The following words and terms, when used in this chapter, have
the following meanings, unless the context clearly indicates otherwise:
(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
(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
(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
(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)
(15) Calendar day--Any day, including weekends and
(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
(H) resolving a crisis that occurs regarding the individual;
(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).
(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
(22) CFC ERS provider--The entity directly providing
CFC ERS to an individual, which may be the DSA or a contractor of
(23) CFC FMS--The term used for FMS on the IPC of an
individual if the individual receives only CFC PAS/HAB through the
(24) CFC PAS/HAB--CFC personal assistance services/habilitation.
(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:
(II) personal hygiene;
(III) household tasks;
(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
(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
(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
(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.
(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
(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;