Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter W - COVERAGE FOR ACQUIRED BRAIN INJURY › Section 21.3102 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this
					 subchapter, have the following meanings, unless the context clearly indicates
					 otherwise:
(1) Acquired brain
				  injury--A neurological insult to the brain that is not hereditary, congenital,
				  or degenerative. The injury to the brain has occurred after birth and results
				  in a change in neuronal activity, which results in an impairment of physical
				  functioning, sensory processing, cognition, or psychosocial behavior.
(2) Cognitive communication therapy--Services
				  designed to address modalities of comprehension and expression, including
				  understanding, reading, writing, and verbal expression of
				  information.
(3) Cognitive
				  rehabilitation therapy--Services designed to address therapeutic cognitive
				  activities, based on an assessment and understanding of the individual's
				  brain-behavioral deficits.
(4)
				  Community reintegration services--Services that facilitate the continuum of
				  care as an affected individual transitions into the community.
(5) Enrollee--A person covered by a health
				  benefit plan.
(6) Health benefit
				  plan--As described in Insurance Code §
										1352.001
				  and §
										1352.002.
(7) Issuer--Those entities identified in
				  Insurance Code §
										1352.001.
(8) Neurobehavioral testing--An evaluation of
				  the history of neurological and psychiatric difficulty, current symptoms,
				  current mental status, and premorbid history, including the identification of
				  problematic behavior and the relationship between behavior and the variables
				  that control behavior. This may include interviews of the individual, family,
				  or others.
(9) Neurobehavioral
				  treatment--Interventions that focus on behavior and the variables that control
				  behavior.
(10) Neurocognitive
				  rehabilitation--Services designed to assist cognitively impaired individuals to
				  compensate for deficits in cognitive functioning by rebuilding cognitive skills
				  and/or developing compensatory strategies and techniques.
(11) Neurocognitive therapy--Services
				  designed to address neurological deficits in informational processing and to
				  facilitate the development of higher level cognitive abilities.
(12) Neurofeedback therapy--Services that
				  utilize operant conditioning learning procedures based on
				  electroencephalography (EEG) parameters, and are designed to result in improved
				  mental performance and behavior, and stabilized mood.
(13) Neurophysiological testing--An
				  evaluation of the functions of the nervous system.
(14) Neurophysiological
				  treatment--Interventions that focus on the functions of the nervous
				  system.
(15) Neuropsychological
				  testing--The administering of a comprehensive battery of tests to evaluate
				  neurocognitive, behavioral, and emotional strengths and weaknesses and their
				  relationship to normal and abnormal central nervous system
				  functioning.
(16)
				  Neuropsychological treatment--Interventions designed to improve or minimize
				  deficits in behavioral and cognitive processes.
(17) Outpatient day treatment
				  services--Structured services provided to address deficits in physiological,
				  behavioral, and/or cognitive functions. Such services may be delivered in
				  settings that include transitional residential, community integration, or
				  nonresidential treatment settings.
(18) Post-acute-care treatment
				  services--Services provided after acute-care confinement and/or treatment that
				  are based on an assessment of the individual's physical, behavioral, or
				  cognitive functional deficits, which include a treatment goal of achieving
				  functional changes by reinforcing, strengthening, or reestablishing previously
				  learned patterns of behavior and/or establishing new patterns of cognitive
				  activity or compensatory mechanisms.
(19) Postacute transition services--Services
				  that facilitate the continuum of care beyond the initial neurological insult
				  through rehabilitation and community reintegration.
(20) Psychophysiological testing--An
				  evaluation of the interrelationships between the nervous system and other
				  bodily organs and behavior.
(21)
				  Psychophysiological treatment--Interventions designed to alleviate or decrease
				  abnormal physiological responses of the nervous system due to behavioral or
				  emotional factors.
(22)
				  Remediation--The process or processes of restoring or improving a specific
				  function.
(23) Services--The work
				  of testing, treatment, and providing therapies to an individual with an
				  acquired brain injury.
(24)
				  Therapy--The scheduled remedial treatment provided through direct interaction
				  with the individual to improve a pathological condition resulting from an
				  acquired brain injury.