Section 261.203 - DefinitionsThe following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:
(1) Active treatment--Continuous, aggressive, consistent implementation of a program of habilitation, specialized and generic training, treatment, health services, and related services. Active treatment does not include services to maintain generally independent individuals who are able to function with little supervision or in the absence of a continuous active treatment program. The program must be directed toward: (A) the acquisition or maintenance of the behaviors necessary for the individual to function with as much self-determination and independence as possible; and(B) the prevention or deceleration of regression or loss of current optimal functional status.(2) Actively involved--Significant, ongoing, and supportive involvement with an individual by a person, as determined by the individual's IDT, based on the person's: (A) interactions with the individual;(B) availability to the individual for assistance or support when needed; and(C) knowledge of, sensitivity to, and advocacy for the individual's needs, preferences, values, and beliefs.(3) Adult--A person who is 18 years of age or older.(4) Affiliate--An employee or independent contractor of a provider applicant or a person with a significant financial interest in a provider applicant, including the following: (A) if the provider applicant is a corporation, then each officer, director, stockholder with an ownership of at least 5 percent, subsidiary, and parent company;(B) if the provider applicant is a limited liability company, then each officer, member, subsidiary, and parent company;(C) if the provider applicant is an individual, then the individual's spouse, each partnership and each partner thereof of which the individual is a partner and each corporation in which the individual is an officer, director, or stockholder with an ownership of at least 5 percent;(D) if the provider applicant is a partnership, then each partner and parent company; or(E) if the provider applicant is a group of co-owners under any other business arrangement, then each owner, officer, director, or the equivalent thereof under the specific business arrangement, and each parent company.(5) Applicant--A person seeking enrollment in the ICF/IID Program or seeking admission to a facility.(6) Applied income--The portion of an individual's cost of care that the individual is responsible for paying. The amount of an individual's applied income is determined by the policies and procedures authorized by the Health and Human Services Commission and depends on the individual's earned and unearned income.(7) Assignment--The transfer of rights, interests, and obligations of the program provider agreement from the program provider to another person.(8) Aversive stimulus--A stimulus that is unpleasant, noxious, startling, or painful; is applied after an inappropriate behavior; and is intended to suppress the inappropriate behavior.(9) Behavior intervention plan--A written plan prescribing the systematic application of behavioral techniques regarding an individual that, at a minimum, contains: (A) reliable and representative baseline data regarding the targeted behavior;(B) a specific objective to decrease or eliminate the targeted behavior;(C) a functional analysis of the events which contribute to or maintain the targeted behavior;(D) detailed procedures for implementing the plan;(E) ongoing, written quantitative data of the targeted behavior;(F) written descriptions of incidents of the targeted behavior including the individual's actions and staff interventions;(G) methods for evaluating plan effectiveness;(H) procedures for making necessary plan revisions at least annually; and(I) a fading process for one-to-one supervision, if the individual is assigned an LON 9.(10) Budgeted amount--The amount of cash that may be disbursed to an individual at regular intervals; for example, weekly, monthly, for discretionary spending without obtaining a sales receipt for the expenditure.(11) Campus-based facility--A facility that is located on the grounds of a state supported living center or the ICF/IID Program component of Rio Grande State Center.(12) CARE--DADS Client Assignment and Registration System, a database with demographic and other data about an individual who is receiving services and supports or on whose behalf services and supports have been requested.(13) Certified capacity--The maximum number of individuals who may reside in a facility, as set forth in the facility's provider agreement.(14) CFR (Code of Federal Regulations)--The compilation of federal agency regulations.(15) Community Center--A community center established under the THSC, Chapter 534, Subchapter A.(16) Community program provider--A program provider acting on behalf of a facility that is not a campus-based facility.(17) CRCG (Community Resource Coordination Group)--A local interagency group composed of public and private agencies that develops service plans for individuals whose needs can be met only through interagency coordination and cooperation. The group's role and responsibilities are described in the Memorandum of Understanding on Coordinated Services to Persons Needing Services from More Than One Agency, available on the Health and Human Services Commission website at www.hhsc.state.tx.us/crcg/crcg.htm.(18) DADS--The Department of Aging and Disability Services.(19) Day--Calendar day, unless otherwise specified.(20) Department--Department of Aging and Disability Services.(21) Discharge--The absence, for a full day or more, of an individual from the facility in which the individual resides, if such absence is not during a therapeutic, extended, or special leave, as described in § 261.226 of this chapter (relating to Leaves).(22) DPoC (directed plan of correction)--A plan developed by DADS sanction team that requires a program provider to take specified actions within specified time frames to correct the program provider's failure to meet one or more federal standards of participation (SoPs) or conditions of participation (CoPs) or lack of compliance with one or more state rules.(23) Effortful task--A task directed by staff that requires physical effort by an individual performed after an inappropriate behavior, including required exercise, negative practice, and restitutional overcorrection.(24) Emergency situation--An unexpected situation involving an individual's health, safety, or welfare, of which a person of ordinary prudence would determine that the LAR should be informed, such as: (A) an individual needing emergency medical care;(B) an individual being removed from his residence by law enforcement;(C) an individual leaving his residence without notifying staff and not being located; and(D) an individual being moved from his residence to protect the individual (for example, because of a hurricane, fire, or flood).(25) Excluded--Temporarily or permanently prohibited by a state or federal authority from participating as a provider in a federal health care program, as defined in 42 USC § 1302a - 7b(f).(26) Exclusionary time-out--A procedure by which an individual is, after an inappropriate behavior, placed alone in an enclosed area in which positive reinforcement is not available and from which egress is physically prevented by staff until appropriate behavior is exhibited.(27) Facility--An intermediate care facility for individuals with an intellectual disability or related conditions.(28) Family-based alternative--A family setting in which the family provider or providers are specially trained to provide support and in-home care for children with disabilities or children who are medically fragile.(29) Full day--A 24-hour period extending from midnight to midnight.(30) Highly restrictive procedure--The application of an aversive stimulus, exclusionary time-out, physical restraint, a requirement to engage in an effortful task, or other technique with a similar degree of restriction or intrusion to manage an individual's inappropriate behavior.(31) Hospice--An entity that is primarily engaged in providing care to terminally ill individuals and is approved by DADS to participate in the Medicaid Hospice Program in accordance with § 30.30 of Title 40 (relating to General Contracting Requirements).(32) ICAP (Inventory for Client and Agency Planning)--A validated, standardized assessment that measures the level of supervision an individual requires and, thus, the amount and intensity of services and supports an individual needs.(33) ICF/IID Program--The Intermediate Care Facilities for Individuals with an Intellectual Disability Program, which provides Medicaid-funded residential services to individuals with an intellectual disability or related conditions.(34) ICF/MR Program--ICF/IID Program.(35) ID/RC Assessment Form--A form used by DADS for LOC determination and LON assignment.(36) IDT (interdisciplinary team)--A group of people assembled by the program provider who possess the knowledge, skills, and expertise to assess an individual's needs and make recommendations for the individual's IPP. The group includes the individual, LAR, intellectual disability professionals and paraprofessionals and, with approval from the individual or LAR, other concerned persons.(37) Individual--A person enrolled in the ICF/IID Program.(38) Intellectual disability--Significant sub-average general intellectual functioning existing concurrently with deficits in adaptive behavior and manifested during the developmental period.(39) IPP (individual program plan)--A plan developed by an individual's IDT that identifies the individual's training, treatment, and habilitation needs and describes services to meet those needs.(40) IQ (intelligence quotient)--A score reflecting the level of an individual's intelligence as determined by the administration of a standardized intelligence test.(41) LAR (legally authorized representative)--A person authorized by law to act on behalf of an individual with regard to a matter described in this subchapter, and may include a parent, guardian, managing conservator of a minor individual, a guardian of an adult individual, or legal representative of a deceased individual.(42) LOC (level of care)--A determination given by DADS to an individual as part of the eligibility process based on data submitted on the ID/RC Assessment Form.(43) Local authority--An entity to which the Health and Human Services Commission's authority and responsibility described in TSHC § 531.002(11) has been delegated.(44) LON (level of need)--An assignment given by DADS to an individual upon which reimbursement for ICF/IID Program services is based. The LON assignment is derived from the service level score obtained from the administration of the ICAP to the individual and from selected items on the ID/RC Assessment Form.(45) Long Term Care Plan--The plan required by THSC, § 533.062, which is developed by DADS and specifies, in part, the capacity of the ICF/IID Program in Texas.(46) Major dental treatment--A dental treatment, intervention, or diagnostic procedure that: (A) has a significant recovery period;(B) presents a significant risk;(C) employs a general anesthetic; or(D) in the opinion of the individual's physician, involves a significant invasion of bodily integrity that requires an incision or the extraction of bodily fluids that produces substantial pain, discomfort, or debilitation.(47) Major medical treatment--A medical, surgical, or diagnostic procedure or intervention that: (A) has a significant recovery period;(B) presents a significant risk;(C) employs a general anesthetic; or(D) in the opinion of the individual's physician, involves a significant invasion of bodily integrity that requires an incision or the extraction of bodily fluids that produces substantial pain, discomfort, or debilitation.(48) Medical necessity--The need for a treatment decision that is essential to avoid adversely affecting an individual's mental or physical health or the quality of care rendered.(49) Mental retardation--Intellectual disability.(50) MRA (mental retardation authority)--A local authority.(51) MR/RC--ID/RC Assessment Form.(52) Natural support network--Those persons, including family members, church members, neighbors, and friends, who assist and sustain an individual with supports that occur naturally within the individual's environment and that are not reimbursed or purposely developed by a person or system.(53) Negative practice--A procedure in which an individual is required, after an inappropriate behavior, to repeatedly engage in an activity that is similar to the inappropriate behavior.(54) Non-state operated facility--A facility for which the program provider is an entity other than DADS, such as a community center or private organization.(55) Occupational therapist (OT)--A person licensed by the Texas Board of Occupational Therapy Examiners to practice occupational therapy, as defined in Texas Occupations Code § 454.002(4).(56) PDP (person-directed plan)--A plan of services and supports developed under the direction of an individual or LAR with the support of a local authority or program provider staff and other people chosen by the individual or LAR.(57) 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.(58) Permanency Planning Review Screen--A screen in CARE that, when completed by a local authority, identifies community supports needed to achieve an individual's permanency planning outcomes and provides information necessary for approval of the individual's initial and continued residence in a facility.(59) Personal funds--The funds that belong to an individual, including earned income, social security benefits, gifts, and inheritances.(60) Personal hold-- (A) A manual method, except for physical guidance or prompting of brief duration, used to restrict: (i) free movement or normal functioning of all or a portion of an individual's body; or(ii) normal access by an individual to a portion of the individual's body.(B) Physical guidance or prompting of brief duration becomes a physical restraint if the individual resists the guidance or prompting.(61) Petty cash fund--Personal funds managed by a program provider that are maintained for individuals' cash expenditures.(62) Physical restraint--A manual method, or a physical or mechanical device, material, or equipment attached or adjacent to an individual's body that the individual cannot remove easily, that restricts freedom of movement or normal access to an individual's body. This term includes a personal hold.(63) Physical therapist (PT)--A person licensed by the Texas Board of Physical Therapy Examiners to practice physical therapy, as defined in Texas Occupations Code § 453.001(4).(64) Pooled account--A trust fund account containing the personal funds of more than one individual.(65) Professional--A person who is licensed or certified by the State of Texas in a health or human services occupation or who meets DADS criteria to be a case manager, service coordinator, qualified intellectual disability professional, or certified psychologist as described in § 5.161 of Title 40 (relating to TDMHMR-Certified Psychologist).(66) Program provider--An entity with whom DADS has a provider agreement.(67) Provider agreement--A written agreement between DADS and a program provider that obligates the program provider to deliver ICF/IID Program services.(68) Provider applicant--An entity seeking to participate as a program provider.(69) Psychoactive medication--Any medication prescribed for the treatment of symptoms of psychosis or other severe mental or emotional disorders and that is used to exercise an effect upon the central nervous system for the purposes of influencing and modifying behavior, cognition, or affective state.(70) Qualified intellectual disability professional (QIDP)--A person with at least a bachelor's degree who has at least one year of experience working with persons with an intellectual disability or related conditions.(71) Qualified rehabilitation professional (QRP)--A person who holds one or more of the following certifications in good standing: (A) certification as an assistive technology professional or a rehabilitation engineering technologist issued by the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA);(B) certification as a seating and mobility specialist issued by RESNA; or(C) certification as a rehabilitation technology supplier issued by the National Registry of Rehabilitation Technology Suppliers.(72) Related condition--Consistent with 42 CFR § 435.1010, a severe and chronic disability that: (A) is attributed to: (i) cerebral palsy or epilepsy; or(ii) any other condition, other than mental illness, found to be closely related to intellectual disability because the condition results in impairment of general intellectual functioning or adaptive behavior similar to that of individuals with intellectual disability, and requires treatment or services similar to those required for individuals with intellectual disability;(B) is manifested before the individual reaches 22 years of age;(C) is likely to continue indefinitely; and(D) results in substantial functional limitation in at least three of the following areas of major life activity: (ii) understanding and use of language;(vi) capacity for independent living.(73) Required exercise--A procedure in which an individual, after an inappropriate behavior, performs or is guided by staff to perform a series of physical movements that are incompatible with the inappropriate behavior.(74) Restitutional overcorrection--A procedure in which an individual is required to correct the consequences of an inappropriate behavior by performing a task that improves the individual's environment.(75) Sales receipt--A written statement issued by the seller that includes: (A) the date it was created; and(B) the cost of the item or service.(76) Separate account--A trust fund account containing the personal funds of only one individual.(77) Specially constituted committee--A committee designated by the program provider in accordance with 42 CFR § 483.440(f)(3) that consists of staff, LARs, individuals (as appropriate), qualified persons who have experience or training in contemporary practices to change an individual's inappropriate behavior, and persons with no ownership or controlling interest in the facility. The committee is responsible, in part, for reviewing, approving, and monitoring individual programs designed to manage inappropriate behavior and other programs that, in the opinion of the committee, involve risks to individuals' safety and rights.(78) SSI--Supplemental Security Income.(79) State-operated facility--A facility for which DADS is the program provider.(80) 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.(81) TDHS--Formerly, this term referred to the Texas Department of Human Services; it now refers to DADS, except in the context of Medicaid eligibility it refers to the Health and Human Services Commission.(82) THSC (Texas Health and Safety Code)--Texas statutes relating to health and safety.(83) Third Party--An individual, entity, or program other than DADS or the program provider, that is or may be liable to pay all or part of the expenditures for ICF/IID Program services, including: (A) a commercial insurance company offering health or casualty insurance to individuals or groups (including both experience-rated insurance contracts and indemnity contracts);(B) a profit or nonprofit prepaid plan offering either medical services or full or partial payment for services; and(C) an organization administering health or casualty insurance plans for professional associations, unions, fraternal groups, employer-employee benefit plans, and any similar organization offering these payments or services, including self-insured and self-funded plans.(84) Trust fund account--An account at a financial institution in the program provider's control that contains personal funds.(85) Unclaimed personal funds--Personal funds managed by the program provider that have not been Transferred to the individual or LAR within 30 days after the individual's discharge.(86) Unidentified personal funds--Personal funds managed by the program provider for which the program provider cannot identify ownership.(87) USC (United States Code)--A compilation of statutes enacted by the United States Congress.(88) Vendor hold--Temporary suspension of ICF/IID payments from DADS to a program provider.(89) Wheeled mobility system--An item of durable medical equipment that is a customized, powered, or manual mobility device or a feature or component of the device, including the following: (A) seated positioning components;(B) powered or manual seating options;(C) specialty driving controls;(D) multiple adjustment frame;(E) nonstandard performance options; and(F) other complex or specialized components.(90) Working day--Any day except a Saturday, a Sunday, or a national or state holiday listed in Texas Government Code § 662.003(a) or (b).26 Tex. Admin. Code § 261.203
Adopted to be effective January 1, 2001, 25 TexReg 12790; amended to be effective September 1, 2001, 26 TexReg 5384; amended to be effective March 31, 2002, 27 TexReg 2475; amended to be effective January 5, 2003, 27 TexReg 12251; Transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; amended to be effective September 1, 2006, 31 TexReg 6795; amended to be effective July1, 2007, 32 TexReg 3856; amended to be effective July 1, 2012, 37 TexReg 4606; amended to be effective November 4, 2013, 38 TexReg 7724; Transferred from Title 40, § 9.203 by Texas Register, Volume 45, Number 35, August 28, 2020, TexReg 6127, eff. 10/1/2020