SECTION 364.3. Definitions

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

(1) Act--The Texas Primary Health Care Services Act, Health and Safety Code, Chapter 31.

(2) Applicant--An individual and/or family applying to receive primary health care services.

(3) Commission--The Texas Health and Human Services Commission.

(4) Commissioner--The Commissioner of Health.

(5) Department--The Department of State Health Services.

(6) Eligible individual--An eligible recipient of primary health care services under the Act.

(7) Other benefit--A benefit, other than a benefit provided under the Act, to which an individual is entitled for payment of the costs of primary health care services, including:

(A) benefits available from:

(i) an insurance policy, group health plan, or prepaid medical care plan;

(ii) Title XVIII or Title XIX of the Social Security Act;

(iii) the Veterans Administration;

(iv) the Civilian Health and Medical Program of the Uniformed Services; and

(v) workers compensation or any other compulsory employer's insurance program.

(B) a public program created by federal or state law, or by an ordinance or rule of a municipality or political subdivision of the state, except those benefits created by the establishment of a city or county hospital, a joint city-county hospital, a county hospital authority, a hospital district, or by the facilities of a publicly supported medical school; or

(C) benefits resulting from a cause of action for medical, facility, or medical transportation expenses, or a settlement or judgment based on the cause of action, if the expenses are related to the need for services provided by the Act.

(8) Primary Health Care Services--May include the following:

(A) diagnosis and treatment;

(B) emergency medical services;

(C) family planning services;

(D) preventive health services;

(E) health education;

(F) laboratory, x-ray, nuclear medicine, or other appropriate diagnostic services;

(G) nutrition services;

(H) health screening;

(I) home health care;

(J) dental care;

(K) transportation;

(L) prescription drugs and devices and durable supplies;

(M) environmental health services;

(N) podiatry services; and

(O) social services.

(9) Program--The primary health care services program created by the Act.

(10) Provider--An entity that, through a grant or a contract with the department, delivers primary health care services that are purchased by the department for the purposes of the Act.

(11) Recipient--An individual receiving primary health care services under the Act.

(12) Request for proposal--A solicitation providing guidance and instructions issued by the department to entities interested in submitting applications to provide primary health care services under the Act.

(13) Services--Primary health care services.

(14) Texas resident--An individual who is physically present within the geographic boundaries of the state, and who:

(A) intends to remain within the state, whether permanently or for an indefinite period;

(B) does not claim residency in any other state or country;

(C) is under 18 years of age, and at least one of his/her parents, managing conservator, or guardian is a bona fide resident of Texas;

(D) is a person residing in Texas and his/her legally dependent spouse is a bona fide resident of Texas; or

(E) is an adult residing in Texas whose legal guardian is a bona fide resident of Texas.

Source Note: The provisions of this §364.3 adopted to be effective May 28, 2006, 31 TexReg 4218; amended to be effective February 14, 2013, 38 TexReg 645; amended to be effective September 1, 2013, 38 TexReg 5505; transferred effective March 1, 2022, as published in the Texas Register February 11, 2022, 47 TexReg 674