|
The following words and terms, when used in this subchapter,
shall have the following meanings, unless the context clearly indicates
otherwise.
(1)Applicant--An individual who applies to the department
for THMP services.
(2)Commissioner--The Commissioner of the Department
of State Health Services.
(3)Department--The Department of State Health Services.
(4)Eligible health insurance policy--A state, federal,
or private health insurance policy that is approved by the THMP and
covers at least one drug from each class of HIV-antiretroviral medication
and covers appropriate primary care services.
(5)Formulary--A list of drugs approved by the department
that includes at least one drug from each class of HIV antiretroviral
medications. https://www.dshs.texas.gov/hivstd/meds/files/formulary.pdf.
(6)Full-LIS--Full Low-income subsidy. The Social Security
Administration provides full-LIS to applicants with income and assets
below specified limits.
(7)HIV--Human immunodeficiency virus. Encompassing
all stages of HIV, including HIV-related conditions and syndromes.
(8)Legally responsible person--A parent, managing
conservator, or other person that is legally responsible for the support
of a minor or a ward.
(9)Medicare prescription drug plan--A Medicare Part
D prescription drug plan or the prescription drug component of a Medicare
Part C Advantage Plan.
(10)Minor--A person who is younger than 18 years of
age and who has not been emancipated by a court or who is not married
or recognized as an adult by the state of Texas.
(11)Open enrollment--A time period during which one
may freely enroll in or change one's selection of a health insurance
plan or other benefit plan that is ordinarily subject to restrictions.
(12)Out-of-pocket costs--The premium, copay, coinsurance,
and deductible amounts that an individual would be expected to pay
when enrolled in a health insurance plan or Medicare prescription
drug plan.
(13)Partial-LIS--Partial Low-income subsidy. The Social
Security Administration provides partial-LIS to applicants with income
and assets above the level of those qualifying for full-LIS, but still
below specified limits.
(14)Payor of last resort--A funding source that may
be used only after all other available public and private funding
sources have been accessed.
(15)Qualifying event--A change of life circumstance
that allows an individual to enroll in or change the selection of
a health insurance plan or other benefit plan outside of open enrollment.
(16)SPAP--The State Pharmacy Assistance Program. The
SPAP is available to low-income individuals living with HIV who also
have Medicare Part D.
(17)Texas resident--An individual is considered a
Texas resident if that person physically resides in Texas and intends
to continue to reside within the state.
(18)THMP--The Texas HIV Medication Program, which
includes the AIDS Drug Assistance Program (ADAP), SPAP, and TIAP.
(19)TIAP--Texas Insurance Assistance Program. TIAP
provides premium and copay assistance with eligible health insurance
policies.
The agency certifies that legal counsel has reviewed
the adoption and found it to be
a valid exercise of the agency's legal
authority.
Filed
with the Office of the Secretary of State on October 28, 2022
TRD-202204235 Cynthia Hernandez
General Counsel
Department of State Health Services
Effective date: November 17, 2022
Proposal publication date: June 10, 2022
For further information, please call: (737) 255-4300
|
