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TITLE 28INSURANCE
PART 1TEXAS DEPARTMENT OF INSURANCE
CHAPTER 3LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES
SUBCHAPTER HHSTANDARDS FOR REASONABLE COST CONTROL AND UTILIZATION REVIEW FOR CHEMICAL DEPENDENCY TREATMENT CENTERS
RULE §3.8001Definitions

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

  (1) Abusable glue or aerosol paint--Glue or aerosol paint that is:

    (A) packaged in a container holding a pint or less by volume or less than two pounds by weight; and

    (B) labeled in accordance with the labeling requirements concerning precautions against inhalation established under the Federal Hazardous Substances Act (15 United States Code §1261, et seq.), and under regulations adopted under that Act.

  (2) Adolescent--A person who is 17 years of age or younger.

  (3) Advanced clinical practitioner--An individual certified as an advanced clinical practitioner by the Texas Department of Human Services.

  (4) Aerosol paint--An aerosol paint product, including a clear or pigmented lacquer or finish.

  (5) Certified social worker--An individual who is certified as a certified social worker by the Texas Department of Human Services.

  (6) Chemical dependency--The abuse of, or the psychological or physical dependence on, or the addiction to, alcohol or a controlled substance.

  (7) Chemical dependency counselor--A person who is licensed by the Texas Commission on Alcohol and Drug Abuse.

  (8) Chemical dependency treatment center--A facility which provides a program for the treatment of chemical dependency pursuant to a written treatment plan approved and monitored by a physician or qualified credentialed counselor and which facility also meets one of the qualifications in subparagraphs (A)-(D) of this paragraph:

    (A) affiliated with a hospital under a contractual agreement with an established system for patient referral;

    (B) accredited as such a facility by the Joint Commission on Accreditation of Hospitals;

    (C) licensed as a chemical dependency treatment program by the Texas Commission on Alcohol and Drug Abuse; or

    (D) licensed, certified, or approved as a chemical dependency treatment program or center by any other state agency having legal authority to so license, certify, or approve.

  (9) Controlled substance--A toxic inhalant, or a substance designated as a controlled substance in the Texas Controlled Substances Act (the Health and Safety Code, §481.002(5)).

  (10) Facility--An individual program, entity, organization, or other provider of chemical dependency treatment services.

  (11) Glue--An adhesive substance intended to be used to join two surfaces.

  (12) Intensive outpatient services--An organized non-residential service providing structured group and individual therapy, educational services, and life skills training which consists of at least 10 hours per week for four to 12 weeks, but less than 24 hours per day.

  (13) Licensed professional counselor--An individual licensed as a professional counselor by the Texas State Board of Examiners of Professional Counselors.

  (14) Licensed vocational nurse--A nurse licensed by the Texas State Board of Vocational Nurse Examiners.

  (15) Partial hospitalization--The provision of treatment for chemical dependency for persons who require care or support or both in a hospital or chemical dependency treatment center but who do not require 24-hour supervision at least 20 hours per week up to 8 weeks.

  (16) Payor--An insurer writing health insurance policies; any preferred provider organization, health maintenance organization, self-insurance plan; or any other person or entity which provides, offers to provide, or administers hospital, outpatient, medical, or other health benefits to persons treated by a health care provider in this state pursuant to any policy, plan or contract.

  (17) Physician -- A licensed doctor of medicine or a doctor of osteopathy.

  (18) Program--A particular type or level of service that is organizationally distinct within a facility.

  (19) Psychiatrist--An individual who is licensed in the State of Texas to practice psychiatry, who is eligible for, or has received, board certification, and who has hospital affiliation and experience in appropriate use of psychotropic drugs.

  (20) Psychologist--An individual licensed as a psychologist by the Texas State Board of Examiners of Psychologists.

  (21) Qualified credentialed counselor--An individual who:

    (A) meets the definition established by the Texas Commission on Alcohol and Drug Abuse; or

    (B) is employed outside the State of Texas and licensed, certified, or registered in a profession corresponding to those described in the definition of Qualified Credentialed Counselor established by the Texas Commission on Alcohol and Drug Abuse.

  (22) Toxic inhalant--A volatile chemical under this section or under the Health and Safety Code, §484.002, or abusable glue or aerosol paint under this section or under the Health and Safety Code, §485.001.

  (23) Treatment provider--Any "chemical dependency treatment center" as defined in this section or in the Insurance Code Article 3.51-9, §2A, and also any certified or licensed practitioner or facility licensed to provide treatment for chemical dependency.

  (24) Utilization review--A system for prospective or concurrent review of the appropriateness of health care services being provided or proposed to be provided in this state.

  (25) Volatile chemical--A chemical or an isomer of a chemical listed in subparagraphs (A)-(X) of this definition, as follows:

    (A) acetone;

    (B) aliphatic hydrocarbons;

    (C) amyl nitrite;

    (D) butyl nitrite;

    (E) carbon tetrachloride;

    (F) chlorinated hydrocarbons;

    (G) chlorofluorocarbons;

    (H) chloroform;

    (I) cyclohexanone;

    (J) diethyl ether;

    (K) ethyl acetate;

    (L) glycol ether inter solvent;

    (M) glycol ether solvent;

    (N) hexane;

    (O) ketone solvent;

    (P) methanol;

    (Q) methyl cellosolve acetate;

    (R) methyl ethyl ketone;

    (S) methyl isobutyl ketone;

    (T) petroleum distillate;

    (U) toluene;

    (V) trichloroethane;

    (W) trichloroethylene; and

    (X) xylol or xylene.


Source Note: The provisions of this §3.8001 adopted to be effective August 28, 1991, 16 TexReg 4403; amended to be effective February 14, 1999, 24 TexReg 713

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