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

1. (1) Acute care hospital--A facility in which a person receives short-term treatment for a severe physical injury or episode of physical illness, an urgent medical condition, or recovery from surgery and:

   1. (A) may include a long-term acute care hospital, an emergency room within an acute care hospital, or an inpatient rehabilitation hospital; and
   2. (B) does not include a stand-alone psychiatric hospital or a psychiatric hospital within an acute care hospital.
2. (2) Alternate placement assistance--Assistance provided to a resident to locate and secure services chosen by the resident or LAR that meets the resident's needs in a setting other than a nursing facility. Alternate placement assistance includes transition planning, pre-move site review, and post-move monitoring.
3. (3) APRN--Advance practice registered nurse. A person licensed to practice professional nursing as an advance practice registered nurse in accordance with Texas Occupations Code, Chapter 301.

4. (4) Behavioral support--Specialized interventions by a qualified service provider to assist a person to increase adaptive behaviors and to replace or modify maladaptive behaviors that prevent or interfere with the person's inclusion in home and family life or community life.

   1. (A) Behavioral support includes:

      1. (i) assessing and analyzing assessment findings so that an appropriate behavior support plan may be designed;
      2. (ii) developing an individualized behavior support plan consistent with the outcomes identified in the HSP;
      3. (iii) training and consulting with family members or other providers and, as appropriate, the person; and
      4. (iv) monitoring and evaluating the success of the behavior support plan and modifying the plan as necessary.

   2. (B) A qualified service provider of behavioral support:

      1. (i) is licensed as a psychologist in accordance with Texas Occupations Code, Chapter 501;
      2. (ii) is licensed as a psychological associate in accordance with Texas Occupations Code, Chapter 501;
      3. (iii) has been issued a provisional license to practice psychology in accordance with Texas Occupations Code, Chapter 501;
      4. (iv) is a certified authorized provider as described in 40 TAC §5.161 (relating to Certified Authorized Provider);
      5. (v) is an LCSW;
      6. (vi) is an LPC; or
      7. (vii) is licensed as a behavior analyst in accordance with Texas Occupations Code, Chapter 506.
5. (5) CMWC--Customized manual wheelchair. In accordance with 40 TAC §19.2703 (relating to Definitions), a wheelchair that consists of a manual mobility base and customized seating system and is adapted and fabricated to meet the individualized needs of a designated resident.
6. (6) Collateral contact--A person who is knowledgeable about the individual seeking admission to a nursing facility or the resident, such as family members, previous providers or caregivers, and who may support or corroborate information provided by the individual or resident.
7. (7) Coma--A state of unconsciousness characterized by the inability to respond to sensory stimuli as documented by a physician.
8. (8) Comprehensive care plan--A plan, defined in 40 TAC §19.2703.
9. (9) Convalescent care--A type of care provided after an individual's release from an acute care hospital that is part of a medically prescribed period of recovery.

10. (10) Day habilitation--Assistance to a person to acquire, retain, or improve self-help, socialization, and adaptive skills necessary to live successfully in the community and participate in home and community life. Day habilitation provides:

    1. (A) individualized activities consistent with achieving the outcomes identified in the person's service plan;
    2. (B) activities necessary to reinforce therapeutic outcomes targeted by other support providers and other specialized services;
    3. (C) services in a group setting, other than the person's residence, for typically up to five days a week, six hours per day on a regularly scheduled basis;
    4. (D) personal assistance for a person who cannot manage personal care needs during the day habilitation activities; and
    5. (E) transportation during the day habilitation activity necessary for a person's participation in the day habilitation activities.
11. (11) DD--Developmental disability. A disability that meets the criteria described in the definition of "persons with related conditions" in 42 Code of Federal Regulations (CFR) §435.1010.
12. (12) Delirium--A serious disturbance in an individual's mental abilities that results in a decreased awareness of the individual's environment and confused thinking.

13. (13) Designated resident--An individual:

    1. (A) whose PE or resident review is positive for ID or DD;
    2. (B) who is 21 years of age or older;
    3. (C) who is a Medicaid recipient; and
    4. (D) who is a resident or has transitioned to the community from a nursing facility within the previous 365 days.

14. (14) DME--Durable Medical Equipment. In accordance with 40 TAC §19.2703, the following items, including any accessories and adaptations needed to operate or access the item:

    1. (A) a gait trainer;
    2. (B) a standing board;
    3. (C) a special needs car seat or travel restraint;
    4. (D) a specialized or treated pressure-reducing support surface mattress;
    5. (E) a positioning wedge;
    6. (F) a prosthetic device; and
    7. (G) an orthotic device.
15. (15) Emergency protective services--Services furnished by the Department of Family and Protective Services to an elderly or disabled individual who has been determined to be in a state of abuse, neglect, or exploitation.

16. (16) Employment assistance--Assistance provided to a person to help the person locate competitive employment in the community, consisting of a service provider performing the following activities:

    1. (A) identifying a person's employment preferences, job skills, and requirements for a work setting and work conditions;
    2. (B) locating prospective employers offering employment compatible with a person's identified preferences, skills, and requirements;
    3. (C) contacting a prospective employer on behalf of a person and negotiating the person's employment;
    4. (D) transporting the person to help the person locate competitive employment in the community; and
    5. (E) participating in SPT meetings.
17. (17) Essential supports--Those supports identified in a transition plan that are critical to a designated resident's health and safety and that are directly related to a designated resident's successful transition to living in the community from residing in a nursing facility.
18. (18) Exempted hospital discharge--A category of nursing facility admission that occurs when a physician has certified that an individual who is being discharged from an acute care hospital is likely to require less than 30 days of nursing facility services for the condition for which the individual was hospitalized.
19. (19) Expedited admission--A category of nursing facility admission that occurs when an individual meets the criteria for one of the following categories: convalescent care, terminal illness, severe physical illness, delirium, emergency protective services, respite, or coma.
20. (20) Habilitation coordination--Assistance for a designated resident residing in a nursing facility to access appropriate specialized services necessary to achieve a quality of life and level of community participation acceptable to the designated resident and LAR on the designated resident's behalf.
21. (21) Habilitation coordinator--An employee of a LIDDA who provides habilitation coordination.
22. (22) HHSC--The Texas Health and Human Services Commission.

23. (23) HSP--Habilitation service plan. A plan developed by the SPT while a designated resident is residing in a nursing facility that:

    1. (A) is individualized and developed through a person-centered approach;

    2. (B) identifies the designated resident's:

       1. (i) strengths;
       2. (ii) preferences;
       3. (iii) desired outcomes; and
       4. (iv) psychiatric, behavioral, nutritional management, and support needs as described in the comprehensive care plan or MDS assessment; and
    3. (C) identifies the specialized services that will accomplish the desired outcomes of the designated resident, or the LAR's on behalf of the designated resident, including amount, frequency, and duration of each service.
24. (24) ID--Intellectual disability, as defined in 42 CFR §483.102(b)(3)(i).

25. (25) IDD habilitative specialized services--The following specialized services available to a resident with ID or DD:

    1. (A) habilitation coordination;
    2. (B) day habilitation;
    3. (C) independent living skills training;
    4. (D) behavioral support;
    5. (E) employment assistance; and
    6. (F) supported employment.

26. (26) IDT--Interdisciplinary team. A team consisting of:

    1. (A) a resident with MI, ID, or DD;
    2. (B) the resident's LAR, if any;
    3. (C) a registered nurse from the nursing facility with responsibility for the resident;

    4. (D) a representative of:

       1. (i) the LIDDA, if the resident has ID or DD;
       2. (ii) the LMHA or LBHA, if the resident has MI; or
       3. (iii) the LIDDA and the LMHA or LBHA, if the resident has MI and DD, or MI and ID; and

    5. (E) others as follows:

       1. (i) a concerned person whose inclusion is requested by the resident or LAR;
       2. (ii) a person specified by the resident, LAR, nursing facility, LIDDA, LMHA, or LBHA, as applicable, who is professionally qualified, certified, or licensed with special training and experience in the diagnosis, management, needs, and treatment of people with MI, ID, or DD; and
       3. (iii) a representative of the appropriate school district if the resident is school age and inclusion of the district representative is requested by the resident or LAR.

27. (27) Independent living skills training--Individualized activities that are consistent with the HSP and provided in a person's residence and at community locations, such as libraries and stores. These activities include:

    1. (A) habilitation and support activities that foster or facilitate improvement or maintenance of the person's ability to perform functional living skills and other daily living activities;
    2. (B) activities for the person's family that help preserve the family unit and prevent or limit out-of-home placement of the person; and
    3. (C) transportation to facilitate the person's employment opportunities and participation in community activities, and between the person's residence and day habilitation site.
28. (28) LAR--Legally authorized representative. A person authorized by law to act on behalf of an individual seeking admission to a nursing facility or resident with regard to a matter described by this chapter, and who may be the parent of a minor child, the legal guardian, or the surrogate decision maker.
29. (29) LBHA--Local behavioral health authority. An entity designated by the executive commissioner of HHSC, in accordance with Texas Health and Safety Code, §533.0356.
30. (30) LCSW--Licensed clinical social worker. A person who is licensed as a licensed clinical social worker in accordance with Texas Occupations Code, Chapter 505.
31. (31) Licensed psychologist--A person who is licensed as a psychologist in accordance with Texas Occupations Code, Chapter 501.
32. (32) LIDDA--Local intellectual and developmental disability authority. An entity designated by the executive commissioner of HHSC, in accordance with Texas Health and Safety Code, §533A.035
33. (33) LMFT--Licensed marriage and family therapist. A person who is licensed as a licensed marriage and family therapist in accordance with Texas Occupations Code, Chapter 502.
34. (34) LMHA--Local mental health authority. An entity designated by the executive commissioner of HHSC, in accordance with Texas Health and Safety Code, §533.035.
35. (35) LPC--Licensed professional counselor. A person who is licensed as a licensed professional counselor in accordance with Texas Occupations Code, Chapter 503.
36. (36) LTC online portal--Long term care online portal. A web-based application used by Medicaid providers to submit forms, screenings, evaluations, and other information.
37. (37) MCO service coordinator--Medicaid managed care organization service coordinator. The staff person assigned by a resident's Medicaid managed care organization to ensure access to and coordination of needed services.
38. (38) MDS assessment--Minimum data set assessment. A standardized collection of demographic and clinical information that describes a resident's overall condition, which a licensed nursing facility in Texas is required to submit for a resident admitted into the facility.
39. (39) MI--Mental illness. Serious mental illness, as defined in 42 CFR §483.102(b)(1).

40. (40) MI specialized services--Specialized services available to a resident with MI as described in the Texas Resilience and Recovery Utilization Management Guidelines, including:

    1. (A) skills training;
    2. (B) medication training;
    3. (C) psychosocial rehabilitation;
    4. (D) case management;
    5. (E) psychiatric diagnostic interview exam; and
    6. (F) supported housing, which includes alternate placement assistance and transitioning to the community.
41. (41) Nursing facility--A Medicaid-certified facility that is licensed in accordance with the Texas Health and Safety Code, Chapter 242.

42. (42) Nursing facility PASRR support activities--Consistent with 40 TAC §19.2703, actions a nursing facility takes in coordination with a LIDDA, LMHA, or LBHA to facilitate the successful provision of an IDD habilitative specialized service or MI specialized service, including:

    1. (A) arranging transportation for a nursing facility resident to participate in an IDD habilitative specialized service or a MI specialized service outside the facility;
    2. (B) sending a resident to a scheduled IDD habilitative specialized service or MI specialized service with food and medications required by the resident; and
    3. (C) stating in the comprehensive care plan an agreement to avoid, when possible, scheduling nursing facility services at times that conflict with IDD habilitative specialized services or MI specialized services.

43. (43) Nursing facility specialized services--The following specialized services available to a resident with ID or DD:

    1. (A) therapy services;
    2. (B) CMWC; and
    3. (C) DME.
44. (44) PA--Physician Assistant. A person who is licensed as a physician assistant in accordance with Texas Occupations Code, Chapter 204.
45. (45) PASRR--Preadmission screening and resident review.

46. (46) PE--PASRR level II evaluation. A face-to-face evaluation:

    1. (A) of an individual seeking admission to a nursing facility who is suspected of having MI, ID, or DD; and

    2. (B) performed by a LIDDA, LHMA, or LBHA to determine if the individual has MI, ID, or DD and, if so, to:

       1. (i) assess the individual's need for care in a nursing facility;
       2. (ii) assess the individual's need for specialized services; and
       3. (iii) identify alternate placement options.
47. (47) Physician--A person who is licensed as a physician in accordance with Texas Occupations Code, Chapter 155.
48. (48) PL1--PASRR level I screening. The process of screening an individual seeking admission to a nursing facility to identify whether the individual is suspected of having MI, ID, or DD.

49. (49) Preadmission process--A category of nursing facility admission:

    1. (A) from a community setting, such as a private home, an assisted living facility, a group home, a psychiatric hospital, or jail, but not an acute care hospital or another nursing facility; and
    2. (B) that is not an expedited admission or an exempted hospital discharge.
50. (50) QIDP--Qualified intellectual disability professional. A person who meets the qualifications described in 42 CFR §483.430(a).
51. (51) QMHP-CS--Qualified mental health professional-community services. A person who meets the qualifications of a QMHP-CS as defined in 25 TAC §412.303 (related to Definitions).
52. (52) Referring entity--The entity that refers an individual to a nursing facility, such as a hospital, attending physician, LAR or other personal representative selected by the individual, a family member of the individual, or a representative from an emergency placement source, such as law enforcement.
53. (53) Resident--An individual who resides in a nursing facility and receives services provided by professional nursing personnel of the facility.

54. (54) Resident review--A face-to-face evaluation of a resident performed by a LIDDA, LMHA, or LBHA:

    1. (A) for a resident with MI, ID, or DD who experienced a significant change in status, to:

       1. (i) assess the resident's need for continued care in a nursing facility;
       2. (ii) assess the resident's need for specialized services; and
       3. (iii) identify alternate placement options; and

    2. (B) for a resident suspected of having MI, ID, or DD, to determine whether the resident has MI, ID, or DD and, if so:

       1. (i) assess the resident's need for continued care in a nursing facility;
       2. (ii) assess the resident's need for specialized services; and
       3. (iii) identify alternate placement options.
55. (55) Respite--Services provided on a short-term basis to a person because of the absence of or the need for relief by the person's unpaid caregiver for a period not to exceed 14 days.
56. (56) RN--Registered nurse. A person licensed to practice professional nursing as a registered nurse in accordance with Texas Occupations Code, Chapter 301.
57. (57) Service coordination--Assistance in accessing medical, social, educational, and other appropriate services and supports, including alternate placement assistance, that will help a person achieve a quality of life and community participation acceptable to the person and LAR on the person's behalf.
58. (58) Service coordinator--An employee of a LIDDA who provides service coordination.
59. (59) Severe physical illness--An illness resulting in ventilator dependence or a diagnosis, such as chronic obstructive pulmonary disease, Parkinson's disease, Huntington's disease, amyotrophic lateral sclerosis, or congestive heart failure, that results in a level of impairment so severe that the individual could not be expected to benefit from specialized services.

60. (60) Specialized services--The following support services, other than nursing facility services, that are identified through the PE or resident review and may be provided to a resident who has a PE or resident review that is positive for MI, ID, or DD:

    1. (A) nursing facility specialized services;
    2. (B) IDD habilitative specialized services; and
    3. (C) MI specialized services.

61. (61) SPT--Service planning team. A team convened by a LIDDA staff person that develops, reviews, and revises the HSP and the transition plan for a designated resident.

    1. (A) The team must include:

       1. (i) the designated resident;
       2. (ii) the designated resident's LAR, if any;
       3. (iii) the habilitation coordinator for discussions and service planning related to specialized services or the service coordinator for discussions related to transition planning if the designated resident is transitioning to the community;
       4. (iv) the MCO service coordinator, if the designated resident does not object;

       5. (v) while the designated resident is in a nursing facility:

          1. (I) a nursing facility staff person familiar with the designated resident's needs; and
          2. (II) a person providing a specialized service to the designated resident or a representative of a provider agency that is providing specialized services for the designated resident;

       6. (vi) if the designated resident is transitioning to the community:

          1. (I) a representative from the community program provider, if one has been selected; and
          2. (II) a relocation specialist; and
       7. (vii) a representative from the LMHA or LBHA, if the designated resident has MI.

    2. (B) Other participants on the SPT may include:

       1. (i) a concerned person whose inclusion is requested by the designated resident or the LAR; and
       2. (ii) at the discretion of the LIDDA, a person who is directly involved in the delivery of services to people with ID or DD.

62. (62) Supported employment--Assistance to sustain competitive employment for a person who, because of a disability, requires intensive, ongoing support to be self-employed, work from the person's residence, or perform in a work setting at which persons without disabilities are employed. Assistance consists of the following activities:

    1. (A) making employment adaptations, supervising, and providing training related to the person's assessed needs;
    2. (B) transporting the person to support the person to be self-employed, work from the person's residence, or perform in a work setting; and
    3. (C) participating in SPT meetings.
63. (63) Surrogate decision maker--An actively involved family member of a resident who has been identified by an IDT in accordance with Texas Health and Safety Code, §313.004 and who is available and willing to consent to medical treatment on behalf of the resident.
64. (64) Terminal illness--A medical prognosis that an individual's life expectancy is six months or less if the illness runs its normal course and that is documented by a physician's certification in the individual's medical record maintained by a nursing facility.

65. (65) Therapy services--In accordance with 40 TAC §19.2703, assessment and treatment to help a designated resident learn, keep, or improve skills and functioning of daily living affected by a disabling condition. Therapy services are referred to as habilitative therapy services. Therapy services are limited to:

    1. (A) physical therapy;
    2. (B) occupational therapy; and
    3. (C) speech therapy.
66. (66) Transition plan--A plan developed by the SPT that describes the activities, timetable, responsibilities, services, and essential supports involved in assisting a designated resident to transition from residing in a nursing facility to living in the community.

Source Note:The provisions of this §303.102 adopted to be effective July 7, 2019, 44 TexReg 3265.