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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

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

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

  (49) ID/RC Assessment--Intellectual Disability/Related Conditions Assessment. A form used by HHSC for LOC determination and LON assignment.

  (50) Immediate threat--A situation that causes, or is likely to cause, serious injury, harm, or impairment to or the death of an individual.

  (51) Implementation plan--A written document developed by the program provider that, for each HCS Program service, except for transportation provided as a supported home living activity, and CFC service, except for CFC support management, on the individual's IPC to be provided by the program provider, includes:

    (A) a list of outcomes identified in the PDP that will be addressed using HCS Program services and CFC services;

    (B) specific objectives to address the outcomes required by subparagraph (A) of this paragraph that are:

      (i) observable, measurable, and outcome-oriented; and

      (ii) derived from assessments of the individual's strengths, personal goals, and needs;

    (C) a target date for completion of each objective;

    (D) the number of units of HCS Program services and CFC services needed to complete each objective;

    (E) the frequency and duration of HCS Program services and CFC services needed to complete each objective; and

    (F) the signature and date of the individual, LAR, and the program provider.

  (52) Individual--A person enrolled in the HCS Program.

  (53) Initial certification survey--A review by HHSC of a program provider with a provisional contract to determine if the program provider is in compliance with the certification principles.

  (54) Initial IPC--The first IPC for an individual developed before the individual's enrollment into the HCS Program.

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

  (56) Intermittent survey--A review by HHSC of a program provider that is not an initial certification survey, a recertification survey, or a follow-up survey, to determine if the program provider is in compliance with the certification principles.

  (57) IPC--Individual plan of care. A written plan that:

    (A) states:

      (i) the type and amount of each HCS Program service and each CFC service, except for CFC support management, to be provided to the individual during an IPC year;

      (ii) the services and supports to be provided to the individual through resources other than HCS Program services or CFC services, including natural supports, medical services, and educational services; and

      (iii) if an individual will receive CFC support management; and

    (B) is authorized by HHSC.

  (58) IPC cost--Estimated annual cost of HCS Program services included on an IPC.

  (59) IPC year--A 12-month period of time starting on the date an initial or renewal IPC begins. A revised IPC does not change the begin or end date of an IPC year.

  (60) Isolated--The scope of a violation that has affected a very limited number of individuals or that has occurred only occasionally.

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

  (62) LIDDA--Local intellectual and developmental disability authority. An entity designated by the executive commissioner of HHSC, in accordance with THSC, §533A.035.

  (63) LOC--Level of care. A determination given to an individual as part of the eligibility determination process based on data submitted on the ID/RC Assessment.

  (64) LON--Level of need. An assignment given by HHSC to an individual upon which reimbursement for host home/companion care, supervised living, residential support, and day habilitation is based.

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

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

  (67) MAO Medicaid--Medical Assistance Only Medicaid. A type of Medicaid by which an applicant or individual qualifies financially for Medicaid assistance but does not receive SSI benefits.

  (68) 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.

  (69) Microboard--A program provider:

    (A) that is a non-profit corporation:

      (i) that is created and operated by no more than 10 persons, including an individual;

      (ii) the purpose of which is to address the needs of the individual and directly manage the provision of HCS Program services or CFC services; and

      (iii) in which each person operating the corporation participates in addressing the needs of the individual and directly managing the provision of HCS Program services or CFC services; and

    (B) that has a service capacity designated in the HHSC data system of no more than three individuals.

  (70) 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.

  (71) 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.

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

  (73) Neglect--A negligent act or omission that caused physical or emotional injury or death to an individual or placed an individual at risk of physical or emotional injury or death.

  (74) Nursing facility--A facility licensed in accordance with THSC, Chapter 242.

  (75) Pattern--The scope of a violation that is not widespread but represents repeated failures by the program provider to comply with certification principles and the failures:

    (A) are found throughout the services provided by the program provider; or

    (B) involve or affect the same individuals, service providers, or volunteers.

  (76) PDP--Person-directed plan. A written plan, based on person-directed planning and developed with an applicant or individual in accordance with the HHSC Person-Directed Plan form and discovery tool found on the HHSC website, that describes the supports and services necessary to achieve the desired outcomes identified by the applicant or individual (and LAR on the applicant's or individual's behalf) and ensure the applicant's or individual's health and safety.

  (77) Performance contract--A written agreement between HHSC and a LIDDA for the performance of delegated functions, including those described in THSC, §533A.035.

  (78) Permanency planning--A philosophy and planning process that focuses on the outcome of family support for an applicant or individual under 22 years of age by facilitating a permanent living arrangement in which the primary feature is an enduring and nurturing parental relationship.

  (79) Permanency Planning Review Screen--A screen in the HHSC data system, completed by a LIDDA, that identifies community supports needed to achieve an applicant's or individual's permanency planning outcomes and provides information necessary for approval to provide supervised living or residential support to the applicant or individual.

  (80) Person-directed planning--An ongoing process that empowers the applicant or individual (and the LAR on the applicant's or individual's behalf) to direct the development of a PDP. The process:

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

    (B) identifies existing supports, including natural supports and other supports available to the applicant or individual and negotiates needed services system supports;

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

    (D) accommodates the applicant's or individual's style of interaction and preferences.

  (81) Physical abuse--Any of the following:

    (A) an act or failure to act performed knowingly, recklessly, or intentionally, including incitement to act, that caused physical injury or death to an individual or placed an individual at risk of physical injury or death;

    (B) an act of inappropriate or excessive force or corporal punishment, regardless of whether the act results in a physical injury to an individual;

    (C) the use of a restraint on an individual not in compliance with federal and state laws, rules, and regulations; or

    (D) seclusion.

  (82) 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.

  (83) Plan of correction--A plan documented on the HHSC Plan of Correction form that includes the corrective action that a program provider will take for each violation identified on a final survey report.

  (84) Plan of removal--A written plan that describes the action a program provider will take to remove an immediate threat that HHSC identifies.

  (85) Post 45-day follow-up survey--A follow-up survey conducted at least 46 calendar days after the exit conference of the survey in which the violation requiring corrective action was identified.

  (86) Post-move monitoring visit--As described in 26 TAC §303.702 (relating to Post-transition Responsibilities), a visit conducted by the service coordinator in the individual's residence and other locations, as determined by the service planning team, for an individual who enrolled in the HCS Program from a nursing facility or enrolled in the HCS Program as a diversion from admission to a nursing facility. The purpose of the visit is to review the individual's residence and other locations to:

    (A) assess whether essential supports identified in the transition plan are in place;

    (B) identify gaps in care; and

    (C) address such gaps, if any, to reduce the risk of crisis, re-admission to a nursing facility, or other negative outcome.

  (87) Pre-enrollment minor home modifications--Minor home modifications, as described in the HCS Program Billing Guidelines, completed before an applicant is discharged from a nursing facility, an ICF/IID, or a GRO and before the effective date of the applicant's enrollment in the HCS Program.

  (88) Pre-enrollment minor home modifications assessment--An assessment performed by a licensed professional as required by the HCS Program Billing Guidelines to determine the need for pre-enrollment minor home modifications.

  (89) Pre-move site review--As described in 26 TAC §303.701 (relating to Transition Planning for a Designated Resident), a review conducted by the service coordinator in the planned residence and other locations, as determined by the service planning team, for an applicant transitioning from a nursing facility to the HCS Program. The purpose of the review is to ensure that essential services and supports described in the applicant's transition plan are in place before the applicant moves to the residence or receives services in the other locations. ervices are provided and that is:

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

  (91) Provisional contract--A contract that HHSC enters into with a program provider in accordance with §49.208 of this title (relating to Provisional Contract Application Approval) that has a term of no more than three years, not including any extension agreed to in accordance with §49.208(e) of this title.

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

Cont'd...

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