26 Tex. Admin. Code § 262.901

Current through Reg. 49, No. 45; November 8, 2024

Section 262.901 - Definitions

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

(1) Applicant--A Texas resident seeking services in the Texas Home Living Program (TxHmL).

(2) Calendar day--Any day, including weekends and holidays.

(3) CDS employer--Consumer directed services employer. This term has the same meaning as the term "employer" set forth in 40 TAC § 41.103(relating to Definitions).

(4) CDS option--Consumer directed services option. This term has the meaning set forth in 40 TAC § 41.103.

(5) CFC--Community First Choice. A state plan option governed by Code of Federal Regulations, Title 42, Chapter 441, Subpart K, regarding Home and Community-Based Attendant Services and Supports State Plan Option (Community First Choice).

(6) CFC PAS/HAB--CFC personal assistance services/habilitation.

(7) CMS--Centers for Medicare & Medicaid Services. The federal agency within the United States Department of Health and Human Services that administers the Medicare and Medicaid programs.

(8) Community setting--A setting accessible to the general public within an individual's community.

(9) Day habilitation--A TxHmL Program service that provides assistance with acquiring, retaining, or improving self-help, socialization, and adaptive skills provided in a location other than the residence of an individual.

(10) DFPS--The Department of Family and Protective Services.

(11) FMSA--Financial management services agency. This term has the meaning set forth in 40 TAC § 41.103.

(12) HHSC--The Texas Health and Human Services Commission.

(13) Hospital--A public or private institution licensed or exempt from licensure in accordance with Texas Health and Safety Code (THSC) Chapters 13, 241, 261, or 552.

(14) ICAP--Inventory for Client and Agency Planning.

(15) ID/RC Assessment--Intellectual Disability/Related Conditions Assessment. A form used by HHSC for level of care determination and level of need assignment.

(16) Implementation plan--A written document developed by a program provider for an individual that, for each TxHmL Program service and CFC service on the individual's individual plan of care (IPC) to be provided by the program provider except for community support and CFC support management, includes:

(A) a list of outcomes identified in the person-directed plan that will be addressed using TxHmL Program services and CFC services;

(B) specific objectives to address the outcomes required by subparagraph (A) of this paragraph that are:

(i) observable, measurable, and outcome-oriented; and

(ii) derived from assessments of the individual's strengths, personal goals, and needs;

(C) a target date for completion of each objective;

(D) the number of units of TxHmL Program services and CFC services needed to complete each objective;

(E) the frequency and duration of TxHmL Program services and CFC services needed to complete each objective; and

(F) the signature and date of the individual, legally authorized representative, and the program provider.

(17) Individual--A person enrolled in the TxHmL Program.

(18) Individualized skills and socialization provider--A legal entity licensed in accordance with Chapter 559, Subchapter H of this title (relating to Individualized Skills and Socialization Provider Requirements).

(19) Initial IPC--The first IPC for an individual developed before the individual's enrollment into the TxHmL Program.

(20) IPC--Individual plan of care. A written plan that:

(A) states:

(i) the type and amount of each TxHmL Program service and each CFC service, except for CFC support management, to be provided to an individual during an IPC year;

(ii) the services and supports to be provided to the individual through resources other than TxHmL Program services or CFC services, including natural supports, medical services, and educational services; and

(iii) if an individual will receive CFC support management; and

(B) is authorized by HHSC.

(21) IPC year--The effective period of an initial IPC and renewal IPC as described in this paragraph.

(A) Except as provided in subparagraph (B) of this paragraph, the IPC year for an initial and renewal IPC is a 365-calendar day period starting on the begin date of the initial or renewal IPC.

(B) If the begin date of an initial or renewal IPC is March 1 or later in a year before a leap year or January 1 - February 28 of a leap year, the IPC year for the initial or renewal IPC is a 366-calendar day period starting on the begin date of the initial or renewal IPC.

(C) A revised IPC does not change the begin or end date of an IPC year.

(22) LAR--Legally authorized representative. A person authorized by law to act on behalf of a person with regard to a matter described in this subchapter, including a parent, guardian, or managing conservator of a minor; a guardian of an adult; an agent appointed under a power of attorney; or a representative payee appointed by the Social Security Administration. An LAR, such as an agent appointed under a power of attorney or representative payee appointed by the Social Security Administration, may have limited authority to act on behalf of a person.

(23) LOC--Level of care. A determination given to an applicant or individual as part of the eligibility determination process based on data submitted on the ID/RC Assessment.

(24) LON--Level of need. An assignment given by HHSC to an applicant or individual that is derived from the ICAP service level score and from selected items on the ID/RC Assessment.

(25) Medicaid HCBS--Medicaid home and community-based services. Medicaid services provided to an individual in an individual's home and community, rather than in a facility.

(26) Nursing facility--A facility licensed in accordance with THSC Chapter 242.

(27) PDP--Person-directed plan. A plan developed using an HHSC form that describes the supports and services necessary to achieve the desired outcomes identified by the applicant or individual and LAR and to ensure the applicant's or individual's health and safety.

(28) Program provider--A person, as defined in 40 TAC § 49.102(relating to Definitions), that has a contract with HHSC to provide TxHmL Program services, excluding a financial management services agency.

(29) Renewal IPC--An IPC required to be developed for an individual at least 30 but not more than 90 calendar days before the expiration of the individual's IPC in accordance with rules governing the TxHmL Program.

(30) Revised IPC--An initial IPC or renewal IPC that is revised during the IPC year in accordance with rules governing the TxHmL Program to add a new TxHmL Program service or CFC service or change the amount of an existing service.

(31) Service coordinator--An employee of a local intellectual and developmental disability authority who provides service coordination to an individual.

(32) Service provider--A person who directly provides a TxHmL Program service or CFC service to an individual.

(33) 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.

(34) TxHmL Program--The Texas Home Living Program.

26 Tex. Admin. Code § 262.901

Adopted by Texas Register, Volume 47, Number 51, December 23, 2022, TexReg 8688, eff. 1/1/2023