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) Actively involved--Significant, ongoing, and supportive
involvement with an individual by a person, as determined by the individual,
based on the person's:
(A) interactions with the individual;
(B) availability to the individual for assistance or
support when needed; and
(C) knowledge of, sensitivity to, and advocacy for
the individual's needs, preferences, values, and beliefs.
(3) Adaptive aid--A service in the Deaf Blind with
Multiple Disabilities (DBMD) Program that:
(A) enables an individual to retain or increase the
ability to perform ADLs or perceive, control, or communicate with
the environment in which the individual lives; and
(B) meets one of the following criteria:
(i) is an item included in the list of adaptive aids
in the Deaf Blind with Multiple Disabilities
Program Manual; or
(ii) is the repair or maintenance of an item on the
list of adaptive aids in the Deaf Blind with
Multiple Disabilities Program Manual that is not covered by
a warranty.
(4) Adaptive behavior--The effectiveness with or degree
to which an individual meets the standards of personal independence
and social responsibility expected of the individual's age and cultural
group as assessed by an adaptive behavior screening assessment.
(5) Adaptive behavior level--The categorization of
an individual's functioning level based on a standardized measure
of adaptive behavior. There are four adaptive behavior levels ranging
from mild limitations in adaptive skills (I) through profound limitations
in adaptive skills (IV).
(6) Adaptive behavior screening assessment--A standardized
assessment used to determine an individual's adaptive behavior level,
and conducted using the current version of one of the following assessment
instruments:
(A) American Association of Intellectual and Developmental
Disabilities (AAIDD) Adaptive Behavior Scales (ABS);
(B) Inventory for Client and Agency Planning (ICAP);
(C) Scales of Independent Behavior; or
(D) Vineland Adaptive Behavior Scales.
(7) ADLs--Activities of daily living. Basic personal
everyday activities, including tasks such as eating, toileting, grooming,
dressing, bathing, and transferring.
(8) Agency foster home--This term has the meaning set
forth in Texas Human Resources Code §42.002.
(9) Alarm call--A signal transmitted from an individual's
Community First Choice (CFC ) Emergency Response Services (ERS ) equipment
to the CFC ERS response center indicating that the individual needs
immediate assistance.
(10) ALF--Assisted living facility. A facility licensed
in accordance with Texas Health and Safety Code Chapter 247.
(11) Alleged perpetrator--A person alleged to have
committed an act of abuse, neglect, or exploitation of an individual.
(12) Audiology--A DBMD Program service that provides
assessment and treatment by a licensed audiologist and includes training
and consultation with an individual's family members or other support
providers.
(13) Auxiliary aid--A service or device that enables
an individual with impaired sensory, manual, or speaking skills to
participate in the person-centered planning process. An auxiliary
aid includes interpreter services, transcription services, and a text
telephone.
(14) Behavior support plan--A comprehensive, individualized
written plan based on a current functional behavior assessment that
includes specific outcomes and behavioral techniques designed to teach
or increase adaptive skills and decrease or eliminate target behaviors.
(15) Behavioral emergency--A situation in which an
individual is acting in an aggressive, destructive, violent, or self-injurious
manner that poses a risk of death or serious bodily harm to the individual
or others.
(16) Behavioral support--A DBMD Program service that
provides specialized interventions to assist an individual in increasing
adaptive behaviors and replacing or modifying behaviors that prevent
or interfere with the individual's inclusion in the community and
consists of the following activities:
(A) conducting a functional behavior assessment;
(B) developing an individualized behavior support plan;
(C) training and consulting with an individual, family
member, or other persons involved in the individual's care regarding
the implementation of the behavior support plan;
(D) monitoring and evaluating the effectiveness of
the behavior support plan;
(E) modifying, as necessary, the behavior support plan
based on monitoring and evaluating the plan's effectiveness; and
(F) counseling and educating an individual, family
members, or other persons involved in the individual's care about
the techniques to use in assisting the individual to control challenging
or socially unacceptable behaviors.
(17) Business day--Any day except a Saturday, a Sunday,
or a national or state holiday listed in Texas Government Code §662.003(a)
or (b).
(18) Calendar day--Any day, including weekends and
holidays.
(19) Case management--The DBMD Program service described
in §260.337 of this chapter (relating to Case Management).
(20) Case manager--A service provider of case management.
(21) CDS option--Consumer directed services option.
A service delivery option defined in 40 TAC §41.103 (relating
to Definitions).
(22) CFC--Community First Choice.
(23) CFC ERS--CFC emergency response services. A CFC
service that provides backup systems and supports used to ensure continuity
of services and supports. CFC ERS includes electronic devices and
an array of available technology, personal emergency response systems,
and other mobile communication devices.
(24) CFC ERS provider--The entity directly providing
CFC ERS to an individual, which may be the program provider or a contractor
of the program provider.
(25) CFC FMS--CFC financial management services. A
CFC service provided to an individual who receives only CFC PAS/HAB
through the CDS option.
(26) CFC PAS/HAB--CFC personal assistance services/habilitation.
A CFC service:
(A) that consists of:
(i) personal assistance services, which provide assistance
to an individual in performing ADLs and IADLs based on the individual's
person-centered service plan, including:
(I) non-skilled assistance with the performance of
the ADLs and IADLs;
(II) household chores necessary to maintain the home
in a clean, sanitary, and safe environment;
(III) escort services, which consist of accompanying
and assisting an individual to access services or activities in the
community, but do not include transporting an individual; and
(IV) assistance with health-related tasks; and
(ii) habilitation, which provides assistance to an
individual in acquiring, retaining, and improving self-help, socialization,
and daily living skills and training the individual on ADLs, IADLs,
and health-related tasks, including:
(I) self-care;
(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.
(27) CFC support consultation--A CFC service that provides
support consultation to an individual who receives only CFC PAS/HAB
through the CDS option.
(28) CFC support management--A CFC service that provides
training on how to select, manage, and dismiss an unlicensed service
provider of CFC PAS/HAB.
(29) CFR--Code of Federal Regulations.
(30) Chemical restraint--A medication used to control
an individual's behavior or to restrict the individual's freedom of
movement that is not a standard treatment for the individual's medical
or psychological condition.
(31) Chore services--A DBMD Program service, other
than CFC PAS/HAB household chores, needed to maintain a clean, sanitary,
and safe environment in an individual's home and consists of heavy
household chores, such as washing floors, windows, and walls, securing
loose rugs and tiles, and moving heavy items or furniture.
(32) CMS--The Centers for Medicare & Medicaid Services.
CMS is the agency within the United States Department of Health and
Human Services that administers the Medicare and Medicaid programs.
(33) Competitive employment--Employment that pays an
individual at least minimum wage if the individual is not self-employed.
(34) Contract--A provisional contract that the Texas
Health and Human Services Commission enters into in accordance with
40 TAC §49.208 (relating to Provisional Contract Application
Approval) that has a term of no more than three 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).
(35) 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.
(36) Day Activity and Health Services Program--This
term has the meaning set forth in Texas Human Resource Code §103.003.
(37) DBMD Program--The Deaf Blind with Multiple Disabilities
Program.
(38) Deafblindness--A chronic condition in which a
person:
(A) has deafness, which is a hearing impairment severe
enough that most speech cannot be understood with amplification; and
(B) has legal blindness, which results from a central
visual acuity of 20/200 or less in the person's better eye, with correction,
or a visual field of 20 degrees or less.
(39) Denial--An action taken by HHSC that:
(A) rejects an individual's request for enrollment
into the DBMD Program;
(B) disallows a DBMD Program service or a CFC service
requested on an individual plan of care (IPC) that was authorized
on the prior IPC; or
(C) disallows a portion of the amount or level of a
DBMD Program service or a CFC service requested on an IPC that was
not authorized on the prior IPC.
(40) Dental treatment--A DBMD 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, and 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
Cont'd... |
