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The following words and terms, when used in this chapter, have
the following meanings, unless the context clearly indicates otherwise.
Individual subchapters may have definitions that are specific to the
subchapter.
(1)Actual harm--A negative outcome that compromises
a resident's physical, mental, or emotional well-being.
(2)Addition--The addition of floor space to a facility.
(3)Administrator--The administrator of a facility.
(4)Administration of medication--Removing a unit or
dose of medication from a previously dispensed, properly labeled container;
verifying the medication with the medication order; giving the proper
medication in the proper dosage to the proper resident at the proper
time by the proper administration route; and recording the time of
administration and dosage administered.
(5)Advanced practice nurse--A person licensed to practice
professional nursing in accordance with Texas Occupations Code, Chapter
301, and authorized by the Texas Board of Nursing to practice as an
advanced practice nurse.
(6)Applicant--A person applying for a license under
Texas Health and Safety Code, Chapter 252.
(7)APA--The Administrative Procedure Act, Texas Government
Code, Chapter 2001.
(8)Attendant personnel--All persons who are responsible
for direct and non-nursing services to residents of a facility. (Nonattendant
personnel are all persons who are not responsible for direct personal
services to residents.) Attendant personnel come within the categories
of: administration, dietitians, medical records, activities, housekeeping,
laundry, and maintenance.
(9)Behavioral emergency--A situation in which severely
aggressive, destructive, violent, or self-injurious behavior exhibited
by a resident:
(A)poses a substantial risk of imminent probable death
of, or substantial bodily harm to, the resident or others;
(B)has not abated in response to attempted preventive
de-escalatory or redirection techniques;
(C)is not addressed in a behavior therapy program;
and
(D)does not occur during a medical or dental procedure.
(10)Care and treatment--Services required to maximize
resident independence, personal choice, participation, health, self-care,
psychosocial functioning and provide reasonable safety, all consistent
with the preferences of the resident.
(11)Change of ownership--An event that results in
a change to the federal taxpayer identification number of the license
holder of a facility. The substitution of a personal representative
for a deceased license holder is not a change of ownership.
(12)CMS--Centers for Medicare & Medicaid Services.
The federal agency that provides funding and oversight for the Medicare
and Medicaid programs. CMS was formerly known as the Health Care Financing
Administration (HCFA).
(13)Controlled substance--A drug, substance, or immediate
precursor as defined in the Texas Controlled Substance Act, Health
and Safety Code, Chapter 481, as amended, or the Federal Controlled
Substance Act of 1970, Public Law 91-513, as amended.
(14)Controlling person of an applicant, license holder,
or facility--A person who, acting alone or with others, has the ability
to directly or indirectly influence or direct the management, expenditure
of money, or policies of an applicant or license holder or of a facility
owned by an applicant or license holder.
(A)The term includes:
(i)a spouse of the applicant or license holder;
(ii)an officer or director, if the applicant or license
holder is a corporation;
(iii)a partner, if the applicant or license holder
is a partnership;
(iv)a trustee or trust manager, if the applicant or
license holder is a trust;
(v)a person that operates or contracts with others
to operate the facility;
(vi)a person who, because of a personal, familial,
or other relationship is in a position of actual control or authority
over the facility, without regard to whether the person is formally
named as an owner, manager, director, officer, provider, consultant,
contractor, or employee of the facility; and
(vii)a person who would be a controlling person of
an entity described in clauses (i) - (vi) of this subparagraph, if
that entity were the applicant or license holder.
(B)The term does not include an employee, lender,
secured creditor, or other person who does not exercise formal or
actual influence or control over the operation of a facility.
(15)DADS--The term referred to the Department of Aging
and Disability Services; it now refers to HHSC.
(16)Dangerous drug--Any drug as defined in the Texas
Dangerous Drug Act, Health and Safety Code, Chapter 483.
(17)Department--HHSC.
(18)Designee--A state agency or entity with which
HHSC contracts to perform specific, identified duties related to the
fulfillment of a responsibility prescribed by this chapter.
(19)Direct ownership interest--Ownership of equity
in the capital, stock, or profits of, or a membership interest in,
an applicant or license holder.
(20)Disclosable interest--Five percent or more direct
or indirect ownership interest in an applicant or license holder.
(21)Drug (also referred to as medication)--A drug
is:
(A)any substance recognized as a drug in the official
United States Pharmacopeia, official Homeopathic Pharmacopeia of the
United States, or official National Formulary, or any supplement to
any of them;
(B)any substance intended for use in the diagnosis,
cure, mitigation, treatment, or prevention of disease in man;
(C)any substance (other than food) intended to affect
the structure or any function of the human body; and
(D)any substance intended for use as a component of
any substance specified in subparagraphs (A) - (C) of this paragraph.
It does not include devices or their components, parts, or accessories.
(22)Establishment--A place of business or a place
where business is conducted which includes staff, fixtures, and property.
(23)Facility--A facility serving persons with an intellectual
disability or related conditions licensed under this chapter as described
in §90.2 of this chapter (relating to Scope) and required to
be licensed under the Health and Safety Code, Chapter 252, or the
entity that operates such a facility; or, in Subchapters C, D, and
F of this chapter, a program provider that must comply with those
subchapters in accordance with §9.212 of this title (relating
to Non-licensed Providers Meeting Licensure Standards).
(24)Governmental unit--A state or a political subdivision
of the state, including a county or municipality.
(25)Health care professional--A person licensed, certified,
or otherwise authorized to administer health care, for profit or otherwise.
The term includes a physician, licensed nurse, physician assistant,
podiatrist, dentist, physical therapist, speech therapist, and occupational
therapist.
(26)Hearing--A contested case hearing held in accordance
with the Administrative Procedure Act, Government Code, Chapter 2001,
and the formal hearing procedures in 1 TAC Chapter 357, Subchapter
I.
(27)HHSC--The Texas Health and Human Services Commission.
(28)Immediate jeopardy to health and safety--A situation
in which immediate corrective action is necessary because the facility's
noncompliance with one or more requirements has caused, or is likely
to cause, serious injury, harm, impairment, or death to a resident
receiving care in the facility.
(29)Immediate threat to the health or safety of a
resident--A situation that causes, or is likely to cause, serious
injury, harm, or impairment or death of a resident.
(30)Incident--An unusual or abnormal event or occurrence
in, at, or affecting the facility or the residents of the facility.
(31)Indirect ownership interest--Any ownership or
membership interest in a person that has a direct ownership interest
in an applicant or license holder.
(32)Inspection--Any on-site visit to or survey of
a facility by HHSC for the purpose of inspection of care, licensing,
monitoring, complaint investigation, architectural review, or similar
purpose.
(33)IPP--Individual program plan. A plan developed
by the interdisciplinary team of a facility resident that identifies
the resident's training, treatment, and habilitation needs, and describes
programs and services to meet those needs.
(34)Isolated--A very limited number of residents are
affected and a very limited number of staff are involved, or the situation
has occurred only occasionally.
(35)Large facility--Facilities with 17 or more resident
beds.
(36)Legal guardian--A person who is appointed guardian
under §693 of the Probate Code.
(37)Legally authorized representative--A person authorized
by law to act on behalf of a person with regard to a matter described
in this chapter, and may include a parent, guardian, or managing conservator
of a minor, or the guardian of an adult.
(38)License--Approval from HHSC to establish or operate
a facility.
(39)License holder--A person that holds a license
to operate a facility.
(40)Licensed nurse--A licensed vocational nurse, registered
nurse, or advanced practice nurse.
(41)Life Safety Code--NFPA 101.
(42)Life safety features--Fire safety components required
by the Life Safety Code such as building construction, fire alarm
systems, smoke detection systems, interior finishes, sizes and thicknesses
of doors, exits, emergency electrical systems, sprinkler systems,
etc.
(43)Local authorities--A local health authority, fire
marshal, building inspector, etc., who may be authorized by state
law, county order, or municipal ordinance to perform certain inspections
or certifications.
(44)Local health authority--The physician having local
jurisdiction to administer state and local laws or ordinances relating
to public health, as described in the Texas Health and Safety Code, §§121.021
- 121.025.
(45)LVN--Licensed vocational nurse. A person licensed
to practice vocational nursing in accordance with Texas Occupations
Code, Chapter 301.
(46)Management services--Services provided under contract
between the owner of a facility and a person to provide for the operation
of a facility, including administration, staffing, maintenance, or
delivery of resident services. Management services shall not include
contracts solely for maintenance, laundry, or food services.
(47)Metered dose inhaler--A device that delivers a
measured amount of medication as a mist that can be inhaled.
(48)NFPA--The National Fire Protection Association.
If the term is immediately followed by a number, it is a reference
to a publication of NFPA, as referenced in NFPA 101.
(49)NFPA 99--NFPA 99, Health Care Facilities Code,
2012 Edition. A publication of the NFPA that provides minimum requirements
for the installation, testing, maintenance, performance, and safe
practices for health care facilities and for material, equipment,
and appliances, used for patient care in health care facilities. CMS
has incorporated NFPA 99, 2012 Edition, except Chapters 7, 8, 12,
and 13, by reference as a Condition of Participation in the ICF/IID
program for facilities that meet the definition of a health care occupancy.
Copies of NFPA 99 may be obtained from NFPA, 1 Batterymarch Park,
Quincy, MA 02169.
(50)NFPA 101--NFPA 101, Life Safety Code, 2012 Edition.
A publication of the NFPA that provides minimum requirements, with
due regard to function, for the design, operation, and maintenance
of buildings and structures for safety to life from fire. CMS has
incorporated NFPA 101, 2012 Edition, by reference as a Condition of
Participation in the ICF/IID program. Copies of NFPA 101 may be obtained
from NFPA, 1 Batterymarch Park, Quincy, MA 02169.
(51)Oral medication--Medication administered by way
or through the mouth and does not include sublingual or buccal.
(52)Pattern of violation--Repeated, but not widespread
in scope, failures of a facility to comply with Texas Health and Safety
Code, Chapter 252, or a rule, standard or order adopted under Chapter
252 that:
(A)result in a violation; and
(B)are found throughout the services provided by the
facility or that affect or involve the same residents or facility
employees.
(53)Person--An individual, firm, partnership, corporation,
association, or joint stock company, and any legal successor of those
entities.
(54)Personal hold--
(A)A manual method, except for physical guidance or
prompting of brief duration, used to restrict:
(i)free movement or normal functioning of all or a
portion of a resident's body; or
(ii)normal access by a resident to a portion of the
resident's body.
(B)Physical guidance or prompting of brief duration
becomes a restraint if the resident resists the guidance or prompting.
(55)Potential for minimal harm--A violation that has
the potential for causing no more than a minor negative impact on
a resident.
(56)QIDP--Qualified intellectual disability professional.
A person who has at least one year of experience working directly
with persons with an intellectual disability or related conditions
and is one of the following:
(A)a doctor of medicine or osteopathy;
(B)a registered nurse; or
(C)an individual who holds at least a bachelor's degree
in one of the following areas:
(i)occupational therapy;
(ii)physical therapy;
(iii)social work;
(iv)speech-language pathology or audiology;
(v)recreation or a specialty area such as art, dance,
music or physical education;
(vi)dietetics; or
(vii)human services, such as sociology, special education,
rehabilitation counseling, or psychology (as specified in Title 42,
Code of Federal Regulations, §483.430(b)(5)(x)(W180).
(57)Quality-of-care monitor--A registered nurse, pharmacist,
or dietitian, employed by HHSC, who is trained and experienced in
long-term care regulations, standards of practice in long-term care,
and evaluation of resident care and functions independently of HHSC
Long Term Care Regulatory Services Division.
(58)Remodeling--The construction, removal, or relocation
of walls and partitions, or construction of foundations, floors, or
ceiling-roof assemblies, including expanding of safety systems (i.e.,
sprinkler systems, fire alarm systems), that will change the existing
plan and use areas of the facility.
(59)Renovation--The restoration to a former better
state by cleaning, repairing, or rebuilding, e.g., routine maintenance,
repairs, equipment replacement, painting.
(60)Resident--A person who resides in a facility.
(61)Restraint--A manual method, or a physical or mechanical
device, material, or equipment attached or adjacent to the resident's
body that the resident cannot remove easily, that restricts freedom
of movement or normal access to the resident's body. This term includes
a personal hold.
(62)RN--Registered nurse. A person licensed to practice
professional nursing in accordance with Texas Occupations Code, Chapter
301.
(63)Seclusion--The involuntary separation of a resident
away from other residents and the placement of the resident alone
in an area from which the resident is prevented from leaving.
(64)Small facilities--Facilities with 16 or fewer
resident beds.
(65)Specialized staff--Personnel with expertise in
developmental disabilities.
(66)Standards--The minimum conditions, requirements,
and criteria with which a facility will have to comply to be licensed
under this chapter.
(67)Topical medication--Medication applied to the
skin but does not include medication administered in the eyes.
(68)Universal precautions--The use of barrier precautions
by facility personnel to prevent direct contact with blood or other
body fluids that are visibly contaminated with blood.
(69)Vaccine preventable diseases--The diseases included
in the most current recommendations of the Advisory Committee on Immunization
Practices of the Centers for Disease Control and Prevention.
(70)Violation--Any noncompliance with Texas Health
and Safety Code, Chapter 252, or any rule under this chapter.
(71)Well-recognized church or religious denomination--An
organization which has been granted a tax-exempt status as a religious
association from the state or federal government.
(72)Widespread in scope--A violation that:
(A)is pervasive throughout the services provided by
the facility; or
(B)that affects or has the potential to affect a large
portion of or all of the residents of the facility.
The agency
certifies that legal counsel
has reviewed the adoption and found it to be a valid exercise of the
agency's legal authority.
Filed with the Office
of the Secretary of State on October 8, 2018
TRD-201804363 Karen Ray
Chief Counsel
Department of Aging and Disability Services
Effective date: October 28, 2018
Proposal publication date: June 22, 2018
For further information, please call: (512) 438-4681
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