  (1) A person who is a full subsidy eligible individual under Medicare Part D must choose and enroll in a Medicare Part D prescription drug plan.
  (2) The LMHA shall educate persons who are not full subsidy eligible individuals about the benefits of enrollment in a Medicare Part D prescription drug plan. The LMHA shall assess whether enrollment in a Medicare Part D prescription drug plan will be cost effective to the person and to the LMHA and shall provide the results of this assessment to the person to assist him or her determine whether to enroll in a Medicare Part D prescription drug plan. If the person decides to enroll in a Medicare Part D prescription drug plan, The LMHA may pay the person's incurred costs under the Medicare Part D prescription drug plan.
  (3) The LMHA shall provide assistance as needed to facilitate all aspects of the Medicare Part D enrollment process. If the person is unable to act in accordance with the requirements set forth in paragraph (1) or (2) of this subsection because of the person's mental illness, lack of adequate notification, or other circumstances beyond the individual's control, the LMHA shall continue to provide medications and must develop and implement a plan to reduce or eliminate the barriers related to the person's inability to act in accordance with the requirement.

Source Note: The provisions of this §412.105 adopted to be effective September 1, 2002, 27 TexReg 2041; amended to be effective September 15, 2005, 30 TexReg 5806