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The following words and terms, when used in these sections, shall have the following meanings, unless the context clearly indicates otherwise. (1)Accessible and flexible services--Services which are delivered in the least intrusive manner possible and are provided in all settings where individuals live, work, and recreate. (2)Administration of medication--The direct application of any medication by injection, inhalation, ingestion, or any other means to the body of a client. The preparation of medication is part of the administration of medication and is the act or process of making ready a medication for administration, including the calculation of a client's medication dosage; altering the form of the medication by crushing, dissolving, or any other method; reconstitution of an injectable medication; drawing an injectable medication into a syringe; preparing an intravenous admixture; or any other act required to render the medication ready for administration. (3)Administrative support site--A facility or site where an agency performs administrative and other support functions but does not provide direct home health, hospice, or personal assistance services. This site does not require an agency license. (4)Administrator--The person who is responsible for the day-to-day operations of an agency. (5)Advanced practice nurse--A registered nurse approved by the Board of Nurse Examiners for the State of Texas to practice as an advanced practice nurse on the basis of completion of an advanced educational program. The term includes a nurse practitioner, nurse midwife, nurse anesthetist, and clinical nurse specialist. (6)Affiliate--With respect to an applicant or owner which is: (A)a corporation--means each officer, director, stockholder with direct ownership of at least 5.0%, subsidiary, and parent company; (B)a limited liability company--means each officer, member, and parent company; (C)an individual--means: (i)the individual's spouse; (ii)each partnership and each partner thereof of which the individual or any affiliate of the individual is a partner; and (iii)each corporation in which the individual is an officer, director, or stockholder with a direct ownership of at least 5.0%. (D)a partnership--means each partner and any parent company; and (E)a group of co-owners under any other business arrangement--means each officer, director, or the equivalent under the specific business arrangement and each parent company. (7)Agency--A home and community support services agency. (8)Alternate delivery site--A facility or site, including a residential unit or an inpatient unit: (A)that is owned or operated by an agency providing hospice services; (B)that is not the hospice's principal place of business; (C)that is located in the geographical area served by the hospice; and (D)from which the hospice provides hospice services. (9)Applicant--The owner of an agency which is applying for a license under the statute. This is the person in whose name the license will be issued. (10)Assistance with medication or treatment regimen--Any needed ancillary aid provided to a client in the client's self-administered medication or treatment regimen, such as reminding a client to take a medication at the prescribed time, opening and closing a medication container, pouring a predetermined quantity of liquid to be ingested, returning a medication to the proper storage area, and assisting in reordering medications from a pharmacy. Such ancillary aid must not include administration of any medication, unless the client has the cognitive ability to direct the administration of their medication and would self-administer if not for a functional limitation. (11)Association--A partnership, limited liability company, or other business entity that is not a corporation. (12)Audiologist--A person who is currently licensed under Texas Civil Statutes, Article 4512j, as an audiologist. (13)Bereavement--The process by which a survivor of a deceased person mourns and experiences grief. (14)Bereavement services--Support services offered to a family during bereavement. Family includes a significant other(s). (15)Branch office--A facility or site in the service area of a parent agency from which home health or personal assistance services are delivered or where active client records are maintained. This does not include inactive records which are stored at an unlicensed site. (16)Care plan-- (A)a written plan prepared by the appropriate health care personnel for a client of the home and community support services agency; or (B)for home dialysis designation, a written plan developed by the physician, registered nurse, dietitian and qualified social worker to personalize the care for the client and enable long- and short-term goals to be met. (17)Case conference--A conference among personnel furnishing services to the client to ensure that their efforts are coordinated effectively and support the objectives outlined in the plan of care or care plan. (18)Certified agency--A home and community support services agency that: (A)provides a home health service; and (B)is certified by an official of the Department of Health and Human Services as in compliance with conditions of participation in Social Security Act, Title XVIII (42 United States Code (USC) §1395 et seq.). (19)Certified home health services--Home health services that are provided by a certified agency. (20)Client--An individual receiving home health, hospice, or personal assistance services from a licensed home and community support services agency. This term includes each member of the primary client's family if the member is receiving ongoing services. This term does not include the spouse, significant other, or other family member living with the client who receives a one-time service (e.g., vaccine) if the spouse, significant other, or other family member receives the service in connection with the care of a client. (21)Clinical note--A dated and signed written notation by agency personnel of a contact with a client containing a description of signs and symptoms; treatment and medication given; the client's reaction; other health services provided; and any changes in physical and emotional condition. (22)Controlling person--A person with the ability, acting alone or in concert with others, to directly or indirectly, influence, direct, or cause the direction of the management, expenditure of money, or policies of an agency or other person. (A)A controlling person includes: (i)a management company, landlord, or other business entity that operates or contracts with others for the operation of an agency; (ii)any person who is a controlling person of a management company or other business entity that operates an agency or that contracts with another person for the operation of an agency; (iii)any other individual who, because of a personal, familial, or other relationship with the owner, manager, landlord, tenant, or provider of an agency, is in a position of actual control or authority with respect to the agency, without regard to whether the individual is formally named as an owner, manager, director, officer, provider, consultant, contractor, or employee of the agency. (B)A controlling person, as described by subparagraph (A)(iii) of this paragraph, does not include an employee, lender, secured creditor, or landlord, or other person who does not exercise formal or actual influence or control over the operation of an agency. (23)Counselor--An individual qualified under Medicare standards to provide counseling services, including bereavement, dietary, spiritual, and other counseling services to both the client and the family. (24)Department--The Texas Department of Human Services (DHS). (25)Dialysis treatment record--For home dialysis designation, a dated and signed written notation by the person providing dialysis treatment which contains a description of signs and symptoms, machine parameters and pressure settings, type of dialyzer and dialysate, actual pre- and post-treatment weight, medications administered as part of the treatment, and the client's response to treatment. (26)Dietitian--A person who is currently licensed under the laws of this state to use the title of licensed dietitian or provisional licensed dietitian, or who is a registered dietitian. (27)Director--The director of the Home and Community Support Services Agencies of the Texas Department of Human Services or his or her designee. (28)End stage renal disease (ESRD)--For home dialysis designation, the stage of renal impairment that appears irreversible and permanent and requires a regular course of dialysis or kidney transplantation to maintain life. (29)Freestanding hospice--An agency that provides hospice services to clients of the agency who are residing at the agency's physical location including inpatient and respite care. (30)Functional need--Needs of the individual which require services without regard to diagnosis or label. (31)Health assessment--A determination of a client's physical and mental status through inventory of systems. (32)Home and community support services agency--A person who provides home health, hospice, or personal assistance services for pay or other consideration in a client's residence, an independent living environment, or another appropriate location. (33)Home health medication aide--A person permitted under the Health and Safety Code, Chapter 142, Subchapter B. (34)Home health service--The provision of one or more of the following health services required by an individual in a residence or independent living environment: (A)nursing; (B)physical, occupational, speech, or respiratory therapy; (C)medical social service; (D)intravenous therapy; (E)dialysis; (F)service provided by unlicensed personnel under the delegation of a licensed health professional; (G)the furnishing of medical equipment and supplies, excluding drugs and medicines; or (H)nutritional counseling. (35)Hospice--A person licensed under this chapter to provide hospice services, including a person who owns or operates a residential unit or an inpatient unit. (36)Hospice services--Services, including services provided by unlicensed personnel under the delegation of a registered nurse or physical therapist, provided to a client or a client's family as part of a coordinated program consistent with the standards and rules adopted under this chapter. These services include palliative care for terminally ill clients and support services for clients and their families that: (A)are available 24 hours a day, seven days a week, during the last stages of illness, during death, and during bereavement; (B)are provided by a medically directed interdisciplinary team; and (C)may be provided in a residence, nursing facility, residential unit, independent living environment, or inpatient unit according to need. These services do not include inpatient care normally provided in a licensed hospital to a terminally ill person who has not elected to be a hospice client. (37)Independent living environment--A client's individual residence, which may include a group home or foster home, or other settings where a client participates in activities, including school, work, or church. (38)Individual/family choice and control--Individuals and families who express preferences and make choices about how their support service needs are met. (39)Inpatient unit--A facility that provides a continuum of medical or nursing care and other hospice services to clients admitted into the unit and that is in compliance with the conditions of participation for inpatient units adopted under Social Security Act, Title XVIII (42 United States Code §1395 et seq.) and standards adopted under this chapter. (40)Interdisciplinary team-- (A)for home dialysis designation, the physician, the registered nurse, the dietitian, and the qualified social worker responsible for planning the care delivered to the home staff-assisted dialysis patient; or (B)a group of individuals who work together in a coordinated manner to provide hospice services and must include a physician, registered nurse, social worker, and counselor. (41)Licensed vocational nurse--A person who is currently licensed under Texas Civil Statutes, Article 4528c, as a licensed vocational nurse. (42)Long-term program--For home dialysis designation, the written documentation of the selection of a suitable treatment modality and dialysis setting which has been selected by the client and the interdisciplinary team. (43)Manager--A person having a contractual relationship to provide management services to a home and community support services agency for the overall operation of a home and community support services agency including administration, staffing, or delivery of services. Examples of contracts for services that will not be considered to be contracts for management services include contracts solely for maintenance, laundry, or food services. (44)Medication administration record--A record used to document the administration of a client's medications. (45)Medication list--A list of a client's medications that includes the recommended dosage and the frequency and method of administration. The medication list is used to identify possible ineffective drug therapy or adverse reactions, significant side effects, drug allergies, and contraindications. The medication list does not include a medication profile. (46)Notarized copy--A sworn affidavit stating that attached copies are true and correct copies of the original documents. (47)Nursing facility--An institution licensed as a nursing home under the Health and Safety Code, Chapter 242. (48)Nutritional counseling--Advising and assisting individuals or families on appropriate nutritional intake by integrating information from the nutrition assessment with information on food and other sources of nutrients and meal preparation consistent with cultural background and socioeconomic status, with the goal being health promotion, disease prevention, and nutrition education. Nutritional counseling may include, but is not limited to, the following: (A)dialogue with the client to discuss current eating habits, exercise habits, food budget and problems with food preparation; (B)discussion of dietary needs to help the client understand why certain foods should be included or excluded from the client's diet and to help with adjustment to the new or revised or existing diet plan; (C)a personalized written diet plan as ordered by the client's physician or practitioner, to include instructions for implementation; (D)providing the client with motivation to help him or her understand and appreciate the importance of the diet plan in getting and staying healthy; or (E)working with the client or the client's family members by recommending ideas for meal planning, food budget planning, and appropriate food gifts. (49)Occupational therapist--A person who is currently licensed under the Occupational Therapy Practice Act, Texas Civil Statutes, Article 8851, as an occupational therapist. (50)Owner--One of the following persons which will hold or does hold a license issued under the statute in the person's name or the person's assumed name: (A)a corporation; (B)a limited liability company; (C)an individual; (D)a partnership if a partnership name is stated in a written partnership agreement or an assumed name certificate; (E)all partners in a partnership if a partnership name is not stated in a written partnership agreement or an assumed name certificate; or (F)all co-owners under any other business arrangement. (51)Palliative care--Intervention services that focus primarily on the reduction or abatement of physical, psychosocial, and spiritual symptoms of a terminal illness. (52)Parent agency--The agency that develops and maintains administrative controls and provides supervision of branch offices and alternate delivery sites. (53)Parent company--A person, other than an individual, who has a direct 100% ownership interest in the owner of an agency. (54)Person--An individual, corporation, or association. (55)Personal assistance services--Routine ongoing care or services required by an individual in a residence or independent living environment that enable the individual to engage in the activities of daily living or to perform the physical functions required for independent living, including respite services. The term includes health-related services performed under circumstances that are defined as not constituting the practice of professional nursing by the Board of Nurse Examiners through a memorandum of understanding with DHS in accordance with Health and Safety Code, §167 142.016, and health-related tasks provided by unlicensed personnel under the delegation of a registered nurse or physician. (56)Physical therapist--A person who is currently licensed under Texas Civil Statutes, Article 4512e, as a physical therapist. Cont'd...
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