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

1. (1) Alternate care giver--An individual identified by the primary care giver who agrees to be trained and to maintain the skills necessary to provide care competently for the client when the primary care giver is unable to do so. An alternate care giver living with the client is not eligible for Medicaid (Title XIX) reimbursement for rendering care to the client.
2. (2) Client--An individual who is eligible to receive private duty nursing services under THSteps-CCP from a provider enrolled in the Texas Medicaid program.
3. (3) Continuous--Ongoing throughout a 24-hour period.
4. (4) Department--The Texas Department of Health.
5. (5) Dependent on technology--Requiring medical devices to compensate for the loss or impairment of a vital body function.
6. (6) Early and Periodic Screening, Diagnosis and Treatment Comprehensive Care Program (EPSDT-CCP)--A mandatory Medicaid program for persons under 21 years of age who meet certain economic eligibility criteria. In Texas EPSDT-CCP is called the Texas Health Steps Comprehensive Care Program (THSteps-CCP).
7. (7) Home health agency--A public or private agency or organization licensed by the department under Chapter 115 of this title (relating to Home and Community Support Services Agencies) to provide licensed home health services. The specific license under which the agency is providing services to Medicaid clients must also be Medicare certified.
8. (8) Individualized comprehensive case management--A structured process by which the orderly provision of services and supports intended to facilitate individual well-being and functioning is planned by a provider other than the service provider.
9. (9) Plan of care--A written regimen established and periodically reviewed by a physician in consultation with the home health agency staff or an enrolled independently practicing nurse provider which meets the plan of care standards at §33.607 of this title (relating to Plan of Care).
10. (10) Primary care giver--An individual(s) who has agreed to accept the responsibility for a client's routine daily care and the provision of food, shelter, clothing, health care, education, nurturing, and supervision. Primary care givers may include but are not limited to parents, foster parents, guardians, or other family members by birth or marriage. A primary care giver provides daily uncompensated care for the client, and participates in the development and implementation of the client's plan of care. The primary care giver or other person living with the client is not eligible for Medicaid (Title XIX) reimbursement for rendering care to the client.
11. (11) Primary physician--A doctor of medicine or doctor of osteopathy (MD or DO) legally authorized to practice medicine or osteopathy at the time and place the service is provided, who in addition provides continuing medical care of the client and continuing medical supervision of the client's plan of care.
12. (12) Private duty nursing--Skilled nursing reimbursed hourly for clients who meet the THSteps-CCP medical necessity criteria and who require individualized, continuous skilled care beyond the level of skilled nursing visits normally authorized under §§29.301-29.307 of this title (relating to Medicaid Home Health Program). Skilled nursing services are provided by a registered nurse or licensed vocational nurse through a licensed and certified home health agency, by a registered nurse enrolled as an independent provider, or by a licensed vocational nurse enrolled as an independent provider in the Texas Medicaid Program.
13. (13) Provider--A home health agency enrolled in the Texas Medicaid Program as a licensed and certified home and community support services agency or an independently practicing registered nurse or licensed vocational nurse enrolled in the Texas Medicaid Program.
14. (14) Respite--Services provided for the purpose of relief to the primary care giver.
15. (15) Skilled nursing--Services provided by a registered nurse as authorized by the Texas Nursing Practice Act, Texas Civil Statutes, Article 4513 et seq., or by a licensed vocational nurse as authorized by the Vocational Nurse Act, Texas Civil Statutes, Article 4528c.
16. (16) Stable and predictable--A situation in which the client's clinical and behavioral status and nursing care needs are non-fluctuating and consistent, including settings where the client's deteriorating condition is expected.
17. (17) Texas Health Steps Comprehensive Care Program (THSteps-CCP)--A federal program known as EPSDT which is required of states by Medicaid for children under 21 years of age who meet certain economic criteria for eligibility. See definition for Early and Periodic Screening, Diagnosis, and Treatment Comprehensive Care Program (EPSDT-CCP).

Source Note:The provisions of this §363.303 adopted to be effective March 31, 1999, 23 TexReg 13077; transferred effective September 1, 2002, as published in the Texas Register December 6, 2002, 27 TexReg 11527.