| (II) personal hygiene;
(III) household tasks;
(IV) mobility;
(V) money management;
(VI) community integration, including how to get around
in the community;
(VII) use of adaptive equipment;
(VIII) personal decision making;
(IX) reduction of challenging behaviors to allow individuals
to accomplish ADLs, IADLs, and health-related tasks; and
(X) self-administration of medication; and
(B) does not include transporting the individual, which
means driving the individual from one location to another.
(29) CFC support consultation--A CFC service that provides
support consultation to an individual who receives only CFC PAS/HAB
through the CDS option.
(30) CFC support management--A CFC service that provides
training on how to select, manage, and dismiss an unlicensed service
provider of CFC PAS/HAB.
(31) CFR--Code of Federal Regulations.
(32) CFS--Continued family services. A CLASS Program
service described in Subchapter E of this chapter (relating to Support
Family Services and Continued Family Services).
(33) CLASS Program--The Community Living Assistance
and Support Services Program.
(34) CMA--Case management agency. A program provider
that has a contract with HHSC to provide case management.
(35) CMS--The Centers for Medicare & Medicaid Services.
CMS is the agency within the United States Department of Health and
Human Services that administers Medicare and Medicaid programs.
(36) Cognitive rehabilitation therapy--A CLASS Program
service that:
(A) assists an individual in learning or relearning
cognitive skills that have been lost or altered as a result of damage
to brain cells or brain chemistry in order to enable the individual
to compensate for lost cognitive functions; and
(B) includes reinforcing, strengthening, or reestablishing
previously learned patterns of behavior, or establishing new patterns
of cognitive activity or compensatory mechanisms for impaired neurological
systems.
(37) Competitive employment--Employment that pays an
individual at least the minimum wage if the individual is not self-employed.
(38) Contract--A provisional contract that HHSC enters
into in accordance with 40 TAC §49.208 (relating to Provisional
Contract Application Approval) that has a term of no more than 3 years,
not including any extension agreed to in accordance with 40 TAC §49.208(e)
or a standard contract that HHSC enters into in accordance with 40
TAC §49.209 (relating to Standard Contract) that has a term of
no more than five years, not including any extension agreed to in
accordance with 40 TAC §49.209(d).
(39) Controlling person--A person who:
(A) has an ownership interest in a program provider;
(B) is an officer or director of a corporation that
is a program provider;
(C) is a partner in a partnership that is a program
provider;
(D) is a member or manager in a limited liability company
that is a program provider;
(E) is a trustee or trust manager of a trust that is
a program provider; or
(F) because of a personal, familial, or other relationship
with a program provider, is in a position of actual control or authority
with respect to the program provider, regardless of the person's title.
(40) Denial--An action taken by HHSC that:
(A) rejects an individual's request for enrollment
into the CLASS Program;
(B) disallows a CLASS Program service or a CFC service
requested on an IPC that was not authorized on the prior IPC; or
(C) disallows a portion of the amount or level of a
CLASS Program service or a CFC service requested on an IPC that was
not authorized on the prior IPC.
(41) Dental treatment--A CLASS Program service that:
(A) consists of the following:
(i) emergency dental treatments, which are procedures
necessary to control bleeding, relieve pain, and eliminate acute infection;
operative procedures that are required to prevent the imminent loss
of teeth; and treatment of injuries to the teeth or supporting structures;
(ii) routine preventative dental treatments, which
are examinations, x-rays, cleanings, sealants, oral prophylaxes, and
topical fluoride applications;
(iii) therapeutic dental treatments, which include
fillings, scaling, extractions, crowns, pulp therapy for permanent
and primary teeth; restoration of carious permanent and primary teeth;
maintenance of space; and limited provision of removable prostheses
when masticatory function is impaired, when an existing prosthesis
is unserviceable, or when aesthetic considerations interfere with
employment or social development;
(iv) orthodontic dental treatments, which are procedures
that include treatment of retained deciduous teeth; cross-bite therapy;
facial accidents involving severe traumatic deviations; cleft palates
with gross malocclusion that will benefit from early treatment; and
severe, handicapping malocclusions affecting permanent dentition with
a minimum score of 26 as measured on the Handicapping Labio-lingual
Deviation Index; and
(v) dental sedation, which is sedation necessary to
perform dental treatment including non-routine anesthesia, (for example,
intravenous sedation, general anesthesia, or sedative therapy prior
to routine procedures) but not including administration of routine
local anesthesia only; and
(B) does not include cosmetic orthodontia.
(42) DFPS--The Texas Department of Family and Protective
Services.
(43) Dietary services--A CLASS Program service that
provides nutrition services, as defined in Texas Occupations Code §701.002.
(44) Direct services--Includes the following services:
(A) CLASS Program services other than case management,
FMS, support consultation, support family services, CFS, and TAS;
(B) CFC PAS/HAB;
(C) CFC ERS; and
(D) CFC support management.
(45) DSA--Direct services agency. A program provider
that has a contract with HHSC to provide direct services.
(46) Employment assistance--A CLASS Program service
that provides assistance to an individual to help the individual locate
competitive employment in the community to the same degree of access
as individuals not receiving CLASS Program services.
(47) Enrollment IPC--The first individual plan of care
(IPC) for an individual developed before the individual's enrollment
into the CLASS Program.
(48) Enrollment IPP--The first individual program plan
(IPP) for an individual developed before the individual's enrollment
into the CLASS Program in accordance with §259.67 of this chapter
(relating to Development of IPPs).
(49) Exploitation--The illegal or improper act or process
of using, or attempting to use, an individual or the resources of
an individual for monetary or personal benefit, profit, or gain.
(50) FMS--Financial management services. A CLASS Program
service that is defined in 40 TAC §41.103 and is provided to
an individual participating in the CDS option.
(51) FMSA--Financial management services agency. An
entity, as defined in 40 TAC §41.103, that provides FMS.
(52) Former military member--A person who served in
the United States Army, Navy, Air Force, Marine Corps, Coast Guard,
or Space Force:
(A) who declared and maintained Texas as the person's
state of legal residence in the manner provided by the applicable
military branch while on active duty; and
(B) who was killed in action or died while in service,
or whose active duty otherwise ended.
(53) Functional behavior assessment--An evaluation
that is used to determine the underlying function or purpose of an
individual's behavior, so an effective behavior support plan can be
developed.
(54) Good cause--As determined by HHSC, a reason outside
the control of a CFC ERS provider that is an acceptable reason for
the CFC ERS provider's failure to comply.
(55) Group setting--A setting, other than an individual's
residence, in which more than one individual or other person is receiving
pre-vocational services or a similar service.
(56) Habilitation--A CLASS Program service that allows
an individual to reside successfully in a community setting by training
the individual to acquire, retain, and improve self-help, socialization,
and daily living skills or assisting the individual with ADLs. Habilitation
services consist of the following:
Cont'd... |
