| (Q) the Youth Empowerment Services Program.
(33) Nursing facility--A facility licensed in accordance
with Texas Health and Safety Code Chapter 242.
(34) Occupational therapist--A person licensed as an
occupational therapist in accordance with Texas Occupations Code Chapter
454.
(35) PCS--Personal Care Services. Support services
provided to a member enrolled in Texas Health Steps CCP who requires
assistance with activities of daily living or instrumental activities
of daily living as described in §363.602 of this title (relating
to Definitions).
(36) PDN--Private duty nursing. Has the same meaning
as the term "Private duty nursing (PDN) Services" in 1 TAC Chapter
363, Subchapter C, §363.303 (relating to Definitions).
(37) Primary Home Care Program--A Medicaid state plan
program operating under Title XIX of the Social Security Act, as described
in 40 TAC Chapter 47.
(38) Physical therapist--A person licensed as a physical
therapist in accordance with Texas Occupations Code Chapter 453.
(39) Program provider--An entity that contracts with
HHSC or an MCO to provide a service described in §354.4005 or
§354.4006 of this subchapter and that uses an EVV vendor system
or an EVV proprietary system. A service provider described in paragraph
(43)(B) of this section is both a program provider and a service provider.
(40) PSO--Proprietary system operator. A program provider
or FMSA that uses an EVV proprietary system.
(41) Reason code--A standardized HHSC-approved code
entered in an EVV system to explain the reason for completing visit
maintenance.
(42) RN--Registered nurse. A person licensed to practice
as a registered nurse as described in Texas Occupations Code Chapter
301.
(43) Service provider--A person who provides a service
described in §354.4005 or §354.4006 of this subchapter and
who:
(A) is employed by or contracting with:
(i) a program provider; or
(ii) a CDS employer; or
(B) who is contracting with:
(i) an MCO; or
(ii) HHSC.
(44) SRO--Service responsibility option. A service
delivery option described in 40 TAC Chapter 43 (relating to Service
Responsibility Option) in which a member or legally authorized representative
selects, trains, and provides daily management of a service provider,
while the fiscal, personnel, and service back-up plan responsibilities
remain with the program provider.
(45) STAR--State of Texas Access Reform.
(46) STAR Health Program--A Medicaid program operating
under Title XIX, Section 1915(a) of the Social Security Act and Texas
Family Code, Chapter 266. The program provides services through a
managed care delivery model to a member enrolled in STAR Health as
described in Chapter 353, Subchapter H of this title (relating to
STAR Health).
(47) STAR Kids Program--A Medicaid program operating
under Title XIX, Section 1115 of the Social Security Act and Texas
Government Code Chapter 533. The program provides services through
a managed care delivery model to a member enrolled in STAR Kids as
described in Chapter 353, Subchapter N of this title (relating to
STAR Kids).
(48) STAR Program--A Medicaid program operating under
Title XIX, Section 1115 of the Social Security Act. The program provides
services through a managed care delivery model to a member enrolled
in STAR as described in Chapter 353, Subchapter I of this title (relating
to STAR).
(49) STAR+PLUS HCBS Program--STAR+PLUS Home and Community-Based
Services Program. A Medicaid program operating through a federal waiver
under Title XIX, Section 1115 of the Social Security Act. The program
provides services to a member eligible to receive HCBS benefits under
the STAR+PLUS Program, as described in Chapter 353, Subchapter M of
this title (relating to Home and Community Based Services in Managed
Care).
(50) STAR+PLUS MMP--STAR+PLUS Medicare-Medicaid Plan.
A managed care program operating under Title XIX, Section 1115A of
the Social Security Act that provides the authority to test and evaluate
a fully integrated care model for clients who are dual eligible. The
STAR+PLUS MMPs contract with CMS and HHSC to participate in the Dual
Demonstration Program described in Chapter 353, Subchapter L of this
title (relating to Texas Dual Eligibles Integrated Care Demonstration
Project).
(51) STAR+PLUS Program--A Medicaid program operating
under Title XIX, Section 1115 of the Social Security Act, and Texas
Government Code Chapter 533. The program provides services through
a managed care delivery model to a member enrolled in STAR+PLUS as
described in Chapter 353, Subchapter G of this title (relating to
STAR+PLUS).
(52) TAC--Texas Administrative Code.
(53) Texas Health Steps CCP--Texas Health Steps Comprehensive
Care Program. A Medicaid comprehensive program approved by CMS under
Title XIX, Section 1905 of the Social Security Act, as described in
Chapter 363 of this title (relating to Texas Health Steps Comprehensive
Care Program.
(54) TxHmL--Texas Home Living Program. A Medicaid waiver
program approved by CMS under Title XIX, Section 1915(c) of the Social
Security Act, as described in 26 TAC Chapter 262 (relating to Texas
Home Living (TxHmL) Program and Community First Choice (CFC)).
(55) Vendor hold--A temporary suspension of payments
for claims that are due to a program provider or FMSA.
(56) Visit maintenance--As described in the EVV Policy
Handbook, a process to:
(A) manually enter data elements described in §354.4009(a)
of this subchapter in an EVV system;
(B) correct the data elements described in §354.4009(a)
of this subchapter that are inaccurate in an EVV visit transaction;
or
(C) include the data elements described in §354.4009(a)
of this subchapter that are missing in an EVV visit transaction.
(57) YES Program--Youth Empowerment Services Program.
A Medicaid waiver approved by CMS under Title XIX, Section 1915(c)
of the Social Security Act as described in 26 TAC Chapter 307, Subchapter
A (relating to Youth Empowerment Services (YES)).
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