Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 98 - TEXAS HIV MEDICATION PROGRAM › Subchapter C - TEXAS HIV MEDICATION PROGRAM › Division 1 - GENERAL PROVISIONS › Section 98.102 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this
						subchapter, shall have the following meanings, unless the context clearly
						indicates otherwise.
(1) Applicant--An
					 individual who applies to the department for THMP services.
(2) Commissioner--The Commissioner of the
					 Department of State Health Services.
(3) Department--The Department of State
					 Health Services.
(4) Eligible
					 health insurance policy--A state, federal, or private health insurance policy
					 that is approved by the THMP and covers at least one drug from each class of
					 HIV-antiretroviral medication and covers appropriate primary care
					 services.
(5) Formulary--A list of
					 drugs approved by the department that includes at least one drug from each
					 class of HIV antiretroviral medications.
https://www.dshs.texas.gov/hivstd/meds/files/formulary.pdf
.
(6) Full-LIS--Full Low-income subsidy. The
					 Social Security Administration provides full-LIS to applicants with income and
					 assets below specified limits.
(7)
					 HIV--Human immunodeficiency virus. Encompassing all stages of HIV, including
					 HIV-related conditions and syndromes.
(8) Legally responsible person--A parent,
					 managing conservator, or other person that is legally responsible for the
					 support of a minor or a ward.
(9)
					 Medicare prescription drug plan--A Medicare Part D prescription drug plan or
					 the prescription drug component of a Medicare Part C Advantage Plan.
(10) Minor--A person who is younger than 18
					 years of age and who has not been emancipated by a court or who is not married
					 or recognized as an adult by the state of Texas.
(11) Open enrollment--A time period during
					 which one may freely enroll in or change one's selection of a health insurance
					 plan or other benefit plan that is ordinarily subject to
					 restrictions.
(12) Out-of-pocket
					 costs--The premium, copay, coinsurance, and deductible amounts that an
					 individual would be expected to pay when enrolled in a health insurance plan or
					 Medicare prescription drug plan.
(13) Partial-LIS--Partial Low-income subsidy.
					 The Social Security Administration provides partial-LIS to applicants with
					 income and assets above the level of those qualifying for full-LIS, but still
					 below specified limits.
(14) Payor
					 of last resort--A funding source that may be used only after all other
					 available public and private funding sources have been accessed.
(15) Qualifying event--A change of life
					 circumstance that allows an individual to enroll in or change the selection of
					 a health insurance plan or other benefit plan outside of open
					 enrollment.
(16) SPAP--The State
					 Pharmacy Assistance Program. The SPAP is available to low-income individuals
					 living with HIV who also have Medicare Part D.
(17) Texas resident--An individual is
					 considered a Texas resident if that person physically resides in Texas and
					 intends to continue to reside within the state.
(18) THMP--The Texas HIV Medication Program,
					 which includes the AIDS Drug Assistance Program (ADAP), SPAP, and
					 TIAP.
(19) TIAP--Texas Insurance
					 Assistance Program. TIAP provides premium and copay assistance with eligible
					 health insurance policies.