25 TAC § 98.102. Definitions, DIVISION 1. GENERAL PROVISIONS

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

(1) Applicant--An individual who applies to the department for THMP services.

(2) Commissioner--The Commissioner of the Department of State Health Services.

(3) Department--The Department of State Health Services.

(4) Eligible health insurance policy--A state, federal, or private health insurance policy that is approved by the THMP and covers at least one drug from each class of HIV-antiretroviral medication and covers appropriate primary care services.

(5) Formulary--A list of drugs approved by the department that includes at least one drug from each class of HIV antiretroviral medications. https://www.dshs.texas.gov/hivstd/meds/files/formulary.pdf.

(6) Full-LIS--Full Low-income subsidy. The Social Security Administration provides full-LIS to applicants with income and assets below specified limits.

(7) HIV--Human immunodeficiency virus. Encompassing all stages of HIV, including HIV-related conditions and syndromes.

(8) Legally responsible person--A parent, managing conservator, or other person that is legally responsible for the support of a minor or a ward.

(9) Medicare prescription drug plan--A Medicare Part D prescription drug plan or the prescription drug component of a Medicare Part C Advantage Plan.

(10) Minor--A person who is younger than 18 years of age and who has not been emancipated by a court or who is not married or recognized as an adult by the state of Texas.

(11) Open enrollment--A time period during which one may freely enroll in or change one's selection of a health insurance plan or other benefit plan that is ordinarily subject to restrictions.

(12) Out-of-pocket costs--The premium, copay, coinsurance, and deductible amounts that an individual would be expected to pay when enrolled in a health insurance plan or Medicare prescription drug plan.

(13) Partial-LIS--Partial Low-income subsidy. The Social Security Administration provides partial-LIS to applicants with income and assets above the level of those qualifying for full-LIS, but still below specified limits.

(14) Payor of last resort--A funding source that may be used only after all other available public and private funding sources have been accessed.

(15) Qualifying event--A change of life circumstance that allows an individual to enroll in or change the selection of a health insurance plan or other benefit plan outside of open enrollment.

(16) SPAP--The State Pharmacy Assistance Program. The SPAP is available to low-income individuals living with HIV who also have Medicare Part D.

(17) Texas resident--An individual is considered a Texas resident if that person physically resides in Texas and intends to continue to reside within the state.

(18) THMP--The Texas HIV Medication Program, which includes the AIDS Drug Assistance Program (ADAP), SPAP, and TIAP.

(19) TIAP--Texas Insurance Assistance Program. TIAP provides premium and copay assistance with eligible health insurance policies.