Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 11 - HEALTH MAINTENANCE ORGANIZATIONS › Subchapter Y - LIMITED SERVICE HMOS › Section 11.2401 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this
					 subchapter, have the meaning indicated below unless the context clearly
					 indicates otherwise:
(1) Acute day
				  treatment--Program-based services focused on the short-term, acute treatment of
				  individuals who require multi-disciplinary treatment to obtain maximum control
				  of psychiatric symptoms. Services are provided in a highly structured and safe
				  environment with constant supervision. Contacts with staff are frequent,
				  activities and services constantly available, and developmental and social
				  supports encouraged and facilitated. Staff receive specialized training in
				  crisis management. Activities are goal oriented, focusing on improving peer
				  interaction, appropriate social behavior, and stress tolerance.
(2) Assessment--The clinical process of
				  obtaining and evaluating historical, social, functional, psychiatric,
				  developmental, or other information from the individual and family seeking
				  services to determine level of need (including urgency) and specific treatment
				  needs (including the preferences of the individual seeking services).
(3) Case management--Case management
				  activities are provided to assist individuals in gaining access to medical,
				  social, educational, and other appropriate services that will help them achieve
				  a quality of life and community participation acceptable to each individual.
				  The role of individuals who provide case management activities is to support
				  and assist the person in achieving goals.
(4) Crisis hotline--A continuously available,
				  staffed telephone service providing information, support, and referrals to
				  callers 24 hours per day, seven days per week.
(5) Crisis respite--Services provided for
				  temporary, short term, periodic relief to individuals or their primary
				  caregivers during a crisis. Program-based respite services involve temporary
				  residential placement outside the usual living situation. Community-based
				  respite services involve introducing respite staff into the usual living
				  situation or providing a place for the individual to go during the day or other
				  services considered to provide respite.
(6) Crisis services--Services, including
				  crisis hotline, crisis intervention, and crisis respite.
(7) Intensive outpatient service--An
				  organized nonresidential service providing structured group and individual
				  therapy, educational services, and life-skills training for less than 24 hours
				  per day.
(8) Medication
				  administration--A service provided to an individual by a licensed nurse or
				  other appropriately trained and certified person under the supervision of a
				  physician or registered nurse as provided by state law to ensure the direct
				  application of a medication to the body of the individual by any means
				  including handing the individual a single dose of medication to be taken
				  orally.
(9) Medication
				  monitoring--A service provided to an individual, family member, or other
				  collateral by a licensed nurse or other appropriately trained and certified
				  person under the supervision of a physician or registered nurse as provided by
				  state law for the purpose of assessment of medication actions, target symptoms,
				  side effects and adverse effects, potential toxicity, and the impact of
				  medication for the individual and family in compliance with the plan of
				  care.
(10) Medication training--A
				  service to an individual, family member, or other collateral by a licensed
				  nurse or other appropriately trained professional or paraprofessional as
				  provided by state law for the purpose of teaching the knowledge and skills
				  needed by the individual, family member, or other collateral in the proper
				  administration and monitoring of prescribed medication in compliance with the
				  individual's plan of care.
(11)
				  Medication-related services--Services, including medication administration,
				  medication monitoring, medication training, and pharmacological
				  management.
(12) Partial
				  hospitalization--The provision of treatment for mental health care or chemical
				  dependency for individuals who require care or support or both in a hospital or
				  chemical dependency treatment center but who do not require 24-hour
				  supervision.
(13) Pharmacological
				  management--Service provided to an individual, family member, or collateral by
				  a physician or other appropriately trained and certified professional as
				  provided by state law for the purpose of determining symptom remission and the
				  medication regimen needed to initiate or maintain an individual's plan of
				  care.
(14) Screening--Gathering
				  triage information necessary to determine a need for in-depth assessment. This
				  information is collected through interview, in person or by phone, with the
				  individual, family member, or collateral as part of the admission or intake
				  process or as necessary.
(15)
				  Treatment planning--Activities for the purpose of medically necessary,
				  prioritized, comprehensive, collaborative, and measurable treatment that
				  reflects the needs and wishes of the individual and builds on the strengths of
				  the individual.