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
Cont'd... |
