| (30) Chemical 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.
(31) Chore services--A DBMD Program service, other
than CFC PAS/HAB household chores, needed to maintain a clean, sanitary,
and safe environment in an individual's home and consists of heavy
household chores, such as washing floors, windows, and walls, securing
loose rugs and tiles, and moving heavy items or furniture.
(32) CMS--The Centers for Medicare & Medicaid Services.
CMS is the agency within the United States Department of Health and
Human Services that administers the Medicare and Medicaid programs.
(33) Competitive employment--Employment that pays an
individual at least minimum wage if the individual is not self-employed.
(34) Contract--A provisional contract that the Texas
Health and Human Services Commission enters into in accordance with
40 TAC §49.208 (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 40 TAC §49.208(e)
or a standard contract that HHSC enters into in accordance with 40
TAC §49.209 (relating to Standard Contract) that has a term of
no more than five years, not including any extension agreed to in
accordance with 40 TAC §49.209(d).
(35) Controlling person--A person who:
(A) has an ownership interest in a program provider;
(B) is an officer or director of a corporation that
is a program provider;
(C) is a partner in a partnership that is a program
provider;
(D) is a member or manager in a limited liability company
that is a program provider;
(E) is a trustee or trust manager of a trust that is
a program provider; or
(F) because of a personal, familial, or other relationship
with a program provider, is in a position of actual control or authority
with respect to the program provider, regardless of the person's title.
(36) Day Activity and Health Services Program--This
term has the meaning set forth in Texas Human Resource Code §103.003.
(37) DBMD Program--The Deaf Blind with Multiple Disabilities
Program.
(38) Deafblindness--A chronic condition in which a
person:
(A) has deafness, which is a hearing impairment severe
enough that most speech cannot be understood with amplification; and
(B) has legal blindness, which results from a central
visual acuity of 20/200 or less in the person's better eye, with correction,
or a visual field of 20 degrees or less.
(39) Denial--An action taken by HHSC that:
(A) rejects an individual's request for enrollment
into the DBMD Program;
(B) disallows a DBMD Program service or a CFC service
requested on an individual plan of care (IPC) that was authorized
on the prior IPC; or
(C) disallows a portion of the amount or level of a
DBMD Program service or a CFC service requested on an IPC that was
not authorized on the prior IPC.
(40) Dental treatment--A DBMD Program service that:
(A) consists of the following:
(i) emergency dental treatments, which are procedures
necessary to control bleeding, relieve pain, and eliminate acute infection;
operative procedures that are required to prevent the imminent loss
of teeth; and treatment of injuries to the teeth or supporting structures;
(ii) routine preventative dental treatments, which
are examinations, x-rays, cleanings, sealants, oral prophylaxes, and
topical fluoride applications;
(iii) therapeutic dental treatments, which include
fillings, scaling, extractions, crowns, and pulp therapy for permanent
and primary teeth; restoration of carious permanent and primary teeth;
maintenance of space; and limited provision of removable prostheses
when masticatory function is impaired, when an existing prosthesis
is unserviceable, or when aesthetic considerations interfere with
employment or social development;
(iv) orthodontic dental treatments, which are procedures
that include treatment of retained deciduous teeth; cross-bite therapy;
facial accidents involving severe traumatic deviations; cleft palates
with gross malocclusion that will benefit from early treatment; and
severe, handicapping malocclusions affecting permanent dentition with
a minimum score of 26 as measured on the Handicapping Labio-lingual
Deviation Index; and
(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);
Cont'd... |
