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TITLE 40SOCIAL SERVICES AND ASSISTANCE
PART 1DEPARTMENT OF AGING AND DISABILITY SERVICES
CHAPTER 2LOCAL AUTHORITY RESPONSIBILITIES
SUBCHAPTER CCHARGES FOR COMMUNITY SERVICES
RULE §2.103Definitions

The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise.

  (1) Ability to pay--The person has third-party coverage that will pay for needed services, the person's maximum monthly fee is greater than zero, or the person has identified payment for a needed service or services in an approved plan utilizing Social Security work incentive provisions (i.e., Plan to Achieve Self-Sufficiency; Impairment Related Work Expense).

  (2) Community services or services--Except for residential services, eligibility determination, and screening, the required and optional mental retardation services described in the performance contract.

  (3) DADS--The Department of Aging and Disability Services.

  (4) Extraordinary expenses--Major medical or health related expenses, major casualty losses, and child care expenses for the previous year or projections for the next year.

  (5) Family members--

    (A) For an unmarried person under age 18 years--The person, the person's parents, and the dependents of the parents, if residing in the same household;

    (B) For an unmarried person age 18 years or older--The person and the person's dependents; or

    (C) For a married person of any age--The person, the person's spouse, and their dependents.

  (6) Gross income--Revenue from all sources before taxes and other payroll deductions. The term does not include child support received.

  (7) Inability to pay--The person's maximum monthly fee is zero and the person:

    (A) does not have third-party coverage;

    (B) has third-party coverage, but has exceeded the maximum benefit of the covered service(s) or the third-party coverage will not pay because the services needed by the person are not covered services; or

    (C) has not identified payment for a needed service or services in an approved plan utilizing Social Security work incentive provisions (i.e., Plan to Achieve Self-Sufficiency; Impairment Related Work Expense).

  (8) Income-based public insurance--Government funded third-party coverage that bases eligibility on income (i.e., CHIP and Medicaid).

  (9) MMF--Maximum monthly fee. A fee that is calculated in accordance with §2.106(b) of this chapter (relating to Determination of Ability to Pay).

  (10) MRA--Mental retardation authority. An entity to which the Health and Human Services Commission's authority and responsibility described in Texas Health and Safety Code, §531.002(11) have been delegated.

  (11) MR priority population--Groups of persons identified in the Health and Human Services Commission's current strategic plan as being most in need of mental retardation services.

  (12) Parent--A biological or adoptive parent of a person under age 18 years.

  (13) Performance contract--A written agreement between DADS and an MRA for the provision of one or more functions as described in Texas Health and Safety Code, §533.035(a).

  (14) Person--A person in the MR priority population who is seeking or receiving services through an MRA.

  (15) Significant financial change--Any change in the person's (or parent's) financial status as shown in the financial documentation, as described in §2.105(d) of this subchapter (relating to Accountability), that affects the person's (or parent's) ability to pay. Examples of a significant financial change are:

    (A) a reduction in income due to the loss of a job or due to a reduction in hours worked on a job;

    (B) an increase in income because of an inheritance or a salary increase;

    (C) an increase or decrease in the number of family members;

    (D) the gain or loss of third-party coverage; and

    (E) an increase or decrease in extraordinary expenses.

  (16) Standard charge--A fixed price for a community service or unit of service.

  (17) Team--A person's service planning team.

  (18) Third-party coverage--A public or private payer of community services (e.g., Medicaid, Medicare, private insurance, CHIP, TRICARE).


Source Note: The provisions of this §2.103 adopted to be effective September 1, 2002, 27 TexReg 2041; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; amended to be effective November 1, 2007, 32 TexReg 7494

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