26 Tex. Admin. Code § 301.505 - Definitions
The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise.
(1) Ability to pay--The
person has third-party coverage that will pay for needed services, the person's
maximum monthly fee is greater than zero, or the person has identified payment
for a needed service or services in an approved plan utilizing Social Security
work incentive provisions (i.e., Plan to Achieve Self-Sufficiency;
Impairment Related Work Expense).
(2) Community services or services--Except
for residential services, eligibility determination, and screening, the
required and optional mental retardation services described in the performance
contract.
(3) DADS--The Department
of Aging and Disability Services.
(4) Extraordinary expenses--Major medical or
health related expenses, major casualty losses, and child care expenses for the
previous year or projections for the next year.
(5) Family members--
(A) For an unmarried person under age 18
years--The person, the person's parents, and the dependents of the parents, if
residing in the same household;
(B)
For an unmarried person age 18 years or older--The person and the person's
dependents; or
(C) For a married
person of any age--The person, the person's spouse, and their
dependents.
(6) Gross
income--Revenue from all sources before taxes and other payroll deductions. The
term does not include child support received.
(7) Inability to pay--The person's maximum
monthly fee is zero and the person:
(A) does
not have third-party coverage;
(B)
has third-party coverage, but has exceeded the maximum benefit of the covered
service(s) or the third-party coverage will not pay because the services needed
by the person are not covered services; or
(C) has not identified payment for a needed
service or services in an approved plan utilizing Social Security work
incentive provisions (i.e., Plan to Achieve Self-Sufficiency;
Impairment Related Work Expense).
(8) Income-based public insurance--Government
funded third-party coverage that bases eligibility on income (i.e., CHIP and
Medicaid).
(9) MMF--Maximum monthly
fee. A fee that is calculated in accordance with § 2.106(b) of this
chapter (relating to Determination of Ability to Pay).
(10) MRA--Mental retardation authority. An
entity to which the Health and Human Services Commission's authority and
responsibility described in Texas Health and Safety Code, §
531.002(11)
have been delegated.
(11) MR
priority population--Groups of persons identified in the Health and Human
Services Commission's current strategic plan as being most in need of mental
retardation services.
(12)
Parent--A biological or adoptive parent of a person under age 18
years.
(13) Performance contract--A
written agreement between DADS and an MRA for the provision of one or more
functions as described in Texas Health and Safety Code, §
533.035(a).
(14) Person--A person in the MR priority
population who is seeking or receiving services through an MRA.
(15) Significant financial change--Any change
in the person's (or parent's) financial status as shown in the financial
documentation, as described in § 2.105(d) of this subchapter (relating to
Accountability), that affects the person's (or parent's) ability to pay.
Examples of a significant financial change are:
(A) a reduction in income due to the loss of
a job or due to a reduction in hours worked on a job;
(B) an increase in income because of an
inheritance or a salary increase;
(C) an increase or decrease in the number of
family members;
(D) the gain or
loss of third-party coverage; and
(E) an increase or decrease in extraordinary
expenses.
(16) Standard
charge--A fixed price for a community service or unit of service.
(17) Team--A person's service planning
team.
(18) Third-party coverage--A
public or private payer of community services (e.g., Medicaid, Medicare,
private insurance, CHIP, TRICARE).
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.