Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 363 - TEXAS HEALTH STEPS COMPREHENSIVE CARE PROGRAM › Subchapter C - PRIVATE DUTY NURSING SERVICES › Section 363.303 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms apply only to this subchapter
					 and have the following meanings, unless the context clearly indicates
					 otherwise.
(1) Contractor--The entity
				  with which HHSC contracts, pursuant to the requirements of the Code of Federal
				  Regulations, Title 42, Part 434.
(2) Correct or ameliorate--To improve,
				  maintain, or slow the deterioration of the recipient's health status.
(3) Day--A calendar day.
(4) Early and Periodic Screening, Diagnosis,
				  and Treatment (EPSDT)--The child and adolescent health component of the
				  Medicaid program for recipients under 21 years of age, defined in the United
				  States Code, Title 42, §1396d(r), and the Code of Federal Regulations,
				  Title 42, §440.40(b). EPSDT means screening, vision, dental, hearing,
				  laboratory, health care, treatment, diagnostic services, and other measures
				  necessary to correct or ameliorate defects and physical and mental illnesses
				  and conditions.
(5) Federal
				  financial participation (FFP)--The federal government's share of a Medicaid
				  expenditure made by a state agency, as defined in the Code of Federal
				  Regulations, Title 45, §95.4.
(6) HHSC--The Texas Health and Human Services
				  Commission or its designee, including a contractor or MCO.
(7) Home and Community Support Services
				  Agency (HCSSA)--A public or private agency or organization licensed by the
				  Texas Department of Aging and Disability Services under 40 TAC Chapter 97
				  (relating to Licensing Standards for Home and Community Support Services
				  Agencies).
(8) Identified
				  contingency plan--A structured process, developed by the recipient or the
				  responsible adult and the Medicaid-enrolled provider, by which a recipient will
				  receive care when a scheduled health care provider is unexpectedly unavailable,
				  as required by 40 TAC §
										RSA
				  97.290(relating to Backup Services and After
				  Hours Care).
(9) Licensed
				  Vocational Nurse (LVN)--An individual who is recognized by the Texas Board of
				  Nursing to practice vocational nursing in Texas at the time and place the
				  service is provided, pursuant to Texas Occupations Code §
										RSA
				  301.002(5) and
				  22 TAC, Part 11 (relating to Texas Board of Nursing).
(10) Medicaid--The Texas Medical Assistance
				  Program, a joint federal and state program provided for in Chapter 32, Texas
				  Human Resources Code, and subject to Title XIX of the Social Security Act, 42
				  U.S.C. §1396 et seq.
(11)
				  Medicaid managed care organization (MCO)--Any entity with which HHSC contracts
				  to provide Medicaid managed care services and that complies with Chapter 353 of
				  this title (relating to Medicaid Managed Care).
(12) Medical Director--HHSC's, its
				  contractor's, or MCO's medical director or associate medical
				  director.
(13) Notice--A letter
				  provided by HHSC, its contractor, or MCO to a recipient informing the recipient
				  of any reduction, denial, or termination of a requested service, as described
				  in the Code of Federal Regulations, Title 42, §431.206 and
				  §431.210.
(14) Physician--A
				  doctor of medicine (MD) or osteopathy (DO) who is licensed in the state in
				  which they practice.
(15) Private
				  duty nursing (PDN) Services--Nursing, described by the Texas Occupations Code
				  Chapter 301, and its implementing regulations at 22 TAC, Part 11 (relating to
				  Texas Board of Nursing), when the recipient requires more individual and
				  continuous care than is available from a visiting nurse or than is routinely
				  provided by the nursing staff of a hospital or skilled nursing facility. PDN
				  services include observation, assessment, intervention, evaluation,
				  rehabilitation, care and counsel, or health teachings of a recipient who has a
				  disability or chronic health condition or who is experiencing a change in
				  normal health processes.
(16)
				  Private duty nursing services provider--An independently practicing registered
				  nurse, a licensed vocational nurse (LVN) under the supervision of a registered
				  nurse, or a home and community support services agency (HCSSA) enrolled in the
				  Texas Medicaid Program to provide private duty nursing services.
(17) Qualified Aide--An aide providing
				  services consistent with the requirements of:
(A) 40 TAC Chapter 94 (relating to Nurse
				  Aides);
(B) 40 TAC Chapter 95
				  (relating to Medication Aides--Program Requirements); or
(C) home health aide outlined in 40 TAC
				  Chapter 97 (relating to Licensing Standards for Home and Community Support
				  Services Agencies).