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RULE §42.103Definitions

    (A) licensed or subject to being licensed in accordance with Texas Health and Safety Code, Chapter 252; or

    (B) certified by DADS, including a state supported living center.

  (48) ICF/IID Program--The Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions Program that provides Medicaid-funded residential services to individuals with an intellectual disability or related conditions.

  (49) ID/RC Assessment (Intellectual Disability/Related Condition Assessment)--An assessment conducted to determine if an individual meets the diagnostic eligibility criteria for the DBMD Program.

  (50) Impairment to independent functioning--An adaptive behavior level of II, III, or IV.

  (51) Individual--A person seeking to enroll or who is enrolled in the DBMD Program.

  (52) Institutional services--Services provided in an ICF/IID or a nursing facility.

  (53) Intellectual disability--Significant sub-average general intellectual functioning existing concurrently with deficits in adaptive behavior and originating during the developmental period.

  (54) Intervener--A service provider with specialized training and skills in deafblindness who, working with one individual at a time, serves as a facilitator to involve an individual in home and community services and activities, and who is classified as an "Intervener", "Intervener I", "Intervener II", or "Intervener III" in accordance with Texas Government Code, §531.0973.

  (55) IPC--Individual Plan of Care. A written plan developed by an individual's service planning team using person-centered planning and documented on a DADS form that:

    (A) meets:

      (i) the criteria in §42.201(a)(5) of this chapter (relating to Eligibility Criteria for DBMD Program Services and CFC Services); and

      (ii) the requirements described in §42.214(a)(1) and (b)(1) - (6) of this chapter (relating to Development of Enrollment Individual Plan of Care (IPC)); and

    (B) is authorized by DADS in accordance with Subchapter B of this chapter (relating to Eligibility, Enrollment, and Review).

  (56) IPP--Individual Program Plan. A written plan documented on a DADS form and completed by an individual's case manager that describes the goals and objectives for each DBMD Program service and CFC service, other than CFC support management, included on the individual's IPC.

  (57) IPC period--The effective period of an IPC as follows:

    (A) for an enrollment IPC, the period of time from the effective date of service approved by DADS until the first calendar day of the same month of the effective date of service in the following year; and

    (B) for a renewal IPC, a 12-month period of time starting on the effective date of a renewal IPC.

  (58) LAR--Legally authorized representative. A person authorized by law to act on behalf of an individual with regard to a matter described in this chapter, and may include a parent, guardian, or managing conservator of a minor, or the guardian of an adult.

  (59) Licensed assisted living--A service provided in a residence licensed in accordance with Chapter 92 of this title (relating to Licensing Standards for Assisted Living Facilities) for four to six individuals.

  (60) Licensed home health assisted living--A service provided by a program provider licensed in accordance with Chapter 97 of this title (relating to Licensing Standards for Home and Community Support Services Agencies) in a residence for no more than three individuals, at least one of whom owns or leases the residence.

  (61) LVN--Licensed vocational nurse. A person licensed to provide vocational nursing in accordance with Texas Occupations Code, Chapter 301, Nurses.

  (62) Managed care organization--This term has the meaning set forth in Texas Government Code, §536.001.

  (63) MAO Medicaid--Medical Assistance Only Medicaid. A type of Medicaid by which an individual qualifies financially for Medicaid assistance but does not receive Supplemental Security Income (SSI) benefits.

  (64) Mechanical restraint--A mechanical device, material, or equipment used to control an individual's behavior by restricting the ability of the individual to freely move part or all of the individual's body. The term does not include a protective device.

  (65) Medicaid--A program funded jointly by the states and the federal government that provides medical benefits to groups of low-income people, some who may have no medical insurance or inadequate medical insurance.

  (66) Medicaid waiver program--A service delivery model authorized under §1915(c) of the Social Security Act in which certain Medicaid statutory provisions are waived by CMS.

  (67) Military member--A member of the United States military serving in the Army, Navy, Air Force, Marine Corps, or Coast Guard on active duty who has declared and maintains Texas as the member's state of legal residence in the manner provided by the applicable military branch.

  (68) Military family member--A person who is the spouse or child (regardless of age) of:

    (A) a military member; or

    (B) a former military member.

  (69) Minor home modifications--Physical adaptation to an individual's residence necessary to address the individual's specific needs and enable the individual to function with greater independence or control the residence's environment.

  (70) Natural supports--Unpaid persons, including family members, volunteers, neighbors, and friends, who assist and sustain an individual.

  (71) Nursing--Treatments and health care procedures provided by an RN or LVN that are:

    (A) ordered by a physician; and

    (B) provided in compliance with:

      (i) Texas Occupations Code, Chapter 301, Nurses; and

      (ii) rules at Texas Board of Nursing at Texas Administrative Code (TAC), Title 22, Part 11, Texas Board of Nursing.

  (72) Nursing facility--A facility that is licensed in accordance with the Texas Health and Safety Code, Chapter 242.

  (73) Occupational therapy--Services that:

    (A) address physical, cognitive, psychosocial, sensory, and other aspects of performance to support an individual's engagement in everyday life activities that affect health, wellbeing, and quality of life; and

    (B) are provided by a person licensed in accordance with Texas Occupations Code, Chapter 454, Occupational Therapists.

  (74) Orientation and mobility--Service that assists an individual to acquire independent travel skills that enable the individual to negotiate safely and efficiently between locations at home, school, work, and in the community.

  (75) Person-centered planning--A process that empowers the individual (and the LAR on the individual's behalf) to direct the development of an IPC that meets the individual's outcomes. The process:

    (A) identifies existing supports and services necessary to achieve the individual's outcomes;

    (B) identifies natural supports available to the individual and negotiates needed services and supports;

    (C) occurs with the support of a group of people chosen by the individual (and the LAR on the individual's behalf); and

    (D) accommodates the individual's style of interaction and preferences regarding time and setting.

  (76) Personal funds--The funds that belong to an individual, including earned income, social security benefits, gifts, and inheritances.

  (77) Personal leave day--A continuous 24-hour period, measured from midnight to midnight, when an individual who resides in a residence in which licensed assisted living or licensed home health assisted living is provided is absent from the residence for personal reasons.

  (78) Physical restraint--Any manual method used to control an individual's behavior, except for physical guidance or prompting of brief duration that an individual does not resist, that restricts:

    (A) the free movement or normal functioning of all or a part of the individual's body; or

    (B) normal access by an individual to a portion of the individual's body.

  (79) Physical therapy--Services that:

    (A) prevent, identify, correct, or alleviate acute or prolonged movement dysfunction or pain of anatomic or physiologic origin; and

    (B) are provided by a person licensed in accordance with Texas Occupations Code, Chapter 453, Physical Therapists.

  (80) Physician--As defined in §97.2 of this title (relating to Definitions), a person who is:

    (A) licensed in Texas to practice medicine or osteopathy in accordance with Texas Occupations Code, Chapter 155;

    (B) licensed in Arkansas, Louisiana, New Mexico, or Oklahoma to practice medicine, who is the treating physician of a client and orders home health or hospice services for the client, in accordance with the Texas Occupations Code, §151.056(b)(4); or

    (C) a commissioned or contract physician or surgeon who serves in the United States uniformed services or Public Health Service if the person is not engaged in private practice, in accordance with the Texas Occupations Code, §151.052(a)(8).

  (81) Program provider--A person, as defined in §49.102 of this title (relating to Definitions), that has a contract with DADS to provide DBMD Program services, excluding an FMSA.

  (82) Protective device--An item or device, such as a safety vest, lap belt, bed rail, safety padding, adaptation to furniture, or helmet, if:

    (A) used only:

      (i) to protect an individual from injury; or

      (ii) for body positioning of the individual to ensure health and safety; and

    (B) not used to modify or control behavior.

  (83) Psychoactive medication 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.

  (84) Public emergency personnel--Personnel of a sheriff's department, police department, emergency medical service, or fire department.

  (85) Reduction--A DADS action taken as a result of a review of a revision or renewal IPC that decreases the amount or level of a service authorized by DADS on the prior IPC.

  (86) Related condition--As defined in the Code of Federal Regulations (CFR), Title 42, §435.1010, a severe and chronic disability that:

    (A) is attributed to:

      (i) cerebral palsy or epilepsy; or

      (ii) any other condition, other than mental illness, found to be closely related to an intellectual disability because the condition results in impairment of general intellectual functioning or adaptive behavior similar to that of individuals with an intellectual disability, and requires treatment or services similar to those required for individuals with an intellectual disability;

    (B) is manifested before the individual reaches 22 years of age;

    (C) is likely to continue indefinitely; and

    (D) results in substantial functional limitation in at least three of the following areas of major life activity:

      (i) self-care;

      (ii) understanding and use of language;

      (iii) learning;

      (iv) mobility;

      (v) self-direction; and

      (vi) capacity for independent living.

  (87) Respite--Services provided on a short-term basis to an individual because of the absence or need for relief of an individual's unpaid caregiver.

  (88) Responder--A person designated to respond to an alarm call activated by an individual.

  (89) Restraint--Any of the following:

    (A) a physical restraint;

    (B) a mechanical restraint; or

    (C) a psychoactive medication restraint.

  (90) Restrictive intervention--An action or procedure that limits an individual's movement, access to other individuals, locations or activities, or restricts an individual's rights, including a restraint, a protective device, and seclusion.

  (91) RN--Registered nurse. A person licensed to provide professional nursing in accordance with Texas Occupations Code, Chapter 301, Nurses.

  (92) Seclusion--A restrictive intervention that is the involuntary separation of an individual away from other individuals in an area that the individual is prevented from leaving.

  (93) Service planning team--A team convened and facilitated by a DBMD Program case manager for the purpose of developing, reviewing, and revising an individual's IPC. The team consists of:

    (A) the individual;

    (B) if applicable, the individual's LAR or an actively involved person;

    (C) the DBMD Program case manager;

    (D) except as described in subparagraph (E) of this paragraph, the program director or a RN designated by the program provider;


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