07-E DSHS Contract 2006-020428 - Laserfiche WebLink

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requests will not be processed for payment by DSHS unless accompanied by a complete corresponding aggregate report; · A Request for Advance or Reimbursement Form 270 (Form GC-IO), or the form specified in the Contractor's Financial Procedures Manual, no later than sixty (60) days after the end of the contract Attachment term; and, · Other reports as deemed necessary by DSHS, upon reasonable notice to Contractor. General Provisions, Compliance and Reporting Article, Section 1.05 is revised to include: Eligibility: All individuals considered for Title V eligibility must be screened and determined eligible using a DSHS or Title V program-approved screening process as updated in the spring of each year when federal poverty levels and eligibility determination forms are revised. General Provisions, Services Article, Section 2.05, is revised to include: Co-pay: Contractor may assess a co-pay from clients who receive services under this contract Attachment. A co-pay shall not be assessed from such clients if their family income is at or below 100% of the most recently defined federal poverty level. A co-pay assessment may not exceed 25% of the amount DSHS pays Contractor for the provision of a given service. A client shall not be denied services due to inability to pay. Contractor shall make reasonable efforts to investigate and apply for all other sources of third party funding available to, or identified by, the patient before submitting DSHS Program claims for allowable costs. General Provisions, Services Article, is revised to include: Pharmacy: If Contractor is dispensing and/or providing prescription medications, e.g., birth control pills, antibiotics, etc., on site, it shall have, at a minimum, a Class D pharmacy license as provided by the Texas Pharmacy Act, Occupations Code, Chapter 560, or shall dispense and/or provide such medications in compliance with other pharmacy statutes with prior approval from DSHS. General Provisions, Funding Article, Section 3.05, is revised to include: Program Income may be collected and retained by Contractor so long as it is used to provide services specified in the scope of work detailed in this contract Attachment. The use of Program Income shall be reported on the monthly billing vouchers for services provided to Title V eligible clients. A TT ACHMENT - Page 3 Ie