25 Tex. Admin. Code § 98.102 - Definitions
The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise.
(1) Applicant--An
individual who applies to the department for THMP services.
(2) Commissioner--The Commissioner of the
Department of State Health Services.
(3) Department--The Department of State
Health Services.
(4) Eligible
health insurance policy--A state, federal, or private health insurance policy
that is approved by the THMP and covers at least one drug from each class of
HIV-antiretroviral medication and covers appropriate primary care
services.
(5) Formulary--A list of
drugs approved by the department that includes at least one drug from each
class of HIV antiretroviral medications.
https://www.dshs.texas.gov/hivstd/meds/files/formulary.pdf.
(6) Full-LIS--Full Low-income subsidy. The
Social Security Administration provides full-LIS to applicants with income and
assets below specified limits.
(7)
HIV--Human immunodeficiency virus. Encompassing all stages of HIV, including
HIV-related conditions and syndromes.
(8) Legally responsible person--A parent,
managing conservator, or other person that is legally responsible for the
support of a minor or a ward.
(9)
Medicare prescription drug plan--A Medicare Part D prescription drug plan or
the prescription drug component of a Medicare Part C Advantage Plan.
(10) Minor--A person who is younger than 18
years of age and who has not been emancipated by a court or who is not married
or recognized as an adult by the state of Texas.
(11) Open enrollment--A time period during
which one may freely enroll in or change one's selection of a health insurance
plan or other benefit plan that is ordinarily subject to
restrictions.
(12) Out-of-pocket
costs--The premium, copay, coinsurance, and deductible amounts that an
individual would be expected to pay when enrolled in a health insurance plan or
Medicare prescription drug plan.
(13) Partial-LIS--Partial Low-income subsidy.
The Social Security Administration provides partial-LIS to applicants with
income and assets above the level of those qualifying for full-LIS, but still
below specified limits.
(14) Payor
of last resort--A funding source that may be used only after all other
available public and private funding sources have been accessed.
(15) Qualifying event--A change of life
circumstance that allows an individual to enroll in or change the selection of
a health insurance plan or other benefit plan outside of open
enrollment.
(16) SPAP--The State
Pharmacy Assistance Program. The SPAP is available to low-income individuals
living with HIV who also have Medicare Part D.
(17) Texas resident--An individual is
considered a Texas resident if that person physically resides in Texas and
intends to continue to reside within the state.
(18) THMP--The Texas HIV Medication Program,
which includes the AIDS Drug Assistance Program (ADAP), SPAP, and
TIAP.
(19) TIAP--Texas Insurance
Assistance Program. TIAP provides premium and copay assistance with eligible
health insurance policies.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.