The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise: (1) Acquired brain injury--A neurological insult to the brain, which is not hereditary, congenital, or degenerative. The injury to the brain has occurred after birth and results in a change in neuronal activity, which results in an impairment of physical functioning, sensory processing, cognition, or psychosocial behavior. (2) Cognitive communication therapy--Services designed to address modalities of comprehension and expression, including understanding, reading, writing, and verbal expression of information. (3) Cognitive rehabilitation therapy--Services designed to address therapeutic cognitive activities, based on an assessment and understanding of the individual's brain-behavioral deficits. (4) Community reintegration services--Services that facilitate the continuum of care as an affected individual transitions into the community. (5) Enrollee--A person covered by a health benefit plan. (6) Health benefit plan--As described in the Insurance Code §1352.001 and §1352.002. (7) Issuer--Those entities identified in the Insurance Code §1352.001. (8) Neurobehavioral testing--An evaluation of the history of neurological and psychiatric difficulty, current symptoms, current mental status, and premorbid history, including the identification of problematic behavior and the relationship between behavior and the variables that control behavior. This may include interviews of the individual, family, or others. (9) Neurobehavioral treatment--Interventions that focus on behavior and the variables that control behavior. (10) Neurocognitive rehabilitation--Services designed to assist cognitively impaired individuals to compensate for deficits in cognitive functioning by rebuilding cognitive skills and/or developing compensatory strategies and techniques. (11) Neurocognitive therapy--Services designed to address neurological deficits in informational processing and to facilitate the development of higher level cognitive abilities. (12) Neurofeedback therapy--Services that utilize operant conditioning learning procedure based on electroencephalography (EEG) parameters, and which are designed to result in improved mental performance and behavior, and stabilized mood. (13) Neurophysiological testing--An evaluation of the functions of the nervous system. (14) Neurophysiological treatment--Interventions that focus on the functions of the nervous system. (15) Neuropsychological testing--The administering of a comprehensive battery of tests to evaluate neurocognitive, behavioral, and emotional strengths and weaknesses and their relationship to normal and abnormal central nervous system functioning. (16) Neuropsychological treatment--Interventions designed to improve or minimize deficits in behavioral and cognitive processes. (17) Other similar coverage--The medical/surgical benefits provided under a health benefit plan. This term recognizes a distinction between medical/surgical benefits, which encompass benefits for physical illnesses or injuries, as opposed to benefits for mental/behavioral health under a health benefit plan. (18) Outpatient day treatment services--Structured services provided to address deficits in physiological, behavioral, and/or cognitive functions. Such services may be delivered in settings that include transitional residential, community integration, or non-residential treatment settings. (19) Post-acute care treatment services--Services provided after acute care confinement and/or treatment that are based on an assessment of the individual's physical, behavioral, or cognitive functional deficits, which include a treatment goal of achieving functional changes by reinforcing, strengthening, or re-establishing previously learned patterns of behavior and/or establishing new patterns of cognitive activity or compensatory mechanisms. (20) Post-acute transition services--Services that facilitate the continuum of care beyond the initial neurological insult through rehabilitation and community reintegration. (21) Psychophysiological testing--An evaluation of the interrelationships between the nervous system and other bodily organs and behavior. (22) Psychophysiological treatment--Interventions designed to alleviate or decrease abnormal physiological responses of the nervous system due to behavioral or emotional factors. (23) Remediation--The process(es) of restoring or improving a specific function. (24) Services--The work of testing, treatment, and providing therapies to an individual with an acquired brain injury. (25) Therapy--The scheduled remedial treatment provided through direct interaction with the individual to improve a pathological condition resulting from an acquired brain injury. |
