Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter L - QUALITY IMPROVEMENT PROCESS FOR CLINICAL INITIATIVES › Section 354.2501 - 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) Advisory
				  committee--In this subchapter, refers to an existing advisory committee that
				  provides guidance to the HHSC executive commissioner and the agency on matters
				  related to the Medicaid program and any quality-related issue and
				  policy.
(2) Authorized submitter--A
				  member of the state legislature; the executive commissioner of HHSC;
				  commissioners of DADS, DARS, DFPS, and DSHS; and chairs of the Medical Care
				  Advisory Committee, the Physician Payment Advisory Committee, and the
				  Electronic Health Information Exchange System Advisory Committee may submit
				  suggestions of clinical initiatives.
(3) Children's Health Insurance Program
				  (CHIP)--The Texas State CHIP that is established under Title XXI of the federal
				  Social Security Act (RSA
				  1397aa, et seq.) and Chapter 62 of the Health
				  and Safety Code.
(4) Clinical
				  initiative--Any effort, project, intervention, or best practice currently being
				  explored, tested, or examined to improve the quality of care for recipients of
				  health care services provided by public or private insurers that can
				  potentially be implemented under the Medicaid program.
(5) Approved clinical initiative--Suggested
				  clinical initiative that has met preliminary review criteria and been
				  determined to warrant further analysis.
(6) Clinical trial--A clinical trial is a
				  type of research study conducted in the clinical setting that follows a
				  pre-determined plan or protocol that compares one treatment against another.
				  The treatment can be a new drug, a new invasive medical device, or care
				  protocol on human subjects.
(7)
				  Department of Aging and Disability Services (DADS)--The HHS agency that
				  administers long-term services and supports for people who are aging and for
				  people with intellectual and physical disabilities. DADS also licenses and
				  regulates providers of these services and administers the state's Guardianship
				  program.
(8) Department of
				  Assistive and Rehabilitation Services (DARS)--The HHS agency that administers
				  programs for people with disabilities and children who have developmental
				  delays.
(9) Department of Family
				  Protective Services (DFPS)--The HHS agency that works with communities to
				  protect children, the elderly, and people with disabilities from abuse,
				  neglect, and exploitation. It also works to protect the health and safety of
				  children in daycare, as well as foster care and other types of 24-hour care.
				  The agency conducts investigations, provides services and referrals, enforces
				  regulation, and provides prevention programs.
(10) Department of State Health Services
				  (DSHS)--The HHS agency that is the state's designated public health
				  agency.
(11) Electronic Health
				  Information Exchange System Advisory Committee--The committee established under
				  § 531.904, Human Resources Code.
(12) Full analysis--A complete analysis of a
				  suggestion for a clinical initiative that has met all preliminary review
				  criteria. The analysis is conducted to determine whether the clinical
				  initiative will improve quality of care under Medicaid and is cost-effective to
				  the state. The analysis includes all elements described under Analysis of
				  Clinical Initiative.
(13) Texas
				  Health and Human Services Commission (HHSC)--The single state agency that
				  administers and oversees the Texas Medicaid program. HHSC is established by and
				  its authority is described in Chapter 531 of the Texas Government
				  Code.
(14) Institution of higher
				  education--As defined by §
										RSA
				  61.003, Education Code, is any public
				  technical institute, public junior college, public senior college or
				  university, medical or dental unit, public state college, or other agency of
				  higher education as defined in this section.
(15) Internet website--HHSC designated
				  website related to the quality improvement process required under this
				  subchapter.
(16) Medicaid--The
				  medical assistance program authorized and funded pursuant to Title XIX of the
				  Social Security Act (RSA
				  1396 et seq) and administered by
				  HHSC.
(17) Medical Care Advisory
				  Committee--The committee established under the authority of Title XIX of the
				  Social Security Act,
				  RSA
				  431.12, and § 32.022, Human Resource
				  Code.
(18) Medicare--A federal
				  system of health insurance for people over 65 years of age and for certain
				  people younger than 65 years of age who have disabilities.
(19) Physician Payment Advisory
				  Committee--The committee created under §
										RSA
				  32.022(d), Human Resources
				  Code.
(20) Preliminary review--An
				  administrative process that determines whether a suggestion for a clinical
				  initiative warrants a full analysis.
(21) Quality improvement--A system to
				  continuously examine, monitor, and revise processes and systems that support
				  and improve administrative and clinical functions.
(22) State-operated health care programs--In
				  this subchapter, refers to programs that are funded solely through state
				  general funds and operated and administered under state laws and
				  rules.
(23) Suggestions--Proposed
				  clinical initiatives submitted by authorized individuals either in written or
				  electronic form.