2015 Tennessee Code
Title 71 - Welfare
Chapter 5 - Programs and Services for Poor Persons
Part 1 - Medical Assistance Act
§ 71-5-103 - Part definitions.

As used in this part, unless the context otherwise requires:

(1) "Adult behavioral health services for the seriously and persistently mentally ill" means behavioral health services for individuals nineteen (19) years of age and older, including, but not limited to, assessment, evaluation, diagnostic, therapeutic intervention, case management, psychiatric medication management, labs related to medication management and pharmacy assistance and coordination;

(2) "Adult emergency dental services" means dental services for individuals twenty-one (21) years of age and older to treat a dental condition that manifests itself by symptoms of sufficient severity, including severe pain, infection or trauma, that:

(A) A prudent layperson who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate dental attention to potentially result in:

(i) Placing the person's, or with respect to a pregnant woman, her unborn child's, health in jeopardy;

(ii) Serious impairment of bodily functions;

(iii) Serious dysfunction of any bodily organ or part; or

(B) Includes treatment of dental condition necessary for an individual to receive essential medical treatment, including, but not limited to, extraction of abscessed or periodontally involved teeth prior to an individual receiving a prosthetic heart valve, a donor organ, other replacement prosthetic devices or head and neck radiation therapy;

(3) "Applicant" means any person who has applied for benefits under this part;

(4) "County office" means the county office of the state department of human services in the county wherein the applicant resides;

(5) "Department" means the department of health;

(6) "Home-based and community-based services" means any of the following supportive services and systems, as approved by the health care financing administration (HCFA), that are provided to older persons and individuals with disabilities to remain independent and avoid inappropriate institutionalization and that help individuals maintain physical, social, and spiritual independence in the least restrictive environment:

(A) Living environments and supportive services, e.g., assisted care living facilities, homes for the aged and assistive technology;

(B) Personal care, homemaker and chore services;

(C) Adult day services;

(D) Congregate and home delivered meals;

(E) Home care organizations;

(F) Rehabilitative care;

(G) Assisted transportation or mobility services; and

(H) Support services to caregivers, including hospice and respite care;

(7) "Medical assistance" means payment of the cost of care, services and supplies necessary to prevent, diagnose, correct or cure conditions in the person that cause acute suffering, endanger life, result in illness or infirmity, interfere with the person's capacity for normal activity, or threaten some significant handicap and that are furnished an eligible person in accordance with this part and the rules and regulations of the department. Such care, services and supplies include services of qualified practitioners licensed under the laws of this state;

(8) "Medically needy" means a class or classes of persons whose present income and financial assets are not sufficient to meet their present liabilities for health costs; provided, that the department of health or the department of human services, as may be designated by the governor, may through regulation establish an income limitation as well as other criteria, such as cash, savings, intangible assets and real and personal property for the determination of "medically needy." To the extent of any federal waiver received by the state that waives any or all of the provisions of Title XIX, compiled in 42 U.S.C. § 1396 et seq., or pursuant to any other federal law as adopted by amendment to the required Title XIX state plan, "medically needy" means those persons whose income and assets are insufficient to purchase health insurance and those persons who are uninsurable as a result of an existing or prior medical condition;

(9) "Mobile dental services" means an intact comprehensive dental services unit operated on-site at a long-term care facility, interfacing with the facility's common electrical and water sources;

(10) "Recipient" means any person who has been determined eligible to receive benefits under this part and who has received such benefits;

(11) "Resident" means any individual who is living within the state, with the intent that such person's permanent home be within the state, and not temporarily. Temporary absences from the state shall not cause a person to lose residential status;

(12) "Responsible parties" means the following representatives and relatives of recipients of medical assistance pursuant to this part who are not financially eligible to receive benefits under this part: parents, spouses, children, and guardians;

(13) "Title XIX" means Title XIX of the Social Security Act as amended (P.L. 89-97), compiled in 42 U.S.C. § 1396 et seq., administered by the United States department of health and human services or its successor in office and including amendments of Title XIX and other federal social security laws replacing that title in whole or in part; and

(14) "Vendor" means any person, institution, agency, or business concern providing medical care services or goods authorized under this part, holding, where applicable, a current valid license to provide such services or to dispense such goods; or any health maintenance organization, as defined in title 56, chapter 32, with which the state has entered into a contract based on a per capita rate of payment for services provided under this part.