| (F) routine case management; and
(G) skills training and development.
(51) NF--Nursing facility. A Medicaid-certified facility
that is licensed in accordance with the Texas Health and Safety Code
Chapter 242.
(52) NF comprehensive care plan--A comprehensive care
plan, defined in §554.2703(3) of this title.
(53) NF PASRR support activities--Actions a NF takes
in coordination with a LIDDA, LMHA, or LBHA to facilitate the successful
provision of an IHSS or MI specialized service, including:
(A) arranging transportation for a NF resident to participate
in an IHSS or a MI specialized service outside the facility;
(B) sending a resident to a scheduled IHSS or MI specialized
service with food and medications required by the resident; and
(C) stating in the NF comprehensive care plan an agreement
to avoid, when possible, scheduling NF services at times that conflict
with IHSS or MI specialized services.
(54) NF specialized services--The following specialized
services available to a resident with ID or DD:
(A) therapy services;
(B) CMWC; and
(C) DME.
(55) PA--Physician assistant. An individual who is
licensed as a physician assistant in accordance with Texas Occupations
Code Chapter 204.
(56) PASRR--Preadmission screening and resident review.
A federal requirement in 42 CFR Part 483, Subpart C that requires
states to prescreen all individuals seeking admission to a Medicaid-certified
NF for ID, DD, and MI.
(57) PCRP--Person-centered recovery plan. For a resident
with MI, the PCRP identifies the services and supports that are needed
to:
(A) meet the needs of the resident with MI;
(B) achieve the desired outcomes; and
(C) maximize the ability for the resident with MI to
live successfully in the most integrated setting possible.
(58) PE--PASRR level II evaluation. An evaluation as
described in §303.302(a)(2) of this chapter (relating to LIDDA,
LMHA, and LBHA Responsibilities Related to the PASRR Process):
(A) of an individual seeking admission to a NF who
is suspected of having MI, ID, or DD; and
(B) performed by a LIDDA, LMHA, or LBHA to determine
if the individual has MI, ID, or DD and, if so, to:
(i) assess the individual's need for care in a NF;
(ii) assess the individual's need for specialized services;
and
(iii) identify alternate placement options.
(59) Physician--An individual who is licensed to practice
medicine in accordance with Texas Occupations Code Chapter 155.
(60) PL1--PASRR level I screening. The process of screening
an individual seeking admission to a NF to identify whether the individual
is suspected of having MI, ID, or DD.
(61) Plan of care--A written plan that includes:
(A) the IHSS required by the NF baseline care plan
or NF comprehensive care plan;
(B) the frequency, amount, and duration of each IHSS
to be provided for the designated resident during a plan year; and
(C) the services and supports to be provided for the
designated resident through resources other than PASRR.
(62) Preadmission process--A category of NF admission:
(A) from a community setting, such as a private home,
an assisted living facility, a group home, a psychiatric hospital,
or jail, but not an acute care hospital or another NF; and
(B) that is not an expedited admission or an exempted
hospital discharge.
(63) QIDP--Qualified intellectual disability professional.
An individual who meets the qualifications described in 42 CFR §483.430(a).
(64) QMHP-CS--Qualified mental health professional-community
services. An individual who meets the qualifications of a QMHP-CS
as defined in §301.303 of this title (relating to Definitions).
(65) Referring entity--The entity that refers an individual
to a NF, 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.
(66) Relocation specialist--An employee or contractor
of an MCO who provides outreach and relocation activities to individuals
in NFs who express a desire to transition to the community.
(67) Resident--An individual who resides in a NF.
(68) Resident review--An evaluation of a resident performed
by a LIDDA, LMHA, or LBHA as described in §303.302(a)(2) of this
chapter (relating to LIDDA, LMHA, and LBHA Responsibilities Related
to the PASRR Process):
(A) for a resident whose PE is positive for MI, ID,
or DD who experienced a significant change in condition, to:
(i) assess the resident's need for continued care in
a NF;
(ii) assess the resident's need for 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 NF;
(ii) assess the resident's need for specialized services;
and
(iii) identify alternate placement options.
(69) Resident with MI--An individual:
(A) who is a resident of a NF;
(B) whose PE or resident review is positive for MI;
(C) who is at least 18 years of age; and
(D) who is a Medicaid recipient.
(70) 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.
(71) RN--Registered nurse. An individual licensed to
practice professional nursing as a registered nurse in accordance
with Texas Occupations Code Chapter 301.
(72) Service coordination--Assistance in accessing
medical, social, educational, and other appropriate services and supports,
including alternate placement assistance, that will help an individual
to achieve a quality of life and community participation acceptable
to the individual and LAR on the individual's behalf.
(73) Service coordinator--An employee of a LIDDA who
provides service coordination.
(74) Service provider agency--An entity that has a
contract with HHSC to provide IHSS for a designated resident.
(75) Severe physical illness--An illness resulting
in ventilator dependence or a 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 specialized services.
(76) Significant change in condition--Consistent with §554.801(2)(C)(ii)
of this title (relating to Resident Assessment), when a resident experiences
a major decline or improvement in the resident's status that:
(A) will not normally resolve itself without further
intervention by NF staff or by implementing standard disease-related
clinical interventions;
(B) has an impact on more than one area of the resident's
health status; and
(C) requires review or revision of the NF comprehensive
care plan, or both.
(77) Specialized services--The following support services,
other than NF services, that are identified through the PE or resident
review and may be provided to a resident who has a PE or resident
review that is positive for MI, ID, or DD:
(A) NF specialized services;
(B) IHSS; and
(C) MI specialized services.
(78) SPT--Service planning team. A team convened by
a LIDDA staff person that develops, reviews, and revises the HSP and
the transition plan for a designated resident. The team must include:
(A) the designated resident;
(B) the designated resident's LAR, if any;
(C) the habilitation coordinator for discussions and
service planning related to specialized services or the service coordinator
for discussions related to transition planning if the designated resident
is transitioning to the community;
(D) the MCO service coordinator, if the designated
resident does not object;
Cont'd... |
