SECTION 363.602. Definitions

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

(1) Activities of Daily Living (ADL)--Activities that include, but are not limited to, eating, toileting, personal hygiene, dressing, bathing, transferring, positioning, and locomotion or mobility.

(2) Assessment--An evaluation conducted with the recipient and responsible adult to determine the recipient's need for services.

(3) Attendant--A person who provides direct care to a recipient.

(4) Consumer Directed Services (CDS)--A service delivery option in which a recipient or legally authorized representative employs and retains service providers and directs the delivery of program services.

(5) Cueing--Indirect intervention provided during the delivery of personal care services to prompt or instruct a recipient with a cognitive impairment or behavioral condition in the performance of ADLs or IADLs to ensure the recipient performs the task properly.

(6) Delegation--Has the meaning assigned by 22 TAC §225.4 (relating to Definitions).

(7) Dependents--Any member of a household, other than the recipient, whose care and support is the legal responsibility of the responsible adult. A dependent includes a disabled adult family member living in the household. Care and support includes meeting the medical, educational, and psychosocial needs of a dependent.

(8) Early and Periodic Screening, Diagnosis, and Treatment Comprehensive Care Program (EPSDT-CCP)--A mandatory Medicaid program for individuals from birth through 20 years of age who meet certain economic eligibility criteria. In Texas EPSDT-CCP is called the Texas Health Steps Comprehensive Care Program (THSteps-CCP).

(9) Financial Management Services (FMS)--Services delivered by the Financial Management Services Agency to an employer such as orientation, training, support, assistance with and approval of budgets, and processing payroll and payables on behalf of the employer.

(10) Financial Management Services Agency (FMSA)--An entity that is certified by the Department of Aging and Disability Services (DADS) and is contracted with HHSC and/or a Managed Care Organization (MCO) to provide financial management services (FMS).

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

(12) Health Maintenance Activities (HMAs)--Has the meaning assigned by 22 TAC §225.4 (relating to Definitions) and §225.8 (relating to Health Maintenance Activities Not Requiring Delegation).

(13) Home and Community Support Services Agency (HCSSA)--A public or private agency or organization that provides home and community supports and is licensed under 40 TAC Chapter 97 (relating to Licensing Standards for Home and Community Support Services Agencies).

(14) Instrumental Activities of Daily Living (IADLs)--Activities include, but are not limited to, meal preparation, grocery or household shopping, light housework, laundry, telephone use or other communication, escort or assistance with transportation services, medication assistance and, money management.

(15) Intervening--Direct contact or intervention provided by an attendant during the delivery of personal care services to a recipient with a physical or cognitive impairment in the performance of ADLs or IADLs to ensure the task is performed properly.

(16) Legally authorized representative (LAR)--A person authorized or required by law to act on behalf of an individual with regard to a matter described in this chapter, including a parent of a minor, step-parent of a minor, guardian of a minor, managing conservator of a minor, or the guardian of an adult.

(17) Managed Care Organization (MCO)--Has the meaning assigned by 1 TAC §353.2 (relating to Definitions).

(18) Personal Care Services (PCS)--Support services provided to a person eligible for THSteps-CCP services who requires assistance with ADLs or IADLs due to physical, cognitive, or behavioral limitations related to his or her disability or chronic health condition.

(19) Practitioner--A person who is currently licensed in a state in which the person practices as a physician, advanced practice nurse, or physician assistant.

(20) Practitioner's Statement of Need (PSON)--The document certifying that the individual has a physical, cognitive, or behavioral limitation related to a disability or chronic health condition.

(21) Recipient--An individual who is eligible to receive services through the medical assistance program.

(22) Redirecting--Intervention provided during the delivery of PCS to divert, change direction, or give new direction to a recipient with a cognitive or behavioral impairment in the performance of ADLs or IADLs to ensure the recipient completes the task.

(23) Responsible Adult--An individual, age 18 or older, who has agreed to accept responsibility for providing food, shelter, clothing, education, nurturing, and supervision for the recipient. The term includes biological parents, adoptive parents, step-parents, foster parents, legal guardians, court-appointed managing conservators or the primary adult who is acting in the role of parent.

(24) Texas Health Steps Comprehensive Care Program (THSteps-CCP)--Medical, dental, and treatment services available as a federally mandated service for eligible EPSDT Medicaid recipients in Texas under the age of 21 years, pursuant to the EPSDT provision of Title XIX of the Social Security Act, 42 U.S.C. §1396d(r) and the Code of Federal Regulations, Title 42, §440.40(b).

Source Note: The provisions of this §363.602 adopted to be effective September 1, 2014, 39 TexReg 5890