| (C) DME.
(31) PASRR--Preadmission screening and resident review.
(32) PASRR determination--A decision made by DADS,
DSHS, or their designee regarding an individual's need for nursing
facility specialized services, LIDDA specialized services, and LMHA
specialized services, based on information in the PE; and, in accordance
with Subchapter Y of this chapter (relating to Medical Necessity Determinations),
whether the individual requires the level of care provided in a nursing
facility. A report documenting the determination is sent to the individual
and LAR.
(33) PE--PASRR Level II evaluation. A face-to-face
evaluation of an individual suspected of having MI, ID, or DD performed
by a LIDDA or an LMHA to determine if the individual has MI, ID, or
DD, and if so to:
(A) assess the individual's need for care in a nursing
facility;
(B) assess the individual's need for nursing facility
specialized services, LIDDA specialized services and LMHA specialized
services; and
(C) identify alternate placement options.
(34) PL1--PASRR Level I screening. The process of screening
an individual to identify whether the individual is suspected of having
MI, ID, or DD.
(35) Pre-admission--A category of nursing facility
admission from a community setting that is not an expedited admission
or an exempted hospital discharge.
(36) Referring entity--The entity that refers an individual
to a nursing facility, such as a hospital, attending physician, LAR
or other personal representative selected by the individual, a family
member of the individual, or a representative from an emergency placement
source, such as law enforcement.
(37) Resident--An individual who resides in a nursing
facility and receives services provided by professional nursing personnel
of the facility.
(38) Resident review--A face-to-face evaluation of
a resident performed by a LIDDA or LMHA:
(A) for a resident with MI, ID, or DD who experienced
a significant change in status, to:
(i) assess the resident's need for continued care in
a nursing facility;
(ii) assess the resident's need for nursing facility
specialized services, LIDDA specialized services and LMHA specialized
services; and
(iii) identify alternate placement options; and
(B) for a resident suspected of having MI, ID, or DD,
to determine whether the resident has MI, ID, or DD and, if so:
(i) assess the resident's need for continued care in
a nursing facility;
(ii) assess the resident's need for nursing facility
specialized services, LIDDA specialized services, and LMHA specialized
services; and
(iii) identify alternate placement options.
(39) Respite--Services provided on a short-term basis
to an individual because of the absence of or the need for relief
by the individual's unpaid caregiver for a period not to exceed 14
days.
(40) Service coordination--As defined in §2.553
of this title (relating to Definitions), assistance in accessing medical,
social, educational, and other appropriate services and supports that
will help an individual achieve a quality of life and community participation
acceptable to the person and LAR on the individual's behalf.
(41) Service coordinator--An employee of a LIDDA who
provides service coordination.
(42) Severe physical illness--An illness resulting
in ventilator dependence or diagnosis such as chronic obstructive
pulmonary disease, Parkinson's disease, Huntington's disease, amyotrophic
lateral sclerosis, or congestive heart failure, that results in a
level of impairment so severe that the individual could not be expected
to benefit from nursing facility specialized services, LIDDA specialized
services or LMHA specialized services.
(43) SPT--Service planning team. A team that develops,
reviews, and revises the ISP for a designated resident.
(A) The SPT always includes:
(i) the designated resident;
(ii) the designated resident's LAR, if any;
(iii) the service coordinator;
(iv) nursing facility staff familiar with the designated
resident's needs;
(v) persons providing nursing facility specialized
services and LIDDA specialized services for the designated resident;
(vi) a representative from a community provider, if
one has been selected; and
(vii) a representative from the LMHA, if the designated
resident has MI.
(B) Other participants on the SPT may include:
(i) a concerned person whose inclusion is requested
by the designated resident or the LAR; and
(ii) at the discretion of the LIDDA, a person who
is directly involved in the delivery of services to people with ID
or DD.
(44) Surrogate decision maker--An actively involved
family member of a resident who has been identified by an IDT in accordance
with Texas Health and Safety Code §313.004 and who is available
and willing to consent on behalf of the resident.
(45) Terminal illness--A medical prognosis that an
individual's life expectancy is six months or less if the illness
runs its normal course, which is documented by a physician's certification
in the individual's medical record maintained by a nursing facility.
(46) Therapy services--Assessment and treatment to
help a designated resident learn, keep, or improve skills and functioning
of daily living affected by a disabling condition. Therapy services
are referred to as habilitative therapy services. Therapy services
are limited to:
(A) physical therapy;
(B) occupational therapy; and
(C) speech therapy.
(47) Transition plan--A plan developed by the SPT that
describes the activities, timetable, responsibilities, services, and
supports involved in assisting a designated resident to transition
from the nursing facility to the community.
|
| Source Note: The provisions of this §554.2703 adopted to be effective July 7, 2015, 40 TexReg 4373; amended to be effective September 10, 2017, 42 TexReg 4468; transferred effective January 15, 2021, as published in the Texas Register December 11, 2020, 45 TexReg 8871 |
