SECTION 373.105. Definitions

For the purposes of this chapter, the following words and terms have the following meanings, unless the context clearly indicates otherwise:

(1) Applied for Covered Medicaid Long-Term Care Services--An individual or his or her representative files an application, a nursing facility submits an admission notice and medical necessity determination, or an individual elects Medicaid waiver services, which results in a covered service being approved under Medicaid.

(2) Claim--A right to recover the total amount of Medicaid assistance paid for the following services: nursing facility; Intermediate Care Facility for the Mentally Retarded (ICF-MR); Home and Community-Based Services (§1915(c), SSA) and Community Attendant Services (§1929(b), SSA); and all related hospital and prescription drug services, provided from the time the decedent was 55 years of age or older.

(3) Cost-effective--Economical to the extent that the amount reasonably expected to be recovered by the Medicaid Estate Recovery Program exceeds the cost of recovery by the program as provided in this chapter.

(4) Decedent--A deceased individual who was 55 years of age or older at the time that covered Medicaid long-term care assistance was received.

(5) Effective date--March 1, 2005, the date on which these rules take effect under §2001.036, Government Code.

(6) Estate--The real and personal property of a decedent, both as such property originally existed and as from time to time changed in form by sale, reinvestment, or otherwise, and as augmented by any accretions and additions and substitutions that are included in the definition of the probate estate found in §3(l), Definitions and Use of Terms, Texas Probate Code.

(7) Federal Poverty Level--Income guidelines established annually by the federal government.

(8) Heirs--Those persons, including the surviving spouse, who are entitled under the statutes of descent and distribution to the estate of a decedent who dies intestate, as defined in §3(o), Definitions and Use of Terms, Texas Probate Code.

(9) Intestate--To die without leaving a valid will.

(10) Legatee--Any person entitled to a legacy under a will, as defined in §3(s), Definitions and Use of Terms, Texas Probate Code.

(11) MERP--The Medicaid Estate Recovery Program.

(12) Personal Representative--Includes executor, independent executor, administrator, temporary administrator, together with their successors as defined in §3(aa), Definitions and Use of Terms, Texas Probate Code.

(13) Recipient--An individual who received covered long-term care Medicaid services on or after the effective date of these rules.

(14) Value of real property--Property value determined by current year tax appraisal district.

Source Note: The provisions of this §373.105 adopted to be effective March 1, 2005, 30 TexReg 830