Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 373 - MEDICAID ESTATE RECOVERY PROGRAM › Subchapter A - GENERAL › Section 373.105 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
For the purposes of this chapter, the following words and
					 terms have the following meanings, unless the context clearly indicates
					 otherwise:
(1) Applied for Covered
				  Medicaid Long-Term Care Services--An individual or his or her representative
				  files an application, a nursing facility submits an admission notice and
				  medical necessity determination, or an individual elects Medicaid waiver
				  services, which results in a covered service being approved under
				  Medicaid.
(2) Claim--A right to
				  recover the total amount of Medicaid assistance paid for the following
				  services: nursing facility; Intermediate Care Facility for the Mentally
				  Retarded (ICF-MR); Home and Community-Based Services (§1915(c), SSA) and
				  Community Attendant Services (§1929(b), SSA); and all related hospital and
				  prescription drug services, provided from the time the decedent was 55 years of
				  age or older.
(3)
				  Cost-effective--Economical to the extent that the amount reasonably expected to
				  be recovered by the Medicaid Estate Recovery Program exceeds the cost of
				  recovery by the program as provided in this chapter.
(4) Decedent--A deceased individual who was
				  55 years of age or older at the time that covered Medicaid long-term care
				  assistance was received.
(5)
				  Effective date--March 1, 2005, the date on which these rules take effect under
				  §
										RSA
				  2001.036, Government Code.
(6) Estate--The real and personal property of
				  a decedent, both as such property originally existed and as from time to time
				  changed in form by sale, reinvestment, or otherwise, and as augmented by any
				  accretions and additions and substitutions that are included in the definition
				  of the probate estate found in §3(l), Definitions and Use of Terms, Texas
				  Probate Code.
(7) Federal Poverty
				  Level--Income guidelines established annually by the federal
				  government.
(8) Heirs--Those
				  persons, including the surviving spouse, who are entitled under the statutes of
				  descent and distribution to the estate of a decedent who dies intestate, as
				  defined in §3(o), Definitions and Use of Terms, Texas Probate
				  Code.
(9) Intestate--To die without
				  leaving a valid will.
(10)
				  Legatee--Any person entitled to a legacy under a will, as defined in
				  §3(s), Definitions and Use of Terms, Texas Probate Code.
(11) MERP--The Medicaid Estate Recovery
				  Program.
(12) Personal
				  Representative--Includes executor, independent executor, administrator,
				  temporary administrator, together with their successors as defined in
				  §3(aa), Definitions and Use of Terms, Texas Probate Code.
(13) Recipient--An individual who received
				  covered long-term care Medicaid services on or after the effective date of
				  these rules.
(14) Value of real
				  property--Property value determined by current year tax appraisal
				  district.