26 Tex. Admin. Code § 87.3 - Definitions

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

(1) AMH--Adult Mental Health program. The home and community-based services adult mental health program, operated under a Texas Medicaid state plan amendment and 26 Texas Administrative Code Chapter 307, Subchapter B (relating to Home and Community-Based Services--Adult Mental Health Program).

(2) Compact with Texans--A document that describes the Texas Health and Human Services Commission's services, principles, and process for filing complaints and requesting information.

(3) Complaint--Any expression of dissatisfaction by a consumer of an HHS program or service about HHS benefits or services. Complaints do not include the following, which are handled through other processes:

(A) allegations of abuse, neglect, or exploitation;

(B) allegations of discrimination or other civil rights violations;

(C) allegations of fraud, waste, or abuse;

(D) requests for Fair Hearings or administrative appeals; or

(E) concerns about regulated individuals and entities.

(4) Consumer--An applicant or a client of HHS programs, as well as a member of the public seeking information about HHS programs.

(5) Contact--A written or oral inquiry or complaint from a consumer, individual, or LAR about HHS programs or services.

(6) DFPS--Texas Department of Family and Protective Services. The state agency established by Texas Human Resources Code Chapter 40 and responsible for administration of Child Protective Services.

(7) Dispute resolution services--An independent and impartial review of a program's actions regarding an HHS consumer complaint that has not been resolved to the consumer's satisfaction.

(8) FCO--Foster Care Ombudsman. The Ombudsman for Children and Youth in Foster Care.

(9) HCS--The Home and Community-based Services Program. A program operated by HHSC in accordance with §1915(c) of the Social Security Act.

(10) Health care provider--A physician, pharmacist, or other licensed provider who is authorized under state law to provide health care services, or a credentialed professional who provides behavioral health, mental health, or substance use disorder services.

(11) HHS--Texas Health and Human Services. The system for providing or otherwise administering health and human services in this state established in Texas Government Code Chapter 521, comprised of HHSC and the Texas Department of State Health Services.

(12) HHSC--Texas Health and Human Services Commission. The agency established by Texas Government Code Chapter 523.

(13) IDD--Intellectual or developmental disability.

(14) IDDO--The Ombudsman for individuals with an intellectual or developmental disability.

(15) Individual--A person seeking or receiving IDD services.

(16) Inquiry--A request by a consumer, individual, or LAR for information about HHS programs or services.

(17) LAR--Legally authorized representative. A person legally authorized to act on behalf of an individual with regard to a matter described in this chapter, and may include a parent, guardian, or managing conservator of a minor, or the guardian of an adult.

(18) LBHA--Local behavioral health authority. An entity designated as the local behavioral health authority in accordance with Texas Health and Safety Code § 533.0356(a).

(19) LIDDA--Local intellectual and developmental disability authority. An entity designated as the local intellectual and developmental disability authority in accordance with Texas Health and Safety Code § 533A.035(a).

(20) LMHA--Local mental health authority. An entity designated as the local mental health authority in accordance with Texas Health and Safety Code § 533.035(a).

(21) MCO--Managed care organization. An entity contracted with HHSC to provide health care services in a Medicaid managed care program.

(22) OBH--Ombudsman for Behavioral Health Access to Care.

(23) OO--Office of the Ombudsman. The HHSC office with authority and responsibility over the HHS system in performing ombudsman functions.

(24) Ombudsman program--An ombudsman program administered by HHSC as established by Texas Government Code § 531.9912.

(25) OMCAT--Ombudsman Managed Care Assistance Team.

(26) Parity--The requirement outlined in Texas Insurance Code, Chapter 1355, Subchapter F that a health benefit plan provide benefits and coverage for mental health conditions and substance use disorders under the same terms and conditions applicable to the plan's medical and surgical benefits and coverage.

(27) Program provider--A person who has a contract with HHSC to provide HCS or TxHmL services.

(28) Retaliation--A harmful action taken because of, or substantially motivated by, reprisal or revenge in response to a legally protected activity, such as making a good faith complaint.

(29) State hospital--A state mental health facility operated by HHSC.

(30) Substantiated complaint--A complaint for which research clearly indicates HHS policy was violated or HHS expectations were not met.

(31) TxHmL--The Texas Home Living Program. A program operated by HHSC in accordance with §1915(c) of the Social Security Act.

(32) Unable to substantiate a complaint--A complaint for which research does not clearly indicate if HHS policy was violated or HHS expectations were met or not met.

(33) Unsubstantiated complaint--A complaint for which research clearly indicates HHS policy was not violated or HHS expectations were met.

(34) Youth--Children and youth in the conservatorship of DFPS, which ends at age 18.

Notes

26 Tex. Admin. Code § 87.3

Adopted by Texas Register, Volume 50, Number 13, March 28, 2025, TexReg 2203, eff. 4/3/2025