| (E) "Cash surrender value" means the amount that the insurer pays the owner if the policy is cancelled before death or before it has matured. The cash surrender value usually increases with the age of the policy. (F) A "participating life insurance policy" is one in which dividends are distributed to the policyholder. (G) "Term life insurance" means life insurance that has no cash, loan, or dividend value, nor the potential for cash, loan, or dividend value. (H) "Dividend" means a share of surplus funds allocated to the policyholders of a participating insurance policy. A dividend generally represents a previous overpayment of premiums. (47) Intermediate care facility for persons with mental retardation or related conditions (ICF/MR)--A Medicaid-certified facility that provides care in a 24-hour specialized residential setting for persons with mental retardation or a related condition. An ICF/MR includes a state supported living center and a state center. (48) Inter vivos trust--A trust established while the person creating the trust is still living. (49) Level of care--The type of care a person is eligible to receive in an ICF/MR based upon an assessment of the person's need for care. (50) Level of care determination--A determination made by the Texas Department of Aging and Disability Services that determines a person's level of care. (51) Life estate--A right to real property conferred in a legal instrument on a person (beneficiary). The right is conferred for the duration of the beneficiary's lifetime or the lifetime of another person. The beneficiary usually has the right to possess, use, and receive profits from the real property during his or her possession. (52) Liquid resource--Cash or other property that can be converted to cash within 20 working days. (53) Long-term care facility--A nursing facility, ICF/MR, or IMD in which medical services are provided. (54) Look-back period--The period of time HHSC considers to determine if a person transferred, gave away, disposed of, or otherwise reduced his or her countable resources and income without receiving equal value in return and with the intent to give away resources in order to qualify for MEPD. (55) Medicaid--A state and federal cooperative program, authorized under Title XIX of the Social Security Act and the Texas Human Resources Code, that pays for certain medical and health care costs for people who qualify. Also known as the medical assistance program. (56) Medical effective date--The date a person's Medicaid coverage begins. (57) Medical necessity--The determination that a person requires the services of a licensed nurse in an institutional setting to carry out a physician's planned regimen for total care. (58) Medical services--Services that are directed toward diagnostic, preventive, therapeutic, or palliative treatment of a medical condition and that are performed, directed, or supervised by a state-licensed health professional. (59) Medicare--Medical coverage available under Title XVIII of the Social Security Act to people 65 years of age or older and to certain disabled people under 65 years of age. (60) MEPD--A Medicaid-funded program for the elderly and people with disabilities. A public assistance program providing institutional and community-based health-related care for the elderly and people with disabilities. MEPD does not provide cash assistance. Examples of MEPD services and programs are: (A) primary home care services; (B) §1915(c) waiver programs, which provide community-based care as an alternative to institutional care; (C) care in a Medicaid-certified long-term care facility; and (D) the Program of All-Inclusive Care for the Elderly (PACE). (61) Mineral rights--Ownership interest in the oil, gas, or minerals beneath the surface of a piece of property. (62) Month of application--The month in which the date of application falls. (63) Noninstitutional setting--A living arrangement in which a person applying for or receiving Medicaid does not live in a long-term care facility or receive services under a §1915(c) waiver program. (64) Nursing facility--An entity that provides organized and structured nursing care and services, and is subject to licensure under Texas Health and Safety Code, Chapter 242. (65) Parent--A child's natural or adoptive parent or the spouse of the natural or adoptive parent. (66) Pension funds--Monies held in a retirement fund under a plan administered by an employer or union, or an individual retirement account (IRA) or Keogh account as described in the Internal Revenue Code. (67) Personal needs allowance--An amount of the recipient's income that a recipient in an institutional setting may retain for personal use. (68) Primary home care services--Medicaid-funded, in-home attendant services provided to a person with a medical need for specific tasks to delay or prevent the person's need for institutional care. (69) Principal place of residence--The home where a person resides, occupies, and lives. (70) Provider--A person, group, or agency contracted to provide a Medicaid-funded service to a person for a fee. (71) Public institution--An institution defined in 20 CFR §416.201. (72) Real property--Land and improvements, including buildings and structures. Real property may also include a mine or quarry, standing timber, or minerals. (73) Recipient--A person receiving benefits under MEPD, including a person whose Medicaid eligibility is being redetermined. (74) Representative payee--A person or an organization selected to receive benefits on behalf of a recipient, if the recipient is not able to manage or direct the management of benefit payments in his or her own interest. (75) Resources--Cash, other liquid assets, or any real or personal property, that a person (or spouse or parent, as appropriate): (A) owns; (B) has the right, authority, or power to convert to cash (if not already cash); and (C) is not legally restricted from using for his or her support and maintenance. (76) Restitution--Securing payment from a recipient when fraud is not indicated or pursued and when the recipient's co-payment has been undercharged because of previously unreported or underreported monthly income or resources. (77) Retirement, Survivors, and Disability Insurance (RSDI)--Benefits provided under Title II of the Social Security Act. (78) Retroactive coverage--Payment for Medicaid-reimbursable medical services received up to three months before the month of application. (79) Social Security--A federal system of retirement and disability insurance for various categories of employed and dependent persons, funded through dedicated payroll taxes. (80) Social Security Act--The federal statute that provides the authority for various programs referenced in this chapter, including Medicare and Medicaid. See also the definition in this section for certain titles in the Social Security Act. (81) Social Security Administration (SSA)--The federal agency that issues Social Security numbers, administers Social Security benefit programs, and manages the SSI program. (82) Social service--A service, other than a medical service, that is intended to assist a person with a physical disability or social disadvantage to function in society on a level comparable to that of a person who does not have such a disability or disadvantage. No in-kind items are expressly identified as social services. (83) Special income limit--The income limit used to test MEPD eligibility for a person or couple in an institutional setting in accordance with §358.433 of this chapter (relating to Special Income Limit). (84) Spousal impoverishment--Provision implemented under §1924 of the Social Security Act (42 U.S.C. §1396r-5) designed to prevent the impoverishment of a family, usually a couple, when one spouse needs care in an institutional setting. (85) State center--A facility operated by the Texas Department of State Health Services with which the Texas Department of Aging and Disability Services contracts to provide services to persons with mental retardation who reside in the facility. (86) State mental health facility--A facility operated by the Texas Department of State Health Services that provides care for people with mental illness who need the safety, structure, and resources of an in-patient setting. (87) State supported living center--A facility operated by the Texas Department of Aging and Disability Services that provides residential services and 24-hour supervision and active treatments to assist people with mental retardation. Cont'd... |
