$2 million in total funds has been made available, through voucher payments, to help offset the initial costs of basic HIE connectivity services for eligible health care providers in the Texas White Space.
To be eligible to participate in the White Space Program, the practice location for which a hospital/physician is applying for a voucher number must be located in the Texas rural White Space.
In order for a qualified HISP to receive a payment for connecting a hospital and/or physician in rural Texas, the following must occur:
If you are an eligible hospital/physician, please click on Next to complete the form to request a voucher number:
Hospital/Physician License Number
Did you learn about the Texas White Space initiative and voucher program or receive direct assistance in requesting a voucher number and/or selecting a THSA-qualified Health Information Services Provider (HISP) from the West Texas HIT Regional Extension Center (REC)?
How or where did you learn about the Texas White Space initiative and voucher program?
West Texas HIT Regional Extension Center (REC)
A THSA-qualified White Space HISP
A fellow physician, physician practice administrator or hospital representative
Texas Organization of Rural & Community Hospitals (TORCH)
Your local or regional medical society
Your state professional association (ex: Texas Medical Association, Texas Hospital Association, other specialty practice association)
The Texas Medicaid Office
This website (www.HIETexas.org)
If "Other," describe:
While the THSA is providing certain federal grant funds pursuant to its contract with the Texas Health and Human Services Commission to offset some initial service costs for White Space physicians and hospitals participating in this voucher program, the THSA is not responsible for providing the actual qualified HISP services under this program. The White Space provider is fully responsible for payment to qualified HISPs for all services rendered after the initial voucher funding allocated for such services has been expended. White Space providers are encouraged to review each HISP's pricing to determine how quickly such funds will be deemed by the HISP to have been expended.
BY REQUESTING A VOUCHER NUMBER, YOU ARE REPRESENTING THAT YOU ARE AUTHORIZED TO BIND YOUR ORGANIZATION TO THESE TERMS AND CONDITIONS, AND THAT UNDER NO CIRCUMSTANCES SHALL THSA BEAR ANY LIABILITY RELATED TO THE QUALIFIED HISP SERVICES OR THE QUALIFIED HISP VENDORS. WHITE SPACE PHYSICIANS AND HOSPITALS ARE FULLY RESPONSIBLE FOR DETERMINING THE VALUE OF ANY HISP SERVICES BEING OFFERED AND FOR NEGOTIATING AGREEMENTS WITH HISP VENDORS REGARDING SUCH SERVICES. THSA RESERVES THE RIGHT TO CANCEL THIS PROGRAM AT ANY TIME. Any liabilities, rights or responsibilities of the qualified HISP vendors or White Space physicians and hospitals should be negotiated between the White Space physicians and hospitals and the qualified HISP vendor(s). White Space physicians and hospitals may want to consult legal counsel regarding such agreements.
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Once the THSA has verified your eligibility to participate in the voucher program, you will receive confirmation and notification of your assigned voucher number by email and may use it at any time following your selection of White Space connectivity services provided by a qualified HISP. When you have selected and contracted with a HISP for such services, please provide the voucher number to the HISP with which you have contracted so that it may report the number and your successful connection to the THSA for verification and payment of the subsidy to the HISP.
Thank you for your request.
THSA will respond soon.
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