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RULE §357.1Definitions

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

  (1) Across the Board Reduction of Services--The agency need not grant a hearing if the sole issue is a Federal or State law requiring an automatic change adversely affecting some or all recipients.

  (2) Action Effective Date--The date the agency action becomes effective.

  (3) Adequate Notice--Notice in accordance with applicable law, rules, and regulations of the programs.

  (4) Agency--Any one of the agencies listed under the Health and Human Services Agencies.

  (5) Agency Action--The agency's decision to:

    (A) reduce, suspend, terminate or deny benefits or eligibility;

    (B) deny certification of a household; or

    (C) grant a benefit in an amount less than requested.

  (6) Agency Representative--An individual from an agency or its designee who is authorized to represent the agency or its designee in a fair hearing.

  (7) Appeal--A request for a review of an agency action or failure to act that may result in a fair hearing.

  (8) Appellant--A client who requests a fair hearing.

  (9) Authorized Representative--A person designated by the appellant in writing or designated by statute, regulation, or rule or named by the appellant on the record who may act on behalf of the appellant at the fair hearing.

  (10) Benefit--A service administered or assistance provided by the agencies or their designees, including determining eligibility for services in the SNAP, TANF, and Medicaid-funded programs, and other agency programs in which state or federal law or rules provide a client the right to a fair hearing.

  (11) Certified Spanish/English Interpreter--An interpreter who is certified by one of the following entities:

    (A) American Translators Association;

    (B) Federally Certified Court Interpreter through the Federal Court Interpreter Certification Examination;

    (C) Interpreter Certification offered through a four-year college or university;

    (D) State Certification Programs;

    (E) United States Department of State (Escort, Seminar, or Conference level); or

    (F) Any other nationally recognized certification program.

  (12) CFR--Code of Federal Regulations.

  (13) Client--A person who applies for or receives benefits from one of the HHS Agencies.

  (14) Date of Appeal Request--The date on which the appellant or the appellant's authorized representative clearly expresses, in writing or orally as required, a desire to appeal.

  (15) Date of Decision--The date of the hearings officer's decision, as noted on the decision document.

  (16) Date of Notice of Agency Action--The date on the written notice informing the client of the agency action.

  (17) Day--Calendar day, unless otherwise specified.

  (18) Designee--A contractor, employee, or other agent designated to act for an agency.

  (19) Fair Hearing--An informal proceeding held before an impartial HHSC hearings officer in which a client appeals an agency action. These hearings are not open to the public.

  (20) Health and Human Services (HHS) Agencies:

    (A) Health and Human Services Commission (HHSC);

    (B) Department of Aging and Disability Services (DADS);

    (C) Department of Assistive and Rehabilitative Services (DARS);

    (D) Department of Family and Protective Services (DFPS);

    (E) Department of State Health Services (DSHS); and

    (F) A reference to an agency includes a designee.

  (21) Health Plan--Includes managed care organizations.

  (22) Hearings Administrator--The administrator for fair and fraud hearings in the HHSC Appeals Division who oversees daily operations and staff conducting fair hearings.

  (23) Hearings Officer--An HHSC employee designated by the Director of the Appeals Division who is responsible for conducting fair hearings and issuing decisions.

  (24) Language Services--Any services that ensure effective communication for full participation of all parties in a hearing.

  (25) Managed Care Organization (MCO)--Has the meaning defined in §353.2 of this title (relating to Definitions).

  (26) Nursing Home Action--The nursing home's decision to transfer or discharge a client.

  (27) Party--An appellant or his authorized representative or an agency or its representative.

  (28) PASARR--Pre-Admission Screening and Resident Review Determination.

  (29) Preponderance--The greater weight of the evidence required in a civil lawsuit for the trier of fact to decide in favor of one side or the other. This preponderance is based on the more convincing evidence and its probable truth or accuracy, and not on the amount of evidence.

  (30) Person with Limited English Language Proficiency (LEP)--Person who does not speak English as a primary language and who has a limited ability to read, speak, write, or understand English.

  (31) Prior Authorization Request--A request for services that is reimbursable only if authorization or approval for the services is obtained before services are rendered.

  (32) SNAP--Supplemental Nutrition Assistance Program, formerly known as Food Stamps.

  (33) TANF--Temporary Assistance for Needy Families.

  (34) Texas Health Steps (THSteps)--A program under Medicaid that provides medical and dental check-ups, diagnosis, and treatment to eligible clients from birth through age 20. THSteps was formerly known as EPSDT.

Source Note: The provisions of this §357.1 adopted to be effective June 29, 2009, 34 TexReg 4292; amended to be effective March 1, 2012, 37 TexReg 1301

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