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TITLE 40SOCIAL SERVICES AND ASSISTANCE
PART 1DEPARTMENT OF AGING AND DISABILITY SERVICES
CHAPTER 9INTELLECTUAL DISABILITY SERVICES--MEDICAID STATE OPERATING AGENCY RESPONSIBILITIES
SUBCHAPTER DHOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC)
RULE §9.153Definitions

The following words and terms, when used in this subchapter, 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 applicant or individual by a person, as determined by the applicant's or individual's service planning team or program provider, based on the person's:

    (A) interactions with the applicant or individual;

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

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

  (3) Actual harm--A negative outcome that compromises an individual's physical, mental, or emotional well-being but does not constitute an immediate threat.

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

  (5) 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.

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

  (7) Applicant--A Texas resident seeking services in the HCS Program.

  (8) Behavioral emergency--A situation in which an individual's severely aggressive, destructive, violent, or self-injurious behavior:

    (A) poses a substantial risk of imminent probable death of, or substantial bodily harm to, the individual or others;

    (B) has not abated in response to attempted preventive de-escalatory or redirection techniques;

    (C) is not addressed in a written behavior support plan; and

    (D) does not occur during a medical or dental procedure.

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

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

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

  (12) CFC--Community First Choice.

  (13) 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.

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

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

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

    (A) 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.

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

  (18) CFC support management--Training regarding how to select, manage, and dismiss an unlicensed service provider of CFC PAS/HAB, as described in the HCS Handbook.

  (19) Chemical restraint--A medication used to control an individual's behavior or to restrict the individual's freedom of movement that is not a standard treatment for the individual's medical or psychological condition.

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

  (21) 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.

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

  (23) Contract--A provisional contract or a standard contract.

  (24) 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.

  (25) CRCG--Community resource coordination group. A local interagency group, composed of public and private agencies that develops service plans for individuals whose needs can be met only through interagency coordination and cooperation. The group's role and responsibilities are described in the Memorandum of Understanding on Coordinated Services to Persons Needing Services from More Than One Agency, available on the HHSC website.

  (26) Critical incident--An event listed in the HCS Provider User Guide found on the HHSC website.

  (27) Critical violation--A violation for which HHSC may assess an administrative penalty before giving a program provider an opportunity to correct the violation. A critical violation:

    (A) is an immediate threat;

    (B) has resulted in actual harm and is widespread;

    (C) has resulted in actual harm and is a pattern; or

    (D) has the potential to result in actual harm and is widespread.

  (28) DADS--HHSC.

  (29) DARS--The Texas Workforce Commission.

  (30) DFPS--The Department of Family and Protective Services.

  (31) Emergency--An unexpected situation in which the absence of an immediate response could reasonably be expected to result in risk to the health and safety of an individual or another person.

  (32) Emergency situation--An unexpected situation involving an individual's health, safety, or welfare, of which a person of ordinary prudence would determine that the LAR should be informed, such as:

    (A) an individual needing emergency medical care;

    (B) an individual being removed from his residence by law enforcement;

    (C) an individual leaving his residence without notifying a staff member or service provider and not being located; and

    (D) an individual being moved from his residence to protect the individual (for example, because of a hurricane, fire, or flood).

  (33) 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.

  (34) Family-based alternative--A family setting in which the family provider or providers are specially trained to provide support and in-home care for children with disabilities or children who are medically fragile.

  (35) FMS--Financial management services. A service, as defined in §41.103 of this title, that is provided to an individual participating in the CDS option.

  (36) FMSA--Financial management services agency. As defined in §41.103 of this title, an entity that provides financial management services to an individual participating in the CDS option.

  (37) Follow-up survey--A review by HHSC of a program provider to determine if the program provider has completed corrective action.

  (38) Former military member--A person who served in the United States Army, Navy, Air Force, Marine Corps, or Coast Guard:

    (A) who declared and maintained Texas as the person's state of legal residence in the manner provided by the applicable military branch while on active duty; and

    (B) who was killed in action or died while in service, or whose active duty otherwise ended.

  (39) Four-person residence--A residence:

    (A) that a program provider leases or owns;

    (B) in which at least one person but no more than four persons receive:

      (i) residential support;

      (ii) supervised living;

      (iii) a non-HCS Program service similar to residential support or supervised living (for example, services funded by DFPS or by a person's own resources); or

      (iv) respite;

    (C) that, if it is the residence of four persons, at least one of those persons receives residential support;

    (D) that is not the residence of any persons other than a service provider, the service provider's spouse or person with whom the service provider has a spousal relationship, or a person described in subparagraph (B) of this paragraph; and

    (E) that is not a dwelling described in §9.155(a)(5)(H) of this subchapter (relating to Eligibility Criteria and Suspension of HCS Program Services and of CFC Services).

  (40) Good cause--As used in §9.174(j) of this subchapter (relating to Certification Principles: Service Delivery), a reason outside the control of the CFC ERS provider, as determined by HHSC.

  (41) GRO--General residential operation. The term has the meaning set forth in Texas Human Resources Code, §42.002.

  (42) HCS Program--The Home and Community-based Services Program operated by HHSC as authorized by CMS in accordance with §1915(c) of the Social Security Act.

  (43) Health-related tasks--Specific tasks related to the needs of an individual, which can be delegated or assigned by licensed health care professionals under state law to be performed by a service provider of CFC PAS/HAB. These include tasks delegated by an RN; health maintenance activities as defined in 22 TAC §225.4 (relating to Definitions), that may not require delegation; and activities assigned to a service provider of CFC PAS/HAB by a licensed physical therapist, occupational therapist, or speech-language pathologist.

  (44) HHSC--The Texas Health and Human Services Commission.

  (45) IADLs--Instrumental activities of daily living. Activities related to living independently in the community, including meal planning and preparation; managing finances; shopping for food, clothing, and other essential items; performing essential household chores; communicating by phone or other media; and traveling around and participating in the community.

  (46) ICAP--Inventory for Client and Agency Planning.

  (47) ICF/IID--Intermediate care facility for individuals with an intellectual disability or related conditions. An ICF/IID is a facility in which ICF/IID Program is:

    (A) licensed in accordance with THSC, Chapter 252; or

Cont'd...

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