26 Tex. Admin. Code § 358.105

Current through Reg. 49, No. 49; December 6, 2024

Section 358.105 - Definitions

The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise.

(1) Adjusted gross income--The gross income of the family, as defined in this section, minus allowable deductions. Adjusted gross income is used to determine the amount of the monthly financial contribution required by a family.

(2) Allowable deductions--Expenses that are not reimbursed by other sources. Allowable deductions are limited to:

(A) the actual medical or dental expenses of the parent or dependent that are primarily related to alleviating or preventing a physical or mental defect or illness, were paid over the previous 12 months, are expected to continue during the eligibility period, and are limited to the cost of:

(i) diagnosis, cure, alleviation, treatment, or prevention of disease;

(ii) treatment of any affected body part or function;

(iii) legal medical services delivered by physicians, surgeons, dentists, and other medical practitioners;

(iv) medication, medical supplies, and diagnostic devices;

(v) premiums paid for insurance that covers the expenses of medical or dental care;

(vi) transportation to receive medical or dental care; and

(vii) medical or dental debt that is being paid on an established payment plan;

(B) child-care and respite expenses for a family member;

(C) costs and fees associated with the adoption of a dependent child; and

(D) court-ordered child support payments paid for a child who is not counted as a family member or dependent.

(3) Applied behavior analysis (ABA)--The design, implementation, and evaluation of systematic environmental changes to produce socially significant change in human behavior through skill acquisition and the reduction of problematic behavior. Applied behavior analysis includes direct observation and measurement of behavior and the identification of functional relations between behavior and the environment. Contextual factors, establishing operations, antecedent stimuli, positive reinforcers, and other consequences are used to produce the desired behavior change.

(4) Autism spectrum disorders--The disorders found in the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) related to autism. An autism spectrum disorder (ASD) diagnosis of autistic disorder, Asperger's disorder, or pervasive developmental disorder not otherwise specified, made under a previous DSM, is acceptable.

(5) BCaBA--A board certified assistant behavior analyst.

(6) BCBA--A board certified behavior analyst.

(7) BCBA-D--A board certified behavior analyst-doctoral.

(8) Child--A son, daughter, foster child, or stepchild who is under age 19 living in the home.

(9) Contractor--A service provider under contract with HHSC to provide autism services.

(10) Cost share--The amount of monthly financial contribution required of a family for a child to participate in the HHSC Children's Autism Program, as described in Subchapter F of this chapter (relating to Cost Share). The cost share is determined using the HHSC Fee Schedule and any applicable insurance deductible, coinsurance, and co-pay amounts. The cost share is the lesser of the fee determined using the HHSC fee schedule, or applicable insurance deductible, coinsurance, and co-pay amounts.

(11) HHSC Comprehensive ABA services--ABA services that are provided to children 3 through 5 years of age by a HHSC contractor to treat all areas of developmental and behavioral needs.

(12) HHSC Focused ABA services--ABA services that are provided to children 3 through 15 years of age by a HHSC contractor to treat one or more deficits or behaviors of excess rather than the full range of developmental domains.

(13) Dependent--A child age 19 or older, parent, stepparent, grandparent, brother, sister, stepbrother, stepsister, or in-law; whose gross income is less than $3,900 a year; and for whom more than half of the person's support is provided for by the parent(s) or guardian(s) during the calendar year.

(14) Direct contact--A term that applies to any person who has physical contact with, physical access to the home of, communication with, or access to confidential information regarding a child enrolled in the HHSC Children's Autism Program or the child's family. Direct contact does not include casual or inadvertent physical contact with, communication with, or contact at an educational presentation or seminar with a child enrolled in the HHSC Children's Autism Program or the child's family.

(15) Family--The child's parent(s) or guardian(s), the child, other children under 19 years of age and other dependents of the parent or guardian.

(16) Fiscal year--The state fiscal year. Begins on September 1 and ends on August 31 of the following year.

(17) Gross income--All income received by the family for determination of the family's cost share, from whatever source, that is considered income by the Internal Revenue Service before federal allowable deductions are applied.

(18) HHSC--The Texas Health and Human Services Commission.

(19) Individualized Education Program (IEP)--A written document that is developed for each public school child who is eligible for special education.

(20) Interest list--A list, maintained by the contractor, of families who have indicated an interest in receiving services, and who meet the eligibility criteria.

(21) LEA--Local educational agency.

(22) Parent--The child's natural or adoptive parent; or the child's guardian.

(23) Parent training--Training that is provided to a parent or guardian as part of the ABA service, in the language used by the parents of the child when feasible. It is delivered either individually or in a group in a home, school, or clinic setting. It includes providing parent education on ABA in general; working collaboratively with parents to identify ways they can help their child at home to generalize learning to other environments, including school settings; and data review, program adjustment, and planning.

(24) Qualified professional--An actively licensed physician or psychologist with training and background related to the diagnosis and treatment of neurodevelopmental disorders.

(25) Texas resident--A person who resides in Texas and intends to remain in the state, either permanently or for an indefinite period.

(26) Third-party payer--A company, organization, insurer, or government agency other than HHSC that makes payment for health care services received by an enrolled child.

(27) Transition plan--A plan that identifies and documents appropriate steps and transition services to support the child and family to smoothly and effectively transition from the HHSC Children's Autism Program to LEA special education services or other community activities, places, or programs the family would like the child to participate in after exiting the HHSC Children's Autism Program.

(28) Treatment plan--A written plan of care, including treatment goals, for providing HHSC autism treatment services to an eligible child and the child's family to enhance the child's development. The intensity and length of Children's Autism Program services is determined by the treatment goals included in the treatment plan. However, the length of autism services shall not exceed 24 months.

26 Tex. Admin. Code § 358.105

Adopted to be effective September 1, 2014, 39 TexReg 6680; Amended by Texas Register, Volume 40, Number 51, December 18, 2015, TexReg 9311, eff. 12/22/2015; Amended by Texas Register, Volume 43, Number 35, August 31, 2018, TexReg 5684, eff. 9/4/2018; Transferred from Title 40, Pt. 2, Chapter 105 by Texas Register, Volume 46, Number 28, July 9, 2021, TexReg 4173, eff. 8/1/2021