The following words and terms, when used in this subchapter,
have the following meanings, unless the context clearly indicates
otherwise:
(1) CDS employer--Consumer directed services employer.
A member or the member's legally authorized representative who participates
in the CDS option and whose financial management services agency (FMSA)
uses an electronic visit verification (EVV) vendor system or an EVV
proprietary system. A CDS employer is responsible for hiring and retaining
a service provider who delivers a service described in §354.4005
of this subchapter (relating to Personal Care Services that Require
the Use of EVV) or §354.4006 of this subchapter (relating to
Home Health Care Services that Require the Use of EVV).
(2) CDS option--Consumer directed services option.
A service delivery option in which a CDS employer employs and retains
a service provider and directs the delivery of a service described
in §354.4005 or §354.4006 of this subchapter.
(3) CFC--Community First Choice. A Medicaid state plan
option governed by Code of Federal Regulations, Title 42, Part 441,
Subpart K, Home and Community-Based Attendant Services and Supports
State Plan Option (Community First Choice). CFC services include the
following.
(A) CFC HAB--CFC habilitation. A Medicaid state plan
service that provides habilitation through CFC as described in §354.1361
of this chapter (relating to Definitions).
(B) CFC PAS--CFC personal assistance services. A Medicaid
state plan service that provides personal assistance services through
CFC as described in §354.1361 of this chapter.
(C) CFC PAS/HAB--CFC personal assistance services/habilitation.
A Medicaid state plan service provided through CFC that provides both
personal assistance services and habilitation.
(4) CLASS Program--Community Living Assistance and
Support Services Program. A Medicaid waiver program approved by the
Centers for Medicare & Medicaid Services under Title XIX, Section
1915(c) of the Social Security Act, as described in 26 TAC Chapter
259 (relating to Community Living Assistance and Support Services
(CLASS) Program and Community First Choice (CFC) Services).
(5) CMS--Centers for Medicare & Medicaid Services.
The federal agency within the United States Department of Health and
Human Services that administers the Medicare and Medicaid programs.
(6) Community Attendant Services Program--A Medicaid
state plan program operating under Title XIX of the Social Security
Act, as described in 40 TAC Chapter 47 (relating to Primary Home Care,
Community Attendant Services, and Family Care Programs).
(7) DBMD Program--Deaf Blind with Multiple Disabilities.
The Medicaid waiver program approved by CMS under Title XIX, Section
1915(c) of the Social Security Act, as described in 26 TAC Chapter
260 (relating to Deaf Blind with Multiple Disabilities (DBMD) Program
and Community First Choice (CFC) Services).
(8) EVV--Electronic visit verification. The documentation
and verification of service delivery through an EVV system.
(9) EVV aggregator--A centralized database that collects,
validates, and stores statewide EVV visit data transmitted by an EVV
system.
(10) EVV claim--A request for payment of a service
described in §354.4005 or §354.4006 of this subchapter submitted
to HHSC, HHSC's designated contractor, or a managed care organization
(MCO) in accordance with the EVV Policy Handbook.
(11) EVV Policy Handbook--A handbook promulgated by
HHSC that contains policies and requirements related to EVV.
(12) EVV portal--An online system established by HHSC
that allows users to perform searches, view reports and view EVV claim
match results associated with data in the EVV aggregator.
(13) EVV portal user--A person who is employed by or
contracts with a program provider or FMSA and has access to the EVV
portal.
(14) EVV proprietary system--An HHSC EVV system purchased
or developed by a program provider or FMSA approved by HHSC in accordance
with §354.4013 of this subchapter (relating to HHSC and MCO Compliance
Reviews and Enforcement Actions) that a program provider or FMSA uses
instead of an EVV vendor system.
(15) EVV system--An EVV vendor system or an EVV proprietary
system used to electronically document and verify the data elements
described in §354.4009(a) of this subchapter (relating to EVV
Visit Transaction and EVV Claim) for a visit conducted to provide
a service described in §354.4005 or §354.4006 of this subchapter.
(16) EVV system user--A person who has access to the
EVV system, including a person employed by or contracting with a program
provider, FMSA, or CDS employer.
(17) EVV vendor system--An EVV system developed and
operated by a vendor that contracts with HHSC or HHSC's designated
contractor that a program provider or FMSA uses instead of an EVV
proprietary system.
(18) EVV visit transaction--A record generated by an
EVV system that contains the data elements described in §354.4009(a)
of this subchapter for a visit conducted to provide a service described
in §354.4005 or §354.4006 of this subchapter.
(19) FC Program--Family Care Program. A program funded
under Title XX, Subtitle A of the Social Security Act, as described
in 40 TAC Chapter 47.
(20) FMSA--Financial management services agency. A
program provider that contracts with HHSC or an MCO to provide financial
management services to a CDS employer as described in 40 TAC Chapter
41 (relating to Consumer Directed Services Option).
(21) HCBS-AMH Program--Home and Community-Based Services
Adult Mental Health Program. A Medicaid state plan option approved
by CMS under Title XIX, Section 1915(i) of the Social Security Act,
as described in 26 TAC Chapter 307, Subchapter B (relating to Home
and Community-Based Services--Adult Mental Health Program).
(22) HCS Program--Home and Community-based Services
Program. A Medicaid waiver program approved by CMS under Title XIX,
Section 1915(c) of the Social Security Act, as described in 26 TAC
Chapter 263 (relating to Home and Community-based Services (HCS) Program
and Community First Choice (CFC)).
(23) HHSC--Texas Health and Human Services Commission.
(24) Home health aide--Has the meaning set forth in
26 TAC §558.2 (relating to Definitions).
(25) ICF/IID--Intermediate care facility for individuals
with an intellectual disability or related conditions. An ICF/IID
is a facility that is licensed in accordance with THSC Chapter 252
or certified by HHSC.
(26) IMD--Institution for mental diseases. Has the
meaning set forth in 25 TAC §419.373 (relating to Definitions).
(27) LVN--Licensed vocational nurse. A person licensed
to practice as a vocational nurse as described in Texas Occupations
Code Chapter 301.
(28) MCO--Managed care organization. Has the meaning
set forth in Texas Government Code §536.001.
(29) MDCP--Medically Dependent Children Program. A
Medicaid waiver program approved by CMS under Title XIX, Section 1915(c)
of the Social Security Act, as described in Chapter 353, Subchapter
M of this title (relating to Home and Community Based Services in
Managed Care).
(30) MDCP STAR Health covered service--Medically Dependent
Children Program STAR Health covered service. A service provided to
a member eligible to receive MDCP benefits under the STAR Health Program.
(31) MDCP STAR Kids covered service--Medically Dependent
Children Program STAR Kids covered service. A service provided to
a member eligible to receive MDCP benefits under the STAR Kids Program.
(32) Member--A person enrolled in one of the following:
(A) traditional Medicaid service delivery model also
referred to as fee-for-service;
(B) the CLASS Program;
(C) the Community Attendant Services Program;
(D) the DBMD Program;
(E) the FC Program;
(F) the HCBS-AMH Program;
(G) the HCS Program;
(H) the Primary Home Care Program;
(I) the STAR Program;
(J) the STAR Health Program;
(K) the STAR Kids Program;
(L) the STAR+PLUS Program;
(M) the STAR+PLUS Home and Community-Based Services
Program;
(N) the STAR+PLUS Medicare-Medicaid Program;
(O) the Texas Home Living Program;
(P) Texas Health Steps Comprehensive Care Program (CCP);
or
Cont'd... |