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Rule §358.103 Definitions

Published: 2015

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  (66) Pension funds--Monies held in a retirement fund under a plan administered by an employer or union, or an individual retirement account (IRA) or Keogh account as described in the Internal Revenue Code.   (67) Personal needs allowance--An amount of the recipient's income that a recipient in an institutional setting may retain for personal use.   (68) Primary home care services--Medicaid-funded, in-home attendant services provided to a person with a medical need for specific tasks to delay or prevent the person's need for institutional care.   (69) Principal place of residence--The home where a person resides, occupies, and lives.   (70) Provider--A person, group, or agency contracted to provide a Medicaid-funded service to a person for a fee.   (71) Public institution--An institution defined in 20 CFR §416.201.   (72) Real property--Land and improvements, including buildings and structures. Real property may also include a mine or quarry, standing timber, or minerals.   (73) Recipient--A person receiving benefits under MEPD, including a person whose Medicaid eligibility is being redetermined.   (74) Representative payee--A person or an organization selected to receive benefits on behalf of a recipient, if the recipient is not able to manage or direct the management of benefit payments in his or her own interest.   (75) Resources--Cash, other liquid assets, or any real or personal property, that a person (or spouse or parent, as appropriate):     (A) owns;     (B) has the right, authority, or power to convert to cash (if not already cash); and     (C) is not legally restricted from using for his or her support and maintenance.   (76) Restitution--Securing payment from a recipient when fraud is not indicated or pursued and when the recipient's co-payment has been undercharged because of previously unreported or underreported monthly income or resources.   (77) Retirement, Survivors, and Disability Insurance (RSDI)--Benefits provided under Title II of the Social Security Act.   (78) Retroactive coverage--Payment for Medicaid-reimbursable medical services received up to three months before the month of application.   (79) Social Security--A federal system of retirement and disability insurance for various categories of employed and dependent persons, funded through dedicated payroll taxes.   (80) Social Security Act--The federal statute that provides the authority for various programs referenced in this chapter, including Medicare and Medicaid. See also the definition in this section for certain titles in the Social Security Act.   (81) Social Security Administration (SSA)--The federal agency that issues Social Security numbers, administers Social Security benefit programs, and manages the SSI program.   (82) Social service--A service, other than a medical service, that is intended to assist a person with a physical disability or social disadvantage to function in society on a level comparable to that of a person who does not have such a disability or disadvantage. No in-kind items are expressly identified as social services.   (83) Special income limit--The income limit used to test MEPD eligibility for a person or couple in an institutional setting in accordance with §358.433 of this chapter (relating to Special Income Limit).   (84) Spousal impoverishment--Provision implemented under §1924 of the Social Security Act (42 U.S.C. §1396r-5) designed to prevent the impoverishment of a family, usually a couple, when one spouse needs care in an institutional setting.   (85) State center--A facility operated by the Texas Department of State Health Services with which the Texas Department of Aging and Disability Services contracts to provide services to persons with mental retardation who reside in the facility.   (86) State mental health facility--A facility operated by the Texas Department of State Health Services that provides care for people with mental illness who need the safety, structure, and resources of an in-patient setting.   (87) State supported living center--A facility operated by the Texas Department of Aging and Disability Services that provides residential services and 24-hour supervision and active treatments to assist people with mental retardation.   (88) Supplemental Security Income (SSI) federal benefit rate--Standard payment amount in the SSI program.   (89) Supplemental Security Income (SSI) program--A federal income supplement program, funded by general tax revenues and managed by the SSA, that provides monthly income to people who are aged, blind, or disabled and have limited income and resources.   (90) Support and maintenance--The value of food and shelter that a person receives.   (91) Temporary Assistance for Needy Families--A program that provides temporary benefits (cash assistance) and work opportunities to families with needy dependent children, authorized under Title IV of the Social Security Act.   (92) Testamentary trust--A trust established by a will.   (93) Texas State Plan for Medical Assistance--Document describing the Medicaid-funded services provided in Texas, in accordance with §1902 of the Social Security Act (42 U.S.C. §1396a).   (94) Third-party resource--A source of payment for medical expenses other than Medicaid.   (95) Three months prior--The three calendar months before the month of application.   (96) Titles to Social Security Act--Divisions of the Social Security Act. Titles referenced in this chapter are:     (A) Title II, which governs RSDI benefits;     (B) Title XVI, which governs the SSI program;     (C) Title XVIII, which governs Medicare; and     (D) Title XIX, which governs Medicaid.   (97) Trust--A trust includes any legal instrument, device, or arrangement which may not be called a trust under state law, but which is similar to a trust. That is, it involves a grantor who transfers property to an individual or entity with fiduciary obligations with the intention that it be held, managed, or administered by the individual or entity for the benefit of the grantor or others. This can include (but is not limited to) escrow accounts, investment accounts, pension funds, irrevocable burial trusts, limited partnerships, and other similar entities managed by an individual or entity with the fiduciary obligations.   (98) Unearned income--Income that is not earned.   (99) U.S.C.--United States Code.   (100) Working day--Any day except Saturday, Sunday, a state holiday, or a federal holiday.

Source Note: The provisions of this §358.103 adopted to be effective September 1, 2009, 34 TexReg 5497