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TITLE 40SOCIAL SERVICES AND ASSISTANCE
PART 1DEPARTMENT OF AGING AND DISABILITY SERVICES
CHAPTER 45COMMUNITY LIVING ASSISTANCE AND SUPPORT SERVICES AND COMMUNITY FIRST CHOICE (CFC) SERVICES
SUBCHAPTER AGENERAL PROVISIONS
RULE §45.103Definitions

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) Actively involved--Significant, ongoing, and supportive involvement with an individual by a person, as determined by the individual, based on the person's:

    (A) interactions with the individual;

    (B) availability to the individual for assistance or support when needed; and

    (C) knowledge of, sensitivity to, and advocacy for the individual's needs, preferences, values, and beliefs.

  (3) Adaptive aid--An item or service that enables an individual to retain or increase the ability to perform ADLs or perceive, control, or communicate with the environment in which the individual lives, and:

    (A) is included in the list of adaptive aids in the CLASS Provider Manual; or

    (B) is the repair and maintenance of an adaptive aid on such list that is not covered by a warranty.

  (4) Adaptive behavior--The effectiveness with or degree to which an individual meets the standards of personal independence and social responsibility expected of the individual's age and cultural group as assessed by a standardized measure.

  (5) Adaptive behavior level--The categorization of an individual's functioning level based on a standardized measure of adaptive behavior. There are four adaptive behavior levels ranging from mild limitations in adaptive skills (I) through profound limitations in adaptive skills (IV).

  (6) Adaptive behavior screening assessment--A standardized assessment used to determine an individual's adaptive behavior level, and conducted using the current version of one of the following assessment instruments:

    (A) American Association of Intellectual and Developmental Disabilities (AAIDD) Adaptive Behavior Scales (ABS);

    (B) Inventory for Client and Agency Planning (ICAP);

    (C) Scales of Independent Behavior; or

    (D) Vineland Adaptive Behavior Scales.

  (7) ADLs--Activities of daily living. Basic personal everyday activities, including tasks such as eating, toileting, grooming, dressing, bathing, and transferring.

  (8) Alarm call--A signal transmitted from an individual's CFC ERS equipment to the CFC ERS response center indicating that the individual needs immediate assistance.

  (9) Alleged perpetrator--A person alleged to have committed an act of abuse, neglect, or exploitation of an individual.

  (10) Aquatic therapy--A service that involves a low-risk exercise method done in water to improve an individual's range of motion, flexibility, muscular strengthening and toning, cardiovascular endurance, fitness, and mobility.

  (11) Auditory integration training/auditory enhancement training--Specialized training that assists an individual to cope with hearing dysfunction or over-sensitivity to certain frequency ranges of sound by facilitating auditory processing skills and exercising the middle ear and auditory nervous system.

  (12) Behavior support plan--A comprehensive, individualized written plan based on a current functional behavior assessment that includes specific objectives and behavioral techniques designed to teach or increase adaptive skills and decrease or eliminate target behaviors.

  (13) Behavioral support--Specialized interventions that assist an individual in increasing adaptive behaviors and replacing or modifying challenging or socially unacceptable behaviors that prevent or interfere with the individual's inclusion in the community and which consist of the following activities:

    (A) conducting a functional behavior assessment;

    (B) developing an individualized behavior support plan;

    (C) training of and consultation with an individual, family member, or other persons involved in the individual's care regarding the implementation of the behavior support plan;

    (D) monitoring and evaluation of the effectiveness of the behavior support plan;

    (E) modifying, as necessary, the behavior support plan based on monitoring and evaluation of the plan's effectiveness; and

    (F) counseling with and educating an individual, family members, or other persons involved in the individual's care about the techniques to use in assisting the individual to control challenging or socially unacceptable behaviors.

  (14) Business day--Any day except a Saturday, a Sunday, or a national or state holiday listed in Texas Government Code §662.003(a) or (b).

  (15) Calendar day--Any day, including weekends and holidays.

  (16) Case management--A service that assists an individual in the following:

    (A) assessing the individual's needs;

    (B) enrolling into the CLASS Program;

    (C) developing the individual's IPC;

    (D) coordinating the provision of CLASS Program services and CFC services;

    (E) monitoring the effectiveness of the CLASS Program services and CFC services and the individual's progress toward achieving the outcomes identified for the individual;

    (F) revising the individual's IPC, as appropriate;

    (G) accessing non-CLASS Program services and non-CFC services;

    (H) resolving a crisis that occurs regarding the individual; and

    (I) advocating for the individual's needs.

  (17) Catchment area--As determined by HHSC, a geographic area composed of multiple Texas counties.

  (18) CDS option--Consumer directed services option. A service delivery option as defined in §41.103 of this title (relating to Definitions).

  (19) CDSA--FMSA.

  (20) CFC--Community First Choice.

  (21) CFC ERS--CFC emergency response services. Backup systems and supports used to ensure continuity of services and supports. CFC ERS includes electronic devices and an array of available technology, personal emergency response systems, and other mobile communication devices.

  (22) CFC ERS provider--The entity directly providing CFC ERS to an individual, which may be the DSA or a contractor of the DSA.

  (23) CFC FMS--The term used for FMS on the IPC of an individual if the individual receives only CFC PAS/HAB through the CDS option.

  (24) CFC PAS/HAB--CFC personal assistance services/habilitation. A service:

    (A) that consists of:

      (i) personal assistance services that provide assistance to an individual in performing ADLs and IADLs based on the individual's person-centered service plan, including:

        (I) non-skilled assistance with the performance of the ADLs and IADLs;

        (II) household chores necessary to maintain the home in a clean, sanitary, and safe environment;

        (III) escort services, which consist of accompanying and assisting an individual to access services or activities in the community, but do not include transporting an individual; and

        (IV) assistance with health-related tasks; and

      (ii) habilitation that provides assistance to an individual in acquiring, retaining, and improving self-help, socialization, and daily living skills and training the individual on ADLs, IADLs, and health-related tasks, such as:

        (I) self-care;

        (II) personal hygiene;

        (III) household tasks;

        (IV) mobility;

        (V) money management;

        (VI) community integration, including how to get around in the community;

        (VII) use of adaptive equipment;

        (VIII) personal decision making;

        (IX) reduction of challenging behaviors to allow individuals to accomplish ADLs, IADLs, and health-related tasks; and

        (X) self-administration of medication; and

    (B) does not include transporting the individual, which means driving the individual from one location to another.

  (25) CFC support consultation--The term used for support consultation on the IPC of an individual if the individual receives only CFC PAS/HAB through the CDS option.

  (26) CFC support management--Training on how to select, manage, and dismiss an unlicensed service provider of CFC PAS/HAB as described in the CLASS Provider Manual.

  (27) CLASS Program--The Community Living Assistance and Support Services Program.

  (28) CMA--Case management agency. A program provider that has a contract with HHSC to provide case management.

  (29) CMS--The Centers for Medicare & Medicaid Services. CMS is the agency within the United States Department of Health and Human Services that administers Medicare and Medicaid programs.

  (30) Cognitive rehabilitation therapy--A service that:

    (A) assists an individual in learning or relearning cognitive skills that have been lost or altered as a result of damage to brain cells or brain chemistry in order to enable the individual to compensate for lost cognitive functions; and

    (B) includes reinforcing, strengthening, or reestablishing previously learned patterns of behavior, or establishing new patterns of cognitive activity or compensatory mechanisms for impaired neurological systems.

  (31) Competitive employment--Employment that pays an individual at least the minimum wage if the individual is not self-employed.

  (32) Continued family services--Services provided to an individual 18 years of age or older who resides with a support family, as described in §45.531 of this chapter (relating to Support Family Requirements), that allow the individual to reside successfully in a community setting by training the individual to acquire, retain, and improve self-help, socialization, and daily living skills or assisting the individual with ADLs. The individual must be receiving support family services immediately before receiving continued family services. Continued family services consist of services described in §45.533 of this chapter (relating to Support Family Duties).

  (33) Contract--A provisional contract that HHSC enters into in accordance with §49.208 of this title (relating to Provisional Contract Application Approval) that has a term of no more than 3 years, not including any extension agreed to in accordance with §49.208(e) of this title or a standard contract that HHSC enters into in accordance with §49.209 of this title (relating to Standard Contract) that has a term of no more than five years, not including any extension agreed to in accordance with §49.209(d) of this title.

  (34) Controlling person--A person who:

    (A) has an ownership interest in a program provider;

    (B) is an officer or director of a corporation that is a program provider;

    (C) is a partner in a partnership that is a program provider;

    (D) is a member or manager in a limited liability company that is a program provider;

    (E) is a trustee or trust manager of a trust that is a program provider; or

    (F) because of a personal, familial, or other relationship with a program provider, is in a position of actual control or authority with respect to the program provider, regardless of the person's title.

  (35) DADS--HHSC.

  (36) Denial--An action taken by HHSC that:

    (A) rejects an individual's request for enrollment into the CLASS Program;

    (B) disallows a CLASS Program service or a CFC service requested on an IPC that was not authorized on the prior IPC; or

    (C) disallows a portion of the amount or level of a CLASS Program service or a CFC service requested on an IPC that was not authorized on the prior IPC.

  (37) Dental treatment--A service that:

    (A) consists of the following:

      (i) emergency dental treatment, which is procedures necessary to control bleeding, relieve pain, and eliminate acute infection; operative procedures that are required to prevent the imminent loss of teeth; and treatment of injuries to the teeth or supporting structures;

      (ii) routine preventative dental treatment, which is examinations, x-rays, cleanings, sealants, oral prophylaxes, and topical fluoride applications;

      (iii) therapeutic dental treatment, which includes fillings, scaling, extractions, crowns, pulp therapy for permanent and primary teeth; restoration of carious permanent and primary teeth; maintenance of space; and limited provision of removable prostheses when masticatory function is impaired, when an existing prosthesis is unserviceable, or when aesthetic considerations interfere with employment or social development;

Cont'd...

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