The following words and terms have the following meanings when used in these sections, unless the context clearly indicates otherwise.

1. (1) Abuse--Means:

   1. (A) the negligent or willful infliction of injury, unreasonable confinement, intimidation, or cruel punishment with resulting physical or emotional harm or pain to an older adult or person with a disability by the person's caretaker, family member, or other individual who has an ongoing relationship with the person; or
   2. (B) any involuntary or nonconsensual sexual conduct that would constitute an offense under Texas Penal Code §21.08 (indecent exposure) or Texas Penal Code Chapter 22 (assaultive offenses), committed by the person's caretaker, family member, or other individual who has an ongoing relationship with the person.
2. (2) Activities of daily living (ADL)--Fundamental tasks required for a person to care for themselves independently. Activities that are essential to daily self-care, including bathing, dressing, grooming, toileting, housekeeping, shopping, meal preparation, and others.
3. (3) Adult--A person at least 18 years of age, or an emancipated minor.
4. (4) Adult Foster Care (AFC)--A Title XX of the Social Security Act program that provides a 24-hour living arrangement with supervision in an Adult Foster Care home for a person who is unable to continue living independently in the person's own home because of physical, mental, or emotional limitations.
5. (5) Applicant--A person initially requesting services.
6. (6) Attendant--A person who is employed by a provider agency to give personal care or housekeeping services or both to a person eligible for Community Attendant Services, Family Care, or Primary Home Care, according to a service plan.
7. (7) Caregiver--A relative, guardian, representative payee, or person who has contact with the applicant or client that is frequent enough or regularly scheduled enough that a personal relationship exists or the applicant or client perceives that person as having a role in helping the applicant or client to meet basic needs.
8. (8) Caregiver support--Relief or rest from caregiving duties given to or arranged for the caregiver of an HHSC client.
9. (9) Caseworker--An HHSC employee responsible for determining eligibility and case management activities.
10. (10) Client--A person determined eligible for Community Care Services Eligibility (CCSE) services or programs.
11. (11) Community Attendant Services (CAS)--A non-technical, medically related Title XIX of the Social Security Act community care program available to an eligible person whose health problems limit the person from performing ADLs in accordance with a practitioner's statement of medical need.
12. (12) Community care service or program--Services or programs provided within the client's own home, neighborhood, or community, as alternatives to institutional care.

13. (13) Community Care Services Eligibility (CCSE) services or programs--A group of HHSC programs or services that provide a variety of Title XIX of the Social Security Act and Title XX of the Social Security Act community-based services:

    1. (A) Adult Foster Care (AFC);
    2. (B) Community Attendant Services (CAS);
    3. (C) Consumer Managed Personal Attendant Services (CMPAS);
    4. (D) Day Activity Health Services (DAHS);
    5. (E) Emergency Response Services (ERS);
    6. (F) Family Care (FC);
    7. (G) Home Delivered Meals (HDM);
    8. (H) Primary Home Care (PHC);
    9. (I) Residential Care (RC); and
    10. (J) Special Services to Persons with Disabilities (SSPD).
14. (14) Community services interest list--A list containing the names of people interested in receiving a Title XX of the Social Security Act community care service or program when Title XX of the Social Security Act funds are available.
15. (15) Consumer Managed Personal Attendant Services (CMPAS)--A Title XX of the Social Security Act HHSC program that provides personal assistance services to people who have physical disabilities who are mentally and emotionally competent and willing to supervise their attendant or have someone who can supervise the attendant for them. The individual interviews, selects, trains, supervises, and releases their personal assistants.
16. (16) Day Activity Health Services (DAHS)--Provides Title XX of the Social Security Act or Title XIX of the Social Security Act services designed to meet an adult's needs in a DAHS facility licensed by HHSC.
17. (17) Earned income--Cash or liquid resources that a person receives for services performed as an employee or because of self-employment. All other income is unearned income.
18. (18) Emancipated minor--A person under 18 who has the power and capacity of an adult. This includes a minor who has had the disabilities of minority removed by a court of law or a minor who, with or without parental consent, has been married. Marriage includes common-law marriage.
19. (19) Emergency Care (EC)--A program authorized under Title XX of the Social Security Act that provides a 24-hour living arrangement in an HHSC licensed facility for as many as 30 days while the case worker seeks permanent care arrangements. EC may be provided in Adult Foster Care (AFC) homes and in Residential Care (RC) facilities.
20. (20) Emergency Response Services (ERS)--Title XX of the Social Security Act services that are provided through an electronic monitoring system that is used by adults living with functional impairment who live alone or who are socially isolated in the community.
21. (21) Emotional or verbal abuse--Any use of verbal communication or other behavior to humiliate, intimidate, vilify, degrade, or threaten with harm.
22. (22) Expedited response--A face-to-face or phone contact with an applicant by the caseworker within five calendar days of the date of the applicant's request for services.
23. (23) Exploitation--The illegal or improper act or process of a caregiver, family member, or other person who has an ongoing relationship with an older adult or person with a disability that involves using, or attempting to use, the resources of the older adult or person with a disability, including the person's social security number or other identifying information, for monetary or personal benefit, profit, or gain without the informed consent of the person.
24. (24) Facility--A legal entity that contracts with HHSC to deliver day services or 24-hour residential services to a client.
25. (25) Family Care (FC)--A program authorized under Title XX of the Social Security Act that provides personal attendant services to an eligible person.

26. (26) Former military member--A person who served in the United States Army, Navy, Air Force, Marine Corps, Space Force, or Coast Guard:

    1. (A) who declared and maintained Texas as the person's state of legal residence in the manner provided by the applicable military branch while on active duty; and
    2. (B) who was killed in action or died while in service, or whose active duty otherwise ended.
27. (27) Fraud--A deliberate misrepresentation or intentional concealment of information to receive or be reimbursed for the delivery of services to which the person is not entitled.
28. (28) Functional need--A person's requirement for assistance with activities of daily living, caused by a physical or mental limitation or disability.
29. (29) HHSC--Texas Health and Human Services Commission, or its designee.
30. (30) HHSC region--One of eleven regions of Texas that provide access to and support for HHSC services.
31. (31) Home Delivered Meals (HDM)--A program authorized under Title XX of the Social Security Act that provides meal delivery to an eligible person in the person's home.
32. (32) Immediate response--A face-to-face or phone contact with an applicant by the caseworker within 24 hours of the applicant's request for services.
33. (33) Income eligible--An adult who is not categorically eligible but has income and resources equal to or less than the eligibility level established by HHSC.
34. (34) Institution--A nursing home, an intermediate care facility for people with intellectual and developmental disabilities, a state supported living center, or a state hospital.
35. (35) Liquid resource--Cash or financial instruments that could be converted to cash within 20 workdays.
36. (36) Medicaid-eligible--A person eligible for federal medical assistance, or eligible for medical assistance only (MAO) in a nursing home or while living in the community or through a federally approved waiver.
37. (37) Medicare--Federal health insurance for anyone at least 65 years of age and some people with certain disabilities or conditions.

38. (38) Military family member--A person who is the spouse or child, regardless of age, of:

    1. (A) a military member; or
    2. (B) a former military member.
39. (39) Military member--A member of the United States military serving in the Army, Navy, Air Force, Marine Corps, Space Force, or Coast Guard on active duty who has declared and kept Texas as the military member's state of legal residence in the manner offered by the applicable military branch.
40. (40) Neglect--The failure to provide for oneself the goods or services, including medical services, which are necessary to avoid physical or emotional harm or pain or the failure of a caretaker to provide the goods or services.
41. (41) Older adult--A person at least 65 years of age.
42. (42) Person--An individual. The term person is used when addressing information relevant to both an applicant and a client.
43. (43) Person with a disability--A person who, because of physical, mental, or developmental impairments, is limited temporarily or permanently in the person's capacity to adequately perform one or more essential activities of daily living. This includes personal and health care, moving around, communicating, and housekeeping.
44. (44) Personal leave--Any leave from a residential care facility except for hospitalization or institutionalization. A day of personal leave is any period of 24 consecutive hours.
45. (45) Primary Home Care (PHC)--A Title XIX of the Social Security Act non-technical, medically related personal attendant service to a person eligible for Medicaid whose health problems limit the person's ability to perform activities of daily living, in accordance with a practitioner's statement of medical need.
46. (46) Provider agency--An agency that has contracted with HHSC to provide programs or services that HHSC has authorized for people.
47. (47) Regional nurse--A registered nurse employed by HHSC who authorizes CAS, PHC, and DAHS.
48. (48) Residential Care (RC)--A Title XX of the Social Security Act Assisted Living and Emergency Care program that provides a 24-hour living arrangement in an HHSC licensed facility.
49. (49) Resource--Any cash or other liquid assets or any real or personal property owned by a person and spouse that could be converted to cash to use for support and maintenance.
50. (50) Responder--A person who responds to an Emergency Response Services (ERS) call activated by a client. Responders may include relatives, neighbors, volunteers, or staff of a sheriff's department, police department, emergency medical service, or fire department.

51. (51) Responsible person--A person who is:

    1. (A) an applicant or client's parent or legal guardian; or
    2. (B) anyone an adult applicant or client designates as the applicant's or client's representative.
52. (52) Special Services to Persons with Disabilities (SSPD)--A Title XX of the Social Security Act program that provides services in various settings to help people develop the skills needed to live independently in the community.
53. (53) Supplemental Security Income (SSI)--Monthly payments made by the Social Security Administration (SSA) to an older person or person with disabilities who meets the requirements for public aid. SSA determines eligibility for SSI.
54. (54) Unearned income--Income received by a person from sources other than self-employment or employee work activities.
55. (55) Unmet need--A requirement for assistance with activities of daily living that cannot be met adequately on an ongoing basis by friends, relatives, volunteers, or service agencies other than HHSC.
56. (56) Verbal referral--A referral made by the caseworker to the provider agency in person or by phone, no later than the first workday after the caseworker's determination that the applicant meets the criteria for an expedited response or an immediate response to a request for service and needs immediate service initiation.

Source Note:The provisions of this §271.1 adopted to be effective February 1, 1989, 13 TexReg 5751; amended to be effective June 1, 1991, 16 TexReg 2608; amended to be effective December 1, 2000, 25 TexReg 11081; transferred effective September 15, 2023, as published in the August 18, 2023, issue of the Texas Register, 48 TexReg 4523; amended to be effective September 10, 2025, 50 TexReg 5936.