SECTION 568.3. Definitions

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

(1) Administrator--The individual, appointed by a governing body, who has authority to represent the hospital and, as delegated by the governing body, has responsibility for operating the hospital in accordance with the hospital's written policies and procedures.

(2) Administrator's designee--An individual designated in a hospital's written policies and procedures to act for a specified purpose on behalf of the administrator.

(3) Admission--The acceptance of an individual to a hospital's custody and care for inpatient mental health treatment based on:

(A) a physician's order issued in accordance with §568.22(f)(2)(B) of this chapter (relating to Voluntary Admission);

(B) a physician's order issued in accordance with §568.23(c)(3) of this chapter (relating to Emergency Detention);

(C) an order of protective custody issued in accordance with Texas Health and Safety Code §574.022;

(D) an order for temporary inpatient mental health services issued in accordance with Texas Health and Safety Code §574.034;

(E) an order for extended inpatient mental health services issued in accordance with Texas Health and Safety Code §574.035;

(F) an order for commitment issued in accordance with Texas Code of Criminal Procedure Chapters 46B or 46C; or

(G) an order for placement in accordance with Texas Family Code Chapter 55.

(4) Adult--An individual 18 years of age.

(5) Business day--Any day except a Saturday, Sunday, or legal holiday listed in Texas Government Code §662.021.

(6) CFR--The Code of Federal Regulations.

(7) Day--Calendar day.

(8) Discharge--The release by a hospital of a patient from the custody and care of the hospital.

(9) DSM--The current edition of the Diagnostic Statistical Manual of Mental Disorders published by the American Psychiatric Association.

(10) Emergency medical condition--A medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain, psychiatric disturbances or symptoms of substance use disorder) such that the absence of immediate medical attention could reasonably be expected to result in:

(A) placing the health of the individual (or with respect to a pregnant woman, the health of the woman or her unborn child) or others in serious jeopardy;

(B) serious impairment to bodily functions;

(C) serious dysfunction of any bodily organ or part;

(D) serious disfigurement; or

(E) in the case of a pregnant woman who is having contractions:

(i) that there is inadequate time to effect a safe transfer to another hospital before delivery; or

(ii) that transfer may pose a threat to the health or safety of the woman or the unborn child.

(11) Governing body--The governing authority of a hospital that is responsible for the hospital's organization, management, control and operation, including appointment of the administrator.

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

(13) Hospital--

(A) A private psychiatric hospital licensed under Texas Health and Safety Code Chapter 577 (relating to Private Mental Hospitals and Other Mental Health Facilities) and Chapter 510 of this title (relating to Private Psychiatric Hospitals and Crisis Stabilization Units); or

(B) an identifiable inpatient mental health services unit in a hospital licensed under Texas Health and Safety Code Chapter 241 (relating to Hospitals) and 25 TAC Chapter 133 (relating to Hospital Licensing).

(14) Interdisciplinary treatment team (IDT)--A group of individuals who possess the knowledge, skills and expertise to develop and implement a patient's treatment plan and includes:

(A) the patient's treating physician;

(B) the patient and the patient's legally authorized representative (LAR), if any;

(C) the staff members identified in the treatment plan as responsible for providing or ensuring the provision of each treatment in accordance with §568.61(c)(1)(E)(iii) of this chapter (relating to Inpatient Mental Health Treatment and Treatment Planning);

(D) any individual identified by the patient or the patient's LAR, unless clinically contraindicated; and

(E) other staff members as clinically appropriate.

(15) Inpatient mental health treatment--Residential care provided in a hospital for a patient with a mental illness diagnosis, which may include a co-occuring diagnosis of a substance use, neurodevelopmental disorder, or both, which includes:

(A) medical services;

(B) nursing services;

(C) social services;

(D) therapeutic activities, if ordered by the treating physician; and

(E) psychological services, if ordered by the treating physician.

(16) Involuntary patient--A patient who is receiving inpatient mental health treatment based on an admission made in accordance with:

(A) §568.23 of this chapter (relating to Emergency Detention); or

(B) §568.24 of this chapter (relating to Admission of an Individual under an Order of Protective Custody, for Court-ordered Inpatient Mental Health Services, or Under Order for Commitment or Order for Placement).

(17) Legally authorized representative (LAR)-- A parent, guardian, or managing conservator of a minor, or the guardian of an adult authorized by law to act on behalf of an individual regarding a matter described in this subchapter regarding:

(A) admission, treatment, transfer, or discharge, including:

(i) a parent, non-Department of Family and Protective Services managing conservator or guardian of minor;

(ii) a Department of Family and Protective Service managing conservator of a minor acting pursuant to Texas Health and Safety Code §572.001(c-2)-(c-4); and

(iii) a person eligible to consent to treatment for a minor under Texas Family Code §32.001(a)(1), (2), or (3), who may request from a district court authorization under Texas Family Code Chapter 35A for the temporary admission of a minor who has been within their care for the past 6 months.

(B) consent on behalf of an individual with regard to a matter described in this subchapter other than admission, treatment, transfer, or discharge, including:

(i) persons described by subparagraph (A) of this paragraph; and

(ii) an agent acting under a Medical Power of Attorney under Texas Health and Safety Code Chapter 250 or a Declaration for Mental Health Treatment under Texas Civil Practice and Remedies Code Chapter 137.

(18) Legal holiday--A holiday listed in Texas Government Code §662.021 and an officially designated county holiday applicable to a court in which proceedings are held under the Texas Mental Health Code.

(19) Licensed marriage and family therapist--An individual who is licensed as a marriage and family therapist by the Texas Behavioral Health Executive Council in accordance with Texas Occupations Code Chapter 502.

(20) Licensed master social worker--An individual who is licensed as a master social worker by the Texas Behavioral Health Executive Council in accordance with Texas Occupations Code Chapter 505.

(21) Licensed professional counselor--An individual who is licensed as a professional counselor by the Texas Behavioral Health Executive Council in accordance with Texas Occupations Code Chapter 503.

(22) Licensed psychologist--An individual who is licensed as a psychologist by the Texas Behavioral Health Executive Council in accordance with Texas Occupations Code Chapter 501.

(23) Licensed social worker--An individual who is licensed as a social worker by the Texas Behavioral Health Executive Council in accordance with Texas Occupations Code Chapter 505.

(24) Licensed vocational nurse (LVN)--An individual who is licensed as a vocational nurse by the Texas Board of Nursing in accordance with Texas Occupations Code Chapter 301.

(25) Mandatory overtime--The time, other than on-call time, a nursing staff member is required to work at a hospital beyond the hours or days that were scheduled for the staff member. Neither the length of the shift (whether 4, 8, 12, or 16 hours) nor the number of shifts scheduled to work per week (whether 4, 5, or 6 per week) is the determinative factor in deciding whether time is mandatory overtime.

(26) Medical services--Services provided or delegated by a physician acting within the scope of the physician's practice, as described in Texas Occupations Code Title 3, Subtitle B (the Medical Practice Act).

(27) Mental illness--An illness, disease, or condition (other than epilepsy, dementia, substance-related and addictive disorders, or intellectual disability) that:

(A) substantially impairs an individual's thought, perception of reality, emotional process, or judgment; or

(B) grossly impairs an individual's behavior as demonstrated by recent disturbed behavior.

(28) Minor--An individual under 18 years of age.

(29) Monitoring--One or more staff members observing a patient on a continual basis or at pre-determined intervals and intervening when necessary to protect the patient from harming self or others.

(30) Neurological screening--A screening to assess an individual's neurological functioning.

(31) Nosocomial infection--A hospital-acquired infection of a patient.

(32) Nursing services--Services provided by, assigned to an LVN by, or delegated to unlicensed assistive personnel (UAP) by an RN acting within the scope of the RN's practice, as described in Texas Occupations Code Chapter 301.

(33) Nursing staff--Staff members of a hospital who are registered nurses, licensed vocational nurses, or UAP.

(34) Occupational therapist--An individual who is licensed as an occupational therapist by the Texas Board of Occupational Therapy Examiners in accordance with Texas Occupations Code Chapter 454.

(35) Pre-admission screening professional (PASP)--A staff member whose responsibilities include conducting a pre-admission screening and who is:

(A) a physician;

(B) a physician assistant;

(C) a registered nurse;

(D) a licensed psychologist;

(E) a psychological associate;

(F) a licensed social worker;

(G) a licensed professional counselor; or

(H) a licensed marriage and family therapist.

(36) Patient--An individual who has been admitted to a hospital and has not been discharged.

(37) Physician--An individual who is licensed as a physician by the Texas Medical Board in accordance with Texas Occupations Code Chapter 155 or otherwise authorized to perform medical acts under that chapter.

(38) Physician assistant--An individual who is licensed as a physician assistant by the Texas Physician Assistant Board in accordance with Texas Occupations Code Chapter 204.

(39) Pre-admission screening--The clinical process used to gather information from a prospective patient, including a medical history, any history of substance use, and the problem for which the prospective patient is seeking treatment, to determine if a physician should conduct an admission examination.

(40) Prospective patient--An individual:

(A) for whom a request for voluntary admission has been made, in accordance with §568.22(a) of this chapter (relating to Voluntary Admission); or

(B) who has been accepted by a hospital for a preliminary examination, in accordance with §568.23(a) of this chapter (relating to Emergency Detention).

(41) Psychological associate--An individual who is licensed as a psychological associate by the Texas Behavioral Health Executive Council in accordance with Texas Occupations Code Chapter 501.

(42) Psychological services--Services provided by a psychologist or psychological associate acting within the scope of the psychologist's practice, as described in Texas Occupations Code Chapter 501.

(43) Psychologist--An individual who is licensed as a psychologist by the Texas State Behavioral Health Executive Council in accordance with Texas Occupations Code Chapter 501.

(44) Registered nurse (RN)--An individual who is licensed as an RN by the Texas Board of Nursing in accordance with Texas Occupations Code Chapter 301.

(45) Sentinel event--Any of the following occurrences:

(A) the death of a patient;

(B) the serious physical injury of a patient;

(C) the serious psychological injury of a patient; or

(D) circumstances that present the imminent risk of death, serious physical injury, or serious psychological injury of a patient.

(46) Social services--Services provided by:

(A) a licensed master social worker or licensed social worker acting within the scope of the social worker's practice, as described in Texas Occupations Code Chapter 505; or

(B) a licensed professional counselor acting within the scope of the professional counselor's practice, as described in Texas Occupations Code Chapter 503.

(47) Stabilize--To provide such medical treatment of the condition necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from or occur during the transfer of the individual from a hospital or, if the emergency medical condition for a woman is that she is in labor, that the woman has delivered the child and the placenta.

(48) Staff members--All personnel of a hospital including full-time and part-time employees, contractors, students, volunteers, and professionals granted privileges by the hospital.

(49) Substance-related disorder--The use of one or more drugs, including alcohol, which significantly and negatively impacts one or more major areas of life functioning and which currently meets the criteria for substance-related and addictive disorders as described in the DSM. May also be known as a substance use disorder, substance abuse disorder, or addictive disorder.

(50) TAC--The Texas Administrative Code.

(51) Therapeutic activity--One of the following structured activities designed to develop, restore or maintain a patient's optimal level of physical and psychosocial functioning:

(A) recreational therapy provided by a therapeutic recreation specialist;

(B) physical therapy, speech therapy, or occupational therapy, provided by a licensed staff member acting within the scope of the staff member's practice;

(C) art therapy provided by a staff member who is a Board-Certified Art Therapist;

(D) music therapy provided by a staff member who is a Board-Certified Music Therapist; or

(E) psychosocial or leisure activities provided by qualified staff members.

(52) Therapeutic recreation specialist--An individual who is certified as a therapeutic recreation specialist by the Texas Consortium for Therapeutic Recreation/Activities Certification or a certified therapeutic recreation specialist by the National Council for Therapeutic Recreation Certification.

(53) Treating physician--A physician who coordinates and oversees the implementation of a patient's treatment plan.

(54) Unit--A discrete and identifiable area of a hospital that includes patients' rooms or other patient living areas and is separated from another similar area:

(A) by a locked door;

(B) by a floor; or

(C) because the other similar area is in a different building.

(55) Unlicensed assistive personnel (UAP)--An individual, not licensed as a health care provider, who provides certain health related tasks or functions in a complementary or assistive role to a registered nurse in providing direct patient care or carrying out common nursing functions.

(56) Voluntary patient--A patient who is receiving inpatient mental health treatment based on an admission made in accordance with:

(A) §568.22 of this chapter (relating to Voluntary Admission); or

(B) §568.26 of this chapter (relating to Voluntary Treatment Following Involuntary Admission).

Source Note: The provisions of this §568.3 adopted to be effective May 27, 2021, 46 TexReg 3276