26 Tex. Admin. Code § 904.5

Current through Reg. 49, No. 44; November 1, 2024

Section 904.5 - Definitions

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

(1) Actively involved--Significant and ongoing involvement with the individual based on the following:

(A) observed interactions of the person with the individual;

(B) advocacy for the individual;

(C) knowledge of and sensitivity to the individual's preferences, values and beliefs; and

(D) availability to the individual for assistance or support when needed.

(2) Applicant--An individual seeking residential services in a residential care facility.

(3) CARE--A Texas Health and Human Services Commission (HHSC) data system with demographic and other data about an individual who is receiving services and supports or on whose behalf services and supports have been requested.

(4) CLOIP--Community living options information process. The activities described in §904.99(a)(2) of this chapter (relating to Consideration of Living Options for Individuals Residing in State MR Facilities) performed by a contract local intellectual and developmental disability authority (LIDDA) to provide information and education about community living options to an individual who is 22 years of age or older residing in a residential care facility and to the individual's legally authorized representative (LAR), if the individual has an LAR.

(5) Commissioner--The executive commissioner of HHSC.

(6) Community-based Services--Services which include:

(A) a Medicaid waiver program in Title XIX, §1915(c) of the Social Security Act, including:

(i) the Community Living Assistance and Support Services Program;

(ii) the Deaf Blind with Multiple Disabilities Program;

(iii) the Home and Community-based Services Program; or

(iv) the Texas Home Living Program;

(B) an intermediate care facility licensed under the Texas Health and Safety Code (THSC) Chapter 252;

(C) services from a local school district;

(D) services from the local mental health authority or local behavioral health authority;

(E) a home and community support services agency licensed under THSC Chapter 142;

(F) local Aging and Disability Resource Center; or

(G) services from the local intellectual and developmental disability authority.

(7) Consensus--A negotiated agreement that all parties can and will support in implementation. The negotiation process involves the open discussion of ideas with all parties encouraged to express opinions.

(8) Contract LIDDA--A LIDDA that has a contract with HHSC to conduct the CLOIP.

(9) Contract mental retardation authority (MRA)-- A contract LIDDA.

(10) 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 Texas Health and Human Services Commission website at https://crcg.hhs.texas.gov.

(11) DADS--The Department of Aging and Disability Services. As a result of the reorganization of health and human services delivery in Texas, DADS was abolished, and its functions transferred to HHSC.

(12) Dangerous behavior--Physically aggressive, self-injurious, sexually aggressive, or seriously disruptive behaviors that require a written behavioral intervention plan to prevent or reduce serious physical injury or psychological injury to the person engaging in these behaviors or others.

(13) Department--Department of Aging and Disability Services, predecessor agency whose functions have been dissolved and transferred to HHSC.

(14) Designated LIDDA--The LIDDA assigned to an individual in the HHSC data system.

(15) Designated MRA-- A designated LIDDA.

(16) Discharge--The release by HHSC of an individual voluntarily admitted or committed by court order for residential care services from the custody and care of a residential care facility and termination of the individual's assignment to the residential care facility in the HHSC data system.

(17) Emergency admission and discharge agreement--A written agreement between the residential care facility, the individual or LAR, and the designated LIDDA that describes:

(A) the purpose of the emergency admission, including the circumstances that precipitated the need for the admission and the expected outcomes from the admission;

(B) the responsibilities of each party regarding the care, treatment, and discharge of the individual, including how the terms of the agreement are monitored;

(C) the length of time of the emergency admission, which is that amount of time necessary to accomplish the purpose of the admission; and

(D) the anticipated date of discharge.

(18) Facility of record--The residential care facility that serves the local service area assigned to the individual's designated-LIDDA.

(19) 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.

(20) Head of the facility--The director of a residential care facility.

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

(22) 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 the individual needs.

(23) ICAP service level--A designation that identifies the level of services needed by an individual as determined by the ICAP.

(24) IDT--Interdisciplinary team. A team comprised of intellectual disability professionals, paraprofessionals, and other concerned persons, as appropriate, who assess an individual's treatment, training, and habilitation needs and make recommendations for services, including recommendations of whether the individual is best served in a residential care facility or in a community setting.

(A) The team must include:

(i) the individual;

(ii) the individual's LAR, if any; and

(iii) persons specified by a LIDDA or a residential care facility, as appropriate, who are professionally qualified or certified or licensed with special training and experience in the diagnosis, management, needs, and treatment of individuals with an intellectual disability.

(B) Other participants in IDT meetings may include:

(i) other concerned persons whose inclusion is requested by the individual or the LAR;

(ii) at the discretion of the LIDDA or residential care facility, persons who are directly involved in the delivery of services to individuals with an intellectual disability;

(iii) if the individual is eligible for public school services, representatives of the appropriate school district;

(iv) actively-involved family members or friends of the individual who has neither the ability to provide legally adequate consent nor an LAR; and

(v) when an individual is a client of the Protection and Advocacy System, a representative of the Protection and Advocacy System.

(25) Individual--A person who has or is believed to have an intellectual disability.

(26) Intellectual disability--Consistent with THSC §591.003, significantly subaverage general intellectual functioning that is concurrent with deficits in adaptive behavior and originated during the developmental period.

(27) Interstate transfer--The admission of an individual to a residential care facility directly from a similar facility in another state.

(28) IQ--Intelligence quotient. A score reflecting the level of an individual's intelligence as determined by the administration of a standardized intelligence test.

(29) LAR--Legally authorized representative. A person authorized by law to act on behalf of an individual regarding a matter described in this chapter, and may include a parent, guardian, or managing conservator of a minor, or the guardian of an adult.

(30) Legally adequate consent--Consent given by a person when each of the following conditions have been met.

(A) Legal status. The individual giving the consent:

(i) is 18 years of age or older, or younger than 18 years of age and is or has been married or had his or her disabilities of minority removed for general purposes by court order, as described in the Texas Family Code Chapter 31; and

(ii) has not been determined by a court to lack capacity to make decisions with regard to the matter for which consent is being sought.

(B) Comprehension of information. The individual giving the consent has been informed of and comprehends the nature, purpose, consequences, risks, and benefits of and alternatives to the procedure and the fact that withholding or withdrawal of consent shall not prejudice the future provision of care and services to the individual with an intellectual disability.

(C) Voluntariness. The consent has been given voluntarily and free from coercion and undue influence.

(31) Less restrictive setting--A setting which allows the greatest opportunity for the individual to be integrated into the community.

(32) LIDDA--Local intellectual and developmental disability authority. An entity to which HHSC's authority and responsibility described in THSC §531.002(12) has been delegated.

(33) Local service area--A geographic area composed of one or more Texas counties delimiting the population which may receive services from a LIDDA.

(34) Mental retardation--Terminology previously used to describe intellectual disability.

(35) Minor--An individual under the age of 18.

(36) MRA--Mental retardation authority. A LIDDA.

(37) 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.

(38) Ombudsman--An employee of HHSC who is responsible for assisting an individual or a person acting on behalf of an individual with an intellectual or developmental disability (IDD) or a group of individuals with an IDD with a complaint or grievance regarding the infringement of the rights of an individual with an IDD or the delivery of intellectual disability services submitted under THSC §592.039. The ombudsman must explain and provide information on HHSC and LIDDA services, facilities, and programs, and the rules, procedures, and guidelines applicable to the individual denied services, and refer the individual to the appropriate entity to assist the individual in gaining access to an appropriate program or in placing the individual on an appropriate interest list.

(39) 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.

(40) Planning team--A team convened by the LIDDA and composed of:

(A) the individual;

(B) the individual's LAR, if any;

(C) actively-involved family members or friends of the individual who has neither the ability to provide legally adequate consent nor an LAR;

(D) other concerned persons whose inclusion is requested by the individual with the ability to provide legally adequate consent or the LAR;

(E) a representative from the designated LIDDA;

(F) a representative from the individual's provider; and

(G) when an individual is a client of the Protection and Advocacy System, a representative of the Protection and Advocacy System.

(41) PIDA--Persons with an Intellectual Disability Act, Texas Health and Safety Code, Title 7, Subtitle D.

(42) PMRA--PIDA.

(43) Provider--A public or private entity that delivers services and supports for individuals as an alternative to a residential care facility, including an intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID), a nursing facility, or an entity that provides waiver services.

(44) Related services--Services for school eligible individuals, as defined in Title 34 Code of Federal Regulations §300.34.

(45) Residential care facility--A state supported living center or the ICF/IID component of the Rio Grande Center.

(46) Respite admission and discharge agreement--A written agreement between the residential care facility, the individual or LAR, and LIDDA, that describes:

(A) the purpose of the respite admission, including the circumstances that precipitated the need for the admission and the expected outcomes from the admission;

(B) the length of time the individual will receive respite services from the residential care facility; and

(C) the responsibilities of each party regarding the care, treatment, and discharge of the individual.

(47) School eligible--A term describing those individuals between the ages of three and 22 who are eligible for public education services.

(48) Service delivery system--All facility and community-based services and supports operated or contracted by HHSC.

(49) Services and supports--Programs and assistance for persons with an intellectual disability that may include a determination of intellectual disability, interdisciplinary team recommendations, education, special training, supervision, care, treatment, rehabilitation, residential care, and counseling, but does not include those services or programs that have been explicitly delegated by law to other state agencies.

(50) Significantly subaverage general intellectual functioning--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 consistent with THSC §591.003.

(51) State MH facility--State mental health facility. A state hospital.

(52) State MR facility--State mental retardation facility. A residential care facility.

(53) State MR facility living options instrument--A written document used to guide the discussion of living options during a planning meeting that results in a recommendation by the IDT of whether the individual should remain in the current living arrangement at the residential care facility or move to an alternative living arrangement.

(54) TGC--Texas Government Code.

(55) THSC--Texas Health and Safety Code.

(56) Waiver services--Home and community-based services provided through a Medicaid waiver program approved by Centers for Medicare and Medicaid Services (CMS), as described in §1915(c) of the Social Security Act.

26 Tex. Admin. Code § 904.5

Adopted by Texas Register, Volume 49, Number 37, September 13, 2024, TexReg 7362, eff. 9/18/2024