The following words and terms, when used in this chapter, have
the following meanings unless the context clearly indicates otherwise:
(1) Abuse--
(A) physical abuse;
(B) sexual abuse; or
(C) verbal or emotional abuse.
(2) Adult--A person who is 18 years of age or older.
(3) Actively involved--Involvement with an individual
that the individual or LAR and other members of the individual's service
planning team deems to be of a quality nature based on the following:
(A) observed interactions of the person with the individual;
(B) a history of advocating for the best interests
of the individual;
(C) knowledge and sensitivity to the individual's preferences,
values, and beliefs;
(D) ability to communicate with the individual; and
(E) availability to the individual for assistance or
support when needed.
(4) Alleged perpetrator--A person alleged to have committed
an act of abuse, neglect, or exploitation of an individual.
(5) Allowable cost--A billable service or item that
is within the rate and spending limits of the rate established by
HHSC and that meets the requirements of an individual's program.
(6) Applicant--Depending on the context, an applicant
is:
(A) a person applying for employment with an employer;
(B) a person or legal entity applying for a contract
with an employer to deliver services to an individual; or
(C) a person enrolling in a program in which the CDS
option is available to the individual as described in §41.108
of this subchapter (relating to Services Available Through the CDS
Option).
(7) Budget--A written projection of expenditures for
each service delivered through the CDS option.
(8) Budgeted unit rate--The unit rate calculated for
employee wages and benefits in the budgeting process for services
delivered through the CDS option. The rate is calculated after employer
support services have been budgeted.
(9) CAS Program--Community Attendant Services Program.
A Medicaid state plan program authorized under Title XIX of the Social
Security Act and described in Chapter 47 of this title (relating to
Primary Home Care, Community Attendant Services, and Family Care Programs).
(10) Case manager--A person who provides case management
services to an individual. The case manager assists an individual
who receives services in gaining access to needed services, regardless
of the funding source for the services, and assists with other duties
in accordance with the rules of the individual's program.
(11) CDS option--Consumer directed services option.
A service delivery option in which an individual or LAR employs and
retains service providers and directs the delivery of program services.
(12) CDSA--An FMSA.
(13) CFC--Community First Choice. The CFC option described
in 1 Texas Administrative Code (TAC) Chapter 354, Subchapter A, Division
27 (relating to Community First Choice).
(14) CFC PAS/HAB--CFC personal assistance services/habilitation.
A Medicaid state plan service provided through CFC.
(15) CFC support management--Training on how to select,
manage, and dismiss an unlicensed service provider of CFC PAS/HAB.
(16) CLASS Program--Community Living Assistance and
Support Services Program. A Medicaid waiver program approved by CMS
under Title XIX, §1915(c) of the Social Security Act and described
in Chapter 45 of this title (relating to Community Living Assistance
and Support Services and Community First Choice (CFC) Services).
(17) CMPAS Program--Consumer Managed Personal Attendant
Services Program. A program authorized under Title XX, Subtitle A
of the Social Security Act and described in Chapter 44 of this title
(relating to Consumer Managed Personal Attendant Services (CMPAS)
Program).
(18) Contractor--A person, who performs one or more
program services, offers service to the general public, performs services
for payment, and with whom an employer has a written service agreement.
A contractor directs and controls when and how the work is performed
as well as the business aspect of the job including expenses and the
business relationship. A contractor may be a sole proprietor.
(19) Controlling person--A person who:
(A) has an ownership interest in an FMSA;
(B) is an officer or director of a corporation that
is an FMSA;
(C) is a partner in a partnership that is an FMSA;
(D) is a member or manager in a limited liability company
that is an FMSA;
(E) is a trustee or trust manager of a trust that is
an FMSA; or
(F) because of a personal, familial, or other relationship
with an FMSA, is in a position of actual control or authority with
respect to the FMSA, regardless of the person's title.
(20) DADS--HHSC.
(21) DBMD Program--Deaf Blind with Multiple Disabilities
Program. A Medicaid waiver program approved by CMS under Title XIX, §1915(c)
of the Social Security Act and described in Chapter 42 of this title
(relating to Deaf Blind with Multiple Disabilities (DBMD) Program
and Community First Choice (CFC) Services).
(22) DFPS--The Department of Family and Protective
Services.
(23) DR--Designated representative. A willing adult
appointed by the employer to assist with or perform the employer's
required responsibilities to the extent approved by the employer.
(24) Employee--A person employed by an employer through
a service agreement to deliver program services and who is paid an
hourly wage for those services, including a support advisor.
(25) Employer--An individual or LAR who chooses to
participate in the CDS option, and, therefore, is responsible for
hiring and retaining service providers to deliver program services.
(26) Employer support services--Services and items
the employer needs to perform employer and employment responsibilities,
as described in §41.507(a)(1) of this chapter (relating to Employer
Support Services Budgeting).
(27) Entity--An organization that has a legal identity
such as a corporation, limited partnership, limited liability company,
professional association, or cooperative.
(28) EVV system--Electronic visit verification system.
As defined in §68.102 of this title (relating to Definitions),
an electronic visit verification system that:
(A) allows a service provider to electronically report:
(i) the service recipient's identity;
(ii) the service provider's identity;
(iii) the date and time the service provider begins
and ends the delivery of services;
(iv) the location of service delivery; and
(v) tasks performed by the service provider; and
(B) meets other guidelines described on the HHSC website.
(29) 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.
(30) FC Program--Family Care Program. A program authorized
under Title XX, Subtitle A of the Social Security Act and described
in Chapter 47 of this title.
(31) FMS--Financial management services. Services delivered
by an FMSA to an employer or DR as described in §41.309(a) of
this chapter (relating to Financial Management Services, CFC Support
Management, and Vendor Fiscal/Employer Agent Responsibilities).
(32) FMSA--A financial management services agency.
A person, as defined in §49.102 of this title (relating to Definitions),
that contracts with HHSC to provide FMS.
(33) HCS Program--Home and Community-based Services
Program. A Medicaid waiver program approved by CMS under Title XIX, §1915(c)
of the Social Security Act and described in Chapter 9, Subchapter
D of this title (relating to Home and Community-based Services (HCS)
Program and Community First Choice (CFC)).
(34) HHSC--The Texas Health and Human Services Commission.
(35) Individual--A person enrolled in a program in
which the CDS option is available, as described in §41.108 of
this subchapter.
(36) LAR--Legally authorized representative. A person
authorized or required by law to act on behalf of an individual with
regard to a matter described in this chapter, including a parent of
a minor, guardian of a minor, managing conservator of a minor, or
the guardian of an adult.
Cont'd... |