Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter A - PURCHASED HEALTH SERVICES › Division 27 - COMMUNITY FIRST CHOICE › Section 354.1361 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following terms, when used in this division, have the
						following meanings unless the context clearly indicates otherwise.
(1) Activities of daily living (ADLs)--Basic
					 personal everyday activities including, but not limited to, tasks such as
					 eating, toileting, grooming, dressing, bathing, and transferring.
(2) CFC emergency response services--Back-up
					 systems and supports including electronic devices to ensure continuity of
					 services and supports.
(3) CFC
					 habilitation--Acquisition, maintenance, and enhancement of skills necessary for
					 the individual to accomplish ADLs, IADLs, and health-related tasks based on the
					 individual's person-centered service plan.
(4) CFC personal assistance
					 services--Services provided to assist an individual in performing ADLs, IADLs,
					 and health-related tasks based on the individual's person-centered service
					 plan.
(5) CFC support
					 management--Voluntary training on how to select, manage, and dismiss
					 attendants.
(6) CFR--Code of
					 Federal Regulations.
(7) CLASS--The
					 Community Living Assistance and Support Services Program operated by DADS as
					 authorized by the Centers for Medicare & Medicaid Services in accordance
					 with §1915(c) of the Social Security Act.
(8) Consumer Directed Services (CDS)
					 option--A service delivery option in which an individual or legally authorized
					 representative employs and retains service providers and directs the delivery
					 of program services.
(9) DADS--The
					 Texas Department of Aging and Disability Services.
(10) DBMD--The Deaf Blind with Multiple
					 Disabilities Program operated by DADS as authorized by the Centers for Medicare
					 & Medicaid Services in accordance with §1915(c) of the Social Security
					 Act.
(11) DSHS--Texas Department of
					 State Health Services.
(12)
					 Financial Management Services (FMS)--Services including, but not limited to,
					 the following activities for individuals using the CDS option: collect and
					 process timesheets of the individual's attendant care providers; process
					 payroll, withholding, filing, and payment of applicable Federal, State, and
					 local employment related taxes and insurance; separately track budget funds and
					 expenditures for each individual; track and report disbursements and balances
					 of each individual's funds; process and pay invoices for services in the
					 person-centered service plan; and provide individual periodic reports of
					 expenditures and the status of the approved service budget to the individual
					 and to HHSC.
(13) Financial
					 management services agency (FMSA)--An entity that is qualified by DADS and is
					 contracted with HHSC and/or an MCO to provide financial management
					 services.
(14) Health-related
					 tasks--In accordance with
					 RSA
					 441.505 and state law, specific tasks related
					 to the needs of an individual which include tasks delegated by a registered
					 nurse, health maintenance activities, and extension of therapy.
(15) HHSC--The Texas Health and Human
					 Services Commission, or its designee.
(16) Home and Community-based Services (HCS)
					 Program--The Home and Community-based Services Program operated by DADS as
					 authorized by the Centers for Medicare & Medicaid Services in accordance
					 with §1915(c) of the Social Security Act.
(17) Home and Community Support Services
					 Agency (HCSSA)--Home and Community Support Services Agency licensed by DADS in
					 accordance with Texas Health and Safety Code, Chapter 142.
(18) Intermediate care facility for
					 individuals with an intellectual disability or related conditions (ICF-IID)--A
					 facility providing care and services to individuals with intellectual
					 disabilities or related conditions as defined in §1905(d) of the Social
					 Security Act.
(19) Instrumental
					 activities of daily living (IADLs)--Activities related to living independently
					 in the community including, but not limited to, meal planning and preparation;
					 managing finances; shopping for food, clothing, and other essential items;
					 performing essential household chores; communicating by phone or other media;
					 and traveling around and participating in the community.
(20) Legally authorized representative
					 (LAR)--A person authorized by law to act on behalf of an individual with regard
					 to a matter described in this division, and may include a parent, guardian, or
					 managing conservator of a minor, or the guardian of an adult.
(21) Local Intellectual and Developmental
					 Disability Authority (LIDDA) --An entity designated by DADS in accordance with
					 the Texas Health and Safety Code, §
											RSA
					 533.035(a).
(22) Managed Care Organization (MCO)--An
					 organization contracted with HHSC in accordance with Chapter 353 of this title
					 (relating to Medicaid Managed Care).
(23) Medical Assistance Only (MAO)--An
					 individual who qualifies financially and functionally for Medicaid assistance
					 but does not receive Supplemental Security Income (SSI) benefits.
(24) Person-centered service planning--A
					 documented service planning process that includes people chosen by the
					 individual, is directed by the individual to the maximum extent possible,
					 enables the individual to make informed choices and decisions, is timely and
					 occurs at times and locations convenient to the individual, reflects cultural
					 considerations of the individual, includes strategies for solving conflict or
					 disagreement within the process, offers choices to the individual regarding the
					 services and supports they receive and from whom, includes a method for the
					 individual to require updates to the plan, and records alternative settings
					 that were considered by the individual.
(25) Service Planning Team--For an individual
					 receiving CFC services, the group of people responsible for creating the
					 individual's person-centered service plan.
(26) Service responsibility option (SRO)--A
					 service delivery option in which an individual or LAR selects, trains, and
					 provides daily management of a service provider, while the fiscal, personnel,
					 and service back-up plan responsibilities remain with an SRO
					 provider.
(27) STAR Health--The
					 managed care program that primarily serves:
(A) children and youth in Texas Department of
					 Family and Protective Services (DFPS) conservatorship;
(B) young adults who voluntarily agree to
					 continue in a foster care placement (if the state as conservator elects to
					 place the child in managed care); and
(C) young adults who are eligible for
					 Medicaid as a result of their former foster care status through the month of
					 their 21st birthday.