The following words and terms, when used in this chapter, have
the following meanings, unless the context clearly indicates otherwise.
(1) Abuse--Negligent or willful infliction of injury,
unreasonable confinement, intimidation, or punishment with resulting
physical or emotional harm or pain to a resident; or sexual abuse,
including involuntary or nonconsensual sexual conduct that would constitute
an offense under Penal Code §21.08 (indecent exposure) or Penal
Code Chapter 22 (assaultive offenses), sexual harassment, sexual coercion,
or sexual assault.
(2) Act--Chapter 242 of the Texas Health and Safety
(3) Activities assessment--See Comprehensive Assessment
and Comprehensive Care Plan.
(4) Activities director--The qualified individual appointed
by the facility to direct the activities program as described in §19.702
of this chapter (relating to Activities).
(5) Addition--The addition of floor space to an institution.
(6) Administrator--Licensed nursing facility administrator.
(7) Admission MDS assessment--An MDS assessment that
determines a recipient’s initial determination of eligibility
for medical necessity for admission into the Texas Medicaid Nursing
(8) Advanced practice registered nurse--A person licensed
by the Texas Board of Nursing as an advanced practice registered nurse.
(9) Affiliate--With respect to a:
(A) partnership, each partner thereof;
(B) corporation, each officer, director, principal
stockholder, and subsidiary; and each person with a disclosable interest;
(C) natural person, which includes each:
(i) person’s spouse;
(ii) partnership and each partner thereof of which
said person or any affiliate of said person is a partner; and
(iii) corporation in which said person is an officer,
director, principal stockholder, or person with a disclosable interest.
(10) Agent--An adult to whom authority to make health
care decisions is delegated under a durable power of attorney for
(11) Alzheimer’s disease and related disorders--Alzheimer’s
disease and any other irreversible dementia described by the Centers
for Disease Control and Prevention or the most current edition of
the Diagnostic and Statistical Manual of Mental Disorders.
(12) Applicant--A person or governmental unit, as those
terms are defined in the Texas Health and Safety Code, Chapter 242,
applying for a license under that chapter.
(13) APA--The Administrative Procedure Act, Texas Government
Code, Chapter 2001.
(14) Attending physician--A physician, currently licensed
by the Texas Medical Board, who is designated by the resident or responsible
party as having primary responsibility for the treatment and care
of the resident.
(15) Authorized electronic monitoring--The placement
of an electronic monitoring device in a resident’s room and
using the device to make tapes or recordings after making a request
to the facility to allow electronic monitoring.
(16) Barrier precautions--Precautions including the
use of gloves, masks, gowns, resuscitation equipment, eye protectors,
aprons, face shields, and protective clothing for purposes of infection
(17) Care and treatment--Services required to maximize
resident independence, personal choice, participation, health, self-care,
psychosocial functioning and reasonable safety, all consistent with
the preferences of the resident.
(18) Certification--The determination by HHSC that
a nursing facility meets all the requirements of the Medicaid or Medicare
(19) Certified Ombudsman--Has the meaning given in
26 TAC §88.2 (relating to Definitions).
(20) Change of ownership--An event that results in
a change to the federal taxpayer identification number of the license
holder of a facility. The substitution of a personal representative
for a deceased license holder is not a change of ownership.
(21) CFR--Code of Federal Regulations.
(22) CMS--Centers for Medicare & Medicaid Services.
(23) Complaint--Any allegation received by HHSC other
than an incident reported by the facility. Such allegations include,
but are not limited to, abuse, neglect, exploitation, or violation
of state or federal standards.
(24) Completion date--The date an RN assessment coordinator
signs an MDS assessment as complete.
(25) Comprehensive assessment--An interdisciplinary
description of a resident’s needs and capabilities including
daily life functions and significant impairments of functional capacity,
as described in §19.801(2) of this chapter (relating to Resident
(26) Comprehensive care plan--A plan of care prepared
by an interdisciplinary team that includes measurable short-term and
long-term objectives and timetables to meet the resident’s needs
developed for each resident after admission. The plan addresses at
least the following needs: medical, nursing, rehabilitative, psychosocial,
dietary, activity, and resident’s rights. The plan includes
strategies developed by the team, as described in §19.802(b)(2)
of this chapter (relating to Comprehensive Care Plans), consistent
with the physician’s prescribed plan of care, to assist the
resident in eliminating, managing, or alleviating health or psychosocial
problems identified through assessment. Planning includes:
(A) goal setting;
(B) establishing priorities for management of care;
(C) making decisions about specific measures to be
used to resolve the resident’s problems; and
(D) assisting in the development of appropriate coping
(27) Controlled substance--A drug, substance, or immediate
precursor as defined in the Texas Controlled Substance Act, Texas
Health and Safety Code, Chapter 481, or the Federal Controlled Substance
Act of 1970, Public Law 91-513.
(28) Controlling person--A person with the ability,
acting alone or in concert with others, to directly or indirectly,
influence, direct, or cause the direction of the management, expenditure
of money, or policies of a nursing facility or other person. A controlling
person does not include a person, such as an employee, lender, secured
creditor, or landlord, who does not exercise any influence or control,
whether formal or actual, over the operation of a facility. A controlling
(A) a management company, landlord, or other business
entity that operates or contracts with others for the operation of
a nursing facility;
(B) any person who is a controlling person of a management
company or other business entity that operates a nursing facility
or that contracts with another person for the operation of a nursing
(C) an officer or director of a publicly traded corporation
that is, or that controls, a facility, management company, or other
business entity described in subparagraph (A) of this paragraph but
does not include a shareholder or lender of the publicly traded corporation;
(D) any other individual who, because of a personal,
familial, or other relationship with the owner, manager, landlord,
tenant, or provider of a nursing facility, is in a position of actual
control or authority with respect to the nursing facility, without
regard to whether the individual is formally named as an owner, manager,
director, officer, provider, consultant, contractor, or employee of
(29) Covert electronic monitoring--The placement and
use of an electronic monitoring device that is not open and obvious,
and the facility and HHSC have not been informed about the device
by the resident, by a person who placed the device in the room, or
by a person who uses the device.
(30) DADS--The term referred to the Department of Aging
and Disability Services; it now refers to HHSC.
(31) Dangerous drugs--Any drug as defined in the Texas
Health and Safety Code, Chapter 483.
(32) Dentist--A practitioner licensed to practice dentistry
by the Texas State Board of Dental Examiners.
(33) Department--The Health and Human Services Commission.
(34) DHS--This term referred to the Texas Department
of Human Services; it now refers to HHSC, unless the context concerns
an administrative hearing. Administrative hearings were formerly the
responsibility of DHS; they now are the responsibility of the HHSC.
(35) Dietitian--A qualified dietitian is one who is
qualified based upon either:
(A) registration by the Commission on Dietetic Registration
of the Academy of Nutrition and Dietetics; or
(B) licensure, or provisional licensure, as a dietitian
under Texas Occupations Code, Chapter 701 and one year of supervisory
experience in dietetic service of a health care facility.
(36) Direct care by licensed nurses--Direct care consonant
with the physician’s planned regimen of total resident care
(A) assessment of the resident’s health care
(B) planning for the resident’s care;
(C) assignment of duties to achieve the resident’s
(D) nursing intervention; and
(E) evaluation and change of approaches as necessary.
(37) Direct ownership interest--Ownership of equity
in the capital, stock, or profits of, or a membership interest in,
an applicant or license holder.
(38) Disclosable interest--Five percent or more direct
or indirect ownership interest in an applicant or license holder.
(39) Distinct part--That portion of a facility certified
to participate in the Medicaid Nursing Facility program.
(40) Drug (also referred to as medication)--Any of
(A) any substance recognized as a drug in the official
United States Pharmacopoeia, official Homeopathic Pharmacopoeia of
the United States, or official National Formulary, or any supplement
to any of them;
(B) any substance intended for use in the diagnosis,
cure, mitigation, treatment, or prevention of disease in man;
(C) any substance (other than food) intended to affect
the structure or any function of the body of man; and
(D) any substance intended for use as a component of
any substance specified in subparagraphs (A) - (C) of this paragraph.
It does not include devices or their components, parts, or accessories.
(41) Electronic monitoring device--Video surveillance
cameras and audio devices installed in a resident’s room, designed
to acquire communications or other sounds that occur in the room.
An electronic, mechanical, or other device used specifically for the
nonconsensual interception of wire or electronic communication is
excluded from this definition.
(42) Emergency--A sudden change in a resident’s
condition requiring immediate medical intervention.
(43) Executive Commissioner--The executive commissioner
of the Health and Human Services Commission.
(44) Exploitation--The illegal or improper act or process
of a caregiver, family member, or other individual who has an ongoing
relationship with a resident using the resources of the resident for
monetary or personal benefit, profit, or gain without the informed
consent of the resident.
(45) Exposure (infections)--The direct contact of blood
or other potentially infectious materials of one person with the skin
or mucous membranes of another person. Other potentially infectious
materials include the following human body fluids: semen, vaginal
secretions, cerebrospinal fluid, peritoneal fluid, amniotic fluid,
saliva in dental procedures, and body fluid that is visibly contaminated
with blood and all body fluids when it is difficult or impossible
to differentiate between body fluids.
(46) Facility--Unless otherwise indicated, a facility
is an institution that provides organized and structured nursing care
and service and is subject to licensure under Texas Health and Safety
Code, Chapter 242.
(A) For Medicaid, a facility is a nursing facility
which meets the requirements of §1919(a) - (d) of the Social
Security Act. A facility may not include any institution that is for
the care and treatment of mental diseases except for services furnished
to individuals age 65 and over and who are eligible as defined in
Chapter 17 of this title (relating to Preadmission Screening and Resident
(B) For Medicare and Medicaid purposes (including eligibility,
coverage, certification, and payment), the "facility" is always the
entity which participates in the program, whether that entity is comprised
of all of, or a distinct part of, a larger institution.
(C) "Facility" is also referred to as a nursing home
or nursing facility. Depending on context, these terms are used to
represent the management, administrator, or other persons or groups
involved in the provision of care of the resident; or to represent
the physical building, which may consist of one or more floors or
one or more units, or which may be a distinct part of a licensed hospital.