26 Tex. Admin. Code § 306.45 - Definitions
The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise.
(1) Administrator--A person
or entity that has authority to represent a facility and is responsible for
implementing and supervising its administrative policies and procedures and for
administratively supervising the provision of services to individuals on a
day-to-day basis.
(2)
Administrator's designee--A staff member designated in a facility's written
policies and procedures to act for a specified purpose on behalf of the
administrator.
(3) Admission--The
acceptance of an individual for crisis stabilization services based on a
physician's order issued in accordance with §306.55 (relating to Voluntary
Admission Criteria and Intake Process) and §
306.57 (relating to Involuntary
Admission Criteria and Intake Process) of this subchapter.
(4) Admission examination--A psychiatric
examination and physical assessment conducted by a physician, to determine if
an individual requesting voluntary admission to an inpatient mental health
facility meets clinical criteria for admission, in accordance with Texas Health
and Safety Code §
572.0025(f).
(5) Adolescent--An individual at least 13
years of age, but younger than 18 years of age.
(6) Adult--An individual 18 years of age or
older.
(7) Adult caregiver--An
adult person whom a parent has authorized to provide temporary care for a
child, as defined in Texas Family Code §
34.0015(1).
(8) APRN--Advanced practice registered nurse.
A registered nurse licensed by the Texas Board of Nursing and as provided in
Texas Occupations Code §
301.152.
(9) Assessment--The administrative process an
inpatient mental health facility uses to gather information from an individual
to determine if the admission is clinically justified, in accordance with Texas
Health and Safety Code §
572.0025(h)(2),
including a medical history and the problem for which the individual is seeking
treatment.
(10) Business day--Any
day except a Saturday, Sunday, or legal holiday listed in Texas Government Code
§
662.021.
(11) Child--An individual at least three
years of age, but younger than 13 years of age.
(12) Confidential information--Any
communication or record (whether oral, written, electronically stored or
transmitted, or in any other form) that consists of or includes any or all of
the information that must be protected from unauthorized use or disclosure as
required by applicable state or federal laws, and as defined in 1 TAC §
390.1(5)
(relating to Definitions).
(13)
Crisis stabilization services--Short-term residential treatment designed to
reduce acute symptoms of a mental illness or serious emotional disturbance of
an individual and prevent admission of the individual to an inpatient mental
health facility.
(14) CSU--Crisis
stabilization unit. A short-term residential treatment unit designed to reduce
an individual's acute symptoms of mental illness or serious emotional
disturbance instead of admission to an inpatient mental health facility,
licensed in accordance with Chapter 510 of this title (relating to Private
Psychiatric Hospitals and Crisis Stabilization Units) and Texas Health and
Safety Code Chapter 577.
(15)
Day--Calendar day, unless otherwise specified.
(16) DD--Developmental disability. As listed
in Texas Health and Safety Code §
531.002(15),
a severe, chronic disability attributable to mental or physical impairment or a
combination of mental and physical impairments that:
(A) manifest before the individual reaches 22
years of age;
(B) are likely to
continue indefinitely;
(C) reflect
the individual's need for a combination and sequence of special,
interdisciplinary, or generic services, individualized supports, or other forms
of assistance that are of a lifelong or extended duration and are individually
planned and coordinated; and
(D)
result in substantial functional limitations in three or more of the following
categories of major life activity:
(i)
self-care;
(ii) receptive and
expressive language;
(iii)
learning;
(iv) mobility;
(v) self-direction;
(vi) capacity for independent living;
and
(vii) economic
self-sufficiency.
(17) Discharge--The formal release of an
individual from the custody and care of an inpatient mental health facility in
accordance with Texas Health and Safety Code §
572.004.
(18) Emergency medical condition--In
accordance with the Emergency Medical Treatment & Labor Act (42 U.S.C. §
1395dd) (Relating to examination and
treatment for emergency medical conditions and women in labor), a medical
condition manifested by acute symptoms of sufficient severity 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)
in serious jeopardy;
(B) serious
impairment to bodily functions;
(C)
serious dysfunction of any bodily organ or part; or
(D) in the case of a pregnant woman having
contractions:
(i) inadequate time to arrange a
safe transfer to a hospital before delivery; or
(ii) a transfer posing a threat to the health
or safety of the woman or the unborn child.
(19) General hospital--A hospital operated
primarily to diagnose, care for, and treat individuals who are physically ill
and licensed in accordance with Texas Health and Safety Code Chapter
241.
(20) HHSC--Texas Health and
Human Services Commission or its designee.
(21) ID--Intellectual disability. Consistent
with Texas Health and Safety Code §
591.003,
significantly sub-average general intellectual functioning existing
concurrently with deficits in adaptive behavior and originates during the
developmental period.
(22)
IDT--Interdisciplinary team. A group of licensed, credentialed, and unlicensed
staff members who possess the knowledge, skills, and expertise to develop and
implement an individual's treatment or recovery plan and also includes:
(A) the individual's treating
physician;
(B) the individual, and
the individual's LAR or adult caregiver, if applicable;
(C) the staff members identified in the
treatment or recovery plan as responsible for providing or ensuring the
provision of each treatment in accordance with §
568.61(c)(1)(E)(iii)
of this title (relating to Inpatient Mental
Health Treatment and Treatment Planning);
(D) any person identified by the individual,
and the individual's LAR or adult caregiver if applicable, unless clinically
contraindicated; and
(E) other
staff members as clinically appropriate.
(23) Individual--A person seeking or
receiving services under this subchapter.
(24) Inpatient mental health facility--A
mental health facility that can provide 24-hour residential and psychiatric
services and that is:
(A) a facility operated
by HHSC;
(B) a private mental
hospital licensed by HHSC;
(C) a
community center, facility operated by or under contract with a community
center or other entity HHSC designates to provide mental health
services;
(D) an identifiable part
of a general hospital in which diagnosis, treatment, and care for individuals
with mental illness is provided and that is licensed by HHSC; or
(E) a hospital operated by a federal
agency.
(25) Intake--The
administrative process for gathering information about an individual and giving
an individual information about an inpatient mental health facility and the
facility's treatment and services, in accordance with Texas Health and Safety
Code §
572.0025(h)(3).
(26) Involuntarily-admitted individual--An
individual receiving inpatient mental health facility services based on an
admission made in accordance with:
(A) Texas
Health and Safety Code Chapter 573 and described in §
306.57(a) of
this subchapter; or
(27)
LAR--Legally authorized representative. A person authorized by law to act on
behalf of an individual regarding a matter described in this subchapter, and
may include a parent, guardian, or managing conservator of a minor, or the
guardian of an adult.
(28)
LBHA--Local behavioral health authority. An entity designated as the local
behavioral health authority by HHSC in accordance with Texas Health and Safety
Code §
533.0356.
(29) Legal holiday--A holiday listed in the
Texas Government Code §
662.021 and an
officially designated county holiday applicable to a court in which proceedings
under the Texas Mental Health Code are held.
(30) LIDDA--Local intellectual and
developmental disability authority. An entity designated as the local
intellectual and developmental disability authority by HHSC in accordance with
Texas Health and Safety Code §
533A.035.
(31) LMHA--Local mental health authority. An
entity designated as the local mental health authority by HHSC in accordance
with Texas Health and Safety Code §
533.035(a).
(32) LPHA--Licensed practitioner of the
healing arts. A person who possesses any of the following state licenses is
considered an LPHA and is automatically certified as a qualified mental health
professional-community services (QMHP-CS):
(A)
a physician;
(B) a physician
assistant;
(C) an APRN;
(D) a licensed psychologist;
(E) a licensed professional
counselor;
(F) a licensed clinical
social worker; or
(G) a licensed
marriage and family therapist.
(33) LVN--Licensed vocational nurse. A person
licensed as a vocational nurse by the Texas Board of Nursing in accordance with
Texas Occupations Code Chapter 301.
(34) Medical director--A physician who is
board eligible or certified in psychiatry by the American Board of Psychiatry
and Neurology or by the American Osteopathic Board of Neurology and Psychiatry
and who provides clinical and policy oversight for the CSU.
(35) Medical record--A compilation of
systematic and organized information relevant to the services provided to an
individual.
(36) Medical
services--Acts or services provided by a physician acting as described in Texas
Occupations Code Chapter 151, or as delegated by a physician, in accordance
with Texas Occupations Code Chapter 157.
(37) Mental illness--An illness, disease, or
condition, other than a sole diagnosis of epilepsy, dementia, substance use
disorder, ID, or DD that:
(A) substantially
impairs an individual's thought, perception of reality, emotional process, or
judgment; or
(B) grossly impairs
behavior as demonstrated by recent disturbed behavior.
(38) Monitoring--One or more staff members
observing an individual in person continuously or at pre-determined intervals;
as ordered by a physician or physician-delegated physician's assistant (PA) or
APRN; or by established protocol; and intervening when necessary to protect the
individual from harming self or others.
(39) Nursing facility--A Medicaid-certified
facility that is licensed in accordance with the Texas Health and Safety Code
Chapter 242.
(40) Nursing
services--Acts or services provided by a registered nurse (RN) acting within
the RN's scope of practice and assigned to an LVN, or delegated to an
unlicensed person, in accordance with Texas Occupations Code Chapter
301.
(41) Nursing staff--A person
required to be licensed in accordance with Texas Occupations Code Chapter 301
to engage in professional or vocational nursing or the person delegated to
perform common nursing functions under the authority of an RN.
(42) Ombudsman--The Ombudsman for Behavioral
Health Access to Care established by Texas Government Code §
547.0002, which
serves as a neutral party to help individuals, including individuals who are
uninsured or have public or private health benefit coverage and behavioral
health care providers navigate and resolve issues related to the individual's
access to behavioral health care, including care for mental health conditions
and substance use disorders.
(43)
PA--Physician's assistant. A person licensed as a physician assistant by the
Texas State Board of Physician Assistant Examiners in accordance with Texas
Occupations Code Chapter 204.
(44)
PASRR--Preadmission screening and resident review.
(45) PASRR Level I screening--The process of
screening an individual seeking admission to a nursing facility to identify
whether the individual is suspected of having a mental illness, ID, or
DD.
(46) PASRR Level II
evaluation--A face-to-face evaluation:
(A) of
an individual seeking admission to a nursing facility who is suspected of
having a mental illness, ID, or DD; and
(B) performed by a LIDDA, LHMA, or LBHA to
determine if the individual has a mental illness, ID, or DD and, if so, to:
(i) assess the individual's need for care in
a nursing facility;
(ii) assess the
individual's need for specialized services; and
(iii) identify alternate placement
options.
(47)
Peer specialist--A person who uses lived experience, in addition to skills
learned in formal training, to deliver strengths-based, person-centered
services to promote an individual's recovery and resiliency, in accordance with
1 TAC Chapter 354, Subchapter N (relating to Peer Specialist
Services).
(48) Physician--A staff
member:
(A) licensed as a physician by the
Texas Medical Board in accordance with Texas Occupations Code Chapter 155;
or
(B) authorized to perform
medical acts under an institutional permit at a Texas postgraduate training
program approved by the Accreditation Council on Graduate Medical Education,
the American Osteopathic Association, or the Texas Medical Board.
(49) Pre-admission screening--The
clinical process used by a QMHP-CS or LPHA to gather information from an
individual, including a medical history, any history of substance use, trauma,
and the problem for which the individual is seeking treatment to determine if a
physician should conduct an admission examination.
(50) Preliminary examination--The psychiatric
examination and assessment for medical stability performed and documented by a
physician in accordance with Texas Health and Safety Code §
573.022 to
determine if emergency detention in an inpatient mental health facility is
clinically justified for an individual for whom:
(A) an application for emergency detention is
filed in accordance with Texas Health and Safety Code §
573.011;
(B) a peace officer or emergency medical
services personnel of an emergency medical services provider transporting the
individual in accordance with a memorandum of understanding executed in
accordance with Texas Health and Safety Code §
573.005 files
a notification of detention completed by the peace officer in accordance with
Texas Health and Safety Code §
573.002(a);
or
(C) the LAR transporting their
adult ward, without the assistance of a peace officer, in accordance with Texas
Health and Safety Code §
573.003, files
an application for detention in accordance with Texas Health and Safety Code
§
573.004.
(51) Psychosocial rehabilitative
services--Services that assist an individual in regaining and maintaining daily
living skills required to function effectively in the community.
(52) QMHP-CS--Qualified mental health
professional-community services. A staff member who is credentialed as a
QMHP-CS who has demonstrated and documented competency in the work to be
performed and:
(A) has a bachelor's degree
from an accredited college or university with a minimum number of hours that is
equivalent to a major in psychology, social work, medicine, nursing,
rehabilitation, counseling, sociology, human growth and development,
gerontology, special education, educational psychology, early childhood
education, or early childhood intervention;
(B) is an RN; or
(C) completes an alternative credentialing
process as determined by an LMHA or LBHA in accordance with HHSC
requirements.
(53)
Recovery--A process of change through which individuals improve their health
and wellness, live a self-directed life, and strive to reach their full
potential.
(54) Recovery or
treatment plan--A written plan:
(A) is
developed in collaboration with the individual, and the individual's LAR or
adult caregiver if applicable, and a QMHP-CS or LPHA;
(B) is amended at any time based on an
individual's needs or requests;
(C)
guides the recovery process and fostering resiliency;
(D) is completed in conjunction with the
assessment tool adopted by HHSC;
(E) identifies the individual's changing
strengths, capacities, goals, preferences, needs, and desired outcomes;
and
(F) includes recommended
services and supports or reasons for the exclusion of services and
supports.
(55)
Restraints--Any personal, mechanical, or chemical restraint defined in 25 TAC
§
415.253 (relating to
Definitions).
(56) RN--Registered
nurse. A staff member licensed as a registered nurse by the Texas Board of
Nursing in accordance with Texas Occupations Code Chapter 301.
(57) Screening--Activities performed by a
QMHP-CS to:
(A) collect triage information
either in person, or through telephone or telehealth interviews with an
individual or collateral contact;
(B) determine if the individual's need is
emergent, urgent, or routine, and conducted before the in person or telehealth
assessment to determine the need for emergency services; and
(C) determine the need for immediate
assessment and mental health treatment recommendations.
(58) Seclusion--The involuntary separation of
an individual from other individuals for any period of time and or the
placement of the individual alone in an area from which the individual is
prevented from leaving, as defined in 25 TAC §
415.253(28).
(59) SED--Serious emotional disturbance. A
diagnosed mental health disorder that substantially disrupts a child's or
adolescent's ability to function socially, academically, and emotionally in
accordance with Texas Government Code §
547.0051.
(60) Serious physical injury--An injury
determined by a physician, or physician-delegated PA or APRN, to require
treatment by an appropriately licensed medical professional or licensed
healthcare professional, or in an emergency department or licensed
hospital.
(61) Stabilize--With
respect to an emergency medical condition, 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 individual's transfer from a facility 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.
(62) Staff
member--Personnel including a full-time and part-time employee, contractor, or
intern, but excluding a volunteer.
(63) Staffing plan--A written plan that:
(A) demonstrates the number, qualifications,
and responsibilities of staff members, including the administrator or designee,
are appropriate for the size and scope of the services provided and that
workloads are reasonable to meet the needs of individuals receiving services;
and
(B) identifies staffing
patterns, hours of coverage, and plans for providing back-up staff in
emergencies.
(64)
Substance use 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 meets the criteria described in the current edition of
the Diagnostic Statistical Manual of Mental Disorders for
substance use disorders.
(65)
TAC--Texas Administrative Code.
(66) Telehealth service--A health-care
service, other than telemedicine medical services, delivered by a health
professional licensed, certified or otherwise entitled to practice in Texas and
acting within the scope of the health professional's license, certification or
entitlement to an individual at a different physical location other than the
health professional using telecommunications or information technology, in
accordance with Texas Occupation Code §111.001(3).
(67) Telemedicine medical service--A
health-care service delivered to an individual at a different physical location
using telecommunications or information technology by:
(A) a physician licensed in Texas;
or
(B) a health professional who
acts under the delegation and supervision of a physician licensed in Texas and
within the scope of the health professional's license in Texas.
(68) Transfer--The movement
(including the discharge) of an individual outside a facility at the facility's
direction, but it does not include such a movement of an individual who has
been declared dead or leaves the facility without the facility's
permission.
(69) Treating
physician--A physician who coordinates and oversees an individual's
treatment.
(70) Unit--A discrete
and identifiable area of an inpatient mental health facility that includes
individuals' rooms or other 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.
(71)
UP--Unlicensed person. A person, not licensed as a health care provider, who
provides certain health related tasks and functions in a complementary or
assistive role to the RN in providing direct care of an individual or carrying
out common nursing functions as described in 22 TAC Chapter 224 (relating to
Delegation of Nursing Tasks by Registered Professional Nurses to Unlicensed
Personnel for Clients with Acute Conditions or in Acute Care Environments) and
care in conformity with this chapter:
(A) who
is monetarily compensated, including nurse aides, assistants, attendants,
technicians, and other individuals providing care or assistance of
health-related services; or
(B) who
is a professional nursing student, not licensed as an RN or LVN, providing care
for monetary compensation and not as part of their formal education.
(72) Voluntarily admitted
individual--An individual receiving facility services based on an admission in
accordance with:
(A)
§
306.55 of this subchapter
(relating to Voluntary Admission Criteria and Intake Process); or
(B)
§
306.59 of this subchapter
(relating to Voluntary Treatment Following Involuntary Admission).
Notes
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