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RULE §260.5Definitions

      (v) dental sedation, which is sedation necessary to perform dental treatment including non-routine anesthesia, (for example, intravenous sedation, general anesthesia, or sedative therapy prior to routine procedures) but not including administration of routine local anesthesia only; and

    (B) does not include cosmetic orthodontia.

  (41) Developmental disability--As defined in the Developmental Disabilities Assistance and Bill of Rights Act of 2000, Section 102(8), a severe, chronic disability of an individual five years of age or older that:

    (A) is attributable to a mental or physical impairment or combination of mental and physical impairments;

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

    (C) is likely to continue indefinitely; and

    (D) results in substantial functional limitations in three or more of the following areas of major life activity:

      (i) self-care;

      (ii) receptive and expressive language;

      (iii) learning;

      (iv) mobility;

      (v) self-direction;

      (vi) capacity for independent living; and

      (vii) economic self-sufficiency.

  (42) DFPS--Department of Family and Protective Services.

  (43) Dietary services--A DBMD Program service that provides nutrition services, as defined in Texas Occupations Code §701.002.

  (44) Employment assistance--A DBMD Program service that provides assistance to an individual to help the individual locate competitive employment in the community to the same degree of access as individuals not receiving DBMD Program services.

  (45) Enrollment Individual Plan of Care (IPC)--The first IPC for an individual developed before the individual's enrollment into the DBMD Program.

  (46) Enrollment Individual Program Plan (IPP)--The first IPP for an individual developed before the individual's enrollment into the DBMD Program in accordance with §260.65 of this chapter (relating to Development of an Enrollment IPP).

  (47) 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.

  (48) FMS--Financial management services. A DBMD Program service that is defined in 40 TAC §41.103 and provided to an individual participating in the CDS option.

  (49) FMSA--Financial management services agency. An entity, as defined in 40 TAC §41.103, that provides FMS.

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

    (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.

  (51) Functional behavior assessment--An evaluation that is used to determine the underlying function or purpose of an individual's behavior, so an effective behavior support plan can be developed.

  (52) Functions as a person with deafblindness--Situation in which a person is determined:

    (A) to have a progressive medical condition, manifested before 22 years of age, that will result in the person having deafblindness; or

    (B) before attaining 22 years of age, to have limited hearing or vision due to protracted inadequate use of either or both of these senses.

  (53) Good cause--As determined by HHSC, A reason outside the control of a CFC ERS provider that is an acceptable reason for the CFC ERS provider's failure to comply.

  (54) HCSSA--Home and community support services agency. An entity required to be licensed under Texas Health and Safety Code (THSC) Chapter 142.

  (55) Health-related tasks--Specific tasks related to the needs of an individual that can be delegated or assigned by a licensed healthcare professional under state law to be performed by a service provider of CFC PAS/HAB. These include:

    (A) tasks delegated by a registered nurse (RN);

    (B) health maintenance activities, as defined in 22 TAC §225.4 (relating to Definitions), that may not require delegation; and

    (C) activities assigned to a service provider of CFC PAS/HAB by a licensed physical therapist, occupational therapist, or speech-language pathologist.

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

  (57) Hospital--A public or private institution that is licensed or is exempt from licensure in accordance with THSC Chapters 13, 241, 261, or 552.

  (58) 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.

  (59) 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 services are provided and that is:

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

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

  (60) 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.

  (61) ID/RC Assessment--Intellectual Disability/Related Conditions Assessment. An HHSC form used to determine the LOC for an individual.

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

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

  (64) Individual transportation plan--A written plan developed by an individual's service planning team and documented on the HHSC Individual Transportation Plan form. The form is used to document how transportation as a residential habilitation activity will be delivered to support an individual's desired goals and outcomes for transportation as identified in the IPP.

  (65) Inpatient chemical dependency treatment facility--A facility licensed in accordance with THSC Chapter 464.

  (66) In person or in-person--Within the physical presence of another person. In person or in-person does not include using videoconferencing or a telephone.

  (67) Institution for mental diseases--Has the meaning set forth in 42 CFR §435.1010.

  (68) Institutional services--Medicaid-funded services provided in a nursing facility or in an ICF/IID.

  (69) Intellectual disability--Consistent with THSC §591.003, significantly sub-average general intellectual functioning that is concurrent with deficits in adaptive behavior and originates during the developmental period.

  (70) 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.

  (71) IPC--Individual plan of care. A written plan developed by an individual's service planning team and documented on the HHSC Individual Plan of Care form. An IPC:

    (A) documents:

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

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

    (B) is authorized by HHSC.

  (72) IPC period--The effective period of an enrollment IPC and a renewal IPC as follows:

    (A) for an enrollment IPC, the period of time from the effective date of the enrollment IPC, as described in §260.67(a)(1)(F) of this chapter (relating to Development of a Proposed Enrollment IPC), through the last calendar day of the 11th month after the month in which enrollment occurred; and

    (B) for a renewal IPC, a 12-month period of time starting on the effective date of a renewal IPC as described in §260.77(a)(1) of this chapter (relating to Renewal and Revision of an IPP and IPC).

  (73) IPP--Individual program plan. A written plan that includes the information described in §260.65(b) of this chapter (relating to Development of an Enrollment IPP) and documented on an HHSC Individual Program Plan form.

  (74) 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, including a parent, guardian, or managing conservator of a minor; a guardian of an adult; an agent appointed under a power of attorney; or a representative payee appointed by the Social Security Administration. An LAR, such as an agent appointed under a power of attorney or representative payee appointed by the Social Security Administration, may have limited authority to act on behalf of a person.

  (75) Licensed assisted living--A DBMD Program service provided by a program provider in an ALF that is owned by the program provider.

  (76) Licensed home health assisted living--A DBMD Program service provided by a program provider licensed as a HCSSA, in a residence for no more than three individuals. The residence must be owned or leased by at least one of the residents and must not be owned or leased by a program provider.

  (77) Licensed vocational nursing--A DBMD Program service that provides vocational nursing, as defined in Texas Occupations Code §301.002.

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

  (79) 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.

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

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

  (82) 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.

  (83) 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.

  (84) Medicaid--A program administered by CMS and funded jointly by the states and the federal government that pays for health care to eligible groups of low-income people.

  (85) Medicaid HCBS--Medicaid home and community-based services. Medicaid services provided to an individual in an individual's home and community, rather than in a facility.

  (86) Mental health facility--A facility licensed in accordance with THSC Chapter 577.

  (87) MESAV--Medicaid Eligibility Service Authorization Verification. The automated system that contains information regarding an individual's Medicaid eligibility and service authorizations.

  (88) 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.

  (89) Military member--A member of the United States military serving in the Army, Navy, Air Force, Marine Corps, Coast Guard, or Space Force 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.

  (90) Minor home modifications--A DBMD Program service that:

    (A) makes a physical adaptation to an individual's residence that:

      (i) is necessary to address the individual's specific needs; and

      (ii) enables the individual to function with greater independence in the individual's residence or to control his or her environment; and

    (B) meets one of the following criteria:

      (i) is included on the list of minor home modifications in the Deaf Blind with Multiple Disabilities Program Manual; or

      (ii) is the repair or maintenance of a minor home modification purchased through the DBMD Program that:

        (I) is needed after one year has elapsed from the date the minor home modification is complete;


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