The following words and terms, when used in this chapter, have
the following meanings, unless the context clearly indicates otherwise.
(1) Adjusted gross income--The gross income of the
family, as defined in this section, minus allowable deductions. Adjusted
gross income is used to determine the amount of the monthly financial
contribution required by a family.
(2) Allowable deductions--Expenses that are not reimbursed
by other sources. Allowable deductions are limited to:
(A) the actual medical or dental expenses of the parent
or dependent that are primarily related to alleviating or preventing
a physical or mental defect or illness, were paid over the previous
12 months, are expected to continue during the eligibility period,
and are limited to the cost of:
(i) diagnosis, cure, alleviation, treatment, or prevention
of disease;
(ii) treatment of any affected body part or function;
(iii) legal medical services delivered by physicians,
surgeons, dentists, and other medical practitioners;
(iv) medication, medical supplies, and diagnostic devices;
(v) premiums paid for insurance that covers the expenses
of medical or dental care;
(vi) transportation to receive medical or dental care;
and
(vii) medical or dental debt that is being paid on
an established payment plan;
(B) child-care and respite expenses for a family member;
(C) costs and fees associated with the adoption of
a dependent child; and
(D) court-ordered child support payments paid for a
child who is not counted as a family member or dependent.
(3) Applied behavior analysis (ABA)--The design, implementation,
and evaluation of systematic environmental changes to produce socially
significant change in human behavior through skill acquisition and
the reduction of problematic behavior. Applied behavior analysis includes
direct observation and measurement of behavior and the identification
of functional relations between behavior and the environment. Contextual
factors, establishing operations, antecedent stimuli, positive reinforcers,
and other consequences are used to produce the desired behavior change.
(4) Autism spectrum disorders--The disorders found
in the current edition of the Diagnostic and Statistical Manual of
Mental Disorders (DSM) related to autism. An autism spectrum disorder
(ASD) diagnosis of autistic disorder, Asperger's disorder, or pervasive
developmental disorder not otherwise specified, made under a previous
DSM, is acceptable.
(5) BCaBA--A board certified assistant behavior analyst.
(6) BCBA--A board certified behavior analyst.
(7) BCBA-D--A board certified behavior analyst-doctoral.
(8) Child--A son, daughter, foster child, or stepchild
who is under age 19 living in the home.
(9) Contractor--A service provider under contract with
HHSC to provide autism services.
(10) Cost share--The amount of monthly financial contribution
required of a family for a child to participate in the HHSC Children's
Autism Program, as described in Subchapter F of this chapter (relating
to Cost Share). The cost share is determined using the HHSC Fee Schedule
and any applicable insurance deductible, coinsurance, and co-pay amounts.
The cost share is the lesser of the fee determined using the HHSC
fee schedule, or applicable insurance deductible, coinsurance, and
co-pay amounts.
(11) HHSC Comprehensive ABA services--ABA services
that are provided to children 3 through 5 years of age by a HHSC
contractor to treat all areas of developmental and behavioral needs.
(12) HHSC Focused ABA services--ABA services that are
provided to children 3 through 15 years of age by a HHSC contractor
to treat one or more deficits or behaviors of excess rather than the
full range of developmental domains.
(13) Dependent--A child age 19 or older, parent, stepparent,
grandparent, brother, sister, stepbrother, stepsister, or in-law;
whose gross income is less than $3,900 a year; and for whom more than
half of the person's support is provided for by the parent(s) or guardian(s)
during the calendar year.
(14) Direct contact--A term that applies to any person
who has physical contact with, physical access to the home of, communication
with, or access to confidential information regarding a child enrolled
in the HHSC Children's Autism Program or the child's family. Direct
contact does not include casual or inadvertent physical contact with,
communication with, or contact at an educational presentation or seminar
with a child enrolled in the HHSC Children's Autism Program or the
child's family.
(15) Family--The child's parent(s) or guardian(s),
the child, other children under 19 years of age and other dependents
of the parent or guardian.
(16) Fiscal year--The state fiscal year. Begins on
September 1 and ends on August 31 of the following year.
(17) Gross income--All income received by the family
for determination of the family's cost share, from whatever source,
that is considered income by the Internal Revenue Service before federal
allowable deductions are applied.
(18) HHSC--The Texas Health and Human Services Commission.
(19) Individualized Education Program (IEP)--A written
document that is developed for each public school child who is eligible
for special education.
(20) Interest list--A list, maintained by the contractor,
of families who have indicated an interest in receiving services,
and who meet the eligibility criteria.
(21) LEA--Local educational agency.
(22) Parent--The child's natural or adoptive parent;
or the child's guardian.
(23) Parent training--Training that is provided to
a parent or guardian as part of the ABA service, in the language used
by the parents of the child when feasible. It is delivered either
individually or in a group in a home, school, or clinic setting. It
includes providing parent education on ABA in general; working collaboratively
with parents to identify ways they can help their child at home to
generalize learning to other environments, including school settings;
and data review, program adjustment, and planning.
(24) Qualified professional--An actively licensed physician
or psychologist with training and background related to the diagnosis
and treatment of neurodevelopmental disorders.
(25) Texas resident--A person who resides in Texas
and intends to remain in the state, either permanently or for an indefinite
period.
(26) Third-party payer--A company, organization, insurer,
or government agency other than HHSC that makes payment for health
care services received by an enrolled child.
(27) Transition plan--A plan that identifies and documents
appropriate steps and transition services to support the child and
family to smoothly and effectively transition from the HHSC Children's
Autism Program to LEA special education services or other community
activities, places, or programs the family would like the child to
participate in after exiting the HHSC Children's Autism Program.
(28) Treatment plan--A written plan of care, including
treatment goals, for providing HHSC autism treatment services to an
eligible child and the child's family to enhance the child's development.
The intensity and length of Children's Autism Program services is
determined by the treatment goals included in the treatment plan.
However, the length of autism services shall not exceed 24 months.
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