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TITLE 26HEALTH AND HUMAN SERVICES
PART 1HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 554NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION
SUBCHAPTER BBNURSING FACILITY RESPONSIBILITIES RELATED TO PREADMISSION SCREENING AND RESIDENT REVIEW (PASRR)
DIVISION 1GENERAL PROVISIONS
RULE §554.2703Definitions

The following words and terms, when used in this subchapter, have the following meanings unless the context clearly indicates otherwise:

  (1) Alternate placement assistance--Assistance provided to a resident to locate and secure services chosen by the resident or LAR that meet the resident's basic needs in a setting other than a nursing facility. Assistance includes the identification of specific services and supports available through alternate resources for which the resident may be eligible and an explanation of the possible benefits and consequences of selecting a setting other than a nursing facility.

  (2) Coma--A state of unconsciousness characterized by the inability to respond to sensory stimuli as documented by a physician.

  (3) Comprehensive care plan--A plan, defined in §19.101 of this chapter (relating to Definitions), that includes, for a designated resident, nursing facility specialized services and nursing facility PASRR support activities.

  (4) Convalescent care--A type of care provided after an individual's release from an acute care hospital that is part of a medically prescribed period of recovery.

  (5) CMWC--Customized manual wheelchair. A wheelchair that consists of a manual mobility base and customized seating system and is adapted and fabricated to meet the individualized needs of a designated resident.

  (6) DADS--Department of Aging and Disability Services or HHSC, as its successor agency. For purposes of the PASRR process, HHSC is the state authority for intellectual and developmental disabilities.

  (7) DD--Developmental disability. A disability that meets the criteria described in the definition of "persons with related conditions" in Code of Federal Regulations (CFR) Title 42, §435.1010.

  (8) Delirium--A serious disturbance in an individual's mental abilities that results in a decreased awareness of the individual's environment and confused thinking.

  (9) Designated resident--A Medicaid recipient with ID or DD who is 21 years of age or older and who is a resident.

  (10) DME--Durable medical equipment. The following items, including any accessories and adaptations needed to operate or access the item:

    (A) a gait trainer;

    (B) a standing board;

    (C) a special needs car seat or travel restraint;

    (D) a specialized or treated pressure-reducing support surface mattress;

    (E) a positioning wedge;

    (F) a prosthetic device; and

    (G) an orthotic device.

  (11) DSHS--Department of State Health Services. For purposes of the PASRR process, DSHS is the state mental health authority.

  (12) Emergency protective services--Services that are furnished by the Department of Family and Protective Services to an elderly or disabled individual who has been determined to be in a state of abuse, neglect, or exploitation.

  (13) Exempted hospital discharge--A category of nursing facility admission that occurs when a physician has certified that an individual who is being discharged from a hospital is likely to require less than 30 days of nursing facility services for the condition for which the individual was hospitalized.

  (14) Expedited admission--A category of nursing facility admission that occurs when an individual meets the criteria for one of the following categories: convalescent care, terminal illness, severe physical illness, delirium, emergency protective services, respite, or coma.

  (15) HHSC--Health and Human Services Commission or its designee.

  (16) ID--Intellectual disability. Mental retardation, as described in CFR Title 42, §483.102(b)(3)(i).

  (17) IDT--Interdisciplinary team. A team consisting of:

    (A) a resident with MI, ID, or DD;

    (B) the resident's LAR, if any;

    (C) a registered nurse from the nursing facility with responsibility for the resident;

    (D) a representative of a LIDDA or LMHA, or if the resident has MI and DD or MI and ID, a representative of the LIDDA and LMHA; and

    (E) other persons, as follows:

      (i) a concerned person whose inclusion is requested by the resident or LAR;

      (ii) a person specified by the resident or LAR, nursing facility, or LIDDA or LMHA, as applicable, who is professionally qualified or certified or licensed with special training and experience in the diagnosis, management, needs and treatment of people with MI, ID, or DD; and

      (iii) a representative of the appropriate school district if the resident is school age and inclusion of the district representative is requested by the resident or LAR.

  (18) Individual--A person seeking admission to a nursing facility.

  (19) ISP--Individual service plan. A service plan developed by the service planning team for a designated resident in accordance with §17.502(2) of this title (relating to Service Planning Team (SPT) Responsibilities for a Designated Resident).

  (20) LAR--Legally authorized representative. A person authorized by law to act on behalf of an individual or resident with regard to a matter described by this subchapter, and who may be the parent of a minor child, the legal guardian, or the surrogate decision maker.

  (21) LIDDA--Local intellectual and developmental disabilities authority. An entity designated by the executive commissioner of HHSC, in accordance with Texas Health and Safety Code §533A.035.

  (22) LIDDA specialized services--Support services, other than nursing facility services, that are identified through the PE or resident review and may be provided to a resident who has ID or DD. LIDDA specialized services are:

    (A) service coordination, which includes alternate placement assistance;

    (B) employment assistance;

    (C) supported employment;

    (D) day habilitation;

    (E) independent living skills training; and

    (F) behavioral support.

  (23) LMHA--Local mental health authority. An entity designated by the executive commissioner of HHSC, in accordance with Texas Health and Safety Code §533.035. For the purposes of this subchapter, LMHA includes an entity designated by DSHS as the entity to perform PASRR functions.

  (24) LMHA specialized services--Support services, other than nursing facility services, that are identified through the PE or resident review and may be provided to a resident who has MI. LMHA specialized services are defined in Title 25, Texas Administrative Code (TAC), Chapter 412, Subchapter I (relating to MH Case Management), including alternate placement, and 25 TAC Chapter 416, Subchapter A (relating to Mental Health Rehabilitative Services).

  (25) LTC Online Portal--Long Term Care Online Portal. A web-based application used by Medicaid providers to submit forms, screenings, evaluations, and the long term services and supports Medicaid identification section of the MDS assessment.

  (26) MDS assessment--Minimum data set assessment. A standardized collection of demographic and clinical information that describes a resident's overall condition, which a nursing facility in Texas is required to submit for a resident of the facility.

  (27) MI--Mental illness. Serious mental illness, as defined in 42 CFR §483.102(b)(1).

  (28) Nursing facility--A Medicaid-certified facility that is licensed in accordance with Texas Health and Safety Code, Chapter 242.

  (29) Nursing facility PASRR support activities--Actions a nursing facility takes in coordination with a LIDDA or LMHA to facilitate the successful provision of LIDDA specialized services or LMHA specialized services, including:

    (A) arranging transportation for a designated resident to participate in a LIDDA specialized service or a LMHA specialized service outside the nursing facility;

    (B) sending a resident to a scheduled LIDDA specialized service or a LMHA specialized service with food and medications required by the resident; and

    (C) including in the comprehensive care plan an agreement to avoid, when possible, scheduling nursing facility services at times that conflict with LIDDA specialized services or LMHA specialized services.

  (30) Nursing facility specialized services--Support services, other than nursing facility services, that are identified through the PE and may be provided to a designated resident. Nursing facility specialized services are:

    (A) therapy services;

    (B) CMWC; and

    (C) DME.

  (31) PASRR--Preadmission screening and resident review.

  (32) PASRR determination--A decision made by DADS, DSHS, or their designee regarding an individual's need for nursing facility specialized services, LIDDA specialized services, and LMHA specialized services, based on information in the PE; and, in accordance with Subchapter Y of this chapter (relating to Medical Necessity Determinations), whether the individual requires the level of care provided in a nursing facility. A report documenting the determination is sent to the individual and LAR.

  (33) PE--PASRR Level II evaluation. A face-to-face evaluation of an individual suspected of having MI, ID, or DD performed by a LIDDA or an LMHA to determine if the individual has MI, ID, or DD, and if so to:

    (A) assess the individual's need for care in a nursing facility;

    (B) assess the individual's need for nursing facility specialized services, LIDDA specialized services and LMHA specialized services; and

    (C) identify alternate placement options.

  (34) PL1--PASRR Level I screening. The process of screening an individual to identify whether the individual is suspected of having MI, ID, or DD.

  (35) Pre-admission--A category of nursing facility admission from a community setting that is not an expedited admission or an exempted hospital discharge.

  (36) Referring entity--The entity that refers an individual to a nursing facility, such as a hospital, attending physician, LAR or other personal representative selected by the individual, a family member of the individual, or a representative from an emergency placement source, such as law enforcement.

  (37) Resident--An individual who resides in a nursing facility and receives services provided by professional nursing personnel of the facility.

  (38) Resident review--A face-to-face evaluation of a resident performed by a LIDDA or LMHA:

    (A) for a resident with MI, ID, or DD who experienced a significant change in status, to:

      (i) assess the resident's need for continued care in a nursing facility;

      (ii) assess the resident's need for nursing facility specialized services, LIDDA specialized services and LMHA specialized services; and

      (iii) identify alternate placement options; and

    (B) for a resident suspected of having MI, ID, or DD, to determine whether the resident has MI, ID, or DD and, if so:

      (i) assess the resident's need for continued care in a nursing facility;

      (ii) assess the resident's need for nursing facility specialized services, LIDDA specialized services, and LMHA specialized services; and

      (iii) identify alternate placement options.

  (39) Respite--Services provided on a short-term basis to an individual because of the absence of or the need for relief by the individual's unpaid caregiver for a period not to exceed 14 days.

  (40) Service coordination--As defined in §2.553 of this title (relating to Definitions), assistance in accessing medical, social, educational, and other appropriate services and supports that will help an individual achieve a quality of life and community participation acceptable to the person and LAR on the individual's behalf.

  (41) Service coordinator--An employee of a LIDDA who provides service coordination.

  (42) Severe physical illness--An illness resulting in ventilator dependence or diagnosis such as chronic obstructive pulmonary disease, Parkinson's disease, Huntington's disease, amyotrophic lateral sclerosis, or congestive heart failure, that results in a level of impairment so severe that the individual could not be expected to benefit from nursing facility specialized services, LIDDA specialized services or LMHA specialized services.

  (43) SPT--Service planning team. A team that develops, reviews, and revises the ISP for a designated resident.

    (A) The SPT always includes:

      (i) the designated resident;

      (ii) the designated resident's LAR, if any;

      (iii) the service coordinator;

      (iv) nursing facility staff familiar with the designated resident's needs;

      (v) persons providing nursing facility specialized services and LIDDA specialized services for the designated resident;

      (vi) a representative from a community provider, if one has been selected; and

Cont'd...

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