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RULE §382.5Definitions

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

  (1) Affiliate--

    (A) An individual or entity that has a legal relationship with another entity, which relationship is created or governed by at least one written instrument that demonstrates:

      (i) common ownership, management, or control;

      (ii) a franchise; or

      (iii) the granting or extension of a license or other agreement that authorizes the affiliate to use the other entity's brand name, trademark, service mark, or other registered identification mark.

    (B) The written instruments referenced in subparagraph (A) of this definition may include a certificate of formation, a franchise agreement, standards of affiliation, bylaws, articles of incorporation or a license, but do not include agreements related to a physician's participation in a physician group practice, such as a hospital group agreement, staffing agreement, management agreement, or collaborative practice agreement.

  (2) Applicant--A female applying to receive services under HTW, including a current client who is applying to renew.

  (3) Budget group--Members of a household whose needs, income, resources, and expenses are considered in determining eligibility.

  (4) Child--An adoptive, step, or natural child who is under 19 years of age.

  (5) Client--A female who receives services through HTW.

  (6) Contraceptive method--Any birth control options approved by the United States Food and Drug Administration, with the exception of emergency contraception.

  (7) Corporate entity--A foreign or domestic non-natural person, including a for-profit or nonprofit corporation, a partnership, or a sole proprietorship.

  (8) Covered service--A medical procedure for which HTW will reimburse an enrolled health-care provider.

  (9) Elective abortion--The intentional termination of a pregnancy by an attending physician who knows that the female is pregnant, using any means that is reasonably likely to cause the death of the fetus. The term does not include the use of any such means:

    (A) to terminate a pregnancy that resulted from an act of rape or incest;

    (B) in a case in which a female suffers from a physical disorder, physical disability, or physical illness, including a life-endangering physical condition caused by or arising from the pregnancy, that would, as certified by a physician, place the female in danger of death or risk of substantial impairment of a major bodily function unless an abortion is performed; or

    (C) in a case in which a fetus has a life-threatening physical condition that, in reasonable medical judgment, regardless of the provision of life-saving treatment, is incompatible with life outside the womb.

  (10) Family planning services--Educational or comprehensive medical activities that enable individuals to determine freely the number and spacing of their children and to select the means by which this may be achieved.

  (11) Federal poverty level--The household income guidelines issued annually and published in the Federal Register by the United States Department of Health and Human Services.

  (12) Health-care provider--A physician, physician assistant, nurse practitioner, clinical nurse specialist, certified nurse midwife, federally qualified health center, family planning agency, health clinic, ambulatory surgical center, hospital ambulatory surgical center, laboratory, or rural health center.

  (13) Health clinic--A corporate entity that provides comprehensive preventive and primary health care services to outpatient clients, which must include both family planning services and diagnosis and treatment of both acute and chronic illnesses and conditions in three or more organ systems. The term does not include a clinic specializing in family planning services.

  (14) HHSC--The Texas Health and Human Services Commission or its designee.

  (15) HTW--The Healthy Texas Women program administered by HHSC as outlined in this subchapter.

  (16) HTW provider--A health-care provider that is qualified to perform covered services. An HTW provider may be contracted with HHSC to provide additional services.

  (17) Medicaid--The Texas Medical Assistance Program, a joint federal and state program provided for in Texas Human Resources Code Chapter 32, and subject to Title XIX of the Social Security Act, 42 U.S.C. §§1396 et seq.

  (18) Minor--In accordance with the Texas Family Code, a person under 18 years of age who has never been married and never been declared an adult by a court (emancipated).

  (19) Third-party resource--A person or organization, other than HHSC or a person living with the applicant or client, who may be liable as a source of payment of the applicant's or client's medical expenses (for example, a health insurance company).

  (20) Unintended pregnancy--Pregnancy a female reports as either mistimed or undesired at the time of conception.

  (21) U.S.C.--United States Code.

Source Note: The provisions of this §382.5 adopted to be effective July 1, 2016, 41 TexReg 4623

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