SECTION 551.3. Definitions

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

(1) Active treatment--A continuous program, which includes aggressive, consistent implementation of specialized and generic training, treatment, health services, and related services, that is directed toward:

(A) acquisition of the behaviors necessary for the resident to function with as much self-determination and independence as possible; and

(B) prevention or deceleration of regression or loss of current optimal functional status.

(2) Actual harm--A negative outcome that compromises a resident's physical, mental, or emotional well-being.

(3) Addition--The addition of floor space to a facility.

(4) Administrator--The administrator of a facility.

(5) Administration of medication--Removing a unit or dose of medication from a previously dispensed, properly labeled container; verifying the medication with the medication order; giving the proper medication in the proper dosage to the proper resident at the proper time by the proper administration route; and recording the time of administration and dosage administered.

(6) Advanced practice nurse--A person licensed to practice professional nursing in accordance with Texas Occupations Code, Chapter 301, and authorized by the Texas Board of Nursing to practice as an advanced practice nurse.

(7) Applicant--A person applying for a license under Texas Health and Safety Code, Chapter 252.

(8) Administrative Procedure Act (APA)--Texas Government Code, Chapter 2001.

(9) Behavioral emergency--A situation in which severely aggressive, destructive, violent, or self-injurious behavior exhibited by a resident:

(A) poses a substantial risk of imminent probable death of, or substantial bodily harm to, the resident or others;

(B) has not abated in response to attempted preventive de-escalatory or redirection techniques;

(C) is not addressed in a behavior therapy program; and

(D) does not occur during a medical or dental procedure.

(10) Care and treatment--Services required to maximize resident independence, personal choice, participation, health, self-care, psychosocial functioning, and provide reasonable safety, all consistent with the preferences of the resident.

(11) CDC--Centers for Disease Control and Prevention.

(12) Change of ownership--An event that results in a change to the federal taxpayer identification number of the license holder of a facility. The substitution of a personal representative for a deceased license holder is not a change of ownership.

(13) CFR--Code of Federal Regulations.

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

(15) Communicable disease--An illness due to an infectious agent or its toxic products that is transmitted directly to a well person from an infected person or animal, or indirectly through an intermediate plant or animal host, vector, or the inanimate environment.

(16) Controlled substance--A drug, substance, or immediate precursor as defined in the Texas Controlled Substances Act, Texas Health and Safety Code, Chapter 481, as amended, or the Federal Controlled Substances Act, United States Code, Title 21, Chapter 13, as amended.

(17) Controlling person of an applicant, license holder, or facility--A person who, acting alone or with others, has the ability to directly or indirectly influence or direct the management, expenditure of money, or policies of an applicant or license holder or of a facility owned by an applicant or license holder.

(A) The term includes:

(i) a spouse of the applicant or license holder;

(ii) an officer or director, if the applicant or license holder is a corporation;

(iii) a partner, if the applicant or license holder is a partnership;

(iv) a trustee or trust manager, if the applicant or license holder is a trust;

(v) a person who operates or contracts with others to operate the facility;

(vi) a person who, because of a personal, familial, or other relationship is in a position of actual control or authority over the facility, without regard to whether the person is formally named as an owner, manager, director, officer, provider, consultant, contractor, or employee of the facility; and

(vii) a person who would be a controlling person of an entity described in clauses (i) - (vi) of this subparagraph, if that entity were the applicant or license holder.

(B) The term does not include an employee, lender, secured creditor, or other person who does not exercise formal or actual influence or control over the operation of a facility.

(18) CPR--cardiopulmonary resuscitation.

(19) Dangerous drug--Any drug as defined in the Texas Dangerous Drug Act, Texas Health and Safety Code, Chapter 483.

(20) Designee--A state agency or entity with which HHSC contracts to perform specific, identified duties related to the fulfillment of a responsibility prescribed by this chapter.

(21) DFPS--Texas Department of Family and Protective Services.

(22) Direct ownership interest--Ownership of equity in the capital, stock, or profits of, or a membership interest in, an applicant or license holder.

(23) Disclosable interest--Five percent or more direct or indirect ownership interest in an applicant or license holder.

(24) Drug (also referred to as medication)--A drug is:

(A) any substance recognized as a drug in the official United States Pharmacopeia, official Homeopathic Pharmacopeia of the United States, or official National Formulary, or any supplement to any of them;

(B) any substance intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease in a person;

(C) any substance (other than food) intended to affect the structure or any function of the human body; or

(D) any substance intended for use as a component of any substance specified in subparagraphs (A) - (C) of this paragraph. It does not include devices or their components, parts, or accessories.

(25) DSHS--Texas Department of State Health Services.

(26) EMC--Emergency Management Coordinator.

(27) EPC--Emergency Preparedness Coordinator.

(28) Emergency situation--an impending or actual situation that:

(A) may interfere with normal activities of a facility or its residents;

(B) may cause:

(i) injury or death to a resident or staff member of the facility; or

(ii) damage to facility property;

(C) requires the facility to respond immediately to mitigate or avoid injury, death, damage, or interference; and

(D) does not include a situation that arises from the medical condition of a resident such as cardiac arrest, obstructed airway, or cerebrovascular accident.

(29) EMR--Employee Misconduct Registry.

(30) Establishment--A place of business or a place where business is conducted which includes staff, fixtures, and property.

(31) Facility--A facility serving persons with an intellectual disability or related conditions licensed under this chapter as described in §551.2 of this chapter (relating to Scope) and required to be licensed under Texas Health and Safety Code, Chapter 252, or the entity that operates such a facility; or, in Subchapters C, D, and F of this chapter, a program provider that must comply with those subchapters in accordance with §261.212 of this title (relating to Non-licensed Providers Meeting Licensure Standards).

(32) Governmental unit--A state or a political subdivision of the state, including a county or municipality.

(33) Guardian--A person who is appointed guardian under Texas Estates Code, Chapter 1101.

(34) Health authority--A physician designated to administer state and local laws relating to public health under the Local Public Health Reorganization Act, Texas Health and Safety Code, Chapter 121. The health authority may be:

(A) a local health authority appointed by the local government jurisdiction; or

(B) a regional director of DSHS if no physician has been appointed by the local government.

(35) Health care professional--A person licensed, certified, or otherwise authorized to administer health care, for profit or otherwise. The term includes a physician, licensed nurse, physician assistant, podiatrist, dentist, physical therapist, speech therapist, and occupational therapist.

(36) Hearing--A contested case hearing held in accordance with the APA and the formal hearing procedures in 1 TAC Chapter 357, Subchapter I(relating to Hearings Under the Administrative Procedure Act).

(37) HHSC--The Texas Health and Human Services Commission.

(38) HVAC--Heating, ventilating, and air-conditioning system.

(39) ICF/IID--An Intermediate Care Facility for Individuals with an Intellectual Disability or Related Conditions.

(40) IDT--Interdisciplinary Team.

(41) Immediate jeopardy to health and safety of a resident--A situation in which immediate corrective action is necessary because the facility's noncompliance with one or more federal requirements has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident receiving care in the certified facility.

(42) Immediate threat to the health or safety of a resident--A situation that causes, or is likely to cause, serious injury, harm, or impairment or death of a resident because of the facility's noncompliance with one or more licensure requirements.

(43) Incident--An unusual or abnormal event or occurrence in, at, or affecting the facility or the residents of the facility.

(44) Indirect ownership interest--Any ownership or membership interest in a person who has a direct ownership interest in an applicant or license holder.

(45) Inspection--Any on-site visit to or survey of a facility by HHSC for the purpose of inspection of care, licensing, monitoring, complaint investigation, architectural review, or similar purpose.

(46) Individual program plan (IPP)--A plan developed by the interdisciplinary team of a facility resident that identifies the resident's training, treatment, and habilitation needs, and describes programs and services to meet those needs.

(47) Isolated--A situation in which a very limited number of residents are affected and a very limited number of staff are involved, or the situation has occurred only occasionally.

(48) Key infectious agents--Bacteria, viruses, and other microorganisms that cause the most common infections and infectious diseases in long-term care facilities, according to the CDC, and can be prevented by establishing, implementing, maintaining, and enforcing proper infection prevention and control policies and procedures.

(49) Legally authorized representative (LAR)--A person authorized by law to act on behalf of a person regarding a matter described in this chapter, and may include a parent, guardian, or managing conservator of a minor, or the guardian of an adult.

(50) Large facility--A facility with a capacity of 17 or more residents.

(51) License--Approval from HHSC to establish or operate a facility.

(52) License holder--A person who holds a license to operate a facility.

(53) Licensed nurse--A licensed vocational nurse, registered nurse, or advanced practice nurse.

(54) LIDDA--Local intellectual and developmental disability authority.

(55) Life Safety Code--NFPA 101.

(56) Life safety features--Fire safety components required by the Life Safety Code such as building construction, fire alarm systems, smoke detection systems, interior finishes, sizes and thicknesses of doors, exits, emergency electrical systems, and sprinkler systems.

(57) Local authorities--A local health authority, fire marshal, building inspector, etc., who may be authorized by state law, county order, or municipal ordinance to perform certain inspections or certifications.

(58) Local health authority--The physician having local jurisdiction to administer state and local laws or ordinances relating to public health, as described in the Texas Health and Safety Code, Chapter 121, Subchapter B.

(59) Licensed vocational nurse(LVN)--A person licensed to practice vocational nursing in accordance with Texas Occupations Code, Chapter 301.

(60) Metered dose inhaler--A device that delivers a measured amount of medication as a mist that can be inhaled.

(61) Multidrug-resistant organisms--Bacteria and other microorganisms that have developed resistance to multiple types of medicine used to act against the microorganism.

(62) NAR--Nurse Aide Registry.

(63) NFPA--The National Fire Protection Association. If the term is immediately followed by a number, it is a reference to a publication of NFPA, as referenced in NFPA 101.

(64) NFPA 10--NFPA 10, Standard for Portable Fire Extinguishers, 2010 Edition.

(65) NFPA 13--NFPA 13, Standard for the Installation of Sprinkler Systems, 2010 Edition.

(66) NFPA 13D--NFPA 13D, Standard for the Installation of Sprinkler Systems in One- and Two-Family Dwellings and Manufactured Homes, 2010 Edition.

(67) NFPA 13R--NFPA 13R, Standard for the Installation of Sprinkler Systems in Residential Occupancies up to and Including Four Stories in Height, 2010 Edition.

(68) NFPA 25--NFPA 25, Standard for the Inspection, Testing, and Maintenance of Water-Based Fire Protection Systems, 2011 Edition.

(69) NFPA 37--NFPA 37, Standard for the Installation and Use of Stationary Combustion Engines and Gas Turbines, 2010 Edition.

(70) NFPA 70--NFPA 70, National Electrical Code, 2011 Edition.

(71) NFPA 72--NFPA 72, National Fire Alarm and Signaling Code, 2010 Edition.

(72) NFPA 90A--NFPA 90A, Standard for the Installation of Air-Conditioning and Ventilating Systems, 2012 Edition.

(73) NFPA 90B--NFPA 90B, Standard for the Installation of Warm Air Heating and Air-Conditioning Systems, 2012 Edition.

(74) NFPA 99--NFPA 99, Health Care Facilities Code, 2012 Edition. A publication of the NFPA that provides minimum requirements for the installation, testing, maintenance, performance, and safe practices for health care facilities and for material, equipment, and appliances, used for patient care in health care facilities. CMS has incorporated NFPA 99, 2012 Edition, except Chapters 7, 8, 12, and 13, by reference as a Condition of Participation in the ICF/IID program for facilities that meet the definition of a health care occupancy. Copies of NFPA 99 may be obtained from NFPA, 1 Batterymarch Park, Quincy, MA 02169.

(75) NFPA 101--NFPA 101, Life Safety Code, 2012 Edition. A publication of the NFPA that provides minimum requirements, with due regard to function, for the design, operation, and maintenance of buildings and structures for safety to life from fire. CMS has incorporated NFPA 101, 2012 Edition, by reference as a Condition of Participation in the ICF/IID program. Copies of NFPA 101 may be obtained from NFPA, 1 Batterymarch Park, Quincy, MA 02169.

(76) NFPA 101A--NFPA 101A, Guide on Alternative Approaches to Life Safety, 2013 Edition.

(77) NFPA 220--NFPA 220, Standard on Types of Building Construction, 2012 Edition.

(78) NFPA 701--NFPA 701, Standard Methods of Fire Tests for Flame Propagation of Textiles and Films, 2010 Edition.

(79) Online Portal--Texas Unified Licensure Information Portal (TULIP).

(80) Oral medication--Medication administered by way or through the mouth, not including sublingual or buccal.

(81) Pattern of violation--Repeated, but not widespread in scope, failures of a facility to comply with Texas Health and Safety Code, Chapter 252, or a rule, standard or order adopted under Chapter 252 that:

(A) result in a violation; and

(B) are found throughout the services provided by the facility or that affect or involve the same residents or facility employees.

(82) Person--An individual, firm, partnership, corporation, association, or joint stock company, and any legal successor of those entities.

(83) Personal hold--

(A) A manual method, except for physical guidance or prompting of brief duration, used to restrict:

(i) free movement or normal functioning of all or a portion of a resident's body; or

(ii) normal access by a resident to a portion of the resident's body.

(B) Physical guidance or prompting of brief duration becomes a restraint if the resident resists the guidance or prompting.

(84) Potential for minimal harm--A violation that has the potential for causing no more than a minor negative impact on a resident.

(85) Potential for more than minimal harm--A violation that results in more than minimal physical, mental, or psychological discomfort to the resident or has the potential to compromise the resident's ability to reach and maintain the highest practicable physical, mental, and psychosocial well-being as defined for the resident.

(86) Qualified intellectual disability professional (QIDP)--A person who has at least one year of experience working directly with persons with an intellectual disability or related conditions and is one of the following:

(A) a doctor of medicine or osteopathy;

(B) a registered nurse; or

(C) an individual who holds at least a bachelor's degree in one of the following areas:

(i) occupational therapy;

(ii) physical therapy;

(iii) social work;

(iv) speech-language pathology or audiology;

(v) recreation or a specialty area such as art, dance, music or physical education;

(vi) dietetics; or

(vii) human services, such as sociology, special education, rehabilitation counseling, or psychology (as specified in 42 CFR §483.430(b)(5)(x).

(87) Rapid influenza diagnostic test--A test administered to a person with flu-like symptoms that can detect the influenza viral nucleoprotein antigen.

(88) Receiving facility--A facility that has agreed to receive the residents of another facility who are evacuated due to an emergency.

(89) Relocation--The new physical location of a facility.

(90) Remodeling--The construction, removal, or relocation of walls and partitions, or construction of foundations, floors, or ceiling-roof assemblies, including expanding of safety systems (e.g.., sprinkler systems, fire alarm systems), that will change the existing plan and use areas of the facility.

(91) Renovation--The restoration to a former better state by cleaning, repairing, or rebuilding (e.g., routine maintenance, repairs, equipment replacement, painting).

(92) Resident--A person who resides in a facility.

(93) Restraint--A manual method, or a physical or mechanical device, material, or equipment, attached or adjacent to the resident's body that the resident cannot remove easily, that restricts freedom of movement or normal access to the resident's body. This term includes a personal hold.

(94) Registered nurse(RN)--A person licensed to practice professional nursing in accordance with Texas Occupations Code, Chapter 301.

(95) Seclusion--The involuntary separation of a resident away from other residents and the placement of the resident alone in an area from which the resident is prevented from leaving.

(96) Small facility--A facility with a capacity of 16 or fewer residents.

(97) Staff--Employee of an ICF/IID or a contracted staff working with residents living in an ICF/IID.

(98) Standards--The minimum conditions, requirements, and criteria with which a facility will have to comply to be licensed under this chapter.

(99) TIA--Tentative Interim Amendment.

(100) TAC--Texas Administrative Code.

(101) Topical medication--Medication applied to the skin, not including medication administered in the eyes.

(102) Universal precautions--The use of barrier precautions by facility staff to prevent direct contact with blood or other body fluids that are visibly contaminated with blood.

(103) Vaccine preventable diseases--The diseases included in the most current recommendations of the Advisory Committee on Immunization Practices of the CDC.

(104) Violation--Any noncompliance with Texas Health and Safety Code, Chapter 252, or any rule under this chapter.

(105) Well-recognized church or religious denomination--An organization which has been granted a tax-exempt status as a religious association from the state or federal government.

(106) Widespread in scope--A violation that:

(A) is pervasive throughout the services provided by the facility; or

(B) that affects or has the potential to affect a large portion of or all the residents of the facility.

Source Note: The provisions of this §551.3 adopted to be effective August 31, 1993, 18 TexReg 2557; transferred effective September 1, 1993, as published in the Texas Register September 3, 1993, 18 TexReg 5885; amended to be effective May 1, 1995, 20 TexReg 1659; amended to be effective May 1, 1998, 23 TexReg 4060; amended to be effective July 1, 2002, 27 TexReg 5525; amended to be effective June 1, 2006, 31 TexReg 4463; amended to be effective September 1, 2010, 35 TexReg 7876; amended to be effective June 1, 2012, 37 TexReg 3871; amended to be effective June 17, 2013, 38 TexReg 3806; amended tobeeffective April 27, 2016, 41 TexReg 2971; amended to be effective October 11, 2017, 42 TexReg 5505; amended to be effective October 28, 2018, 43 TexReg 7191; transferred effective May 1, 2019, as published in the Texas Register April 12, 2019, 44 TexReg 1883; amended to be effective February 24, 2022, 47 TexReg 787