| (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
(iii) is an adult residing in Texas, including an adult
whose parent(s), managing conservator, guardian of the adult's person,
or caretaker (with whom the adult resides and plans to continue to
reside).
(64) Treatment plan--The plan of care for the client
(time and treatment specific) as certified by and implemented under
the supervision of a physician or other practitioner in the program.
(65) United States Public Health Service price--The
average manufacturer price for a drug in the preceding calendar quarter
under Title XIX of the Social Security Act, reduced by the rebate
percentage, as authorized by the Veterans Health Care Act of 1992
(P.L. 102-585, November 4, 1992).
(66) Urgent need for health care benefits--A need for
health care services when the lack of those services would cause a
permanent increase in disability, intense pain or suffering, or death.
(67) Ward--An individual placed under the protection
of a guardian, or a person who by reason of incapacity is under the
protection of a court either directly or through a guardian appointed
by the court.
|
| Source Note: The provisions of this §351.2 adopted to be effective July 1, 2001, 26 TexReg 2979; amended to be effective March 27, 2003, 28 TexReg 2523; amended to be effective June 1, 2006, 31 TexReg 4200; amended to be effective October 3, 2010, 35 TexReg 8921; amended to be effective April 21, 2013, 38 TexReg 2362; transferred effective March 15, 2022, as published in the February 25, 2022 issue of the Texas Register, 47 TexReg 982 |
