| (22) Exempted hospital discharge--A category of NF
admission that occurs when a physician has certified that an individual
who is being discharged from an acute care hospital is likely to require
less than 30 days of NF services for the condition for which the individual
was hospitalized.
(23) Expedited admission--A category of NF admission
that occurs when an individual meets the criteria for one of the following
categories: convalescent care, terminal illness, severe physical illness,
delirium, emergency protective services, respite, or coma.
(24) Extenuating circumstances--Circumstances beyond
the LIDDA's, LMHA's or LBHA's control that prevents meeting in person.
A disaster declared by the governor is excluded from this definition.
(25) Habilitation coordination--Assistance for a designated
resident residing in a NF to access appropriate specialized services
necessary to achieve a quality of life and level of community participation
acceptable to the designated resident and LAR on the designated resident's
behalf.
(26) Habilitation coordinator--An employee of a LIDDA
who provides habilitation coordination.
(27) HHSC--The Texas Health and Human Services Commission.
(28) HHSC instructor-led training--Training delivered
by an HHSC employee.
(29) HSP--Habilitation service plan. A plan developed
by the SPT while a designated resident is residing in a NF that:
(A) is individualized and developed through a person-centered
approach;
(B) identifies the designated resident's:
(i) strengths;
(ii) preferences;
(iii) desired outcomes; and
(iv) psychiatric, behavioral, nutritional management,
and support needs as described in the NF comprehensive care plan or
MDS assessment; and
(C) identifies the specialized services that will accomplish
the desired outcomes of the designated resident, or the LAR's on behalf
of the designated resident, including amount, frequency, and duration
of each service.
(30) ID--Intellectual disability, as defined in 42
CFR §483.102(b)(3)(i).
(31) IDD--Intellectual and developmental disability.
(32) IDT--Interdisciplinary team. A team consisting
of:
(A) a resident with MI, ID, or DD;
(B) the resident's LAR, if any;
(C) an RN from the NF with responsibility for the resident;
(D) a representative of:
(i) the LIDDA, if the resident has ID or DD;
(ii) the LMHA or LBHA, if the resident has MI; or
(iii) the LIDDA and the LMHA or LBHA, if the resident
has MI and DD, or MI and ID; and
(E) others as follows:
(i) a concerned person whose inclusion is requested
by the resident or LAR;
(ii) an individual specified by the resident, LAR,
NF, LIDDA, LMHA, or LBHA, as applicable, who is professionally qualified,
certified, or licensed with special training and experience in the
diagnosis, management, needs, and treatment of people with MI, ID,
or DD; and
(iii) a representative of the appropriate school district
if the resident is school age and inclusion of the district representative
is requested by the resident or LAR.
(33) IHSS--IDD habilitative specialized services. IHSS
are:
(A) behavioral support;
(B) day habilitation;
(C) employment assistance;
(D) independent living skills training; and
(E) supported employment.
(34) ILST--Independent living skills training. An IHSS
that:
(A) is assistance provided for a designated resident
that is consistent with the designated resident's HSP;
(B) is provided in the designated resident's NF or
in a community setting;
(C) includes expanded interactions, skills training
activities, and programs of greater intensity or frequency beyond
those a NF is required to provide by 42 CFR §483.24; and
(D) consists of:
(i) habilitation and support activities that foster
improvement of or facilitate a designated resident's ability to attain,
learn, maintain, or improve functional living skills and other daily
living activities;
(ii) activities that help preserve the designated resident's
bond with family members;
(iii) activities that foster inclusion in community
activities generally attended by people without disabilities;
(iv) transportation to facilitate a designated resident's
employment opportunities and participation in community activities,
and between the designated resident's NF and a community setting;
and
(v) participating in SPT and IDT meetings.
(35) Implementation plan--A plan for each IHSS on the
designated resident's plan of care that includes:
(A) a list of the designated resident's outcomes identified
in the HSP that will be addressed using IHSS;
(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;
(C) a target date for completion of each objective;
(D) the frequency, amount, and duration of IHSS needed
to complete each objective; and
(E) the signature and date of the designated resident,
LAR, and service provider agency.
(36) In-person (or in person)--Within the physical
presence of another person. In-person or in person does not include
audio-visual or audio-only communication.
(37) LAR--Legally authorized representative. An individual
authorized by law to act on behalf of an individual seeking admission
to a NF or resident with regard to a matter described by this chapter,
and who may be the parent of a minor child, the legal guardian, or
the surrogate decision maker.
(38) LBHA--Local behavioral health authority. An entity
designated by the executive commissioner of HHSC, in accordance with
Texas Health and Safety Code §533.0356.
(39) LCSW--Licensed clinical social worker. An individual
who is licensed as a licensed clinical social worker in accordance
with Texas Occupations Code Chapter 505.
(40) Licensed psychologist--An individual who is licensed
as a psychologist in accordance with Texas Occupations Code Chapter
501.
(41) LIDDA--Local intellectual and developmental disability
authority. An entity designated by the executive commissioner of HHSC,
in accordance with Texas Health and Safety Code §533A.035.
(42) LMFT--Licensed marriage and family therapist.
An individual who is licensed as a marriage and family therapist in
accordance with Texas Occupations Code Chapter 502.
(43) LMHA--Local mental health authority. An entity
designated by the executive commissioner of HHSC, in accordance with
Texas Health and Safety Code §533.035.
(44) LPC--Licensed professional counselor. An individual
who is licensed as a professional counselor in accordance with Texas
Occupations Code Chapter 503.
(45) LTC online portal--Long term care online portal.
A web-based application used by Medicaid providers to submit forms,
screenings, evaluations, and other information.
(46) MCO service coordinator--Managed care organization
service coordinator. The staff person assigned by a resident's Medicaid
managed care organization to ensure access to and coordination of
needed services.
(47) MDS assessment--Minimum data set assessment. A
standardized collection of demographic and clinical information that
describes a resident's overall condition, which a licensed NF in Texas
is required to submit for a resident admitted into the facility.
(48) MI--Mental illness. Serious mental illness, as
defined in 42 CFR §483.102(b)(1).
(49) MI quarterly meeting--A quarterly meeting that
is convened by the LMHA or LBHA for a resident with MI to develop,
review, or revise the PCRP and the transition plan, if the resident
is transitioning to the community.
(50) MI specialized services--Specialized services
for a resident with MI, if eligible, as described in the Texas Resilience
and Recovery Utilization Management Guidelines, including:
(A) crisis intervention services;
(B) day programs for acute needs;
(C) medication training and support services;
(D) psychiatric diagnostic interview examination;
(E) psychosocial rehabilitation services;
Cont'd... |
