Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 353 - MEDICAID MANAGED CARE › Subchapter R - TELECOMMUNICATIONS IN MANAGED CARE SERVICE COORDINATION AND ASSESSMENTS › Section 353.1502 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this
					 subchapter, have the following meanings unless the context clearly indicates
					 otherwise.
(1) Assessments--Managed
				  care organization (MCO) evaluation of a member's medical and functional service
				  needs, including community-based long-term services and supports, behavioral
				  health services, therapies (e.g., physical, occupational, speech), and nursing
				  services. This includes the MCO's completion of program-specific instruments
				  and forms.
(2) Audio-only--An
				  interactive, two-way audio communication that uses only sound and that meets
				  the privacy requirements of the Health Insurance Portability and Accountability
				  Act. Audio-only includes the use of telephonic communication. Audio-only does
				  not include face-to-face communication.
(3) Audio-visual--Interactive, two-way audio
				  and video communication that conforms to privacy requirements under the Health
				  Insurance Portability and Accountability Act. Audio-visual does not include
				  audio-only or in-person communication.
(4) C.F.R.--Code of Federal
				  Regulations.
(5) Change in
				  condition--A significant change in a member's health, caregiver support, or
				  functional status that will not normally resolve itself without further
				  intervention and requires review of and revision to the member's current
				  service plan or individual service plan.
(6) Community-based long-term services and
				  supports (LTSS)--Services provided to a qualified member in their home or
				  another community-based setting necessary to allow the member to remain in the
				  most integrated setting possible. Community-based LTSS includes Medicaid state
				  plan services available to all members, as well as services available to
				  members who qualify for the Home and Community Based Services (HCBS) Program or
				  Medicaid 1915(c ) waiver programs, including the STAR+PLUS Home and
				  Community-Based Services (HCBS) Program and the Medically Dependent Children
				  Program. Community-based LTSS is available to both HCBS -eligible and non-HCBS
				  eligible members. Community-based LTSS in Medicaid managed care varies by
				  program model.
(7) Community First
				  Choice (CFC)--A Medicaid state plan benefit described in 1 TAC Chapter 354,
				  Subchapter A, Division 27 (relating to Community First Choice).
(8) Covered services--Unless a service or
				  item is specifically excluded under the terms of the state plan, a federal
				  waiver, a managed care services contract, or an amendment to any of these, the
				  phrase "covered services" means all health care, long term services and
				  supports, nonemergency medical transportation services, or dental services or
				  items that the MCO must arrange to provide and pay for on a member's behalf
				  under the terms of the contract executed between the MCO and the Texas Health
				  and Human Services Commission, including:
(A)
				  all services or items comprising "medical assistance" as defined in Human
				  Resources Code §
											32.003;
				  and
(B) all value-added services
				  under such contract.