The following words, terms, and phrases have the following
meanings when used in this chapter, unless the context clearly indicates
otherwise:
(1) Abuse--
(A) physical abuse;
(B) sexual abuse; or
(C) verbal or emotional abuse.
(2) ADL--Activity of daily living. An activity that
is essential to daily self-care. An ADL does not include a service
that must be provided or supervised by licensed personnel.
(3) Alleged perpetrator--A person alleged to have committed
an act of abuse, neglect, or exploitation of an individual.
(4) Attendant--A person who provides authorized tasks
to an individual.
(5) CAS Program--Community Attendant Services Program.
A Medicaid state plan program authorized under Title XIX, §1929(b)
of the Social Security Act that provides personal attendant services
to an eligible individual.
(6) Case worker--An HHSC employee who is responsible
for case authorization and management activities.
(7) 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.
(8) Contract manager--An HHSC employee who is responsible
for the overall management of the contract with the provider.
(9) Controlling person--A person who:
(A) has an ownership interest in a provider;
(B) is an officer or director of a corporation that
is a provider;
(C) is a partner in a partnership that is a provider;
(D) is a member or manager in a limited liability company
that is a provider;
(E) is a trustee or trust manager of a trust that is
a provider; or
(F) because of a personal, familial, or other relationship
with a provider, is in a position of actual control or authority with
respect to the provider, regardless of the person's title.
(10) Days--Any reference to days means calendar days,
unless otherwise specified in the text. Calendar days include weekends
and holidays.
(11) DFPS--The Department of Family and Protective
Services.
(12) Expedited referral--In the PHC Program or CAS
Program, an oral request from a case worker to a provider when the
case worker determines that an individual's needs require that pre-initiation
activities be completed in less than 14 days.
(13) 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. In
the FC Program, if services are not provided through the CDS option,
exploitation includes theft as defined in Chapter 31 of the Texas
Penal Code.
(14) FC Program--Family Care Program. A program authorized
under Title XX, Subtitle A, of the Social Security Act that provides
personal attendant services to an eligible individual.
(15) Financial management services--A service, as defined
in §41.103 of this title (relating to Definitions), that is provided
to an individual participating in the consumer directed services option.
(16) FMSA--Financial management services agency. As
defined in §41.103 of this title, an entity that provides financial
management services to an individual participating in the consumer
directed services option.
(17) Functional limitation--An individual's requirement
for assistance with one or more ADLs caused by a physical limitation
or disability.
(18) HHSC--The Texas Health and Human Services Commission.
(19) IADL--Instrumental activities of daily living.
Activities related to living independently in the community.
(20) Imminent danger--An immediate or real threat.
(21) Individual--A person who is enrolled in the PHC
Program, CAS Program, or FC Program and, unless the context indicates
otherwise, the person's representative.
(22) 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.
(23) Medical need--A medical diagnosis that results
in a functional limitation.
(24) 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.
(25) Non-priority--The eligibility status for service
delivery as determined by the case worker for an individual who does
not meet the criteria described in §48.2918(d) of this title
(relating to Primary Home Care or Community Attendant Services). Services
delivered to such an individual may be referred to as non-priority
services, and an attendant who serves such an individual may be referred
to as a non-priority attendant.
(26) Notice--Includes oral, fax, secure email, and
other forms of written notice.
(27) Oral notice--Directly speaking with a person.
Oral notice does not include a message left by voice mail.
(28) PHC Program--Primary Home Care Program. A Medicaid
state plan program authorized under Title XIX, §1902(a)(10)(A)
of the Social Security Act that provides personal attendant services
to an eligible individual.
(29) Physical abuse--Any of the following:
(A) an act or failure to act performed knowingly, recklessly,
or intentionally, including incitement to act, that caused physical
injury or death to an individual or placed an individual at risk of
physical injury or death;
(B) an act of inappropriate or excessive force or corporal
punishment, regardless of whether the act results in a physical injury
to an individual; or
(C) the use of a restraint or seclusion.
(30) Physical restraint--Any manual method used to
control an individual's behavior, except for physical guidance or
prompting of brief duration that an individual does not resist, that
restricts:
(A) the free movement or normal functioning of all
or a part of the individual's body; or
(B) normal access by an individual to a portion of
the individual's body.
(31) Practitioner--A person who holds a doctor of medicine
or doctor of osteopathy degree and is currently licensed in Texas,
Louisiana, Arkansas, Oklahoma or New Mexico; a physician assistant
currently licensed in Texas; or a registered nurse approved by the
Texas Board of Nursing to practice as an advanced practice registered
nurse.
(32) Practitioner's statement--The HHSC Practitioner's
Statement of Medical Need form.
(33) Priority--The eligibility status for service delivery
as determined by the case worker for an individual who meets the criteria
described in §48.2918(d) of this title. Services delivered to
such an individual may be referred to as priority services, and an
attendant who serves such an individual may be referred to as a priority
attendant.
(34) Provider--A licensed home and community support
services agency that has a contract with HHSC to provide PHC Program,
CAS Program, and FC Program services.
(35) Reckless behavior--Acting with conscious indifference
to the consequences.
(36) Regional nurse--An HHSC employee who is responsible
for authorizing the CAS Program for an individual.
(37) Representative--An individual's spouse, other
responsible party, designated representative, or legally authorized
representative.
(38) Restraint--Any of the following:
(A) a chemical restraint;
(B) a mechanical restraint; or
(C) a physical restraint.
(39) Routine referral--In the PHC Program or CAS Program,
a written request from the case worker to a provider to evaluate an
individual for service delivery when the case worker determines that
the individual's needs do not require an expedited referral.
(40) Seclusion--The involuntary placement of an individual
alone in an area from which the individual is prevented from leaving.
(41) Secure email--Electronic mail that uses sufficient
precautions to protect the privacy and security of identifying information
in compliance with the requirements of the Health Insurance Portability
and Accountability Act of 1996.
(42) Service delivery plan--A single document that
is agreed upon and signed by an individual and a provider containing
the elements described in §47.45(a)(2) of this chapter (relating
to Pre-Initiation Activities). A single document may be more than
one page.
(43) Service schedule--A schedule for delivering attendant
services containing the elements described in §47.45(a)(2)(C)(iii)
of this chapter.
Cont'd... |
