SECTION 266.101. Definitions

The following words and terms, when used in this chapter, shall have the following meanings, unless the context clearly indicates otherwise. Individual subchapters may have definitions that are specific to the subchapter.

(1) APRN--Advanced practice registered nurse. A registered nurse licensed under Texas Occupations Code Chapter 301 to practice as an advanced practice registered nurse.

(2) Attending physician--A person who:

(A) is any of the following:

(i) a doctor of medicine or osteopathy legally authorized to practice medicine and surgery by the State in which he or she performs that function or action;

(ii) an APRN who meets the training, education, and experience requirements as described in 42 CFR §410.75(b); or

(iii) a physician assistant who meets the requirements in 42 CFR §410.74(c); and

(B) is identified by the individual, at the time he or she elects to receive hospice care, as having the most significant role in the determination and delivery of the individual's medical care.

(3) Cap year--The 12-month period ending September 30 used in the application of the caps on hospice reimbursement specified in §266.217 of this chapter (relating to Medicaid Hospice Payments and Limitations).

(4) CFR--Code of Federal Regulations.

(5) CHC--Continuous home care. A category of care provided during a period of crisis consisting primarily of skilled nursing care.

(6) CMS--Centers for Medicare and Medicaid Services. The federal agency that provides funding and oversight for the Medicare and Medicaid programs.

(7) Crisis--A sudden or severe intensification of symptoms that appropriate medical intervention and nursing services could reasonably be expected to ameliorate. Expected fluctuations in an individual's condition related to the end of life process are not a crisis.

(8) Curative--Designed to restore a person to health.

(9) Employee--An employee, as defined in the Social Security Act §210(j) (42 U.S.C. §410), of the hospice or, if the hospice is a subdivision of an agency or organization, an employee of the agency or organization who is appropriately trained and assigned to the hospice unit. The term "employee" also refers to a volunteer under the jurisdiction of the hospice.

(10) HHSC--Texas Health and Human Services Commission.

(11) ICF/IID--Intermediate care facility for individuals with an intellectual disability or related conditions.

(12) IDT--Interdisciplinary team. An interdisciplinary team must include persons who are qualified and competent to practice in the following professional roles:

(A) physician who is an employee or under contract with the hospice who may also be the hospice medical director or the hospice medical director's designee;

(B) an APRN who:

(i) is an employee or under contract with the hospice; and

(ii) may perform the assessment described in §266.203(d) of this chapter (relating to Certification of Terminal Illness);

(C) a registered nurse;

(D) a social worker; and

(E) a pastoral or other counselor.

(13) Licensed vocational nurse--A nurse licensed under Texas Occupations Code Chapter 301 to practice vocational nursing.

(14) Period of crisis--A period of time during which an individual requires continuous care that is primarily skilled nursing care to achieve palliation or management of acute medical symptoms.

(15) Physician--A doctor of medicine or doctor of osteopathy currently licensed by the Texas Medical Board to practice medicine or osteopathy at the time and place the service is provided.

(16) Physician Assistant--An individual who is licensed as a physician assistant under Texas Occupations Code Chapter 204.

(17) Representative--An individual who has been authorized under state law to terminate medical care or to elect or revoke the election of hospice care on behalf of a terminally ill individual who is mentally or physically incapacitated.

(18) RN--Registered nurse. An individual licensed under Texas Occupations Code Chapter 301 to practice professional nursing.

(19) SIA--Service intensity add-on. Payments for direct patient care provided by a social worker or an RN during the last seven days of life when provided during routine home care.

(20) Skilled nursing care--Tasks that are determined by the assessing RN to require the skill of a licensed nurse when considering the inherent complexity of the task, the condition of the individual, and the accepted standards of medical and nursing practice.

(21) Social worker--A person who is currently licensed as a social worker under Texas Occupations Code Chapter 505.

(22) TAC--Texas Administrative Code.

(23) Terminally ill--The individual has a medical prognosis that his or her life expectancy is six months or less if the illness runs its normal course.

(24) TMHP--Texas Medicaid & Healthcare Partnership. The Texas Medicaid program claims administrator.

(25) Utilization review--Medical record review of paid hospice claims to determine if provider compliance meets the requirements for payment of services.

Source Note: The provisions of this §266.101 adopted to be effective July 26, 2022, 47 TexReg 4331