| (35) Income--The gross income, either earned or unearned,
before deductions over a given period of time for each family member.
(36) Managing conservator--A person designated by a
court to have daily legal responsibility for a child.
(37) Medicaid--A program of medical care authorized
by Title XIX of the Social Security Act and the Human Resources Code.
(38) Medical home--A respectful partnership between
a client, the client's family as appropriate, and the client's primary
health care setting. A medical home is family centered health care
that is accessible, continuous, comprehensive, coordinated, compassionate,
and culturally competent. A medical home provides primary care that
includes preventive care, care coordination, and appropriate referral
and collaboration with specialist and other service providers as required.
(39) Medicare--A federal program that provides medical
care for people age 65 or older and the disabled as authorized by
Title XVIII of the Social Security Act.
(40) Natural home--The home in which a person lives
that is either the residence of his or her parent(s), foster parent(s)
or guardian, or extended family member(s), or the home in the community
where the person has chosen to live, alone or with other persons.
A natural home may utilize natural support systems such as family,
friends, co-workers, and services available to the general population
as they are available.
(41) Other benefit--A benefit, other than a benefit
provided under this chapter, to which a person is entitled for payment
of the costs of services included in the scope of coverage of the
CSHCN Services Program including, but not limited to, benefits available
from:
(A) an insurance policy, group health plan, health
maintenance organization, or prepaid medical or dental care plan;
(B) home, auto, or other liability insurance;
(C) Title XVIII, Title XIX, or Title XXI of the Social
Security Act (42 U.S.C. §§1395 et seq., 1396 et
seq., and 1397aa et seq.), as amended;
(D) the United States Department of Veterans Affairs;
(E) the United States Department of Defense;
(F) workers' compensation or any other compulsory employers'
insurance program;
(G) a public program created by federal or state law
or under the authority of a municipality or other political subdivision
of the state, excluding benefits created by the establishment of a
municipal or county hospital, a joint municipal-county hospital, a
county hospital authority, a hospital district, a county indigent
health care program, or the facilities of a publicly supported medical
school; or
(H) a cause of action for the cost of care, including
medical care, dental care, facility care, and medical supplies, required
for a person applying for or receiving services from the department
or a settlement or judgment based on the cause of action if the expenses
are related to the need for services provided under this chapter.
(42) Otologist--A physician whose specialty is diseases
of the ear.
(43) Permanency planning--A planning process undertaken
for children with chronic illness or developmental disabilities who
reside in institutions or are at risk of institutional placement,
with the explicit goal of securing a permanent living arrangement
that enhances the child's growth and development, which is based on
the philosophy that all children belong in families and need permanent
family relationships. Permanency planning is directed toward securing:
a consistent, nurturing environment, an enduring, positive adult relationship(s),
and a specific person who will be an advocate for the child throughout
the child's life. Permanency planning provides supports to enable
families to nurture their children, to reunite with their children
when they have been placed outside the home, and to place their children
in family environments.
(44) Person--An individual, corporation, government
or governmental subdivision or agency, business trust, partnership,
association, or any other legal entity.
(45) Physician--A person licensed by the Texas Medical
Board to practice medicine in this state.
(46) Physician assistant--A person licensed as a physician
assistant by the Texas Physician Assistant Board.
(47) Practitioner--A person who is licensed to practice
medicine, dentistry, nursing or an allied health profession.
(48) Prematurity or born prematurely--A child born
at less than 36 weeks gestational age and hospitalized since birth.
(49) Program--The Children with Special Health Care
Needs (CSHCN) Services Program.
(50) Provider--A person or facility as defined in §38.6
of this title (relating to Providers) that delivers services purchased
by the CSHCN Services Program for the purpose of implementing the
Act.
(51) Rehabilitation services--The process of the physical
restoration, improvement, or maintenance of a body function destroyed
or impaired by congenital defect, disease, or injury which includes
the following acute and chronic or rehabilitative services:
(A) facility care, medical and dental care, and occupational,
speech, and physical therapies;
(B) the provision of medications, braces, orthotic
and prosthetic devices, durable medical equipment, and other medical
supplies; and
(C) other services specified in this chapter.
(52) Respite care--A service provided on a short-term
basis for the purpose of relief to the primary care giver in providing
care to individuals with disabilities. Respite services can be provided
in either in-home or out-of-home settings on a planned basis or in
response to a crisis in the family where a temporary caregiver is
needed.
(53) Rural health clinic--A rural health clinic is
designated by CMS to provide core medical services in a Medically
Underserved Area.
(54) Routine child care--Child care for a child who
needs supervision while the parent or guardian is at work, in school,
or in job training.
(55) Services--The care, activities, and supplies provided
under the Act, including but not limited to, both acute and chronic
or rehabilitative medical care, dental care, facility care, medications,
durable medical equipment, medical supplies, occupational, physical,
and speech therapies, family support services, case management services,
and other care specified by program rules.
(56) Social service organization--For purposes of this
chapter, a for-profit or nonprofit corporation or other entity, not
including individual persons, that provides funds for travel, meal,
lodging, and family supports expenses in advance to enable CSHCN
Services Program clients to obtain program services.
(57) Specialty center--A facility and staff that meet
the CSHCN Services Program minimum standards established in this chapter
and are designated for use by CSHCN Services Program clients as part
of the comprehensive services for a specific medical condition.
(58) Spenddown--A process that allows an applicant
to obtain program financial eligibility when the applicant's family
income exceeds 200% of the FPL. The family must prove cumulative medical
expenses that exceed the difference between the family income and
200% of the FPL income limit.
(59) State--The State of Texas.
(60) Subrogation--Assumption by third party, such as
a second creditor or an insurance company, of another person's legal
right to collect a debt or damages.
(61) Supplemental Security Income Program (SSI)--Title
XVI of the Social Security Act which provides for payments to individuals
(including children under age 18) who are disabled and have limited
income and resources.
(62) Support--The contribution of money or services
necessary for a person's maintenance, including, but not limited to,
food, clothing, shelter, transportation, and health care.
(63) Texas resident--A person who:
(A) is physically present within the geographic boundaries
of the state;
(B) has an intent to remain within the state;
(C) maintains an abode within the state (i.e., house
or apartment, not merely a post office box);
(D) has not come to Texas from another country for
the purpose of obtaining medical care with the intent to return to
the person's native country;
(E) does not claim residency in any other state or
country; and
(i) is a minor child residing in Texas whose parent(s),
managing conservator, guardian of the child's person, or caretaker
(with whom the child consistently resides and plans to continue to
reside) is a Texas resident;
(ii) is a person residing in Texas who is the legally
dependent spouse of a Texas resident; or
Cont'd... |
