1 Tex. Admin. Code § 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 C.F.R.
484.80.
(5) Home health aide services--Services which
can be provided by a qualified home health aide, including those listed in
42 C.F.R.
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 C.F.R.
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
C.F.R. 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.
Notes
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