The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise. (1)Accessible and flexible services--Services that [ 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 implementing and supervising the administrative polices and operations of a home and community support services agency and for administratively supervising the provision of all services to agency clients on a day-to-day basis. (5)Advanced practice nurse--A registered nurse who is approved by the Texas Board of Nursing to practice as an advanced practice nurse and who maintains compliance with the applicable rules of the Texas Board of Nursing. See the Texas Board of Nursing's definition of advanced practice nurse in 22 TAC §221.1 [(concerning definitions)]. (6)Advisory committee--A committee, board, commission, council, conference, panel, task force, or other similar group, or any subcommittee or other subgroup, established for the purpose of obtaining advice or recommendations on issues or policies that are within the scope of a person's responsibility. (7)Affiliate--With respect to an applicant or license holder that[, which] is: (A)a corporation--means each officer, director, and stockholder with direct ownership of at least 5.0 percent [ 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 or disclosable interest of at least 5.0 percent [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. (8)Agency--A home and community support services agency. (9)Alternate delivery site (ADS)--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 , which for[. For] the purposes of this definition, means it is not the parent agency [the hospice's principal place of business is the parent office for the hospice]; (C)that is located in the geographical area served by the hospice; and (D)from which the hospice provides hospice services. (10)Applicant--The owner of an agency that is applying for a license under the statute. This is the person in whose name the license will be issued. (11)Assistance with self-administration of medication--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 includes administration of any medication when the client has the cognitive ability to direct the administration of their medication and would self-administer if not for a functional limitation. (12)Association--A partnership, limited liability company, or other business entity that is not a corporation. (13)Audiologist--A person who is currently licensed under the Texas Occupations Code, Chapter 401, as an audiologist. (14)Bereavement--The process by which a survivor of a deceased person mourns and experiences grief. (15)Bereavement services--Support services offered to a family during bereavement. Services may be provided to persons other than family members, including residents of a skilled nursing facility, nursing facility, or intermediate care facility for individuals with an intellectual disability or related conditions, when appropriate and identified in a bereavement plan of care. [Family includes a significant other(s).] (16)Biologicals--A medicinal preparation made from living organisms and their products, including serums, vaccines, antigens, and antitoxins. (17)Boarding home facility--An establishment defined in Texas Health and Safety Code §260.001(2). (18) [(16)] 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 that are stored at an unlicensed site. (19) [(17)] Care plan-- (A)a written plan prepared by the appropriate health care professional 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. (20) [(18)] 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. (21) [(19)] Certified agency--A home and community support services agency, or portion of the 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.). (22) [(20)] Certified home health services--Home health services that are provided by a certified agency. (23)CFR--Code of Federal Regulations. The regulations and rules promulgated by agencies of the Federal government that address a broad range of subjects, including hospice care and home health services. (24) [(21)] CHAP--Community Health Accreditation Program, Inc. An independent, nonprofit accrediting body that publicly certifies that an organization has voluntarily met certain standards for home and community-based health care. (25) [(22)] Chief financial officer--An individual who is responsible for supervising and managing all financial activities for a home and community support services agency. (26) [(23)] 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 (for example, vaccination) [(e.g., vaccine)] if the spouse, significant other, or other family member receives the service in connection with the care of a client. (27) [(24)] 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. (28) [(25)] CMS--Centers for Medicare and Medicaid Services. The federal agency that administers the Medicare program and works in partnership with the states to administer Medicaid. (29) [(26)] Complaint--An allegation against an agency regulated by DADS or against an employee of an agency regulated by DADS that involves a violation of this chapter or the statute. (30) [(27)] Community disaster resources--A local, statewide, or nationwide emergency system that provides information and resources during a disaster, including weather information, transportation, evacuation, and shelter information, disaster assistance and recovery efforts, evacuee and disaster victim resources, and resources for locating evacuated friends and relatives. (31) [(28)] Controlling person--A person with the ability, acting alone or 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 or other business entity that operates or contracts with others for the operation of an agency; (ii)a 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; and (iii)any other individual who, because of a personal, familial, or other relationship with the owner, manager, 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 other person who does not exercise formal or actual influence or control over the operation of an agency. (32) [(29)] Conviction--An adjudication of guilt based on a finding of guilt, a plea of guilty, or a plea of nolo contendere. (33) [(30)] 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. (34) [(31)] DADS--Department of Aging and Disability Services. (35) [(32)] Day--Any reference to a day means a calendar day, unless otherwise specified in the text. A calendar day includes weekends and holidays. (36) [(33)] Deficiency--A finding of noncompliance with federal requirements resulting from a survey. (37) [(34)] Designated survey office--A DADS Home and Community Support Services Agencies Program office located in an agency's geographic region. (38) [(35)] 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. (39) [(36)] Dietitian--A person who is currently licensed under the laws of the State of Texas to use the title of licensed dietitian or provisional licensed dietitian, or who is a registered dietitian. (40) [(37)] Disaster--The occurrence or imminent threat of widespread or severe damage, injury, or loss of life or property resulting from a natural or man-made cause, such as fire, flood, earthquake, wind, storm, wave action, oil spill or other water contamination, epidemic, air contamination, infestation, explosion, riot, hostile military or paramilitary action, or energy emergency. In a [freestanding] hospice inpatient unit, a disaster also includes failure of the heating or cooling system, power outage, explosion, and bomb threat. (41) [(38)] 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. [(39)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.] (42) [(40)] Functional need--Needs of the individual that require services without regard to diagnosis or label. (43) [(41)] Health assessment--A determination of a client's physical and mental status through inventory of systems. (44) [(42)] 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. (45) [(43)] Home health aide--An individual working for an agency who meets at least one of the requirements for home health aides as defined in §97.701 of this chapter (relating to Home Health Aides). (46) [(44)] Home health medication aide--An unlicensed [A] person issued a permit by DADS to administer medication to a client [permitted ] under the Texas Health and Safety Code, Chapter 142, Subchapter B. (47) [(45)] 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, including blood pressure monitoring and diabetes treatment; (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 or supervision of a licensed health professional; (G)the furnishing of medical equipment and supplies, excluding drugs and medicines; or (H)nutritional counseling. (48) [(46)] 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. (49)Hospice aide--A person working for an agency licensed to provide hospice services who meets the qualifications for a hospice aide as described in §97.843 of this chapter (relating to Hospice Aide Qualifications). (50)Hospice homemaker--A person working for an agency licensed to provide hospice services who meets the qualifications described in §97.845 of this chapter (relating to Hospice Homemaker Qualifications). (51) [(47)] 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 home, nursing facility, residential unit, 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. For the purposes of this definition, the word "home" includes a person's "residence" as defined in this section. (52) [(48)] Independent living environment--A client's residence, which may include a group home, [ or] foster home, or boarding home facility, or other settings where a client participates in activities, including school, work, or church. Cont'd...
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