SECTION 354.1031. General

(a) Purpose. The purpose of this division is to establish rules for the Title XIX (Medicaid) home health services benefit.

(b) Definitions. The following words and terms when used in this division, have the following meanings, unless the context clearly indicates otherwise.

(1) Allowed practitioner--An individual:

(A) that maintains a valid and registered prescriptive authority agreement in accordance with Texas Occupations Code, Chapter 157, Subchapter B; and

(B) is licensed as:

(i) a physician assistant under Texas Occupations Code, Chapter 204; or

(ii) an advanced practice registered nurse licensed by the Texas Board of Nursing as a:

(I) certified nurse practitioner; or

(II) clinical nurse specialist.

(2) Durable medical equipment (DME)--Equipment and appliances that are primarily and customarily used to serve a medical purpose, generally are not useful to an individual in the absence of a disability, illness or injury, can withstand repeated use, and can be reusable or removable.

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

(4) Home health aide--An individual who meets the Medicare home health agency personnel qualifications and training requirements established for home health aides in 42 CFR §484.80.

(5) Home health aide services--Services which can be provided by a qualified home health aide, including those listed in 42 CFR §484.80.

(6) Home health agency--A public or private agency or organization, licensed by the State of Texas to provide home health services and qualified to participate as a Medicare home health agency under 42 CFR, Part 484, Subparts A - C (relating to Home Health Services).

(7) Home health services--Covered services, DME and supplies which are provided to a qualified Medicaid recipient at the recipient's place of residence by home health agency staff or providers of DME and supplies under 42 CFR §440.70 and §354.1037 of this division (relating to Written Plan of Care) and §354.1039 of this division (relating to Benefits and Limitations of Home Health Services).

(8) Intermittent--Home health aide or skilled nursing services provided less than on a daily basis, less than eight hours per day.

(9) Part-time--Home health aide or skilled nursing services provided any number of days per week, less than eight hours per day.

(10) Plan of care--A written regimen established and periodically reviewed by a physician or an allowed practitioner in consultation with home health agency staff, which meets the plan of care standards at 42 CFR §484.60 and §354.1037 of this division.

(11) Supplies--Health care related items that are required to address an individual's medical disability, illness, or injury and are:

(A) consumable or disposable; or

(B) cannot withstand repeated use by more than one individual.

Source Note: The provisions of this §354.1031 adopted to be effective June 26, 1997, 22 TexReg 5826; transferred effective September 1, 2001, as published in the Texas Register May 24, 2002, 27 TexReg 4561; amended to be effective November 14, 2002, 27 TexReg 10588; amended to be effective September 21, 2022, 47 TexReg 5779