The following words and phrases, when used in this subchapter,
have the following meanings unless the context clearly indicates otherwise:
(1) Across the Board Reduction of Services--The agency
need not grant a hearing if the sole issue is a Federal or State law
requiring an automatic change adversely affecting some or all recipients.
(2) Action Effective Date--The date the agency action
(3) Adequate Notice--Notice in accordance with applicable
law, rules, and regulations of the programs.
(4) Agency--Any one of the agencies listed under the
Health and Human Services Agencies.
(5) Agency Action--The agency's decision to:
(A) reduce, suspend, terminate or deny benefits or
(B) deny certification of a household; or
(C) grant a benefit in an amount less than requested.
(6) Agency Representative--An individual from an agency
or its designee who is authorized to represent the agency or its designee
in a fair hearing.
(7) Appeal--A request for a review of an agency action
or failure to act that may result in a fair hearing.
(8) Appellant--A client who requests a fair hearing.
(9) Authorized Representative--A person designated
by the appellant in writing or designated by statute, regulation,
or rule or named by the appellant on the record who may act on behalf
of the appellant at the fair hearing.
(10) Benefit--A service administered or assistance
provided by the agencies or their designees, including determining
eligibility for services in the SNAP, TANF, and Medicaid-funded programs,
and other agency programs in which state or federal law or rules provide
a client the right to a fair hearing.
(11) Certified Spanish/English Interpreter--An interpreter
who is certified by one of the following entities:
(A) American Translators Association;
(B) Federally Certified Court Interpreter through the
Federal Court Interpreter Certification Examination;
(C) Interpreter Certification offered through a four-year
college or university;
(D) State Certification Programs;
(E) United States Department of State (Escort, Seminar,
or Conference level); or
(F) Any other nationally recognized certification program.
(12) CFR--Code of Federal Regulations.
(13) Client--A person who applies for or receives benefits
from one of the HHS Agencies.
(14) Date of Appeal Request--The date on which the
appellant or the appellant's authorized representative clearly expresses,
in writing or orally as required, a desire to appeal.
(15) Date of Decision--The date of the hearings officer's
decision, as noted on the decision document.
(16) Date of Notice of Agency Action--The date on the
written notice informing the client of the agency action.
(17) Day--Calendar day, unless otherwise specified.
(18) Designee--A contractor, employee, or other agent
designated to act for an agency.
(19) Fair Hearing--An informal proceeding held before
an impartial HHSC hearings officer in which a client appeals an agency
action. These hearings are not open to the public.
(20) Health and Human Services (HHS) Agencies:
(A) Health and Human Services Commission (HHSC);
(B) Department of Aging and Disability Services (DADS);
(C) Department of Assistive and Rehabilitative Services
(D) Department of Family and Protective Services (DFPS);
(E) Department of State Health Services (DSHS); and
(F) A reference to an agency includes a designee.
(21) Health Plan--Includes managed care organizations.
(22) Hearings Administrator--The administrator for
fair and fraud hearings in the HHSC Appeals Division who oversees
daily operations and staff conducting fair hearings.
(23) Hearings Officer--An HHSC employee designated
by the Director of the Appeals Division who is responsible for conducting
fair hearings and issuing decisions.
(24) Language Services--Any services that ensure effective
communication for full participation of all parties in a hearing.
(25) Managed Care Organization (MCO)--Has the meaning
defined in §353.2 of this title (relating to Definitions).
(26) Nursing Home Action--The nursing home's decision
to transfer or discharge a client.
(27) Party--An appellant or his authorized representative
or an agency or its representative.
(28) PASARR--Pre-Admission Screening and Resident Review
(29) Preponderance--The greater weight of the evidence
required in a civil lawsuit for the trier of fact to decide in favor
of one side or the other. This preponderance is based on the more
convincing evidence and its probable truth or accuracy, and not on
the amount of evidence.
(30) Person with Limited English Language Proficiency
(LEP)--Person who does not speak English as a primary language and
who has a limited ability to read, speak, write, or understand English.
(31) Prior Authorization Request--A request for services
that is reimbursable only if authorization or approval for the services
is obtained before services are rendered.
(32) SNAP--Supplemental Nutrition Assistance Program,
formerly known as Food Stamps.
(33) TANF--Temporary Assistance for Needy Families.
(34) Texas Health Steps (THSteps)--A program under
Medicaid that provides medical and dental check-ups, diagnosis, and
treatment to eligible clients from birth through age 20. THSteps was
formerly known as EPSDT.