The following words and terms, when used in this chapter, have
the following meanings, unless the context clearly indicates otherwise.
(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
(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
(5) Business day--Any day except a Saturday, a Sunday,
or a national or state holiday listed in Texas Government Code §662.003(a)
(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
(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
(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
(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
(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
(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,
(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
(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
(37) NF--Nursing facility. A Medicaid-certified facility
that is licensed in accordance with the Texas Health and Safety Code
(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
(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:
(i) assess the individual's need for care in a NF;
(ii) assess the individual's need for specialized services;
(iii) identify alternate placement options.
(42) Physical abuse--Any of the following:
(A) an act or failure to act performed knowingly, recklessly,
or intentionally, including incitement to act, that caused physical
injury or death to a designated resident or placed a designated resident
at risk of physical injury or death;
(B) an act of inappropriate or excessive force or corporal
punishment, regardless of whether the act results in a physical injury
to a designated resident;
(C) the use of a restraint on a designated resident
not in compliance with federal and state laws and rules; or
(43) Physical restraint--Any manual method used to
control a designated resident's behavior, except for physical guidance
or prompting of brief duration that a designated resident does not
resist, that restricts:
(A) the free movement or normal functioning of all
or a part of the designated resident's body; or
(B) normal access by a designated resident to a portion
of the designated resident's body.
(44) Plan of care--A written plan that includes:
(A) the IHSS required by the NF baseline or comprehensive
(B) the frequency, amount, and duration of each IHSS
to be provided for the designated resident during a plan year; and
(C) the services and supports to be provided for the
designated resident through resources other than PASRR.
(45) Plan year--A 12-month period starting on the date
of the initial or annual IDT meeting. A revised or transfer plan of
care does not change the begin or end date of a plan year.
(46) Renewal plan of care--A plan of care developed
for a designated resident in accordance with §368.302(a) of this
chapter (relating to Renewal and Revision of a Plan of Care).
(47) Restraint--Any of the following:
(A) a physical restraint;
(B) a mechanical restraint; or
(C) a chemical restraint.
(48) Revised plan of care--An initial or renewal plan
of care that is revised during a plan year in accordance with §368.302(b)
of this chapter to add a new IHSS or change the frequency, amount,
or duration of an existing IHSS.
(49) Seclusion--The involuntary placement of a designated
resident alone in an area from which the designated resident is prevented
(50) Service provider agency--An entity that has a
contract with HHSC to provide IHSS for a designated resident.
(51) Sexual abuse--Any of the following:
(A) sexual exploitation of a designated resident;
(B) non-consensual or unwelcomed sexual activity with
a designated resident; or
(C) consensual sexual activity between a designated
resident and an individual service provider, staff member, volunteer,
or controlling person, unless a consensual sexual relationship with
an adult designated resident existed before the individual service
provider, staff member, volunteer, or controlling person became an
individual service provider, staff member, volunteer, or controlling
(52) Sexual activity--An activity that is sexual in
nature, including kissing, hugging, stroking, or fondling with sexual
(53) Sexual exploitation--A pattern, practice, or scheme
of conduct against a designated resident that can reasonably be construed
as being for the purposes of sexual arousal or gratification of any
(A) which may include sexual contact; and
(B) does not include obtaining information about a
designated resident's sexual history within standard accepted clinical
(54) SPT--Service planning team, as defined in §303.102
of this title.
(55) Staff member--An employee or contractor of a service
(56) Surrogate decision maker--An actively involved
person who has been identified by an IDT in accordance with Texas
Health and Safety Code §313.004 and who is available and willing
to consent to medical treatment on behalf of the designated resident.
(57) TAC--Texas Administrative Code.