SECTION 354.1361. Definitions

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 42 CFR §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, §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.

(28) STAR+PLUS--The managed care program that operates under a federal waiver and primarily provides, arranges, and coordinates preventive, primary, acute care, and long-term services and supports to persons with disabilities and elderly persons age 65 and over who qualify for Medicaid by virtue of their SSI or MAO status.

(29) STAR+PLUS home and community-based services (HCBS)--The program that provides person-centered care services that are delivered in the home or in a community setting, as authorized through a federal waiver under §1115 of the Social Security Act, to qualified clients who are 65 years of age or older, are blind, or have a disability, as cost-effective alternatives to institutional care in nursing facilities.

(30) Supplemental Security Income (SSI)--The federal cash assistance program of direct financial payments to people who are 65 years of age or older, are blind, or have a disability administered by the Social Security Administration (SSA) under Title XVI of the Social Security Act.

(31) Texas Home Living (TxHmL)--The Texas Home Living Program operated by DADS as authorized by the Centers for Medicare & Medicaid Services in accordance with §1915(c) of the Social Security Act.

Source Note: The provisions of this §354.1361 adopted to be effective June 1, 2015, 40 TexReg 2746; amended to be effective June 2, 2016, 41 TexReg 3905