The following words and terms, when used in this chapter, shall
have the following meanings, unless the context clearly indicates
otherwise. Individual subchapters may have definitions that are specific
to the subchapter.
(1) APRN--Advanced practice registered nurse. A registered
nurse licensed under Texas Occupations Code Chapter 301 to practice
as an advanced practice registered nurse.
(2) Attending physician--A person who:
(A) is any of the following:
(i) a doctor of medicine or osteopathy legally authorized
to practice medicine and surgery by the State in which he or she performs
that function or action;
(ii) an APRN who meets the training, education, and
experience requirements as described in 42 CFR §410.75(b); or
(iii) a physician assistant who meets the requirements
in 42 CFR §410.74(c); and
(B) is identified by the individual, at the time he
or she elects to receive hospice care, as having the most significant
role in the determination and delivery of the individual's medical
care.
(3) Cap year--The 12-month period ending September
30 used in the application of the caps on hospice reimbursement specified
in §266.217 of this chapter (relating to Medicaid Hospice Payments
and Limitations).
(4) CFR--Code of Federal Regulations.
(5) CHC--Continuous home care. A category of care provided
during a period of crisis consisting primarily of skilled nursing
care.
(6) CMS--Centers for Medicare and Medicaid Services.
The federal agency that provides funding and oversight for the Medicare
and Medicaid programs.
(7) Crisis--A sudden or severe intensification of symptoms
that appropriate medical intervention and nursing services could reasonably
be expected to ameliorate. Expected fluctuations in an individual's
condition related to the end of life process are not a crisis.
(8) Curative--Designed to restore a person to health.
(9) Employee--An employee, as defined in the Social
Security Act §210(j) (42 U.S.C. §410), of the hospice or,
if the hospice is a subdivision of an agency or organization, an employee
of the agency or organization who is appropriately trained and assigned
to the hospice unit. The term "employee" also refers to a volunteer
under the jurisdiction of the hospice.
(10) HHSC--Texas Health and Human Services Commission.
(11) ICF/IID--Intermediate care facility for individuals
with an intellectual disability or related conditions.
(12) IDT--Interdisciplinary team. An interdisciplinary
team must include persons who are qualified and competent to practice
in the following professional roles:
(A) physician who is an employee or under contract
with the hospice who may also be the hospice medical director or the
hospice medical director's designee;
(B) an APRN who:
(i) is an employee or under contract with the hospice;
and
(ii) may perform the assessment described in §266.203(d)
of this chapter (relating to Certification of Terminal Illness);
(C) a registered nurse;
(D) a social worker; and
(E) a pastoral or other counselor.
(13) Licensed vocational nurse--A nurse licensed under
Texas Occupations Code Chapter 301 to practice vocational nursing.
(14) Period of crisis--A period of time during which
an individual requires continuous care that is primarily skilled nursing
care to achieve palliation or management of acute medical symptoms.
(15) Physician--A doctor of medicine or doctor of osteopathy
currently licensed by the Texas Medical Board to practice medicine
or osteopathy at the time and place the service is provided.
(16) Physician Assistant--An individual who is licensed
as a physician assistant under Texas Occupations Code Chapter 204.
(17) Representative--An individual who has been authorized
under state law to terminate medical care or to elect or revoke the
election of hospice care on behalf of a terminally ill individual
who is mentally or physically incapacitated.
(18) RN--Registered nurse. An individual licensed under
Texas Occupations Code Chapter 301 to practice professional nursing.
(19) SIA--Service intensity add-on. Payments for direct
patient care provided by a social worker or an RN during the last
seven days of life when provided during routine home care.
(20) Skilled nursing care--Tasks that are determined
by the assessing RN to require the skill of a licensed nurse when
considering the inherent complexity of the task, the condition of
the individual, and the accepted standards of medical and nursing
practice.
(21) Social worker--A person who is currently licensed
as a social worker under Texas Occupations Code Chapter 505.
(22) TAC--Texas Administrative Code.
(23) Terminally ill--The individual has a medical prognosis
that his or her life expectancy is six months or less if the illness
runs its normal course.
(24) TMHP--Texas Medicaid & Healthcare Partnership.
The Texas Medicaid program claims administrator.
(25) Utilization review--Medical record review of paid
hospice claims to determine if provider compliance meets the requirements
for payment of services.
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