Revision 26-1; Effective March 16, 2026

A

Abuse — The infliction of injury, unreasonable confinement, intimidations, punishment, mental anguish, sexual abuse or exploitation of a person. Types of abuse include:

• Physical abuse is a physical act by a person that may cause physical injury to another person.
• Psychological abuse is an act, other than verbal, that may inflict emotional harm, invoke fear or humiliate, intimidate, degrade or demean a person.
• Sexual abuse is an act or attempted act such as rape, incest, sexual molestation, sexual exploitation, sexual harassment or inappropriate or unwanted touching of a person by another.
• Verbal abuse is using words to threaten, coerce, intimidate, degrade, demean, harass or humiliate a person.

Action — An action is defined as the:

• denial or limited authorization of a requested Medicaid service, including the type or level of service;
• reduction, suspension, or termination of a previously authorized service;
• failure to provide services in a timely manner;
• denial in whole or in part of payment for a service; or
• failure of an MCO to act within the time frames set forth by the HHSC and state and federal law.

An action does not include expiration of a time-limited service.

Activities of Daily Living (ADL) — Basic personal everyday activities that include bathing, dressing, transferring including from bed to chair, toileting, mobility, eating, grooming, positioning and helping with self-administration of medication.

Acute Care — Preventive care, primary care, and other medical care provided under the direction of a provider for a condition having a relatively short duration.

Adult — A person 18 years or older, or an emancipated minor.

Advanced Placement — An interest list release option available to members in response to Senate Bill (SB) 1207. MDCP members denied MN at reassessment or those who aged out of MDCP can request advanced placement to move up on another 1915 (c) waiver program interest list. Members may only advance on another 1915 (c) waiver interest list(s) using their MDCP request date if they are now or have ever been on the interest list(s) requested. 

Adverse Action — A termination, suspension or reduction of Medicaid eligibility or covered services.

Agency Option (AO) — A service delivery option where the provider is responsible for managing the day-to-day activities of the attendant and all business details.

Appeal — A request for a state fair hearing concerning an HHSC action.

Appeals and Mitigation (A&M) — A specialized group of HHSC staff who process client MEPD and TW appeals, represent the agency during the appeal hearing, and implement decisions following the outcome of an appeal.

Applicant — A person who is released from the MDCP interest list, confirmed interest in MDCP and:

• has submitted Form H1200, Application for Assistance – Your Texas Benefits; or
• PSU staff has submitted a referral for an assessment to an MCO. 

Authorized Representative (AR) — For medical programs, the person designated with written consent by an individual, applicant, member or recipient to:

• sign an application on the individual’s, applicant’s or member’s behalf;
• complete and submit a renewal form;
• receive copies of the individual’s, applicant’s or member’s notices and other communications from the agency; and
• act on behalf of the individual, applicant or member in all other matters with the agency.

B 

Behavioral Health Service — A covered service for the treatment of mental, emotional or substance use disorders.

Business Day — Any day except a Saturday, Sunday or legal holiday listed in the Texas Government Code, Section 662.021.

C 

Capitated Service — A benefit available to members under the Texas Medicaid program where an MCO is responsible for payment.

Capitation Rate — A fixed predetermined fee paid by HHSC to the MCO each month. This is per the contract for each enrolled member in exchange for the MCO arranging or providing for a defined set of covered services to the member. It is regardless of the amount of covered services used by the enrolled member.

Caregiver — A person who helps care for someone who is ill, has a disability, or has functional limitations and requires assistance. Informal caregivers are relatives, friends or others who provide unpaid care. Paid caregivers provide services in exchange for payment for the services rendered.

Centers for Medicare and Medicaid Services (CMS) — The federal agency that administers Medicare and Medicaid.

Client — Any Medicaid-eligible recipient.

Code of Federal Regulations (CFR) — The codified federal regulatory law that governs most federal programs, including Medicaid.

Community Care Services Eligibility (CCSE) — A group of services purchased by HHSC in response to recommendations of the Texas Legislature. CCSE provides services in a person's own home or community for aged or disabled Texans who are not self-sufficient, and who might otherwise be subject to premature institutionalization or to abuse, neglect or exploitation.

Community First Choice (CFC) Option — PAS habilitation services focused on:

• the acquisition, maintenance and enhancement of skills;
• emergency response services; and
• support management provided in a community setting for eligible Medicaid members in the MDCP and STAR+PLUS HCBS program who have received an institutional LOC determination.

Community Living Assistance and Support Services (CLASS) — A non-capitated 1915(c) Medicaid waiver which provides home and community-based services to people with intellectual or developmental disabilities, other than intellectual disability, as an alternative to living in an intermediate care facility.

Complaint — Any dissatisfaction expressed by a complainant, verbally or in writing, to the MCO about any matter related to the MCO other than an action. Subjects for complaints may include:

• the quality of care of services provided;
• aspects of interpersonal relationships such as rudeness of a provider or employee; and
• failure to respect the individual's, applicant's or member's rights.

Complex Care Services (CCS) — Also known as the MDCP/DBMD Escalation Help Line. The escalation help line is dedicated to individuals and families that receive benefits from the MDCP or DBMD program and can help solve issues related to STAR Kids managed care.

Comprehensive Care Program (CCP) — A package of Medicaid services available to clients based on medical necessity that goes beyond regular Medicaid services for all ages and is part of the THSteps benefit for clients under 21.

Consumer Directed Services (CDS) Employer — A member, AR, LAR, parent or court appointed guardian who chooses to participate in the CDS option and therefore is responsible for hiring and retaining service providers to deliver program services.

Consumer Directed Services (CDS) Option — A service delivery option where a member, AR or LAR employs and retains service providers and directs the delivery of the MDCP or the STAR+PLUS HCBS program PAS and respite services. A member participating in the CDS option must use an FMSA chosen by the member, AR or LAR to provide financial management services.

Continued Benefits — Continuing or restoring benefits to the level authorized immediately before the notice of adverse action.

Co-payment — The amount of personal income a person must pay toward the cost of his or her care. Co-payment was formerly known as applied income.

Covered services — All health care, long term services and supports, or dental services or items that the MCO must arrange to provide and pay on a member's behalf under the terms of the contract executed between the MCO and HHSC. This is unless a service or item is specifically excluded under the terms of the Medicaid state plan, a federal waiver, a managed care services contract, or an amendment to any of these. These services include:

• all services or items including medical assistance, defined in Section 32.003 of the Human Resources Code; and
• all value-added services under such contract.

D

Day — A calendar day, unless otherwise specified in the text. A calendar day includes weekends and legal holidays.

Day Activity and Health Services (DAHS) — Licensed DAHS facilities provide daytime services, up to 10 hours per day, Monday through Friday, to people who live in the community. Services address physical, mental, medical and social needs. People may attend up to five days per week, depending on their eligibility.

Deaf Blind with Multiple Disabilities (DBMD) — A non-capitated 1915(c) Medicaid waiver which provides home and community-based services to people who are deaf and blind and have a third disability.

Denial — Closure of an application with a finding of ineligibility.

Designated Representative (DR) — A willing adult appointed by the CDS employer to help with, or perform, the employer's required responsibilities to the extent approved by the employer. A DR, usually a family member, is not a paid service provider and is at least 18.

Disability — A physical or mental impairment that substantially limits one or more of a person's major life activities. This includes caring for oneself, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, socializing or working.

Dual Eligible — A Medicaid recipient who is also eligible for Medicare.

Durable Medical Equipment (DME) — Purchased or rented items such as hospital beds, iron lungs, oxygen equipment, seat lift equipment, wheelchairs and other medically necessary equipment prescribed by a health care provider to be used in a person's home. These items must be reusable. These items may require the Certificate of Medical Necessity form required by Medicare and Medicaid to use certain durable medical equipment prescribed by a health care provider.

E 

Early and Periodic Screening, Diagnosis and Treatment (EPSDT) — A federal Medicaid benefit for MDCP members under 21 years.  It is called THSteps in Texas.

Eligibility Date — The first date all eligibility criteria are met.

Emergency Response Services (ERS) — Services provided through an electronic monitoring system. It is used by functionally impaired adults who live alone or who are functionally isolated in the community. In an emergency, the person can press a call button to signal for help. The electronic monitoring system, which has a 24-hour, seven-day-a-week monitoring capability, helps ensure that the appropriate person or service provider responds to an alarm call from a person.

Emergency Service — A covered inpatient and outpatient service. It is given by a network provider or out-of-network provider qualified to provide such service and needed to evaluate or stabilize an emergency medical condition or an emergency behavioral health condition. For health care MCOs, the term emergency service includes post-stabilization care services.

Enrollment — The process where a member determined to be eligible for Medicaid is enrolled in a Medicaid MCO serving the service area where the member lives.

Enrollment Broker — A contracted entity that helps individuals, applicants and members select and enroll with an MCO. If requested, the enrollment broker also may help the member in choosing a PCP.

Exploitation — An act of depriving, defrauding or otherwise getting the personal property of a person by taking advantage of a person's disability or impairment.

F 

Fair Hearing — An administrative procedure that affords applicants and members the statutory right and opportunity to appeal adverse decisions or actions about program eligibility or termination, suspension or reduction of services by HHSC.

Family Member — A person who is related by blood, affinity or law to an individual, applicant and member.

Federal Waiver — Any waiver permitted under federal law and approved by CMS that allows states to implement Medicaid managed care.

Financial Management Services (FMS) — Services delivered by the FMSA to the member, LAR or AR who chooses the CDS option. Services include orientation, training, support, assistance with and approval of budgets, and processing payroll and payables on behalf of the member, LAR or AR.

Financial Management Services Agency (FMSA) — An agency that contracts with the MCO to provide FMS to members who choose the CDS option.

First Position — An interest list release option available to members in response to Senate Bill (SB) 1207. Eligible MDCP members denied MN at reassessment can choose first position and move to the top of the MDCP interest list to be assessed for the program again when an interest list slot becomes available. Members can only pursue the first position option one time.

Functional Necessity — A member's need for services and supports with ADLs or IADLs to be healthy and safe in the most integrated setting possible. This determination is based on the results of a functional assessment.

G 

Guardian — A person appointed as a guardian of the estate or of the person by a court.

H 

Habilitation — Acquisition, maintenance, and enhancement of skills necessary for the applicant and member to accomplish ADLs, IADLs, and health-related tasks. These are based on the applicant's and member's person-centered service plan.

Health Information — Any information, verbal or recorded in any form or medium, that:

• is created or received by a health care provider, health plan, public health authority, employer, life insurer, school or university, or health care clearinghouse; and
• relates to:
  • the past, present, or future physical or mental health or condition of any individual, applicant and member;
  • the provision of health care to an individual, applicant and member; or
  • the past, present, or future payment for the provision of health care to an individual, applicant or member.

Health Maintenance Activity (HMA) — A task that may be exempt from delegation based on the registered nurse assessment that enables the member to stay in an independent living environment. It goes beyond activities of daily living because of the higher skill level required to perform.

Health Insurance Portability and Accountability Act (HIPAA) — A federal law designed to provide privacy standards to protect patients' medical records and other health information given to health plans, doctors, hospitals and other health care providers.

Home and Community-based Services (HCS) — A non-capitated 1915(c) Medicaid waiver. It provides home and community-based services to a person with an intellectual or developmental disabilities as cost-effective alternatives to institutional care.

Home and Community-Based Services – Adult Mental Health (HCBS-AMH) program — A 1915(i) Medicaid waiver program designed to increase available support services for adults with Serious Mental Illness (SMI) and a history of long-term psychiatric hospitalization, frequent arrests, or frequent hospital emergency room use. The program provides an array of services to match each person's needs. Services are designed to support long-term recovery from mental illness.

I 

Income — Any item a person receives in cash or in-kind that can be used to meet his or her need for food or shelter. For purposes of determining MEPD financial eligibility, income includes the receipt of any item that can be applied, either directly or by sale or conversion, to meet the basic needs of food or shelter.

Individual — A person who is released from the MDCP interest list, confirmed interest in MDCP and:

• has not submitted Form H1200, Application for Assistance - Your Texas Benefits; or
• PSU staff has not submitted a referral for an assessment to an MCO.

Individual Education Plan (IEP) — An individualized education program developed by the parents and educators for each child with a disability. It is developed, reviewed, and revised in a meeting per the Individuals with Disabilities Education Act. The IEP describes the goals the team sets for a child during the school year, and any special support needed to help achieve them.

Individual Service Plan (ISP) — An individualized and person-centered plan for members enrolled in the MDCP or the STAR+PLUS HCBS program. It identifies and documents the member’s preferences, strengths and health and wellness needs to develop short-term objectives and actions. It ensures personal outcomes are achieved in the most integrated setting. The ISP is supported by results of the member's program-specific assessment and must meet the requirements of 42 CFR Section 441.301.

Individual Service Plan (ISP) Service Tracking Tool — The member, MCO and family members develop this ISP at least once a year by. It documents necessary MDCP services determined by the member’s team and the budget associated with delivering the services. The total cost of the member’s budget provided on this tool must be below the determined cost limit. This is also known as Form 2604.

Institutional Care — Long-term nursing care, treatment or services received in a Medicaid-certified long-term care facility.

Institutional Setting — A living arrangement where a person applying for or receiving Medicaid lives in a Medicaid-certified long-term care facility or receives services under an HCBS waiver program. Formerly known as a vendor living arrangement.

Instrumental Activities of Daily Living (IADLs) — Activities related to independent living. They include preparing meals, managing money, shopping for groceries or personal items, performing light or heavy housework, doing laundry and using a phone.

Intellectual and Developmental Disability (IDD) — A disability with onset during the developmental period that includes limitations in both intellectual and adaptive functioning. It covers many everyday conceptual, social and practical skills. IDD can begin at any time, up to 22. It usually lasts throughout a person's lifetime.

Interdisciplinary Team (IDT) — All entities involved in planning the member’s plan of care (POC). This typically includes the member, AR, LAR, service coordinator and primary care physician.

Intermediate Care Facility for Individuals with an Intellectual Disability or Related Conditions (ICF/IID) — A Medicaid-certified facility that provides care in a 24-hour specialized residential setting for people with an intellectual disability or related conditions. An ICF/IID includes a state supported living center and a state center.

Interest List (IL) — A list of people who have contacted HHSC and expressed an interest in receiving waiver services, but who have not applied for or been determined eligible for services.

L 

Legal Holiday — A legal holiday, including national and state holidays, as defined in the Texas Government Code, Section 662.003.

Legally Authorized Representative (LAR) — A person authorized by law to act on behalf of a member, including a parent of a minor, guardian of a minor, managing conservator of a minor or the guardian of an adult. It is defined by state or federal law, including Texas Occupations Code Section 151.002(6), Texas Health and Safety Code Section166.164, and Texas Estates Code Section 752.

Level of Care (LOC) — The type of care a person is eligible to receive in an ICF/IID. It is based on an assessment of the person's need for care.

Local Intellectual and Developmental Disability Authorities (LIDDAs) — Authorities that serve as the point of entry for publicly funded IDD programs, whether the program is provided by a public or private entity. LIDDAs:

• provide or contract to provide an array of services and supports for people with IDD;
• are responsible for enrolling eligible people into the following Medicaid programs:
  • ICF/IID, which includes state supported living centers;
  • HCS;
  • TxHmL; and
• are responsible for permanency planning for people under 22 who live in an ICF/IID, state supported living center or a residential setting of the HCS Program.

Long Term Services and Supports (LTSS) — A service provided to a qualified member in his or her home or other community-based setting necessary to allow the member to stay in the most integrated setting possible. Helps members live in the community instead of an institutionalized setting. LTSS includes services provided under the Medicaid state plan as well as services available to people who qualify for MDCP, STAR+PLUS HCBS or 1915(c) Medicaid waiver services. LTSS is available through an MCO in STAR+PLUS, STAR Health, and STAR Kids varies by program model.

M 

Managed Care Contracts and Oversight (MCCO) — A unit within the Medicaid Children's Health Insurance Program (CHIP) Division of HHSC that is responsible for administrative and operational aspects of administering the Medicaid managed care programs.

Managed Care Organization (MCO) — An established health maintenance organization or Approved Non-Profit Health Corporation (ANHC) that arranges for the delivery of health care services. Per Section 843 of the Texas Insurance Code, it is currently licensed as such in the state of Texas.

MCOHub – A secure internet bulletin board the state and MCOs use to share PII and PHI.

MDCP Enrollment Form – A form created in the TMHP LTCOP meant to help HHSC maintain MDCP enrollment records.

Medicaid — A program administered by the federal CMS and funded jointly by the states and the federal government. It pays for health care to eligible groups of people.

Medicaid Eligible — A person who is financially eligible for Medicaid because the person receives SSI cash benefits or is determined by HHSC to be financially eligible for Medicaid.

Medicaid Estate Recovery Program (MERP) — A program that requires HHSC, as the state Medicaid agency, to recover the costs of Medicaid long-term care benefits received by certain Medicaid recipients. Review the MERP website for further information.

Medicaid for the Elderly and People with Disabilities (MEPD) — A public assistance program providing medical assistance, institutional and community-based health-related care, and Medicare cost-sharing assistance for the elderly and people with disabilities. MEPD does not provide cash assistance.

Examples of MEPD services and programs are:

• primary home care services;
• HCBS waiver programs, which provide community-based care as an alternative to institutional care;
• care in a Medicaid-certified long-term care facility;
• the Program of All-Inclusive Care for the Elderly (PACE);
• Medicaid Buy-In programs; and
• Medicare Savings Programs.

Medical Assistance Only (MAO) — A person who qualifies financially and functionally for Medicaid assistance but does not receive SSI benefits, as defined in Title 1 Texas Administrative Code (TAC) Section 358, Section 360, and Section 361. This relates to MEPD, Medicaid Buy-In Program and Medicaid Buy-In for Children Program.

Medical Consenter – A court appointed individual for a child, such as a relative or someone involved in the life of a child, who is in the Texas Department of Family and Protective Services (DFPS) conservatorship. The responsibility of a medical consenter is to provide medical consent. Medical consent means deciding on whether to agree or not agree to a medical test, treatment, procedure, or a prescription medication.

Medical Necessity (MN) — The medical criteria a person must meet for admission to a Texas NF as defined in Title 26 Texas Administrative Code (TAC) Section 554.2401.

Medically Dependent Children Program (MDCP) — A 1915(c) Medicaid waiver program that provides LTSS HCBS to help the primary caregiver care for a member with an NF level of need and their families in the community.

Medicare — The federal health insurance program for people 65 or older, certain younger people with disabilities and people with end-stage renal disease (ESRD).

Member — A person who is currently enrolled in and receiving services through the MDCP or STAR+PLUS HCBS program.

Money Follows the Person (MFP) — A process where funds used for payment of institutional care follows the person when transitioning to the community. MFP allows a Medicaid eligible applicant approved for the MDCP or STAR+PLUS HCBS program before leaving the NF, to move to the community.

Mutually Exclusive Services — Two or more services that may not be authorized for the same member during the same time.

N 

Neglect — The failure to provide a person the reasonable care required, including but not limited to:

• food;
• clothing;
• shelter;
• medical care;
• personal hygiene; and
• protection from harm.

Non-capitated Service — A benefit available to members under the Texas Medicaid program that an MCO is not responsible for payment.

Non-institutional Setting — A living arrangement that a person applying for or receiving Medicaid does not live in a long-term care facility or receive services under an HCBS waiver program. Formerly known as a non-vendor living arrangement.

Nursing Facility (NF) — A residential institution that primarily provides:

• skilled nursing care and related services for residents who require medical or nursing care;
• rehabilitation services for the rehabilitation of injured, disabled or sick people; or
• health-related care and services on a regular basis, to people who, because of their mental or physical condition, require care and services above the level of room and board, which is made available to them only through institutional facilities.

O

Office of the Medical Director (OMD) — a unit in the Medicaid and CHIP Division comprised of physicians, dentists, nurses and support staff who:

• provide clinical consultation;
• ensure that people receive appropriate services; and
• mitigate overuse through utilization reviews.

OMD also provides clinical input, support, and direction to align Medicaid CHIP policy with population health initiatives. The OMD is responsible for manual review if the STAR Kids Screening and Assessment Instrument (SK-SAI) fails automatic MN approval into the TMHP Long Term Care Portal (LTCOP).

P 

Permanency Planning — The placement process for children in a nursing facility. Permanency planning is a philosophy and planning process that focuses on the outcome of family support by facilitating a permanent living arrangement with the primary feature of an enduring and nurturing parental relationship. Texas Government Code Section 531.151.

Person-centered Planning — A documented service planning process that:

• includes people chosen by the applicant or member;
• is directed by the applicant or member to the maximum extent possible;
• lets the applicant or member make choices and decisions;
• is timely and occurs when and where it is convenient to the applicant or member;
• reflects cultural considerations of the applicant or member;
• includes strategies to solve conflict or disagreement within the process;
• offers choices to the applicant or member about the services and supports they receive and from whom;
• includes a method for the applicant or member to require updates to the plan; and
• records alternative settings that were considered by the applicant or member.

Personal Assistance Services (PAS) — A range of services provided by one or more people. They are designed to help a person with a disability perform daily living activities on or off the job. The person would typically perform these services without help if the person did not have a disability.

Personal Care Services (PCS) — Services that include bathing, dressing, preparing meals, feeding, grooming, taking self-administered medication, toileting, ambulation, and help with other personal needs or maintenance.

Personal Identifiable Information (PII) — Information that is a subset of health information. Includes demographic information collected from a person, and:

• is created or received by a health care provider, health plan, employer, or health care clearinghouse; and
• relates to:
  • the past, present, or future physical or mental health or condition of a person;
  • the provision of health care to a person; or
  • the past, present, or future payment for the provision of health care to a person; and
  • that identifies the person; or
  • a reasonable basis to believe the information can be used to identify the person.

Plan of Care (POC) — A care plan the MCO develops for its members that includes acute care and LTSS. The POC is different from the ISP.

Primary care provider (PCP) — A physician or other provider who:

• has agreed with the health care MCO to provide a medical home to members; and
• is responsible for providing initial and primary care to patients, maintaining the continuity of patient care, and initiating referral for care.

Program Support Unit (PSU) Staff — An HHSC unit of staff who support and handle certain aspects of the STAR Kids program and STAR+PLUS program.

Protected Health Information (PHI) — The HIPAA Privacy Rule provides federal protections for PHI held by covered entities. It gives patients a range of rights about that information. At the same time, the Privacy Rule is balanced to permit the disclosure of personal health information needed for patient care and other important purposes.

Provider —  An appropriately credentialed and licensed person, facility, agency, institution, organization or other entity, and its employees and subcontractors. This person has a contract with the MCO for the delivery of covered services to the MCO’s members.

Q 

Qualified Income Trust (QIT) ( Miller Trust) — An irrevocable trust specially designed to legally divert a person or married couple’s income into a trust. This results in the income being excluded for purposes of determining eligibility for nursing home (institutional) Medicaid and 1915(c) Medicaid waiver services.

R 

Respite Care Services — Direct care services needed because of a person's disability. They provide a primary caregiver temporary relief from caregiving activities when the primary caregiver normally performs such activities.

Responsible Adult — An adult, defined by Texas Family Code Section101.003, who has agreed to accept the responsibility for providing food, shelter, clothing, education, nurturing, and supervision for a participant. Responsible adults include biological parents, adoptive parents, foster parents, guardians, court-appointed managing conservators, and other family members by birth or marriage. If the participant is 18 years or older, the responsible adult must be the participant's managing conservator or legal guardian.

Responsible Party — A person who:

• helps or represents an individual, applicant or member in the application or eligibility redetermination process; or
• is familiar with the individual, applicant or member and his or her financial affairs and functional condition.

S 

Service Area — The counties included in any HHSC-defined service area as applicable to each MCO.

Service Coordinator — The MCO staff person with primary responsibility for providing service coordination and care management to STAR Kids and STAR+PLUS members.

Service Provider (Employee) — A person who is hired, trained, and managed by the employer to provide services authorized by the MCO.

Service Responsibility Option (SRO) — A service delivery choice that empowers the member to manage most day-to-day activities. This includes supervision of the person providing PAS. The member decides how to provide services. It leaves the business details to a provider of the member's choosing.

Social Security Administration (SSA) — A federal agency that administers the social insurance programs in the U.S and authorizes Medicaid and waiver services.

State of Texas Access Reform (STAR) — STAR managed care program that operates under a federal waiver. It primarily provides, arranges for, and coordinates preventive, primary, acute care, and pharmacy services for low-income families, children and pregnant women.

STAR Health — The managed care program that operates under the Medicaid state plan and primarily serves:

• children and youth in DFPS conservatorship;
• young adults who voluntarily agree to continue in a foster care placement if the state as conservator elects to place the child in managed care; and
• young adults who are eligible for Medicaid because of their former foster care status through the month of their 21st birthday.

STAR Kids — Authority granted to the state of Texas to allow delivery of LTSS and acute care services to children and young adults with disabilities under 21. The STAR Kids program helps members live in the community in lieu of an NF.

STAR+PLUS Home and Community Based Services (HCBS) program — Authority granted to the state of Texas to allow delivery of community-based LTSS to adults with disabilities over the 21. The STAR+PLUS program helps members live in the community in lieu of an NF.

STAR+PLUS program — The STAR+PLUS Medicaid managed care program where HHSC contracts with MCOs to provide, arrange, and coordinate preventive, primary, acute and long-term care covered services to adult people with disabilities and elderly people 65 and over who qualify for Medicaid through the SSI program or the MAO program. Children under 21 who qualify for Medicaid through the SSI program, may voluntarily participate in the STAR+PLUS program. The STAR+PLUS program is the umbrella designation that includes both the STAR+PLUS services and STAR+PLUS HCBS program.

STAR+PLUS Program Specialist — The staff person responsible, along with MCCO, for STAR+PLUS policy development.

State Plan — The agreement between the CMS and HHSC about the operation of the Texas Medicaid program, per the requirements of Title XIX of the Social Security Act.

Supplemental Security Income (SSI) — A federal income supplement program funded by general tax revenues, and not Social Security taxes, designed to help aged, blind and disabled people with little or no income by providing cash to meet basic needs for food, clothing and shelter.

Support Advisor — An employee who provides support consultation to an employer, a DR, or a member receiving services through the CDS Option.

Support Consultation — An optional service. It is provided by a support advisor giving a level of help and training beyond what the FMSA provides through FMS or CFC support management. Support consultation helps a CDS employer meet the required employer responsibilities of the CDS option and to successfully manage the delivery of program services.

Supported Employment (SE) — Services that help the member sustain competitive employment or self-employment.

Suspension — A temporary end of any waiver service without losing Medicaid or program eligibility.

T 

Transition Assistance Services (TAS) Agency — An agency that provides a one-time service to a Medicaid-eligible resident of an NF located in Texas. Helps the resident move from the NF into the community.

Termination — Closure of an ongoing case due to a finding of ineligibility.

Texas Administrative Code (TAC) — A compilation of all the state rules in Texas that implement state programs and services.

Texas Health and Human Services Commission (HHSC) — Administrative agency in the executive department of the state of Texas established under Texas Government Code Section 531. HHSC is the single state agency charged with administration and oversight of the Texas Medicaid program, including Medicaid managed care.

Texas Home Living (TxHmL) — The Texas Home Living Program, operated by HHSC and approved by CMS per 1915(c) of the Social Security Act. TxHmL provides community-based services and supports to eligible people who live in their own homes or in their family homes.

Texas Medicaid & Healthcare Partnership (TMHP) — The Texas contractor administering Medicaid provider enrollment and fee-for-service (FFS) claims processing. TMHP is responsible for processing the Medical Necessity and Level of Care (MN/LOC) assessment for the STAR+PLUS HCBS program.

Texas Medicaid & Healthcare Partnership (TMHP) Long-Term Care Online Portal (LTCOP) – The portal used to submit, monitor, and manage MN/LOC Assessments, STAR Kids Screening and Assessment Instrument (SK-SAI), and STAR Kids Individual Service Plan (SK-ISP). An MCO can also submit H1700-1 Home and Community Based Services (HCBS) STAR+PLUS Waiver Individual Service Plan (ISP) forms.

Third-Party Resource (TPR) — Any person, entity or program that could be liable to pay for or provide  medical help or support to a recipient under the approved Medicaid state plan. Could also be as part of their caregiving arrangement without pay.

Texas Health Steps (THSteps) — The EPSDT benefit in Texas.

Texas Health Steps-Comprehensive Care Program (THSteps-CCP) — THSteps is also known as the EPSDT service. It is Medicaid's comprehensive medical, dental and case management preventive child health service for Medicaid-eligible recipients from birth through 20. It includes MDCP members. THSteps:

• expands recipient awareness of existing medical, dental and case management services through outreach and informing efforts; and
• recruits and retains a qualified provider pool to assure the availability of comprehensive preventive medical, dental and case management services.

TxMedCentral — A secure internet bulletin board the state and MCOs use to share PII and PHI.

U 

Unlicensed Assistive Person (UAP) — A paraprofessional who helps individuals, applicants or members with physical disabilities, mental impairments, and other health care needs with their ADLs. They also provide bedside care. A UAP may perform nursing tasks only in specific situations, as governed by the Title 22 TAC Section 224 and Title 22 TAC Section 225.

Upgrade — When an existing STAR+PLUS member requests STAR+PLUS HCBS program services. Could also be if the MCO determines the member would benefit from the STAR+PLUS HCBS program. Then grants services after meeting waiver eligibility criteria.

Utilization Review (UR) — A formal assessment of the medical necessity, efficiency or appropriateness of services and treatment plans on a prospective, concurrent or retrospective basis.

V 

Value-added Service (VAS) — A service provided by an MCO that is not medical assistance. It is defined by Section 32.003 of the Texas Human Resources Code. 

Y

Youth Empowerment Services Waiver (YES) — A 1915(c) Medicaid waiver program that provides community-based services to help children and youth 3 through 18 at risk of institutionalization due to a serious emotional disturbance (SED). YES waiver services are family-centered, coordinated, and effective at preventing out-of-home placement to promote lifelong independence and self-defined success.