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RULE §48.1201Definitions of Program Terms

The following words and terms have the following meanings when used in these sections, unless the context clearly indicates otherwise:

  (1) Abuse--The willful infliction of injury, unreasonable confinement, intimidation, or cruel punishment with resulting physical harm, pain, or mental anguish; or the willful deprivation by a caretaker or one's self of goods or services which are necessary to avoid physical harm, mental anguish, or mental illness. (Chapter 48, Human Resources Code)

  (2) Activities of daily living (ADL)--Activities that are essential to daily self-care; including bathing, dressing, grooming, toileting, housekeeping, shopping, meal preparation, and others.

  (3) Adult--A person 18 or older, or an emancipated minor.

  (4) Aged or elderly person--A person 65 or older.

  (5) Applicant--A person initially requesting services.

  (6) Attendant--A person who is employed by a provider agency to give personal care or housekeeping services or both to an eligible family care or primary home care client, according to a service plan.

  (7) Caregiver--A relative, guardian, representative payee, or person who has contact with the client that is frequent enough or regularly scheduled enough that a personal relationship exists or the client perceives that person as having a role in helping the client to meet basic needs.

  (8) Caregiver support--An interval of rest or relief from caregiving duties given to or arranged for the caregiver of a DHS client.

  (9) Client--A person determined eligible for Community Care for the Aged and Disabled (CCAD) services.

  (10) Community care--Services provided within the client's own home, neighborhood, or community, as alternatives to institutional care. Community care is sometimes called alternate care.

  (11) Controlling interest--An owner who is a sole proprietor, a partner owning 5.0% or more of the partnership, or a corporate stockholder owning 5.0% or more of the outstanding stock of the contracted provider, or a member of the board of directors.

  (12) Disabled/incapacitated person--A person who, because of physical, mental, or developmental impairment, is limited temporarily or permanently in his capacity to adequately perform one or more essential activities of daily living, which include, but are not limited to, personal and health care, moving around, communicating, and housekeeping.

  (13) Earned income--Cash or liquid resources that a client receives for services he performs as an employee or as a result of self-employment. All other income is unearned income.

  (14) Emancipated minor--A person under 18 who has the power and capacity of an adult. This includes a minor who has had the disabilities of minority removed by a court of law or a minor who, with or without parental consent, has been married. Marriage includes common-law marriage.

  (15) Emotional or verbal abuse--Any use of verbal communication or other behavior to humiliate, intimidate, vilify, degrade, or threaten with harm.

  (16) Expedited response--A face-to-face contact with an applicant by the caseworker within five calendar days of the date of the applicant's request for services.

  (17) Exploitation--The illegal or improper act or process of a caregiver or others using an adult's income and resources for monetary or personal benefit, profit, or gain.

  (18) Facility--A legal entity that contracts with the department to deliver to clients day services or 24-hour residential services.

  (19) Fraud--A deliberate misrepresentation or intentional concealment of information in order to receive or to be reimbursed for the delivery of services to which the individual is not entitled.

  (20) Functional need--An individual's requirement for assistance with activities of daily living, caused by a physical or mental limitation or disability.

  (21) Immediate response--A face-to-face contact with an applicant by the caseworker within 24 hours of the applicant's request for services.

  (22) Income eligible (I.E.)--An adult who, although neither a Medicaid recipient nor a food stamp head of household or spouse, nevertheless has income and resources equal to or less than the eligibility level established by the department.

  (23) Institution--A nursing home, an intermediate care facility for the mentally retarded (ICF-MR), a state school, or a state hospital.

  (24) Liquid resource--Cash or financial instruments that could be converted to cash within 20 workdays.

  (25) Medicaid eligible--An individual eligible for federal medical assistance as an SSI or TANF client, or eligible for medical assistance only (MAO) in a nursing home or while living in the community or through a federally approved waiver.

  (26) Medicare eligible--An aged or disabled person who is a recipient of Social Security or railroad retirement benefit payments and meets eligibility criteria to have certain medical expenses paid by the federal Medicare program.

  (27) Neglect--The failure to provide for one's self the goods or services which are necessary to avoid physical harm, mental anguish, or mental illness; or the failure of a caretaker to provide the goods or services. (Chapter 48, Human Resources Code)

  (28) Personal leave--Any leave from a residential care facility except for hospitalization or institutionalization. A day of personal leave is any period of 24 consecutive hours.

  (29) Prior approval--A regional nurse's authorization that payment may be made to a provider agency, because a client meets the medical criteria for the requested Medicaid service.

  (30) Provider agency--An agency that has contracted with DHS to provide the CCAD services that DHS has authorized for eligible clients.

  (31) Provisional contract--A time-limited contract.

  (32) Resource--Any cash or other liquid assets or any real or personal property owned by an individual and spouse that could be converted to cash to use for support and maintenance.

  (33) Responder--A person who responds to an emergency response services (ERS) call activated by a client. Responders may include relatives, neighbors, volunteers, or staff of a sheriff's department, police department, emergency medical service, or fire department.

  (34) Sexual abuse--Sexual contact or conduct which is without the voluntary, informed consent of the elderly or disabled adult.

  (35) Supplemental security income (SSI)--Monthly payments made by the Social Security Administration (SSA) to an aged or disabled individual who meets the requirements for public aid. SSA determines eligibility for SSI.

  (36) Support system--The network of family members, close friends, and neighbors who are usually available and willing to provide regular or occasional assistance to a person.

  (37) Unearned income--Income received by a client from sources other than self-employment or employee work activities.

  (38) Unmet need--A requirement for assistance with activities of daily living that cannot be met adequately on an ongoing basis by friends, relatives, volunteers, or service agencies other than DHS.

  (39) Verbal referral--A referral made by the caseworker to the provider agency in person or by telephone, no later than the first workday after the caseworker's determination that the applicant meets the criteria for an expedited or immediate response to a request for service, and needs immediate service initiation.

Source Note: The provisions of this §48.1201 adopted to be effective February 1, 1989, 13 TexReg 5751; amended to be effective June 1, 1991, 16 TexReg 2608; amended to be effective December 1, 2000, 25 TexReg 11081

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