| (C) serious dysfunction of any bodily organ or part.
(25) Emotional or behavioral condition--Behavior which
varies significantly from normal, that is chronic and does not quickly
disappear, and that is unacceptable because of social or cultural
expectations. Emotional or behavioral responses which are so different
from those of the generally accepted, age-appropriate norms of people
with the same ethnic or cultural background as to result in significant
impairment in social relationships, self-care, educational progress,
or classroom behavior. Examples include but are not limited to the
following:
(A) an inability to build or maintain satisfactory
age-appropriate interpersonal relationships with peers or adults;
(B) dangerously aggressive, self-destructive, severely
withdrawn, or noncommunicative behaviors;
(C) a pervasive mood of unhappiness or depression;
or
(D) evidence of excessive anxiety or fears.
(26) Facility--A hospital, psychiatric hospital, rehabilitation
hospital or center, ambulatory surgical center, renal dialysis center,
specialty center, or outpatient clinic.
(27) Family--For the purpose of determining family
size for program eligibility, the family includes the following persons
who live in the same residence:
(A) the applicant;
(B) those related to the applicant as a parent, stepparent,
or spouse who have a legal responsibility to support the applicant,
or guardians or managing conservators who have a duty to provide food,
shelter, education, and medical care for the applicant;
(C) children under age 19 or wards of the applicant;
and
(D) children under age 19 or wards of a parent, stepparent,
or spouse.
(28) Family support services--Disability-related support,
resources, or other assistance provided to the family of a child with
special health care needs. The term may include services described
by Part A of the Individuals with Disabilities Education Act (20 U.S.C. §1400
et seq.), as amended, and permanency planning, as that term
is defined by Government Code, §531.151.
(29) Federal Poverty Level (FPL)--The minimum income
needed by a family for food, clothing, transportation, shelter, and
other necessities in the United States, according to the United States
Department of Health and Human Services, or its successor agency or
agencies. The FPL varies according to family size and after adjustment
for inflation, is published annually in the Federal Register.
(30) Federally qualified health center--A federally
qualified health center is designated by CMS to provide core medical
services to a Medically Underserved Population.
(31) Financial independence--A state in which a person
currently files his or her own personal U.S. income tax return and
is not claimed as a dependent by any other person on his or her U.S.
income tax return.
(32) Guardian--A statutory officer appointed under
the Texas Probate Code who has a duty to provide food, shelter, education,
and medical care for his or her ward.
(33) Health care benefits--CSHCN Services Program benefits
consisting of diagnosis and evaluation services, rehabilitation services,
medical home care management services, family support services, transportation
related services, and insurance premium payment services.
(34) Health insurance and health benefits plan--A policy
or plan, individual, group, or government-sponsored, that an individual
purchases or in which an individual participates that provides benefits
when medical or dental costs are or would be incurred. Sources of
health insurance include, but are not limited to, health insurance
policies, buy-in programs, health maintenance organizations, preferred
provider organizations, employee health welfare plans, union health
welfare plans, medical expense reimbursement plans, United States
Department of Defense or Department of Veterans Affairs benefit plans,
Medicaid, CHIP, and Medicare. Benefits may be in any form, including,
but not limited to, reimbursement based upon cost, cash payment based
upon a schedule, or access without charge or at minimal charge to
providers of medical or dental care. Benefits from a municipal or
county hospital, joint municipal-county hospital, county hospital
authority, hospital district, county indigent health care programs,
or the facilities of a publicly supported medical school shall not
constitute health insurance for purposes of this chapter.
(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.
Cont'd... |
