The following words and terms, when used in this subchapter,
have the following meanings, unless the context clearly indicates
otherwise:
(1) Adolescent--An individual who is at least 13 years
of age, but younger than 18 years of age.
(2) Adult--An individual who is 18 years of age or
older.
(3) Assessment or reassessment--A systematic process
for determining an individual's need for any clinically necessary
medical, educational, social, or other services (e.g., taking client
history, gathering information from other sources, identifying the
needs of the individual, and completing related documentation).
(4) Business day--Any day except a Saturday, Sunday,
or legal holiday listed in the Texas Government Code, §662.021.
(5) Case manager--An employee who provides MH case
management services.
(6) Child--An individual who is at least three years
of age, but younger than 13 years of age.
(7) CFR--Code of Federal Regulations.
(8) Community based--A description of the location
where routine or intensive case management services are provided (i.e.,
in an individual's community).
(9) Community mental health center or CMHC--An entity
established in accordance with the Texas Health and Safety Code, §534.001,
as a community mental health center or a community mental health and
mental retardation center.
(10) Community resources--People or entities providing
services that address the identified needs of individuals receiving
MH case management services (e.g., providers of medical care, food,
clothing, child care, employment, or housing).
(11) Community services specialist or CSSP--A staff
member who, as of August 31, 2004:
(A) has received:
(i) a high school diploma; or
(ii) a high school equivalency certificate issued in
accordance with the law of the issuing state; and
(B) has had three continuous years of documented full-time
experience in the provision of MH case management services; and
(C) has demonstrated competency in the provision and
documentation of MH case management services in accordance with this
subchapter and the MH Case Management Billing Guidelines.
(12) Crisis--A situation in which:
(A) the individual presents an immediate danger to
self or others;
(B) the individual's mental or physical health is at
risk of serious deterioration; or
(C) an individual believes that he or she presents
an immediate danger to self or others or that his or her mental or
physical health is at risk of serious deterioration.
(13) Day--A calendar day, unless otherwise specified.
(14) Department--Department of State Health Services
(DSHS).
(15) Designee--A person or entity named by the department
to act on its behalf.
(16) Dual relationship--A situation that occurs if
a case manager interacts with an individual in more than one capacity,
whether it be before, during, or after the professional, social, or
business relationship. Dual relationships can occur simultaneously
or consecutively.
(17) Employee--A person who receives a W2 Wage and
Tax Statement from a provider.
(18) Individual--A person seeking or receiving MH case
management services.
(19) Institution for mental diseases or IMD--Based
on 42 CFR §435.1009, a hospital, nursing facility, or other institution
of more than 16 beds that is primarily engaged in providing psychiatric
diagnosis, treatment, or care of individuals with mental illness,
including medical attention, nursing care, and related services.
(20) Intensive case management--A focused effort to
coordinate community resources that assist a child or adolescent in
gaining access to necessary care and services appropriate to the child's
or adolescent's needs. The standards for providing intensive case
management services are set forth in §412.407 of this title (relating
to MH Case Management Services Standards).
(21) Intensive case management plan or plan--A written
document that is part of the medical record and is developed by a
case manager, in collaboration with the individual and the individual's
LAR or primary caregiver, that identifies services needed by the individual
and sets forth a plan for how the individual may gain access to the
identified services.
(22) Legally authorized representative or LAR--A person
authorized by law to act on behalf of an individual with regard to
a matter described in this subchapter, including, but not limited
to, a parent, guardian, or managing conservator.
(23) Level of care or LOC--A designation given to the
department's standardized packages of mental health services, based
on the uniform assessment and the utilization management guidelines,
which specify the type, amount, and duration of MH case management
services to be provided to an individual.
(24) Life domains--Areas of life in which a child or
adolescent has unmet needs, including, but not limited to safety,
health, emotional, psychological, social, educational, cultural, and
legal needs.
(25) Local Behavioral Health Authority (LBHA)--An entity
designated as the local behavioral health authority in accordance
with Texas Health and Safety Code, §533.0356.
(26) Medically necessary--A clinical determination
made by an LPHA that services:
(A) are reasonable and necessary for the treatment
of a mental health disorder or to improve, maintain, or prevent deterioration
of functioning resulting from such a disorder;
(B) are provided in accordance with accepted standards
of practice in behavioral health care;
(C) are furnished in the most appropriate and least
restrictive setting in which services can be safely provided;
(D) are at the most appropriate level or amount of
service that can be safely provided; and
(E) could not have been omitted without adversely affecting
the individual's mental and/or physical health or the quality of care
rendered.
(27) Mental health (MH) case management services--Activities
that assist an individual in gaining and coordinating access to necessary
care and services appropriate to the individual's needs. Case management
activities include assessment, recovery planning, referral and linkage,
and monitoring and follow up. Activities may be provided as routine
case management or intensive case management.
(28) Monitoring and follow-up--Activities and contacts
that are necessary to ensure that referrals and linkages are effectively
implemented and adequately addressing the needs of the individual.
The activities and contacts may be with the individual, LAR, primary
caregiver, family members, providers, or other people and entities
to determine whether services are being furnished, the adequacy of
those services, and changes in the needs or status of the individual.
(29) Primary caregiver--A person 18 years of age or
older who:
(A) has actual care, control, and possession of a child
or adolescent; or
(B) has assumed responsibility for providing shelter
and care for an adult.
(30) Provider--An entity that is:
(A) a community mental health center that has a contract
with the department to provide general revenue-funded MH case management
services, Medicaid-funded MH case management services, or both;
(B) a Local Behavioral Health Authority (LBHA) that
has a contract with the department to provide general revenue-funded
MH case management services, or a subcontractor of a LBHA.
(31) Qualified mental health professional-community
services or QMHP-CS--A staff member who meets the definition of a
QMHP-CS set forth in Subchapter G of this chapter (relating to Mental
Health Community Services Standards).
(32) Recovery--A process of change through which individuals
improve their health and wellness, live a self-directed life, and
strive to reach their full potential.
(33) Recovery plan or treatment plan--A written plan
developed with the individual and, as required, the LAR and a QMHP-CS
that specifies the individual's recovery goals, objectives, and strategies/interventions
in conjunction with the uniform assessment that guides the recovery
process and fosters resiliency as further described in §412.322(e)
of this title (relating to Provider Responsibilities for Treatment
Planning and Service Authorization) concerning content and timeframe
of treatment plan.
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