The following words and terms, when used in this subchapter,
will have the following meanings, unless the context clearly indicates
otherwise.
(1) Ability to Pay--The determination that the family
is financially able to pay out-of-pocket, for their child's early
childhood intervention services.
(2) Adjusted Income--The dollar amount equal to the
family's annual gross income minus their allowable deductions. The
contractor uses adjusted income to determine the family's ability
to pay and to calculate the family's maximum charge.
(3) Allowable Deductions--Certain unreimbursed family
expenses that are subtracted from the family's gross income to calculate
their adjusted income.
(4) CHIP--The Children's Health Insurance Program (CHIP)
administered by HHSC.
(5) Dependent--Any person who meets the definition
of 26 USC §152 Dependent Defined.
(6) Family Cost Share System--The system of collecting
reimbursement for early childhood intervention services from public
insurance, private insurance, and out-of-pocket payments from families.
(7) Family size--The total number of people in the
family, including the child's parents who live in the home, the child,
and other dependents of the parent. Other dependents do not have to
live in the home, but they must be financially dependent upon the
parent.
(8) Federal Poverty Guidelines--The poverty guidelines
updated periodically in the Federal Register by the United States
Department of Health and Human Services under the authority of 42
USC §9902(2).
(9) Gross Income--All income received by the family
considered income by the Internal Revenue Service before federal allowable
deductions are applied.
(10) Inability to Pay--The determination that the family
is financially unable to make out-of-pocket payments because the family
has an adjusted income at or below 100% of the federal poverty level.
(11) Maximum Charge--The maximum out-of-pocket amount
the contractor can charge the family for services delivered in one
calendar month.
(12) Out-of-Pocket--Payment received from the family
to pay for their child's early childhood intervention services. This
includes insurance co-pays, co-insurance, and deductibles as well
as payment for services not covered by the family's insurance.
(13) Sliding Fee Scale--The HHSC-developed scale of
maximum charges that is based on the federal poverty guidelines.
(14) Third-Party Payor--A company, organization, insurer,
or government agency that makes payments for the early childhood intervention
services received by a child and family. Third-party payors include
commercial insurance companies, HMOs, PPOs, and public insurance such
as Medicaid, CHIP, and TRICARE.
(15) TRICARE--The U.S. Department of Defense health
care entitlement for active duty, Guard and Reserve, retired members
of the military, and their eligible family members and survivors.
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| Source Note: The provisions of this §350.1405 adopted to be effective May 1, 2014, 39 TexReg 3449; amended to be effective June 30, 2019, 44 TexReg 3280; transferred effective March 1, 2021, as published in the Texas Register February 5, 2021, 46 TexReg 941 |
