Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 350 - EARLY CHILDHOOD INTERVENTION SERVICES › Subchapter N - FAMILY COST SHARE SYSTEM › Section 350.1405 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this
					 subchapter, will have the following meanings, unless the context clearly
					 indicates otherwise.
(1) Ability to
				  Pay--The determination that the family is financially able to pay
				  out-of-pocket, for their child's early childhood intervention
				  services.
(2) Adjusted Income--The
				  dollar amount equal to the family's annual gross income minus their allowable
				  deductions. The contractor uses adjusted income to determine the family's
				  ability to pay and to calculate the family's maximum charge.
(3) Allowable Deductions--Certain
				  unreimbursed family expenses that are subtracted from the family's gross income
				  to calculate their adjusted income.
(4) CHIP--The Children's Health Insurance
				  Program (CHIP) administered by HHSC .
(5) Dependent--Any person who meets the
				  definition of
				  26 USC §
											152 Dependent Defined.
(6) Family Cost Share System--The system of
				  collecting reimbursement for early childhood intervention services from public
				  insurance, private insurance, and out-of-pocket payments from
				  families.
(7) Family size--The
				  total number of people in the family, including the child's parents who live in
				  the home, the child, and other dependents of the parent. Other dependents do
				  not have to live in the home, but they must be financially dependent upon the
				  parent.
(8) Federal Poverty
				  Guidelines--The poverty guidelines updated periodically in the Federal Register
				  by the United States Department of Health and Human Services under the
				  authority of
				  42
				  USC §
											9902(2).
(9) Gross Income--All income received by the
				  family considered income by the Internal Revenue Service before federal
				  allowable deductions are applied.
(10) Inability to Pay--The determination that
				  the family is financially unable to make out-of-pocket payments because the
				  family has an adjusted income at or below 100% of the federal poverty
				  level.
(11) Maximum Charge--The
				  maximum out-of-pocket amount the contractor can charge the family for services
				  delivered in one calendar month.
(12) Out-of-Pocket--Payment received from the
				  family to pay for their child's early childhood intervention services. This
				  includes insurance co-pays, co-insurance, and deductibles as well as payment
				  for services not covered by the family's insurance.
(13) Sliding Fee Scale--The HHSC-developed
				  scale of maximum charges that is based on the federal poverty
				  guidelines.
(14) Third-Party
				  Payor--A company, organization, insurer, or government agency that makes
				  payments for the early childhood intervention services received by a child and
				  family. Third-party payors include commercial insurance companies, HMOs, PPOs,
				  and public insurance such as Medicaid, CHIP, and TRICARE.
(15) TRICARE--The U.S. Department of Defense
				  health care entitlement for active duty, Guard and Reserve, retired members of
				  the military, and their eligible family members and survivors.