| (115) Qualified mental health professional - community
services--Has the meaning given in §301.303 of this title (relating
to Definitions).
(116) Qualified surveyor--An employee of HHSC who has
completed state and federal training on the survey process and passed
a federal standardized exam.
(117) Quality assessment and assurance committee--A
group of health care professionals in a facility who develop and implement
appropriate action to identify and rectify substandard care and deficient
facility practice.
(118) Quality measure report--A report that provides
information derived from an MDS that provides a numeric value to quality
indicators. This data is available to the public as part of the Nursing
Home Quality Initiative (NHQI), and is intended to provide objective
measures for consumers to make informed decisions about the quality
of care in a nursing facility.
(119) Quality-of-care monitor--A registered nurse,
pharmacist, or dietitian employed by HHSC who is trained and experienced
in long-term care facility regulation, standards of practice in long-term
care, and evaluation of resident care, and functions independently
of HHSC Regulatory Services Division.
(120) RAI--Resident Assessment Instrument. An assessment
tool used to conduct comprehensive, accurate, standardized, and reproducible
assessments of each resident's functional capacity as specified by
the Secretary of the U. S. Department of Health and Human Services.
At a minimum, this instrument must consist of the MDS core elements
as specified by CMS; utilization guidelines; and Care Area Assessment
process.
(121) Recipient--Any individual residing in a Medicaid
certified facility or a Medicaid certified distinct part of a facility
whose daily vendor rate is paid by Medicaid.
(122) Rehabilitative services--Rehabilitative therapies
and devices provided to help a person regain, maintain, or prevent
deterioration of a skill or function that has been acquired but then
lost or impaired due to illness, injury, or disabling condition. The
term includes physical and occupational therapy, speech-language pathology,
and psychiatric rehabilitation services.
(123) Representative payee--A person designated by
the Social Security Administration to receive and disburse benefits,
act in the best interest of the beneficiary, and ensure that benefits
will be used according to the beneficiary's needs.
(124) Resident--Any individual residing in a nursing
facility.
(125) Resident group--A group or council of residents
who meet regularly.
(126) Resident representative--
(A) Any of the following:
(i) an individual chosen by the resident to act on
behalf of the resident in order to support the resident in decision-making;
access medical, social, or other personal information of the resident;
manage financial matters; or receive notifications;
(ii) a person authorized by state or federal law (including
agents under power of attorney, representative payees, and other fiduciaries)
to act on behalf of the resident in order to support the resident
in decision-making; access medical, social, or other personal information
of the resident; manage financial matters; or receive notifications;
(iii) legal representative, as used in Section 712
of the Older Americans Act (40 U.S.C. §3058g); or
(iv) the court-appointed guardian of a resident.
(B) This definition is not intended to expand the scope
of authority of any resident representative beyond that authority
specifically authorized by the resident, state or federal law, or
a court of competent jurisdiction.
(127) Responsible party--An individual authorized by
the resident to act for him as an official delegate or agent. Responsible
party is usually a family member or relative, but may be a legal guardian
or other individual. Authorization may be in writing or may be given
orally.
(128) Restraint--A chemical or physical restraint.
(129) Restraint 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.
(130) RN--Registered nurse. An individual currently
licensed by the Texas Board of Nursing as a registered nurse.
(131) RN assessment coordinator--A registered nurse
who signs and certifies a comprehensive assessment of a resident's
needs, using the RAI, including the MDS, as specified by HHSC.
(132) RUG--Resource Utilization Group. A categorization
method, consisting of 34 categories based on the MDS, that is used
to determine a recipient's service and care requirements and to determine
the daily rate HHSC pays a nursing facility for services provided
to the recipient.
(133) Secretary--Secretary of the U.S. Department of
Health and Human Services.
(134) Services required on a regular basis--Services
which are provided at fixed or recurring intervals and are needed
so frequently that it would be impractical to provide the services
in a home or family setting. Services required on a regular basis
include continuous or periodic nursing observation, assessment, and
intervention in all areas of resident care.
(135) SNF--A skilled nursing facility or distinct part
of a facility that participates in the Medicare program. SNF requirements
apply when a certified facility is billing Medicare for a resident's
per diem rate.
(136) Social Security Administration--Federal agency
for administration of social security benefits. Local social security
administration offices take applications for Medicare, assist beneficiaries
file claims, and provide information about the Medicare program.
(137) Social worker--A qualified social worker is an
individual who is licensed, or provisionally licensed, by the Texas
State Board of Social Work Examiners as prescribed by the Texas Occupations
Code, Chapter 505, and who has at least:
(A) a bachelor's degree in social work; or
(B) similar professional qualifications, which include
a minimum educational requirement of a bachelor's degree and one year
experience met by supervised employment providing social services
in a health care setting.
(138) Standards--The minimum conditions, requirements,
and criteria established in this chapter with which an institution
must comply to be licensed under this chapter.
(139) State Medicaid claims administrator--The entity
under contract with HHSC to process Medicaid claims in Texas.
(140) State Ombudsman--Has the meaning given in §88.2
of this title.
(141) State plan--A formal plan for the medical assistance
program, submitted to CMS, in which the State of Texas agrees to administer
the program in accordance with the provisions of the State Plan, the
requirements of Titles XVIII and XIX, and all applicable federal regulations
and other official issuances of the U.S. Department of Health and
Human Services.
(142) Stay agreement--An agreement between a license
holder and the executive commissioner that sets forth all requirements
necessary to lift a stay and rescind a license revocation proposed
under §554.2107 of this chapter (relating to Revocation of a
License by the HHSC Executive Commissioner).
(143) Substandard quality of care violation--A violation
of §554.401(a) or (b); §554.402(b), (c), or (m); §554.406(d)
- (h); §554.417(a), (b), or (d); §554.425(b)(1); §554.504(a); §554.601; §554.602; §554.701; §554.703; §554.706(a),
(c), (d)(1) - (5), or (e)(7); §554.801; §554.901; §554.904(2)
or (4); §554.1501(5), (6), or (7); or §554.1601(e)(2) of
this chapter (relating to Resident Rights) that constitutes:
(A) an immediate threat to resident health or safety;
(B) a pattern of or actual harm that is not an immediate
threat; or
(C) a widespread potential for more than minimal harm,
but less than an immediate threat, with no actual harm.
(144) Supervision--General supervision, unless otherwise
identified.
(145) Supervision (direct)--Authoritative procedural
guidance by a qualified person for the accomplishment of a function
or activity within the qualified person's sphere of competence. If
the person being supervised does not meet assistant-level qualifications
specified in this chapter and in federal regulations, the supervisor
must be on the premises and directly supervising.
Cont'd... |
