| (38) 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.
(39) 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.
(40) ID/RC Assessment--A form used by HHSC for LOC
determination and LON assignment.
(41) Immediate threat--A situation that caused, or
is likely to cause, serious physical harm or serious emotional harm
to an individual, or the death of an individual.
(42) Implementation plan--A written document developed
by a program provider for an individual that, for each TxHmL Program
service, except for transportation provided as a community support
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 TxHmL 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 TxHmL Program services and
CFC services needed to complete each objective;
(E) the frequency and duration of TxHmL Program services
and CFC services needed to complete each objective; and
(F) the signature and date of the individual, LAR,
and the program provider.
(43) Individual--A person enrolled in the TxHmL Program.
(44) 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.
(45) Intellectual disability--Significant sub-average
general intellectual functioning existing concurrently with deficits
in adaptive behavior and manifested during the developmental period.
(46) 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.
(47) IPC--Individual plan of care. A written plan that:
(A) states:
(i) the type and amount of each TxHmL Program service
and each CFC service, except for CFC support management, to be provided
to an individual during an IPC year;
(ii) the services and supports to be provided to the
individual through resources other than TxHmL 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.
(48) IPC cost--Estimated annual cost of program services
included on an IPC.
(49) IPC year--A 12-month period of time starting on
the date an authorized initial or renewal IPC begins.
(50) Isolated--The scope of a violation that has affected
a very limited number of individuals or that has occurred only occasionally.
(51) 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.
(52) LIDDA--Local intellectual and developmental disability
authority. An entity designated by the executive commissioner of
HHSC, in accordance with THSC §533A.035.
(53) LOC--Level of care. A determination made by HHSC
about an applicant or individual as part of the TxHmL Program eligibility
determination process based on data electronically transmitted on
the ID/RC Assessment.
(54) LON--Level of need. An assignment given by HHSC
for an applicant or individual that is derived from the service level
score obtained from the administration of the ICAP to the individual
and from selected items on the ID/RC Assessment.
(55) LVN--Licensed vocational nurse. A person licensed
to practice vocational nursing in accordance with Texas Occupations
Code, Chapter 301.
(56) Managed care organization--This term has the meaning
set forth in Texas Government Code, §536.001.
(57) 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 Supplemental Security
Income (SSI) benefits.
(58) 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.
(59) 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 the TxHmL 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 TxHmL Program services or CFC services;
and
(B) that has a service capacity designated in the HHSC
data system of no more than three individuals.
(60) 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.
(61) 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.
(62) Natural supports--Unpaid persons, including family
members, volunteers, neighbors, and friends, who assist and sustain
an individual.
(63) 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.
(64) Nursing facility--A facility licensed in accordance
with THSC, Chapter 242.
(65) Own home or family home--A residence that is not:
(A) an ICF/IID;
(B) a nursing facility;
(C) an assisted living facility licensed or subject
to being licensed in accordance with THSC, Chapter 247;
(D) a residential child-care operation licensed or
subject to being licensed by DFPS unless it is a foster family home
or a foster group home;
(E) a facility licensed or subject to being licensed
by the Department of State Health Services;
(F) a residential facility operated by the Texas Workforce
Commission;
(G) a residential facility operated by the Texas Juvenile
Justice Department, a jail, or a prison; or
(H) a setting in which two or more dwellings, including
units in a duplex or apartment complex, single family homes, or facilities
listed in subparagraphs (A) - (G) of this paragraph, but excluding
supportive housing under Section 811 of the National Affordable Housing
Act of 1990, meet all of the following criteria:
(i) the dwellings create a residential area distinguishable
from other areas primarily occupied by persons who do not require
routine support services because of a disability;
(ii) most of the residents of the dwellings are persons
with an intellectual disability; and
(iii) the residents of the dwellings are provided
routine support services through personnel, equipment, or service
facilities shared with the residents of the other dwellings.
(66) 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
Cont'd... |
