2200, Definitions

Revision 22-2; Effective April 1, 2022

The following words and terms, when used in this manual, have the following meanings:

Class D (Clinic) Pharmacy License – A pharmacy license issued to a pharmacy to dispense limited types of drug or devices under a prescription drug order. Information to apply for a Class D Pharmacy License may be found on the Texas State Board of Pharmacy’s website.

Client – A person who is eligible to receive medical care, treatment or services. The term client and patient may be used interchangeably in other sources.  

Compass 21 – Texas Medicaid & Healthcare Partnership’s automated claims processing system used to process claims for services delivered to HHSC FPP and Medicaid.

Consultation – A type of service provided by a health care provider with expertise in a medical or surgical specialty and who, upon request of another appropriate health care provider, assists with the evaluation and/or management of a patient.

Contraception – The means of pregnancy prevention, including permanent and temporary methods.

Contraceptive Methods – A broad range of birth control options, approved by the U.S. Food and Drug Administration, except for emergency contraception.

Contractor – An entity that HHSC has contracted with to provide services. The contractor is the responsible entity even if there is a subcontractor involved who provides the services. The terms contractor and contract may be used interchangeably with grantee and grant in other sources.

Co-pay or Co-payment – Money collected directly from clients for services.

Cost Reimbursement – Funding used to develop and maintain contractor infrastructure for the provision of family planning services.

Eligibility Date – The date an individual is determined eligible for the program. The eligibility expiration date will be twelve months after the eligibility date.

Family Planning Services – Educational or comprehensive medical activities that enable clients to freely determine the number and spacing of their children and select the means by which this may be achieved.

Federal Poverty Level (FPL) – The minimum amount of income that a family needs for food, clothing, transportation, shelter and other necessities, as determined by the U.S. Department of Health and Human Services. FPL varies according to family size. The number is adjusted for inflation and reported annually in the Federal Poverty Guidelines. Public assistance programs, such as Medicaid, define eligibility income limits in terms of a percentage of FPL.

Fee-for-Service – The payment mechanism for services that are reimbursed on a set rate per unit of service (also known as unit rate).

Fiscal Year – The state fiscal year is from September 1 through August 31.

Health and Human Services Commission (HHSC) – Provides support for the Health and Human Services agencies, administers the state’s Medicaid and other client service programs, sets policies, defines covered benefits, and determines client eligibility for major programs.

Health Care Provider – A physician, physician assistant, nurse practitioner, clinical nurse specialist, certified nurse midwife, federally qualified health center, family planning agency, health clinic, ambulatory surgical center, hospital ambulatory surgical center, laboratory or rural health center. “Health care provider” is used interchangeably with “provider” throughout this manual.

Healthy Texas Women (HTW) – A Medicaid program administered by HHSC to provide uninsured women with women’s health and family planning services such as women’s health exams, health screenings and birth control. HTW providers must provide client services on a fee-for-service basis and may also, but are not required to, contract with HHSC to provide support services that enhance the HTW fee-for-service client delivery on a cost reimbursement basis. 

Informed Consent – The process by which a health care provider ensures that the benefits and risks of a diagnostic or treatment plan, the benefits and risks of other options, and the benefits and risks of taking no action are explained to a patient in a manner that is understandable to that patient and allows the person to participate and make sound decisions about her or his own medical care.

Intimate Partner Violence (IPV) – Physical, sexual or psychological harm by a current or former partner or spouse. IPV may also be referred to as domestic violence or family violence.

Long-Acting Reversible Contraceptives (LARCs) – Methods of contraception that are effective for an extended period without requiring user action. LARCs include intrauterine devices (IUDs) and subdermal contraceptive implants.

Medicaid – The Texas Medical Assistance Program, a joint federal and state program provided for in Texas Human Resources Code Chapter 32 and subject to Title XIX of the Social Security Act, 42 U.S.C. §1396 et seq

Minor – In accordance with the Texas Family Code, a person under 18 years of age who is not and has not been married or who has not had the disabilities of minority removed for general purposes (i.e., emancipated).

Monthly Voucher Packet – Required forms (B-13X, 4116 and Data Management) to request reimbursement for the categorical contract.

Outreach – Activities that are conducted with the purpose of informing and educating the community about services and increasing the number of individuals served.

Program Income – Money that is collected directly by the contractor, subcontractor or provider for services provided under the contract award (that is, patient co-pay fees and donations).

Referral – The process of directing or redirecting a medical case or a person to an appropriate specialist or agency for information, help or treatment.

Reproductive Life Plan – A plan that outlines an individual’s personal goals regarding whether to have children, the desired number of children, and the best timing and spacing of children. Counseling should include the importance of developing a reproductive life plan and information about reproductive health, family planning methods and services, and how to obtain preconception health services, as needed.

Texas Medicaid & Healthcare Partnership (TMHP) – The Texas Medicaid Claims and Primary Care Case Management administrator. HHSC contracts with TMHP to process claims for providers.