(a) Purpose. The purpose of this division is to establish
rules for the Title XIX (Medicaid) home health services benefit.
(b) Definitions. The following words and terms when
used in this division, have the following meanings, unless the context
clearly indicates otherwise.
(1) Allowed practitioner--An individual:
(A) that maintains a valid and registered prescriptive
authority agreement in accordance with Texas Occupations Code, Chapter
157, Subchapter B; and
(B) is licensed as:
(i) a physician assistant under Texas Occupations Code,
Chapter 204; or
(ii) an advanced practice registered nurse licensed
by the Texas Board of Nursing as a:
(I) certified nurse practitioner; or
(II) clinical nurse specialist.
(2) Durable medical equipment (DME)--Equipment and
appliances that are primarily and customarily used to serve a medical
purpose, generally are not useful to an individual in the absence
of a disability, illness or injury, can withstand repeated use, and
can be reusable or removable.
(3) HHSC--The Texas Health and Human Services Commission
or its designee.
(4) Home health aide--An individual who meets the Medicare
home health agency personnel qualifications and training requirements
established for home health aides in 42 CFR §484.80.
(5) Home health aide services--Services which can be
provided by a qualified home health aide, including those listed in
42 CFR §484.80.
(6) Home health agency--A public or private agency
or organization, licensed by the State of Texas to provide home health
services and qualified to participate as a Medicare home health agency
under 42 CFR, Part 484, Subparts A - C (relating to Home Health Services).
(7) Home health services--Covered services, DME and
supplies which are provided to a qualified Medicaid recipient at the
recipient's place of residence by home health agency staff or providers
of DME and supplies under 42 CFR §440.70 and §354.1037 of
this division (relating to Written Plan of Care) and §354.1039
of this division (relating to Benefits and Limitations of Home Health
Services).
(8) Intermittent--Home health aide or skilled nursing
services provided less than on a daily basis, less than eight hours
per day.
(9) Part-time--Home health aide or skilled nursing
services provided any number of days per week, less than eight hours
per day.
(10) Plan of care--A written regimen established and
periodically reviewed by a physician or an allowed practitioner in
consultation with home health agency staff, which meets the plan of
care standards at 42 CFR §484.60 and §354.1037 of this division.
(11) Supplies--Health care related items that are required
to address an individual's medical disability, illness, or injury
and are:
(A) consumable or disposable; or
(B) cannot withstand repeated use by more than one
individual.
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Source Note: The provisions of this §354.1031 adopted to be effective June 26, 1997, 22 TexReg 5826; transferred effective September 1, 2001, as published in the Texas Register May 24, 2002, 27 TexReg 4561; amended to be effective November 14, 2002, 27 TexReg 10588; amended to be effective September 21, 2022, 47 TexReg 5779 |