SECTION 331.5. Definitions

The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:

(1) Actively involved person--For an individual who lacks the ability to provide legally adequate consent and who does not have a legally authorized representative (LAR), a person whose significant and ongoing involvement with the individual is determined by the individual's designated MRA to be supportive of the individual based on the person's:

(A) observed interactions with the individual;

(B) knowledge of and sensitivity to the individual's preferences, values, and beliefs;

(C) availability to the individual for assistance or support; and

(D) advocacy for the individual's preferences, values, and beliefs.

(2) CARE--DADS Client Assignment and Registration System.

(3) CFC services--Community First Choice services. State plan services described in 1 Texas Administrative Code (TAC) Chapter 354, Subchapter A, Division 27 (relating to Community First Choice).

(4) DADS--The Department of Aging and Disability Services.

(5) Department--The Department of Aging and Disability Services.

(6) Designated LIDDA--As identified in DADS data system, the LIDDA responsible for assisting an individual and LAR or actively involved person to access services and supports.

(7) Designated MRA--Designated LIDDA.

(8) Duration--The specified period of time during which service coordination is provided to an individual.

(9) Frequency--The minimum number of times during a specified period that an individual is to be contacted by a service coordinator based on the individual's need for contacts as determined by person-directed planning.

(10) General revenue--Funds appropriated by the Texas Legislature for use by DADS.

(11) HCS Program--The Home and Community-based Services Program. A program operated by DADS as authorized by the Centers for Medicare and Medicaid Services in accordance with §1915(c) of the Social Security Act.

(12) ICF/IID--Intermediate care facility for individuals with an intellectual disability or related conditions. An ICF/IID is a facility in which ICF/IID Program services are provided.

(13) ICF/IID level-of-care--A level-of-care described in §9.238 of this title (relating to ICF/MR Level of Care I Criteria) or §9.239 of this title (relating to ICF/MR Level of Care VIII Criteria).

(14) ICF/IID Program--The Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions Program. A program operated by DADS that provides Medicaid-funded residential services to individuals with an intellectual disability or related conditions, as described in §1905(d) of the Social Security Act.

(15) ICF/MR--ICF/IID.

(16) ICF/MR Program--ICF/IID Program.

(17) Individual--A person who is or is believed to be a member of the LIDDA priority population.

(18) Institution--One of the following:

(A) an ICF/IID;

(B) a nursing facility;

(C) an assisted living facility licensed or subject to being licensed in accordance with THSC, Chapter 247;

(D) a residential child-care operation licensed or subject to being licensed by the Department of Family and Protective Services unless it is a foster family home or a foster group home;

(E) a facility licensed or subject to being licensed by the Department of State Health Services;

(F) a facility operated by the Department of Assistive and Rehabilitative Services; or

(G) a prison.

(19) Institution for mental diseases (IMD)--As defined in 25 TAC §419.373, a hospital of more than 16 beds that is primarily engaged in providing psychiatric diagnosis, treatment, and care of individuals with mental diseases, including medical care, nursing care, and related services.

(20) Intellectual disability--Consistent with Texas Health and Safety Code (THSC), §591.003, significantly subaverage general intellectual functioning existing concurrently with deficits in adaptive behavior and manifested during the developmental period.

(21) LAR (legally authorized representative)--A person authorized by law to act on behalf of an individual with regard to a matter described in this subchapter, and who may be a parent, guardian, or managing conservator of a child, or the guardian of an adult.

(22) LIDDA--Local intellectual and developmental disability authority. An entity designated by the executive commissioner of the Texas Health and Human Services Commission in accordance with THSC, §533A.035.

(23) LIDDA priority population--A population as defined in §5.153 of this title (relating to Definitions).

(24) Local service area--A geographic area composed of one or more Texas counties.

(25) MCO--Managed care organization. This term has the meaning set forth in Texas Government Code, §536.001.

(26) Mental retardation--Intellectual disability.

(27) Mental retardation priority population or MR priority population--LIDDA priority population.

(28) MRA (mental retardation authority)--LIDDA.

(29) Parent Case Management Program--A program that utilizes experienced, trained parents of individuals with disabilities to provide case management for other families.

(30) Partners in Policy Making--A leadership training program administered by the Texas Planning Council for Developmental Disabilities for self-advocates and parents.

(31) Permanency planning--A philosophy and planning process that focuses on the outcome of family support for an individual under 22 years of age by facilitating a permanent living arrangement in which the primary feature is an enduring and nurturing parental relationship.

(32) Person-directed planning--A philosophy and planning process that empowers an individual and, on the individual's behalf, an LAR or actively involved person, to direct the development of a plan of services and supports.

(33) Plan of services and supports--A written plan that:

(A) describes the desired outcomes identified by the individual, or LAR or actively involved person on behalf of the individual;

(B) describes the services and supports to be provided to the individual, including service coordination; and

(C) identifies the frequency, in accordance with §2.556(d)(1) of this subchapter (relating to LIDDA's Responsibilities), and duration of service coordination to be provided to the individual.

(34) Related condition--Consistent with Code of Federal Regulations, Title 42, §435.1010, a severe and chronic disability that:

(A) is attributable to:

(i) cerebral palsy or epilepsy; or

(ii) any other condition, other than mental illness, found to be closely related to an intellectual disability because the condition results in impairment of general intellectual functioning or adaptive behavior similar to that of persons with an intellectual disability, and requires treatment or services similar to those required for those persons with an intellectual disability;

(B) is manifested before the person reaches 22 years of age;

(C) is likely to continue indefinitely; and

(D) results in substantial functional limitation in three or more of the following areas of major life activity:

(i) self-care;

(ii) understanding and use of language;

(iii) learning;

(iv) mobility;

(v) self-direction; and

(vi) capacity for independent living.

(35) Relative--A person related to the individual within the fourth degree of consanguinity or within the second degree of affinity.

(36) Service coordination--Assistance in accessing medical, social, educational, and other appropriate services and supports that will help an individual achieve a quality of life and community participation acceptable to the individual (and LAR on the individual's behalf) as follows:

(A) crisis prevention and management--linking and assisting the individual and LAR or actively involved person to secure services and supports that will enable them to prevent or manage a crisis;

(B) monitoring--ensuring that the individual receives needed services, evaluating the effectiveness and adequacy of services, and determining if identified outcomes are meeting the individual's needs and desires as indicated by the individual and LAR or actively involved person;

(C) assessment--identifying the individual's needs and the services and supports that address those needs as they relate to the nature of the individual's presenting problem and disability; and

(D) service planning and coordination--identifying, arranging, advocating, collaborating with other agencies, and linking for the delivery of outcome-focused services and supports that address the individual's needs and desires as indicated by the individual and LAR or actively involved person.

(37) State MH facility (state mental health facility)--A state hospital or state center with an inpatient psychiatric component operated by the Department of State Health Services.

(38) State supported living center--A state-supported and structured residential facility that is an ICF/IID operated by DADS to provide persons with an intellectual disability a variety of services, including medical treatment, specialized therapy, and training in the acquisition of personal, social, and vocational skills, but does not include a community-based facility owned by DADS.

(39) Subaverage general intellectual functioning--Consistent with THSC, §591.003, measured intelligence on standardized general intelligence tests of two or more standard deviations (not including standard error of measurement adjustments) below the age-group mean for the tests used.

(40) THSC--Texas Health and Safety Code.

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

Source Note: The provisions of this §331.5 adopted to be effective August 31, 2004, 29 TexReg 8313; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; amended to be effective August 1, 2005, 30 TexReg 4334; amended to be effective June 1, 2010, 35 TexReg 4439; amended to be effective March 20, 2016, 41 TexReg 1864; transferred effective July 1, 2022, as published in the Texas Register June 3, 2022, 47 TexReg 3275