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

1. (1) Actively involved person--For an individual who lacks the ability to provide legally adequate consent and who does not have an LAR, a person whose significant and ongoing involvement with the individual is determined by the individual's designated LIDDA to be supportive of the individual based on the person's:

   1. (A) observed interactions with the individual;
   2. (B) knowledge of and sensitivity to the individual's preferences, values, and beliefs;
   3. (C) availability to the individual for assistance or support; and
   4. (D) advocacy for the individual's preferences, values, and beliefs.
2. (2) Audio-only--A synchronous interactive, two-way audio communication that uses only sound and meets the privacy requirements of the Health Insurance Portability and Accountability Act (HIPAA). Audio-only includes the use of telephonic communication. Audio-only does not include audio-visual or in-person communication.
3. (3) Audio-visual--A synchronous interactive, two-way audio and video communication that conforms to privacy requirements under HIPAA. Audio-visual does not include audio-only or in-person communication.
4. (4) CFC services--Community First Choice services. State plan services described in 1 TAC Chapter 354, Subchapter A, Division 27 (relating to Community First Choice).
5. (5) Comprehensive encounter (Encounter Type A)--Contact with an individual receiving services as defined in 1 TAC §355.746 (relating to Reimbursement Methodology for Mental Retardation Service Coordination) and including comprehensive encounters funded by general revenue.
6. (6) Designated LIDDA--As identified in the HHSC data system, the LIDDA responsible for assisting an individual and LAR or actively involved person to access services and supports.
7. (7) Duration--The specified period of time during which service coordination is provided to an individual.
8. (8) Frequency--The minimum number of times during a specified period that an individual is to be contacted by a service coordinator in person based on the individual's need for contacts as determined by person-centered planning.
9. (9) Follow-up encounter (Encounter Type B)--Contact with the individual receiving services as defined in 1 TAC §355.746 (relating to Reimbursement Methodology for Mental Retardation Service Coordination) and including follow-up encounters funded by general revenue.
10. (10) General revenue--Funds appropriated by the Texas Legislature for use by HHSC.
11. (11) HCS Program--The Home and Community-based Services Program. A program operated by HHSC as authorized by the Centers for Medicare & Medicaid Services in accordance with §1915(c) of the Social Security Act.
12. (12) HHSC--The Texas Health and Human Services Commission.
13. (13) ICF/IID--Intermediate care facility for individuals with an intellectual disability or related conditions. An ICF/IID is a facility in which ICF/IID Program services are provided.
14. (14) ICF/IID level-of-care--A level-of-care described in §261.238 of this title (relating to ICF/MR Level of Care I Criteria) or §261.239 of this title (relating to ICF/MR Level of Care VIII Criteria).
15. (15) ICF/IID Program-- A program operated by HHSC that provides Medicaid-funded residential services to individuals with an intellectual disability or related conditions, as described in §1905(d) of the Social Security Act.
16. (16) ICF/MR--ICF/IID.
17. (17) In-person (or in person)--Within the physical presence of another person. In-person or in person does not include audio-visual or audio-only communication.
18. (18) Individual--A person who is or is believed to be a member of the LIDDA priority population.

19. (19) Institution--One of the following:

    1. (A) an ICF/IID;
    2. (B) a nursing facility licensed or subject to being licensed in accordance with THSC Chapter 242;
    3. (C) an assisted living facility licensed or subject to being licensed in accordance with THSC Chapter 247;
    4. (D) a child-care operation subject to regulation by HHSC as a general residential operation under Texas Human Resources Code Chapter 42;
    5. (E) a hospital;
    6. (F) an inpatient chemical dependency treatment facility;
    7. (G) a mental health facility;
    8. (H) a facility operated by the Texas Workforce Commission; or
    9. (I) a prison.
20. (20) Institution for mental diseases--As defined in §273.3 of this title (relating to Definitions), a hospital of more than 16 beds that is primarily engaged in providing psychiatric diagnosis, treatment, and care of individuals with mental diseases, including medical care, nursing care, and related services.
21. (21) Intellectual disability--Consistent with THSC §591.003, significantly subaverage general intellectual functioning existing concurrently with deficits in adaptive behavior and manifested during the developmental period.
22. (22) LAR--Legally authorized representative. A person authorized by law to act on behalf of an individual with regard to a matter described in this chapter, and who may be a parent, guardian, or managing conservator of a child; or the guardian of an adult.
23. (23) LIDDA--Local intellectual and developmental disability authority. An entity designated by the executive commissioner of HHSC in accordance with THSC §533A.035.
24. (24) LIDDA priority population--A population as defined in §304.102 of this title (relating to Definitions).
25. (25) Local service area--A geographic area composed of one or more Texas counties defining the population that may receive services from a LIDDA.
26. (26) MCO--Managed care organization. This term has the meaning set forth in Texas Government Code §543A.0001.
27. (27) Permanency planning--A philosophy and planning process that focuses on the outcome of family support for an individual under 22 years of age by facilitating a permanent living arrangement in which the primary feature is an enduring and nurturing parental relationship.
28. (28) Person-centered planning--A philosophy and planning process that empowers an individual and, on the individual's behalf, an LAR or actively involved person, to direct the development of a plan of services and supports.

29. (29) Plan of services and supports--A written plan that:

    1. (A) describes the desired outcomes identified by an individual, or an LAR or actively involved person on behalf of the individual;
    2. (B) describes the services and supports to be provided to the individual, including service coordination;
    3. (C) identifies the frequency of in-person contacts to be provided to the individual, in accordance with §331.11(h) of this chapter (relating to Designated LIDDA's Responsibilities); and
    4. (D) identifies the duration of service coordination to be provided to the individual.

30. (30) Related condition--Consistent with 42 CFR §435.1010, a severe and chronic disability that:

    1. (A) is attributable to:

       1. (i) cerebral palsy or epilepsy; or
       2. (ii) any other condition, other than mental illness, found to be closely related to an intellectual disability because the condition results in impairment of general intellectual functioning or adaptive behavior similar to that of people with intellectual disabilities, and requires treatment or services similar to those required for people with intellectual disabilities;
    2. (B) is manifested before the person reaches 22 years of age;
    3. (C) is likely to continue indefinitely; and

    4. (D) results in substantial functional limitation in three or more of the following areas of major life activity:

       1. (i) self-care;
       2. (ii) understanding and use of language;
       3. (iii) learning;
       4. (iv) mobility;
       5. (v) self-direction; and
       6. (vi) capacity for independent living.
31. (31) Relative--A person related to the individual within the fourth degree of consanguinity or within the second degree of affinity.

32. (32) Service coordination--Through both comprehensive and follow-up encounters, service coordination consists of assistance in accessing medical, social, educational, and other appropriate services and supports that will help an individual achieve a quality of life and community participation acceptable to the individual, or individual and LAR as follows:

    1. (A) crisis prevention and management--linking and assisting the individual and LAR or actively involved person to secure services and supports that will enable them to prevent or manage a crisis;
    2. (B) monitoring--ensuring that the individual receives needed services, evaluating the effectiveness and adequacy of services, and determining if identified outcomes are meeting the individual's needs and desires as indicated by the individual and LAR or actively involved person;
    3. (C) assessment--identifying the individual's needs and the services and supports that address those needs as they relate to the nature of the individual's presenting problem and disability; and
    4. (D) service planning and coordination--identifying, arranging, advocating, collaborating with other agencies, and linking for the delivery of outcome-focused services and supports that address the individual's needs and desires as indicated by the individual and LAR or actively involved person.
33. (33) State hospital--Consistent with THSC §552.0011, a hospital operated by HHSC primarily to provide inpatient care and treatment for individuals with mental illness.
34. (34) State supported living center--A state-supported and structured residential facility that is an ICF/IID operated by HHSC to provide persons with an intellectual disability a variety of services, including medical treatment, specialized therapy, and training in the acquisition of personal, social, and vocational skills, but does not include a community-based facility owned by HHSC.
35. (35) Subaverage general intellectual functioning--Consistent with THSC §591.003, measured intelligence on standardized general intelligence tests of two or more standard deviations (not including standard error of measurement adjustments) below the age-group mean for the tests used.
36. (36) TAC--Texas Administrative Code. A compilation of state agency rules published by the Texas Secretary of State in accordance with Texas Government Code Chapter 2002, Subchapter C.
37. (37) THSC--Texas Health and Safety Code.
38. (38) TxHmL Program--The Texas Home Living Program. A program operated by HHSC as authorized by the Centers for Medicare & Medicaid Services in accordance with §1915(c) of the Social Security Act.

Source Note:The provisions of this §331.5 adopted to be effective August 31, 2004, 29 TexReg 8313; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; amended to be effective August 1, 2005, 30 TexReg 4334; amended to be effective June 1, 2010, 35 TexReg 4439; amended to be effective March 20, 2016, 41 TexReg 1864; transferred effective July 1, 2022, as published in the Texas Register June 3, 2022, 47 TexReg 3275; amended to be effective October 19, 2025, 50 TexReg 6669.