The following words and terms, when used in this chapter, have
the following meanings unless the context clearly indicates otherwise:
(1) Abuse--
(A) physical abuse;
(B) sexual abuse; or
(C) verbal or emotional abuse.
(2) Adult--A person who is 18 years of age or older.
(3) Actively involved--Involvement with an individual
that the individual or LAR and other members of the individual's service
planning team deems to be of a quality nature based on the following:
(A) observed interactions of the person with the individual;
(B) a history of advocating for the best interests
of the individual;
(C) knowledge and sensitivity to the individual's preferences,
values, and beliefs;
(D) ability to communicate with the individual; and
(E) availability to the individual for assistance or
support when needed.
(4) Alleged perpetrator--A person alleged to have committed
an act of abuse, neglect, or exploitation of an individual.
(5) Allowable cost--A billable service or item that
is within the rate and spending limits of the rate established by
HHSC and that meets the requirements of an individual's program.
(6) Applicant--Depending on the context, an applicant
is:
(A) a person applying for employment with an employer;
(B) a person or legal entity applying for a contract
with an employer to deliver services to an individual; or
(C) a person enrolling in a program in which the CDS
option is available to the individual as described in §41.108
of this subchapter (relating to Services Available Through the CDS
Option).
(7) Budget--A written projection of expenditures for
each service delivered through the CDS option.
(8) Budgeted unit rate--The unit rate calculated for
employee wages and benefits in the budgeting process for services
delivered through the CDS option. The rate is calculated after employer
support services have been budgeted.
(9) CAS Program--Community Attendant Services Program.
A Medicaid state plan program authorized under Title XIX of the Social
Security Act and described in Chapter 47 of this title (relating to
Primary Home Care, Community Attendant Services, and Family Care Programs).
(10) Case manager--A person who provides case management
services to an individual. The case manager assists an individual
who receives services in gaining access to needed services, regardless
of the funding source for the services, and assists with other duties
in accordance with the rules of the individual's program.
(11) CDS option--Consumer directed services option.
A service delivery option in which an individual or LAR employs and
retains service providers and directs the delivery of program services.
(12) CDSA--An FMSA.
(13) CFC--Community First Choice. The CFC option described
in 1 Texas Administrative Code (TAC) Chapter 354, Subchapter A, Division
27 (relating to Community First Choice).
(14) CFC PAS/HAB--CFC personal assistance services/habilitation.
A Medicaid state plan service provided through CFC.
(15) CFC support management--Training on how to select,
manage, and dismiss an unlicensed service provider of CFC PAS/HAB.
(16) CLASS Program--Community Living Assistance and
Support Services Program. A Medicaid waiver program approved by CMS
under Title XIX, §1915(c) of the Social Security Act and described
in Chapter 45 of this title (relating to Community Living Assistance
and Support Services and Community First Choice (CFC) Services).
(17) CMPAS Program--Consumer Managed Personal Attendant
Services Program. A program authorized under Title XX, Subtitle A
of the Social Security Act and described in Chapter 44 of this title
(relating to Consumer Managed Personal Attendant Services (CMPAS)
Program).
(18) Contractor--A person, who performs one or more
program services, offers service to the general public, performs services
for payment, and with whom an employer has a written service agreement.
A contractor directs and controls when and how the work is performed
as well as the business aspect of the job including expenses and the
business relationship. A contractor may be a sole proprietor.
(19) Controlling person--A person who:
(A) has an ownership interest in an FMSA;
(B) is an officer or director of a corporation that
is an FMSA;
(C) is a partner in a partnership that is an FMSA;
(D) is a member or manager in a limited liability company
that is an FMSA;
(E) is a trustee or trust manager of a trust that is
an FMSA; or
(F) because of a personal, familial, or other relationship
with an FMSA, is in a position of actual control or authority with
respect to the FMSA, regardless of the person's title.
(20) DADS--HHSC.
(21) DBMD Program--Deaf Blind with Multiple Disabilities
Program. A Medicaid waiver program approved by CMS under Title XIX, §1915(c)
of the Social Security Act and described in Chapter 42 of this title
(relating to Deaf Blind with Multiple Disabilities (DBMD) Program
and Community First Choice (CFC) Services).
(22) DFPS--The Department of Family and Protective
Services.
(23) DR--Designated representative. A willing adult
appointed by the employer to assist with or perform the employer's
required responsibilities to the extent approved by the employer.
(24) Employee--A person employed by an employer through
a service agreement to deliver program services and who is paid an
hourly wage for those services, including a support advisor.
(25) Employer--An individual or LAR who chooses to
participate in the CDS option, and, therefore, is responsible for
hiring and retaining service providers to deliver program services.
(26) Employer support services--Services and items
the employer needs to perform employer and employment responsibilities,
as described in §41.507(a)(1) of this chapter (relating to Employer
Support Services Budgeting).
(27) Entity--An organization that has a legal identity
such as a corporation, limited partnership, limited liability company,
professional association, or cooperative.
(28) EVV system--Electronic visit verification system.
As defined in §68.102 of this title (relating to Definitions),
an electronic visit verification system that:
(A) allows a service provider to electronically report:
(i) the service recipient's identity;
(ii) the service provider's identity;
(iii) the date and time the service provider begins
and ends the delivery of services;
(iv) the location of service delivery; and
(v) tasks performed by the service provider; and
(B) meets other guidelines described on the HHSC website.
(29) Exploitation--The illegal or improper act or process
of using, or attempting to use, an individual or the resources of
an individual for monetary or personal benefit, profit, or gain.
(30) FC Program--Family Care Program. A program authorized
under Title XX, Subtitle A of the Social Security Act and described
in Chapter 47 of this title.
(31) FMS--Financial management services. Services delivered
by an FMSA to an employer or DR as described in §41.309(a) of
this chapter (relating to Financial Management Services, CFC Support
Management, and Vendor Fiscal/Employer Agent Responsibilities).
(32) FMSA--A financial management services agency.
A person, as defined in §49.102 of this title (relating to Definitions),
that contracts with HHSC to provide FMS.
(33) HCS Program--Home and Community-based Services
Program. A Medicaid waiver program approved by CMS under Title XIX, §1915(c)
of the Social Security Act and described in Chapter 9, Subchapter
D of this title (relating to Home and Community-based Services (HCS)
Program and Community First Choice (CFC)).
(34) HHSC--The Texas Health and Human Services Commission.
(35) Individual--A person enrolled in a program in
which the CDS option is available, as described in §41.108 of
this subchapter.
(36) LAR--Legally authorized representative. A person
authorized or required by law to act on behalf of an individual with
regard to a matter described in this chapter, including a parent of
a minor, guardian of a minor, managing conservator of a minor, or
the guardian of an adult.
(37) LIDDA--Local intellectual and developmental disability
authority. An entity designated by the HHSC executive commissioner,
in accordance with Texas Health and Safety Code §533A.035.
(38) Minor--A person who is 17 years of age or younger.
(39) Neglect--A negligent act or omission that caused
physical or emotional injury or death to an individual or placed an
individual at risk of physical or emotional injury or death.
(40) Non-program resource--A resource, other than an
individual's HHSC program.
(41) Parent--A natural, legal, foster, or adoptive
parent of a minor.
(42) PHC Program--Primary Home Care Program. A Medicaid
state plan program authorized under Title XIX of the Social Security
Act and described in Chapter 47 of this title.
(43) 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 an individual or placed an individual 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 an individual;
(C) the use of a restraint on an individual not in
compliance with federal and state laws, rules, and regulations; or
(D) seclusion.
(44) Relative--A person related to an employer within
the fourth degree of consanguinity or within the second degree of
affinity.
(45) Seclusion--The involuntary placement of an individual
alone in an area from which the individual is prevented from leaving.
(46) Service agreement--A written agreement or acknowledgment
between two parties that defines the relationship and lists respective
roles and responsibilities.
(47) Service backup plan--A documented plan to ensure
that critical services delivered through the CDS option are provided
to an individual when normal service delivery is interrupted or there
is an emergency.
(48) Service coordinator--An employee of a LIDDA who
is responsible for assisting an applicant, individual, or LAR to access
needed medical, social, educational, and other appropriate services,
including an HHSC program or service. A service coordinator provides
case management services to an individual.
(49) Service plan--A document developed in accordance
with rules governing an individual's program that identifies the services
to be provided to the individual, the number of units of each service
to be provided, and the projected cost of each service.
(50) Service planning team--A group of people identified
in accordance with the requirements of an individual's program. Some
HHSC programs refer to the service planning team as an interdisciplinary
team.
(51) Service provider--An employee, contractor, or
vendor.
(52) Sexual abuse--Any of the following:
(A) sexual exploitation of an individual;
(B) non-consensual or unwelcomed sexual activity with
an individual; or
(C) consensual sexual activity between an individual
and a service provider, staff person, or controlling person, unless
a consensual sexual relationship with an adult individual existed
before the service provider, staff person, or controlling person became
a service provider, staff person, or controlling person.
(53) Sexual activity--An activity that is sexual in
nature, including kissing, hugging, stroking, or fondling with sexual
intent.
(54) Sexual exploitation--A pattern, practice, or scheme
of conduct against an individual that can reasonably be construed
as being for the purposes of sexual arousal or gratification of any
person:
(A) which may include sexual contact; and
(B) does not include obtaining information about an
individual's sexual history within standard accepted clinical practice.
(55) Staff person--An employee, contractor, or volunteer
of an FMSA.
(56) Support advisor--An employee who provides support
consultation to an employer or DR.
(57) Support consultation--An optional service that
is provided by a support advisor and provides a level of assistance
and training beyond that provided by the FMSA through FMS or CFC support
management. Support consultation helps an employer to meet the required
employer responsibilities of the CDS option and to successfully manage
the delivery of program services.
Cont'd... |
