1 Tex. Admin. Code § 353.1403

Current through Register Vol. 49, No. 48, November 29, 2024

Section 353.1403 - Definitions

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

(1) Adult--An individual who is age 21 or older.

(2) CFP--Certified Family Partner. A person who meets the credentialing requirements in § 353.1415(d) of this subchapter (relating to Staff Member Credentialing).

(3) CFR--Code of Federal Regulations.

(4) Child or youth--An individual who is under age 21.

(5) Clinical supervision--An LPHA's or QMHP-CS's oversight of a staff member who delivers mental health targeted case management and mental health rehabilitative services to ensure that services are clinically appropriate and in compliance with this subchapter.

(6) Community data--Additional information gathered during the uniform assessment.

(7) CSSP--Community services specialist. A staff member of a local mental health authority who has documented full-time experience in the provision of mental health targeted case management and mental health rehabilitative services prior to August 31, 2004. See definition in 25 TAC §RSA 412.303(relating to Definitions).

(8) Comprehensive provider agency--An entity that provides or subcontracts for the delivery of the full array of mental health targeted case management and mental health rehabilitative services set forth in Chapter 354, Subchapter M of this title (relating to Mental Health Targeted Case Management and Mental Health Rehabilitation), with the exception of § 354.2715 of this title (relating to Day Programs for Acute Needs).

(9) Credentialing--A process by which the comprehensive provider agency reviews and approves a staff member's educational background, work experience, and licensure status (as applicable) to ensure that the staff member meets requirements for staff member credentialing as outlined in §353.1415. The process includes primary source verification of credentials, establishing and applying specific criteria and prerequisites to determine the staff member's initial and ongoing competency, and assessing and validating the staff member's qualifications to deliver care.

(10) HHSC--The Texas Health and Human Services Commission, or its designee.

(11) Individual--A person seeking or receiving mental health targeted case management, mental health rehabilitative services, or both under this subchapter.

(12) Intensive case management--A level of mental health targeted case management that includes a focused effort to coordinate community resources, uses evidence-based wraparound process planning to address a child's or youth's unmet needs across life domains, and assists a child or youth in gaining access to necessary care and services appropriate to the child's or youth's needs.

(13) Intensive case management plan--A written document that is part of the medical record for a child or youth receiving intensive case management and is developed by a case manager, in collaboration with the child or youth and the child's or youth's LAR or primary caregiver, that identifies services needed by the child or youth and sets forth a plan for how the child or youth may gain access to the identified services.

(14) 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, including a parent, guardian, or managing conservator of a minor, or the guardian of an adult.

(15) Life domains--Areas of life, including safety, health, emotional, psychological, social, educational, cultural, and legal.

(16) LPHA--Licensed Practitioner of the Healing Arts. A staff member who is:

(A) a physician;

(B) a licensed professional counselor;

(C) a licensed clinical social worker;

(D) a licensed psychologist;

(E) an advanced practice registered nurse;

(F) a physician assistant; or

(G) a licensed marriage and family therapist.

(17) Management information system--An information system designed to plan, organize, staff, direct, and control the operations and clinical decision-making of a managed care organization or comprehensive provider agency.

(18) Medication training and support services--Medication training and support services consist of education and guidance about medications and their possible side effects.

(19) Mental health rehabilitative services--Services that are individualized, age-appropriate, and provide training and instructional guidance that restore an individual's functional deficits due to serious mental illness or serious emotional disturbance. The services are designed to improve or maintain the individual's ability to remain in the community as a fully integrated and functioning member of that community.

(20) Mental health targeted case management--Services furnished to assist individuals with severe mental illness and functional impairments or serious emotional disorders and functional impairments to gain access to needed medical, social, educational, and other services.

(21) Peer provider--Staff with lived experience with a mental health condition who meet the credentialing requirements in § 353.1415(c) of this subchapter.

(22) Pharmacological management--In-depth management of psychopharmacological agents to treat an individual's mental health symptoms.

(23) Primary caregiver--A person 18 years of age or older who has:

(A) actual care, control, and possession of a child or youth; or

(B) assumed responsibility for providing shelter and care for an adult.

(24) Psychiatric diagnostic evaluation--An integrated biopsychosocial assessment, including history, mental status, and recommendations.

(25) QMHP-CS--Qualified Mental Health Professional-Community Services. Staff who meet the credentialing requirements in § 353.1415(a) of this subchapter.

(26) Re-credentialing--The periodic process of reevaluating a staff member's competency and qualifications.

(27) Recovery--A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.

(28) Recovery or treatment plan (recovery/treatment plan)--A written plan that:

(A) is developed with the individual, the LAR if required, other persons whose inclusion is requested by the individual or LAR and who agree to participate, and a QMHP-CS or LPHA;

(B) is completed in conjunction with the uniform assessment;

(C) is amended at any time based on an individual's needs;

(D) guides the recovery process and fosters resiliency;

(E) identifies the individual's changing strengths, capacities, goals, preferences, needs, and desired outcomes; and

(F) identifies services and supports to meet the individual's goals, preferences, needs and desired outcomes.

(29) Referral and linkage--Activities that help link an individual with medical, social, educational, and other providers that are capable of providing needed services.

(30) Staff member--Comprehensive provider agency personnel, including a full-time or part-time employee, contractor, or intern, but excluding a volunteer.

(31) Strengths-based--The concept used in service delivery that identifies, builds on, and enhances the capabilities, knowledge, skills, and assets of the individual, LAR, or primary caregiver, and family, their community, and other team members. The focus is on increasing functional strengths and assets rather than on the elimination of deficits.

(32) UA--Uniform assessment. A required assessment that assists in determining the medical necessity of services. For adults, the UA includes the Adult Needs and Strengths Assessment (ANSA), community data, relevant rating scales, diagnostic information, and any other state-required assessment tools and procedures. For children or youth, the UA includes the Child and Adolescent Needs and Strengths (CANS) assessment, community data, relevant rating scales, diagnostic information, and any other state-required assessment tools and processes.

(33) Utilization management guidelines--Guidelines developed by HHSC that establish the type, amount, and duration of mental health targeted case management services and mental health rehabilitative services for each individual.

(34) Wraparound Process Planning--A strengths-based approach used in intensive case management to develop an intensive case management plan that addresses the child's or youth's unmet needs across life domains.

1 Tex. Admin. Code § 353.1403

Adopted by Texas Register, Volume 43, Number 41, October 12, 2018, TexReg 6816, eff. 10/17/2018