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 person--An individual who has
significant, ongoing, and supportive involvement with a designated
resident, as determined by the SPT based on the individual's:
(A) observed interactions with the designated resident;
(B) availability to the designated resident for assistance
or support when needed; and
(C) knowledge of, sensitivity to, and advocacy for
the designated resident's needs, preferences, values, and beliefs.
(3) Acute care hospital--A health care facility in
which an individual receives short-term treatment for a severe physical
injury or episode of physical illness, an urgent medical condition,
or recovery from surgery and:
(A) may include a long-term acute care hospital, an
emergency room within an acute care hospital, or an inpatient rehabilitation
hospital; and
(B) does not include a stand-alone psychiatric hospital
or a psychiatric hospital within an acute care hospital.
(4) Alleged perpetrator--An individual alleged to have
committed an act of abuse, neglect, or exploitation of a designated
resident.
(5) 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).
(6) Calendar day--Any day, including weekends and holidays.
(7) CFR--Code of Federal Regulations.
(8) Chemical restraint--A medication used to control
a designated resident's behavior or to restrict the designated resident's
freedom of movement that is not a standard treatment for the designated
resident's medical or psychological condition.
(9) CMS--Centers for Medicare & Medicaid Services.
(10) Competitive employment--Employment in the competitive
labor market that is performed on a full-time or part-time basis in
an integrated setting and that pays a designated resident:
(A) at or above minimum wage; and
(B) not less than the customary wage and level of benefits
paid by an employer to individuals who do not have disabilities performing
the same or similar work.
(11) Contract--A written agreement between HHSC and
a service provider agency that obligates the service provider agency
to provide a service for a designated resident in exchange for payment
from HHSC.
(12) Contract area--A geographic area composed of one
or more Texas counties as identified in the contract to be served
by a service provider agency.
(13) Controlling person--An individual who:
(A) has a controlling ownership interest in a service
provider agency;
(B) is a managing employee of a service provider agency;
(C) has been delegated the authority to obligate or
act on behalf of a service provider agency;
(D) is an officer or director of a corporation that
is a service provider agency;
(E) is a partner in a partnership that is a service
provider agency;
(F) is a member or manager in a limited liability company
that is a service provider agency;
(G) is a trustee or trust manager of a trust that is
a service provider agency;
(H) because of a personal, familial, or other relationship
with a service provider agency, is in a position of actual control
or authority with respect to the service provider agency, regardless
of the individual's title.
(14) Critical incident--An event that:
(A) involves a designated resident;
(B) occurs during the provision of IHSS; and
(C) may involve:
(i) a serious injury;
(ii) a medication error;
(iii) a restraint;
(iv) an emergency room visit, hospitalization, or call
to 911 for a medical or psychiatric emergency;
(v) an arrest;
(vi) an unauthorized departure;
(vii) an allegation or confirmation of abuse, neglect,
or exploitation; or
(viii) a death.
(15) Day Activity and Health Services program--A program
defined in Texas Human Resources Code §103.003(2).
(16) DD--Developmental disability. A disability that
meets the criteria described in the definition of "persons with related
conditions" in 42 CFR §435.1010.
(17) Designated resident--An individual:
(A) whose PE or resident review is positive for ID
or DD;
(B) who is at least 21 years of age;
(C) who is a Medicaid recipient; and
(D) who is a resident or has transitioned to the community
from a NF within the previous 365 days.
(18) DFPS--The Texas Department of Family and Protective
Services.
(19) Exploitation--The illegal or improper act or process
of using, or attempting to use, a designated resident or the resources
of a designated resident for monetary or personal benefit, profit,
or gain.
(20) Habilitation coordination--Assistance for a designated
resident residing in a NF to access appropriate specialized services
necessary to achieve a quality of life and level of community participation
acceptable to the designated resident and LAR.
(21) Habilitation coordinator--An employee of a LIDDA
who provides habilitation coordination.
(22) HHSC--The Texas Health and Human Services Commission.
(23) HSP--Habilitation service plan, as defined in §303.102
of this title (relating to Definitions).
(24) ID--Intellectual disability, as defined in 42
CFR §483.102(b)(3)(i).
(25) IDD--Intellectual and developmental disability.
(26) IDD PASRR Handbook--Intellectual and Developmental
Disability Preadmission Screening and Resident Review Handbook.
(27) IDT--Interdisciplinary team, as defined in §303.102
of this title.
(28) IHSS--IDD habilitative specialized services, described
in §368.201 of this chapter (relating to Description of IHSS).
(29) Individual service provider--An individual, who
may be an employee or contractor of the service provider agency, who
directly provides an IHSS for a designated resident.
(30) Initial plan of care--The first plan of care for
a designated resident developed after an initial IDT meeting.
(31) LAR--Legally authorized representative. An individual
authorized by law to act on behalf of a designated resident about
a matter described in this chapter and may include the legal guardian
or surrogate decision maker.
(32) LIDDA--Local intellectual and developmental disability
authority. An entity designated by the executive commissioner of HHSC,
in accordance with Texas Health and Safety Code §533A.035.
(33) Local service area--A geographic area, composed
of one or more Texas counties as identified in the LIDDA's performance
contract to be served by a LIDDA.
(34) Mechanical restraint--A mechanical device, material,
or equipment used to control a designated resident's behavior by restricting
the ability of the designated resident to freely move part or all
of the designated resident's body.
(35) MI--Mental illness. Serious mental illness, as
defined in 42 CFR §483.102(b)(1).
(36) Neglect--A negligent act or omission that caused
physical or emotional injury or death to a designated resident or
placed a designated resident at risk of physical or emotional injury
or death.
(37) NF--Nursing facility. A Medicaid-certified facility
that is licensed in accordance with the Texas Health and Safety Code
Chapter 242.
(38) NF baseline care plan--A baseline care plan developed
in accordance with 26 TAC §554.802(a) (relating to Comprehensive
Person-Centered Care Planning).
(39) NF comprehensive care plan--A comprehensive care
plan, defined in 26 TAC §554.2703(3) (relating to Definitions).
(40) PASRR--Preadmission screening and resident review.
A federal requirement in 42 CFR Part 483, Subpart C.
(41) PE--PASRR level II evaluation. A face-to-face
evaluation:
(A) of an individual seeking admission to a NF who
is suspected of having MI, ID, or DD; and
(B) performed by a LIDDA, local mental health authority,
or local behavioral health authority to determine if the individual
has MI, ID, or DD and, if so, to:
Cont'd... |
