The following words and terms, when used in this subchapter,
have the following meanings, unless the context clearly indicates
otherwise.
(1) Adolescent--An individual who is at least 13 years
of age, but younger than 18 years of age.
(2) Adult--An individual who is 18 years of age or
older.
(3) APRN or Advanced practice registered 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. The term is synonymous with "advanced
nurse practitioner."
(4) Authorization period--The duration for which the
provider has obtained authorization in accordance with §416.6(a)
of this title (relating to Service Authorization and Recovery Plan).
(5) Business day--Any day except a Saturday, Sunday,
or legal holiday listed in Texas Government Code, §662.021.
(6) CFP or Certified family partner--A person who:
(A) is 18 years of age or older;
(B) has received:
(i) a high school diploma; or
(ii) a high school equivalency certificate issued in
accordance with the laws applicable to the issuing agency;
(C) has at least one year of lived experience raising
a child or adolescent with an emotional or mental health issues as
a parent or LAR;
(D) has at least one year of experience navigating
a child-service system (e.g., mental health, juvenile justice, social
security, or special education) as a parent or LAR; and
(E) has successfully completed the certified family
partner (CFP) training and passed the certification examination recognized
by the department.
(7) CFR--The Code of Federal Regulations.
(8) Child--An individual who is at least three years
of age, but younger than 13 years of age.
(9) Crisis--A situation in which:
(A) an individual presents an immediate danger to self
or others;
(B) an 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.
(10) CSSP or community services specialist--A staff
member who, as of August 30, 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) has had three continuous years of documented full-time
experience in the provision of MH rehabilitative services; and
(C) has demonstrated competency in the provision and
documentation of MH rehabilitative services in accordance with this
subchapter and the MH Rehabilitative Services Billing Guidelines.
(11) CSU or crisis stabilization unit--A crisis stabilization
unit licensed under the Texas Health and Safety Code, Chapter 577;
and Chapter 134 of this title (relating to Private Psychiatric Hospitals
and Crisis Stabilization Units).
(12) Day--Calendar day, unless otherwise specified.
(13) Department--The Department of State Health Services.
(14) Direct clinical supervision--An LPHA's or QMHP's
interaction with a staff member who delivers MH rehabilitative services
to ensure that MH rehabilitative services are clinically appropriate
and in compliance with this subchapter by:
(A) conducting a documented meeting with the staff
member at regularly scheduled intervals; and
(B) conducting documented observations of the staff
member providing MH rehabilitative services at a frequency determined
by the supervisor based on the staff member's skill level.
(15) Face-to-face--A contact with an individual that
occurs when the individual is in the physical presence of the staff
member who is delivering the service. Face-to-face does not include
contacts made through the use of electronic media.
(16) Group--A face-to-face service delivery modality
involving at least one staff member and:
(A) two to eight adults; or
(B) two to six children or adolescents and may include
their LARs or primary caregivers, which do not count toward the group
size limit.
(17) Health risk factors--Circumstances that contribute
to the premature death and disabling chronic diseases such as heart
disease, diabetes and cancers. They include, but are not limited to,
substance abuse or addiction, high blood pressure, tobacco use, high
blood glucose, use of and side effects of some neuroleptic medications,
physical inactivity, overweight and obesity, and unsafe sex.
(18) IMD or institution for mental diseases--Based
on 42 CFR §435.1009, a hospital, nursing facility, or other institution
of more than 16 beds that is primarily engaged in providing diagnosis,
treatment, or care of individuals with serious mental illness, including
medical attention, nursing care, and related services.
(19) Individual--A person seeking or receiving MH rehabilitative
services.
(20) In vivo--The individual's natural environment
(e.g., the individual's residence, work place, or school).
(21) LAR or legally authorized representative--A person
authorized by law to act on behalf of an adult, child, or adolescent
with regard to a matter described in this subchapter, including, but
not limited to, a parent, guardian, or managing conservator.
(22) LMFT or Licensed marriage and family therapist--An
individual 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.
(23) Licensed medical staff member--A staff member
who is:
(A) a physician (MD) or (DO);
(B) a physician assistant (PA);
(C) an APRN;
(D) a registered nurse (RN);
(E) an LVN; or
(F) a pharmacist.
(24) LPC or Licensed professional counselor--A person
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.
(25) LOC or level of care--A designation given to the
department's standard sets of mental health services, based on the
uniform assessment and utilization management guidelines referenced
in §416.17 of this title (relating to Guidelines), which specify
the type, amount, and duration of MH rehabilitative services to be
provided to an individual.
(26) LPHA or licensed practitioner of the healing arts--This
term shall have the meaning set forth in the §412.303 of this
title (relating to Definitions).
(27) LVN or licensed vocational nurse--A staff member
who is licensed as a vocational nurse by the Texas Board of Nursing
in accordance with Texas Occupations Code, Chapter 301.
(28) Mental health (MH) rehabilitative services--Services
that:
(A) are individualized, age-appropriate training and
instructional guidance that restore an individual's functional deficits
due to serious mental illness or SED;
(B) are designed to improve or maintain the individual's
ability to remain in the community as a fully integrated and functioning
member of that community; and
(C) consist of the following services:
(i) crisis intervention services;
(ii) medication training and support services;
(iii) psychosocial rehabilitative services;
(iv) skills training and development services; and
(v) day programs for acute needs.
(29) Medicaid provider--A Medicaid-enrolled provider
with which the department has a Medicaid provider agreement to provide
MH rehabilitative services under the State's Medicaid Program.
(30) Medical necessity or medically necessary--A clinical
determination made by an LPHA that services:
(A) are reasonable and necessary for the treatment
of a serious mental illness; or to improve, maintain, or prevent
deterioration of functioning resulting from such a disorder;
(B) are provided in accordance with accepted standards
of practice in behavioral health care;
(C) are furnished in the most appropriate and least
restrictive setting in which services can be safely provided;
Cont'd... |
