Section 301.505 - DefinitionsThe following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise.
(1) Ability to pay--The person has third-party coverage that will pay for needed services, the person's maximum monthly fee is greater than zero, or the person has identified payment for a needed service or services in an approved plan utilizing Social Security work incentive provisions (i.e., Plan to Achieve Self-Sufficiency; Impairment Related Work Expense).(2) Community services or services--Except for residential services, eligibility determination, and screening, the required and optional mental retardation services described in the performance contract.(3) DADS--The Department of Aging and Disability Services.(4) Extraordinary expenses--Major medical or health related expenses, major casualty losses, and child care expenses for the previous year or projections for the next year.(5) Family members-- (A) For an unmarried person under age 18 years--The person, the person's parents, and the dependents of the parents, if residing in the same household;(B) For an unmarried person age 18 years or older--The person and the person's dependents; or(C) For a married person of any age--The person, the person's spouse, and their dependents.(6) Gross income--Revenue from all sources before taxes and other payroll deductions. The term does not include child support received.(7) Inability to pay--The person's maximum monthly fee is zero and the person: (A) does not have third-party coverage;(B) has third-party coverage, but has exceeded the maximum benefit of the covered service(s) or the third-party coverage will not pay because the services needed by the person are not covered services; or(C) has not identified payment for a needed service or services in an approved plan utilizing Social Security work incentive provisions (i.e., Plan to Achieve Self-Sufficiency; Impairment Related Work Expense).(8) Income-based public insurance--Government funded third-party coverage that bases eligibility on income (i.e., CHIP and Medicaid).(9) MMF--Maximum monthly fee. A fee that is calculated in accordance with § 2.106(b) of this chapter (relating to Determination of Ability to Pay).(10) MRA--Mental retardation authority. An entity to which the Health and Human Services Commission's authority and responsibility described in Texas Health and Safety Code, § 531.002(11) have been delegated.(11) MR priority population--Groups of persons identified in the Health and Human Services Commission's current strategic plan as being most in need of mental retardation services.(12) Parent--A biological or adoptive parent of a person under age 18 years.(13) Performance contract--A written agreement between DADS and an MRA for the provision of one or more functions as described in Texas Health and Safety Code, § 533.035(a).(14) Person--A person in the MR priority population who is seeking or receiving services through an MRA.(15) Significant financial change--Any change in the person's (or parent's) financial status as shown in the financial documentation, as described in § 2.105(d) of this subchapter (relating to Accountability), that affects the person's (or parent's) ability to pay. Examples of a significant financial change are: (A) a reduction in income due to the loss of a job or due to a reduction in hours worked on a job;(B) an increase in income because of an inheritance or a salary increase;(C) an increase or decrease in the number of family members;(D) the gain or loss of third-party coverage; and(E) an increase or decrease in extraordinary expenses.(16) Standard charge--A fixed price for a community service or unit of service.(17) Team--A person's service planning team.(18) Third-party coverage--A public or private payer of community services (e.g., Medicaid, Medicare, private insurance, CHIP, TRICARE).26 Tex. Admin. Code § 301.505
Transferred from 40 TAC § 2.103 Texas Register, Volume 49, Number 24, June 14, 2024, TexReg 4433, eff. 7/15/2024