The following words and terms, when used in this subchapter,
have the following meanings, unless the context clearly indicates
otherwise:
(1) Access--The ability to obtain mental health community
services based upon components such as availability and acceptability
of services to the individual, or the individual's Legally Authorized
Representative (LAR) on the individual's behalf, transportation, distance,
hours of operation, language, and the cultural competency of staff
members. Barriers to access may be structural, financial, or specific
to the individual.
(2) Adolescent--An individual who is at least 13 years
of age, but younger than 18 years of age.
(3) Adult--An individual who is 18 years of age or
older.
(4) Advanced practice nurse--A staff member who is
a registered nurse approved by the Texas Board of Nursing as a clinical
nurse specialist in psychiatric/mental health or nurse practitioner
in psychiatric/mental health, in accordance with Texas Occupations
Code, Chapter 301.
(5) Advocacy--Support for an individual or family member
in expressing and resolving issues or concerns regarding access to
or quality and appropriateness of services.
(6) Appeal--A mechanism for an independent review of
an adverse determination.
(7) Assessment--A systematic process for measuring
an individual's service needs.
(8) Child--An individual who is at least three years
of age, but younger than 13 years of age.
(9) Competency--Demonstrated knowledge and skilled
performance of a particular activity.
(10) Continuity of services--Services that ensure uninterrupted
services are provided to an individual during a transition between
service types (e.g., inpatient services, outpatient services) or providers,
in accordance with applicable rules (e.g., Chapter 412, Subchapter
D of this title (relating to Mental Health Services - Admission, Continuity,
and Discharge)). These activities include:
(A) assisting with admissions and discharges;
(B) facilitating access to appropriate services and
supports in the community, including identifying and connecting the
individual with community resources;
(C) participating in the individual's treatment plan
development and reviews;
(D) promoting implementation of the individual's treatment
plan or continuing care plan; and
(E) facilitating coordination and follow-up between
the individual and the individual's family, as well as with available
community resources.
(11) COPSD or co-occurring psychiatric and substance
use disorders--The co-occurring diagnoses of psychiatric disorders
and substance use disorders.
(12) Credentialing--A process to review and approve
a staff member's educational status, experience, and licensure status
(as applicable) to ensure that the staff member meets the departmental
requirements for service provision. The process includes primary source
verification of credentials, establishing and applying specific criteria
and prerequisites to determine the staff member's initial and ongoing
competency and assessing and validating the staff member's qualification
to deliver care. Re-credentialing is the periodic process of reevaluating
the staff's competency and qualifications.
(13) Crisis--A situation in which:
(A) the individual presents an immediate danger to
self or others; or
(B) the individual's mental or physical health is at
risk of serious deterioration; or
(C) an individual believes that he or she presents
an immediate danger to self or others or that his or her mental or
physical health is at risk of serious deterioration.
(14) Crisis services--Mental health community services
or other necessary interventions provided to an individual in crisis.
(15) CSSP or community services specialist--A staff
member who, as of August 31, 2004:
(A) received:
(i) a high school diploma; or
(ii) a high school equivalency certificate issued in
accordance with the law of the issuing state;
(B) had three continuous years of documented full-time
experience in the provision of mental health rehabilitative services
or case management services; and
(C) demonstrated competency in the provision and documentation
of mental health rehabilitative or case management services in accordance
with Chapter 419, Subchapter L of this title (relating to Mental Health
Rehabilitative Services) and Chapter 412, Subchapter I of this title
(relating to Mental Health Case Management Services).
(16) Cultural competency--Demonstrated knowledge and
skill by a staff member to effectively respond to an individual's
needs through knowledge of communication, actions, customs, beliefs,
and values, within the individual's racial, ethnic, religious beliefs,
disability, and social groups.
(17) Department--Department of State Health Services
(DSHS).
(18) Department-approved algorithm--An evidence-based
process for providing psychiatric care to adults with severe and persistent
mental illnesses and children and adolescents with serious emotional
disturbance, consisting of consensus-derived guidelines for medication
treatment, training and support for physicians, standardized documentation,
and patient and family education.
(19) DSM--The current edition of the Diagnostic
Statistical Manual of Mental Disorders published by the American
Psychiatric Association.
(20) Emergency care services--Mental health community
services or other necessary interventions directed to address the
immediate needs of an individual in crisis in order to assure the
safety of the individual and others who may be placed at risk by
the individual's behaviors, including, but not limited to, psychiatric
evaluations, administration of medications, hospitalization, stabilization
or resolution of the crisis.
(21) Face-to-face--A contact with an individual that
occurs in person. Face-to-face does not include contacts made through
the use of video conferencing or telecommunication technologies, including
telemedicine.
(22) Family member--Any person who an individual identifies
as being a member of their family.
(23) Family partner--An experienced, trained primary
caregiver (i.e., parent of an individual with a mental illness or
serious emotional disturbance) who provides peer mentoring, education,
and support to the caregivers of a child who is receiving mental health
community services.
(24) HIPAA--The Health Insurance Portability and Accountability
Act, 42 U.S.C. §1320d et seq.
(25) Identifying information--The name, address, date
of birth, social security number, or any information by which the
identity of an individual can be determined either directly or by
reference to other publicly available information. The term includes
medical records, graphs, and charts that contain an individual's information;
statements made by the individual either orally or in writing while
receiving mental health community services; videotapes, audiotapes,
photographs, and other recorded media; and any acknowledgment that
an individual is receiving or has received services from a state facility,
LMHA, MCO, or provider.
(26) Indicator--A defined, measurable variable used
to monitor the quality or appropriateness of an important aspect of
an individual's care or service or an organization's performance of
related functions, processes, or outcomes. Indicators can measure
activities, events, occurrences, or outcomes for which data can be
collected to allow comparison with a threshold, a benchmark, or prior
performance.
(27) Individual--A person who is seeking or receiving
mental health community services from or through a provider.
(28) LAR or legally authorized representative--A person
authorized by law to act on behalf of an individual with regard to
a matter described in this subchapter, including, but not limited
to, a parent, guardian, or managing conservator.
(29) LCDC or licensed chemical dependency counselor--A
counselor licensed by the department pursuant to the Texas Occupations
Code, Chapter 504.
(30) LCSW or licensed clinical social worker--A staff
member who is licensed as a clinical social worker by the Texas State
Board of Social Worker Examiners in accordance with the Texas Occupations
Code, Chapter 505.
(31) LMFT or licensed marriage and family therapist--A
staff member who is licensed as a licensed marriage and family therapist
by the Texas State Board of Examiners of Marriage and Family Therapists
in accordance with Texas Occupations Code, Chapter 502.
(32) LMHA or local mental health authority--An entity
designated as the local mental authority by the department in accordance
with the Texas Health and Safety Code, §533.035(a).
(33) LOC or level of care--A designation given to the
department's standardized packages of mental health community services,
based on the uniform assessment and the utilization management guidelines,
which recommend the type, amount, and duration of mental health community
services to be provided to an individual.
(34) LPC or licensed professional counselor--A staff
member who is licensed as a licensed professional counselor by the
Texas State Board of Examiners of Professional Counselors in accordance
with Texas Occupations Code, Chapter 503.
(35) LPHA or licensed practitioner of the healing arts--A
staff member who is:
(A) a physician;
(B) a licensed professional counselor (LPC);
(C) a licensed clinical social worker (LCSW);
(D) a psychologist;
(E) an advanced practice registered nurse (APRN);
(F) a physician assistant (PA); or
(G) a licensed marriage and family therapist (LMFT).
(36) LVN or licensed vocational nurse--A staff member
who is licensed as a licensed vocational nurse by the Texas Board
of Nursing in accordance with Texas Occupations Code, Chapter 301.
(37) Management information system--An information
system designed to supply an LMHA or MCO with information needed to
plan, organize, staff, direct, and control their operations and clinical
decision-making.
(38) MCO or managed care organization--An entity that
has a current Texas Department of Insurance certificate of authority
to operate as a Health Maintenance Organization (HMO) in the Texas
Insurance Code, Chapter 843, or as an approved nonprofit health corporation
in the Texas Insurance Code, Chapter 844, and that provides mental
health community services pursuant to a contract with the department.
(39) Medical necessity--The need for a service that:
(A) is reasonable and necessary for the diagnosis or
treatment of a mental health disorder or a co-occurring psychiatric
and substance use disorder (COPSD) in order to improve or maintain
an individual's level of functioning;
(B) is provided in accordance with professionally accepted
clinical guidelines and standards of practice in behavioral health
care;
(C) is furnished in the most clinically appropriate,
available setting in which the service can be safely provided;
(D) is provided at a level that is safe and appropriate
for the individual's needs and facilitates the individual's recovery;
and
(E) could not be omitted without adversely affecting
the individual's mental or physical health or the quality of care
rendered.
(40) Medical record--The systematic, organized account,
compiled by health care providers, of information relevant to the
services provided to an individual. This includes an individual's
history, present illness, findings on examination, treatment and discharge
plans, details of direct and indirect care and services, and notes
on progress.
(41) Mental health community services--All services
medically necessary to treat, care for, supervise, and rehabilitate
individuals who have a mental illness or emotional disorder or a COPSD.
These services include services for the prevention of and recovery
from such disorders, but do not include inpatient services provided
in a state facility.
(42) Mental illness--An illness, disease, or condition
(other than a sole diagnosis of epilepsy, dementia, substance use
disorder, mental retardation, or pervasive developmental disorder)
that:
(A) substantially impairs an individual's thought,
perception of reality, emotional process, development, or judgment;
or
(B) grossly impairs an individual's behavior as demonstrated
by recent disturbed behavior.
(43) Peer provider--A staff member who:
(A) has received:
(i) a high school diploma; or
(ii) a high school equivalency certificate issued in
accordance with the law of the issuing state;
(B) has at least one cumulative year of receiving mental
health community services; and
(C) is under the direct clinical supervision of an
LPHA.
(44) Physician--A staff member who is:
(A) licensed as a physician by the Texas Medical Board
in accordance with Texas Occupations Code, Chapter 155; or
Cont'd... |
