SECTION 33.2. Definitions

The following words or terms, when used in this chapter, have the following meanings unless the context clearly indicates otherwise:

(1) Authorized adult--A person, including an adult related to the child, who is authorized by a child's parent or guardian to accompany that child to a THSteps medical or dental check-up or treatment visit.

(2) Client--Any individual under the age of 21 who has been determined eligible for Medicaid.

(3) Department--Department of State Health Services.

(4) EPSDT--Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) is a mandatory program under Medicaid that provides medical and dental check-ups, diagnosis, and treatment to eligible clients from birth through age 20. EPSDT is known in Texas as Texas Health Steps (THSteps).

(5) Guardian--An individual legally authorized to make decisions, including medical consent, on behalf of a minor.

(6) HHSC--Health and Human Services Commission.

(7) Medicaid--The medical assistance program implemented by the State of Texas under the provisions of Title XIX of the Social Security Act, as amended, at 42 USC, §1396, et seq.

(8) Medically necessary--Medical services that are supported by documentation which show the services are:

(A) reasonable and necessary to prevent illness, medical or dental conditions, or provide early screening, interventions, and/or treatments for conditions that cause suffering or pain, cause physical deformity or limitations in function, threaten to cause or worsen a disability, cause illness or infirmity of a client, or endanger life;

(B) consistent with health care practice guidelines and standards that are issued by professionally recognized health care organizations or governmental agencies;

(C) consistent with the diagnoses of the conditions;

(D) no more intrusive or restrictive than necessary to provide a proper balance of safety, effectiveness, and efficiency;

(E) not experimental or investigative; and

(F) not primarily for the convenience of the client or provider.

(9) OIG--Office of Investigator General at the Health and Human Services Commission.

(10) THSteps--Texas Health Steps (THSteps) is the Texas name for the federally-mandated Medicaid program known as EPSDT.

(11) TMPPM--Texas Medicaid Provider Procedures Manual.

(12) TSBDE--The Texas State Board of Dental Examiners.

Source Note: The provisions of this §33.2 adopted to be effective February 28, 2008, 33 TexReg 1550