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RULE §350.1405Definitions

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.

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

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