| (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... |
