26 Tex. Admin. Code § 554.101 - Definitions
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise.
(1) Abuse--Negligent or
willful infliction of injury, unreasonable confinement, intimidation, or
punishment with resulting physical or emotional harm or pain to a resident; or
sexual abuse, including involuntary or nonconsensual sexual conduct that would
constitute an offense under Texas Penal Code §
21.08 (relating to
Indecent Exposure) or Texas Penal Code, Chapter 22 (relating to Assaultive
Offenses), sexual harassment, sexual coercion, or sexual assault.
(2) Act--Chapter 242 of the Texas Health and
Safety Code.
(3) Activities
assessment--See Comprehensive Assessment and Comprehensive Care Plan.
(4) Activity director--The qualified
individual appointed by the facility to direct the activities program as
described in §
554.702 of this chapter (relating
to Activities).
(5) Addition--The
addition of floor space to an institution.
(6) Administrator--A person currently
licensed in accordance with Chapter 555 of this title (relating to Nursing
Facility Administrators).
(7)
Admission MDS assessment--An MDS assessment that determines a recipient's
initial determination of eligibility for medical necessity for admission into
the Texas Medicaid Nursing Facility Program.
(8) Advanced practice registered nurse--A
person licensed as a registered nurse and approved to practice as an advanced
practice registered nurse by the Texas Board of Nursing.
(9) Adverse event--An untoward, undesirable,
and usually unanticipated event that causes death or serious injury, or the
risk of death or serious injury.
(10) Alzheimer's Disclosure Statement for
Nursing Facilities--The HHSC-prescribed form a facility uses to describe the
nature of care or treatment of residents with Alzheimer's disease and related
disorders.
(11) Alzheimer's disease
and related disorders--Alzheimer's disease and any other irreversible dementia
described by the Centers for Disease Control and Prevention or the most current
edition of the Diagnostic and Statistical Manual of Mental Disorders.
(12) Applicant--A person or governmental
unit, as those terms are defined in the Texas Health and Safety Code, Chapter
242, applying for a license under that chapter.
(13) Attending physician--A physician,
currently licensed by the Texas Medical Board, who is designated by the
resident or resident representative as having primary responsibility for the
treatment and care of the resident.
(14) Authorized electronic monitoring--The
placement of an electronic monitoring device in a resident's room and using the
device to make tapes or recordings after making a request to the facility to
allow electronic monitoring.
(15)
Barrier precautions--Precautions including the use of gloves, masks, gowns,
resuscitation equipment, eye protectors, aprons, face shields, and protective
clothing for purposes of infection control.
(16) Care and treatment--Services required to
maximize resident independence, personal choice, participation, health,
self-care, psychosocial functioning, and reasonable safety, all consistent with
the preferences of the resident.
(17) Certification--The determination by HHSC
that a nursing facility meets all the requirements of the Medicaid or Medicare
programs.
(18) Certified
facility--A facility that meets the requirements of the Medicare program, the
Medicaid program, or both.
(19)
Certified Ombudsman--Has the meaning given in §
88.2 of this title (relating to
Definitions).
(20) CFR--Code of
Federal Regulations.
(21) 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.
(22) Chemical
restraints--Any drug administered for the purpose of discipline or convenience,
and not required to treat the resident's medical symptoms.
(23) CMS--Centers for Medicare & Medicaid
Services.
(24) Complaint--Any
allegation received by HHSC other than an incident reported by the facility.
Such allegations include, but are not limited to, abuse, neglect, exploitation,
or violation of state or federal standards.
(25) Completion date--The date an RN
assessment coordinator signs an MDS assessment as complete.
(26) Comprehensive assessment--An
interdisciplinary description of a resident's needs and capabilities including
daily life functions and significant impairments of functional capacity, as
described in §
554.801(2) of
this chapter (relating to Resident Assessment).
(27) Comprehensive care plan--A plan of care
prepared by an interdisciplinary team that includes measurable short-term and
long-term objectives and timetables to meet the resident's needs developed for
each resident after admission. The plan addresses at least the following needs:
medical, nursing, rehabilitative, psychosocial, dietary, activity, and
resident's rights. The plan includes strategies developed by the team, as
described in §
554.802(c)(2) of
this chapter (relating to Comprehensive Person-Centered Care Planning),
consistent with the physician's prescribed plan of care, to assist the resident
in eliminating, managing, or alleviating health or psychosocial problems
identified through assessment. Planning includes:
(A) goal setting;
(B) establishing priorities for management of
care;
(C) making decisions about
specific measures to be used to resolve the resident's problems; and
(D) assisting in the development of
appropriate coping mechanisms.
(28) Controlling person--A person with the
ability, acting alone or in concert with others, to directly or indirectly,
influence, direct, or cause the direction of the management, expenditure of
money, or policies of a nursing facility or other person. A controlling person
does not include a person, such as an employee, lender, secured creditor, or
landlord, who does not exercise any influence or control, whether formal or
actual, over the operation of a facility. A controlling person includes:
(A) a management company, landlord, or other
business entity that operates or contracts with others for the operation of a
nursing facility;
(B) any person
who is a controlling person of a management company or other business entity
that operates a nursing facility or that contracts with another person for the
operation of a nursing facility;
(C) an officer or director of a publicly
traded corporation that is, or that controls, a facility, management company,
or other business entity described in subparagraph (A) of this paragraph but
does not include a shareholder or lender of the publicly traded corporation;
and
(D) any other individual who,
because of a personal, familial, or other relationship with the owner, manager,
landlord, tenant, or provider of a nursing facility, is in a position of actual
control or authority with respect to the nursing facility, without regard to
whether the individual is formally named as an owner, manager, director,
officer, provider, consultant, contractor, or employee of the
facility.
(29) Covert
electronic monitoring--The placement and use of an electronic monitoring device
that is not open and obvious, and the facility and HHSC have not been informed
about the device by the resident, by a person who placed the device in the
room, or by a person who uses the device.
(30) DADS--The term referred to the
Department of Aging and Disability Services; it now refers to HHSC.
(31) Dentist--A practitioner licensed to
practice dentistry by the Texas State Board of Dental Examiners.
(32) DHS--This term referred to the Texas
Department of Human Services; it now refers to HHSC.
(33) Dietitian--A qualified dietitian is one
who is qualified based upon either:
(A)
registration by the Commission on Dietetic Registration of the Academy of
Nutrition and Dietetics; or
(B)
licensure, or provisional licensure, as a dietitian under Texas Occupations
Code, Chapter 701 and one year of supervisory experience in dietetic service of
a health care facility.
(34) Direct ownership interest--Ownership of
equity in the capital, stock, or profits of, or a membership interest in, an
applicant or license holder.
(35)
Disclosable interest--Five percent or more direct or indirect ownership
interest in an applicant or license holder.
(36) Distinct part--That portion of a
facility certified to participate in the Medicaid Nursing Facility program or
as a SNF in the Medicare program.
(37) Drug (also referred to as
medication)--Any of the following:
(A) any
substance recognized as a drug in the official United States Pharmacopoeia,
official Homeopathic Pharmacopoeia 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
humans;
(C) any substance (other
than food) intended to affect the structure or any function of the body of a
human; and
(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.
(38) Electronic monitoring device--Video
surveillance cameras and audio devices installed in a resident's room, designed
to acquire communications or other sounds that occur in the room. An
electronic, mechanical, or other device used specifically for the nonconsensual
interception of wire or electronic communication is excluded from this
definition.
(39) Emergency--A
sudden change in a resident's condition requiring immediate medical
intervention.
(40) Essential
Caregiver--A family member, friend, guardian, volunteer, or other person
designated for in-person visits by an individual, resident, or client or the
individual's, resident's, or client's guardian or legally authorized
representative (LAR) during a public health emergency or disaster. In case of
conflict between an individual's, resident's, or client's selection and a
guardian's selection on behalf of the individual, resident, or client, the
guardian's selection prevails, in accordance with the terms of the
guardianship. If an individual, resident, or client has no guardian and is
unable to select an essential caregiver, the individual's, resident's, or
client's LAR may select the essential caregiver.
(41) Executive Commissioner--The executive
commissioner of the Texas Health and Human Services Commission.
(42) Exploitation--The illegal or improper
act or process of a caregiver, family member, or other individual who has an
ongoing relationship with a resident using the resources of the resident for
monetary or personal benefit, profit, or gain without the informed consent of
the resident.
(43) Facility--Unless
otherwise indicated, a facility is an institution that provides organized and
structured nursing care and service and is subject to licensure under Texas
Health and Safety Code, Chapter 242.
(A) For
Medicaid, a facility is a nursing facility that meets the requirements of
§1919(a) - (d) of the Social Security Act (42 United States Code §
1396r(a)
- (d)). A facility may not include any
institution that is for the care and treatment of mental diseases except for
services furnished to individuals age 65 and over and who are eligible as
defined in Chapter 303 of this title (relating to Preadmission Screening and
Resident Review (PASRR)).
(B) For
Medicare and Medicaid purposes (including eligibility, coverage, certification,
and payment), the "facility" is always the entity which participates in the
program, whether that entity is comprised of all, or a distinct part of, a
larger institution.
(C) "Facility"
is also referred to as a nursing home or nursing facility. Depending on
context, these terms are used to represent the management, administrator, or
other persons or groups involved in the provision of care of the resident; or
to represent the physical building, which may consist of one or more floors or
one or more units, or which may be a distinct part of a licensed
hospital.
(44) Family
council--A group of family members, friends, or legal guardians of residents,
who organize and meet privately or openly.
(45) Family representative--An individual
appointed by the resident to represent the resident and other family members,
by formal or informal arrangement.
(46) Fiduciary agent--An individual who holds
in trust another's monies.
(47)
Goals--Long-term: general statements of desired outcomes. Short-term:
measurable, time-limited, expected results that provide the means to evaluate
the resident's progress toward achieving long-term goals.
(48) Governmental unit--A state or a
political subdivision of the state, including a county or
municipality.
(49) Health care
provider--An individual, including a physician, or facility licensed,
certified, or otherwise authorized to administer health care, in the ordinary
course of business or professional practice.
(50) Hearing--A contested case hearing held
in accordance with the Administrative Procedure Act, Texas Government Code,
Chapter 2001, and the formal hearing procedures in 1 Texas Administrative Code
Chapter 357, Subchapter I (relating to Hearings Under the Administrative
Procedure Act) and 40 TAC Chapter 91 (relating to Hearings Under the
Administrative Procedure Act).
(51)
HHSC--The Texas Health and Human Services Commission.
(52) HIV--Human Immunodeficiency
Virus.
(53) Incident--An abnormal
event, including accidents or injury to staff or residents, which is documented
in facility reports. An occurrence in which a resident may have been subject to
abuse, neglect, or exploitation must also be reported to HHSC.
(54) Indirect ownership interest--Any
ownership or membership interest in a person that has a direct ownership
interest in an applicant or license holder.
(55) Infection control--A program designed to
prevent the transmission of disease and infection in order to provide a safe
and sanitary environment.
(56)
Inspection--Any on-site visit to or survey of an institution by HHSC for the
purpose of licensing, monitoring, complaint investigation, architectural
review, or similar purpose.
(57)
Involuntary seclusion--Separation of a resident from others or from the
resident's room or confinement to the resident's room, against the resident's
will or the will of a person who is legally authorized to act on behalf of the
resident. Monitored separation from other residents is not involuntary
seclusion if the separation is a therapeutic intervention that uses the least
restrictive approach for the minimum amount of time, not to exceed 24 hours,
until professional staff can develop a care plan to meet the resident's
needs.
(58)
IV--Intravenous.
(59) Legend drug
or prescription drug--Any drug that requires a written or telephonic order of a
practitioner before it may be dispensed by a pharmacist, or that may be
delivered to a particular resident by a practitioner in the course of the
practitioner's practice.
(60)
License holder--A person that holds a license to operate a facility.
(61) Licensed health professional--A
physician; physician assistant; advanced practice registered nurse; physical,
speech, or occupational therapist; pharmacist; physical therapist assistant
occupational therapy assistant; registered professional nurse; licensed
vocational nurse; licensed dietitian; licensed social worker; or certified
respiratory care practitioner.
(62)
Licensed vocational nurse (LVN)--A nurse who is currently licensed by the Texas
Board of Nursing as a licensed vocational nurse.
(63) Life Safety Code--NFPA 101.
(64) Life safety features--Fire safety
components required by NFPA 101, including building construction, fire alarm
systems, smoke detection systems, interior finishes, sizes and thicknesses of
doors, exits, emergency electrical systems, and sprinkler systems.
(65) Life support--Use of any technique,
therapy, or device to assist in sustaining life. (See §
554.419 of this chapter (relating
to Advance Directives)).
(66) Local
authorities--Persons, including, but not limited to, local health authority,
fire marshal, and building inspector, who may be authorized by state law,
county order, or municipal ordinance to perform certain inspections or
certifications.
(67) Local health
authority--The physician appointed by the governing body of a municipality or
the commissioner's court of the county to administer state and local laws
relating to public health in the municipality's or county's jurisdiction as
defined in Texas Health and Safety Code §
121.021.
(68) Long-term care-regulatory--HHSC
Regulatory Services Division, which is responsible for surveying nursing
facilities to determine compliance with regulations for licensure and
certification for Medicaid participation.
(69) Major injury--An injury that qualifies
as a major injury under NFPA 99.
(70) Management services--Services provided
under contract between the owner of a facility and a person to provide for the
operation of a facility, including administration, staffing, maintenance, or
delivery of resident services. Management services do not include contracts
solely for maintenance, laundry, or food service.
(71) Manager--A person, other than a licensed
nursing home administrator, having a contractual relationship to provide
management services to a facility.
(72) Managing local ombudsman--Has the
meaning given in §
88.2 of this title.
(73) MDS--Minimum data set. See
RAI.
(74) MDS nurse reviewer--A
registered nurse employed by HHSC to monitor the accuracy of the MDS assessment
submitted by a Medicaid-certified nursing facility.
(75) Medicaid applicant--A person who
requests the determination of eligibility to become a Medicaid
recipient.
(76) Medicaid nursing
facility vendor payment system--Electronic billing and payment system for
reimbursement to nursing facilities for services provided to eligible Medicaid
recipients.
(77) Medicaid
recipient--A person who meets the eligibility requirements of the Title XIX
Medicaid program, is eligible for nursing facility services, and resides in a
Medicaid-participating facility.
(78) Medical director--A physician licensed
by the Texas Medical Board, who is engaged by the nursing home to assist in and
advise regarding the provision of nursing and health care.
(79) Medical power of attorney--The legal
document that designates an agent to make treatment decisions if the individual
designator becomes incapable.
(80)
Medication aide--A person who holds a current permit issued under the
Medication Aide Training Program as described in Chapter 557 of this title
(relating to Medication Aides--Program Requirements) and acts under the
authority of a person who holds a current license under state law which
authorizes the licensee to administer medication.
(81) Memory Care Disclosure Statement for
Nursing Facilities--The HHSC-prescribed form a facility uses when the facility
advertises, markets, or otherwise promotes that it provides services to
residents with Alzheimer's disease and related disorders.
(82) Memory care services--Services provided
by a nursing facility that meet the needs of residents with a diagnosis of
Alzheimer's disease or related disorders or a diagnosis of dementia.
(83) Misappropriation--The taking, secretion,
misapplication, deprivation, transfer, or attempted transfer to any person not
entitled to receive any property, real or personal, or anything of value
belonging to or under the legal control of a resident without the effective
consent of the resident or other appropriate legal authority, or the taking of
any action contrary to any duty imposed by federal or state law prescribing
conduct relating to the custody or disposition of property of a
resident.
(84) MN--Medical
necessity. A determination, made by physicians and registered nurses who are
employed by or contract with the state Medicaid claims administrator, that a
recipient requires the services of a licensed nurse in an institutional setting
to carry out a physician's planned regimen for total care. A recipient's need
for custodial care in a 24-hour institutional setting does not constitute
medical necessity.
(85)
Neglect--The failure to provide goods or services, including medical services,
that are necessary to avoid physical or emotional harm, pain, or mental
illness.
(86) NFPA--National Fire
Protection Association.
(87) NFPA
99--NFPA 99, Health Care Facilities Code, 2012 Edition.
(88) NFPA 101--NFPA 101, Life Safety Code,
2012 Edition.
(89) Nurse aide--An
individual who provides nursing or nursing-related services to residents in a
facility under the supervision of a licensed nurse. This term may include an
individual who provides these services through an agency or under a contract
with the facility. This definition does not include an individual who is a
licensed health professional, a registered dietitian, or someone who volunteers
such services without pay. A nurse aide is not authorized to provide nursing or
nursing-related services for which a license or registration is required under
state law. Nurse aides do not include those individuals who furnish services to
residents only as paid feeding assistants.
(90) Nurse practitioner--An advanced practice
registered nurse licensed by the Texas Board of Nursing in the role of Nurse
Practitioner.
(91) Nurses'
station--A nurses' station is an area designated as the focal point on all
shifts for the administration and supervision of resident-care activities for a
designated number of resident bedrooms.
(92) Nursing care--Services provided by
nursing personnel which include, but are not limited to, observation; promotion
and maintenance of health; prevention of illness and disability; management of
health care during acute and chronic phases of illness; guidance and counseling
of individuals and families; and referral to physicians, other health care
providers, and community resources when appropriate.
(93) Nursing facility or nursing home--See
definition of "facility."
(94)
Nursing personnel--Persons assigned to give direct personal and nursing
services to residents, including registered nurses, licensed vocational nurses,
nurse aides, and medication aides. Unlicensed personnel function under the
authority of licensed personnel.
(95) Objectives--See definition of
"goals."
(96) OBRA--Omnibus Budget
Reconciliation Act of 1987, which includes provisions relating to nursing home
reform.
(97) Ombudsman intern--Has
the meaning given in §
88.2 of this title.
(98) Ombudsman Program--Has the meaning given
in §
88.2 of this title.
(99) Paid feeding assistant--An individual
who meets the requirements of §
554.1113 of this chapter (relating
to Paid Feeding Assistants) and who is paid to feed residents by a facility or
who is used under an arrangement with another agency or organization.
(100) Palliative Plan of Care--Appropriate
medical and nursing care for residents with advanced and progressive diseases
for whom the focus of care is controlling pain and symptoms while maintaining
optimum quality of life.
(101)
PASARR or PASRR--Preadmission Screening and Resident Review.
(102) Patient care-related electrical
appliance--An electrical appliance that is intended to be used for diagnostic,
therapeutic, or monitoring purposes in a patient care area, as defined in
Standard 99 of the National Fire Protection Association.
(103) Person--An individual, firm,
partnership, corporation, association, joint stock company, limited
partnership, limited liability company, or any other legal entity, including a
legal successor of those entities.
(104) Person-centered care--To focus on the
resident as the locus of control, and to support the resident in making choices
and having control over the resident's daily life.
(105) Pharmacist--An individual, licensed by
the Texas State Board of Pharmacy to practice pharmacy, who prepares and
dispenses medications prescribed by a practitioner.
(106) Physical restraint--Any manual method,
or physical or mechanical device, material or equipment attached, or adjacent
to the resident's body, that the individual cannot remove easily which
restricts freedom of movement or normal access to one's body. The term includes
a restraint hold.
(107)
Physician--A doctor of medicine or osteopathy currently licensed by the Texas
Medical Board to practice medicine.
(108) Physician assistant (PA)--An individual
who is licensed as a physician assistant under Texas Occupations Code, Chapter
204.
(109) Podiatrist--A
practitioner whose profession encompasses the care and treatment of feet who is
licensed to practice podiatry by the Texas State Board of Podiatric Medical
Examiners.
(110) Poison--Any
substance that federal or state regulations require the manufacturer to label
as a poison and is to be used externally by the consumer from the original
manufacturer's container. Drugs to be taken internally that contain the
manufacturer's poison label, but are dispensed by a pharmacist only by or on
the prescription order of a practitioner, are not considered a poison, unless
regulations specifically require poison labeling by the pharmacist.
(111) Practitioner--A physician, podiatrist,
dentist, or an advanced practice registered nurse or physician assistant to
whom a physician has delegated authority to sign a prescription order, when
relating to pharmacy services.
(112) Private and unimpeded access--Access to
enter a facility, or communicate with a resident outside of the hearing or view
of others, without interference or obstruction from facility employees,
volunteers, or contractors.
(113)
PRN (pro re nata)--As needed.
(114)
Provider--The individual or legal business entity that is contractually
responsible for providing Medicaid services under an agreement with
HHSC.
(115) Qualified mental health
professional - community services--Has the meaning given in §
301.303 of this title (relating to
Definitions).
(116) Qualified
surveyor--An employee of HHSC who has completed state and federal training on
the survey process and passed a federal standardized exam.
(117) Quality assessment and assurance
committee--A group of health care professionals in a facility who develop and
implement appropriate action to identify and rectify substandard care and
deficient facility practice.
(118)
Quality measure report--A report that provides information derived from an MDS
that provides a numeric value to quality indicators. This data is available to
the public as part of the Nursing Home Quality Initiative (NHQI), and is
intended to provide objective measures for consumers to make informed decisions
about the quality of care in a nursing facility.
(119) Quality-of-care monitor--A registered
nurse, pharmacist, or dietitian employed by HHSC who is trained and experienced
in long-term care facility regulation, standards of practice in long-term care,
and evaluation of resident care, and functions independently of HHSC Regulatory
Services Division.
(120)
RAI--Resident Assessment Instrument. An assessment tool used to conduct
comprehensive, accurate, standardized, and reproducible assessments of each
resident's functional capacity as specified by the Secretary of the U. S.
Department of Health and Human Services. At a minimum, this instrument must
consist of the MDS core elements as specified by CMS; utilization guidelines;
and Care Area Assessment process.
(121) Recipient--Any individual residing in a
Medicaid certified facility or a Medicaid certified distinct part of a facility
whose daily vendor rate is paid by Medicaid.
(122) Rehabilitative services--Rehabilitative
therapies and devices provided to help a person regain, maintain, or prevent
deterioration of a skill or function that has been acquired but then lost or
impaired due to illness, injury, or disabling condition. The term includes
physical and occupational therapy, speech-language pathology, and psychiatric
rehabilitation services.
(123)
Reportable conduct--Conduct subject to reporting to the Employee Misconduct
Registry (EMR) established under Texas Health and Safety Code, Chapter 253,
including:
(A) abuse or neglect that causes
or may cause death or harm to a resident;
(B) sexual abuse of a resident;
(C) financial exploitation of a resident in
an amount of $25 or more; and
(D)
emotional, verbal, or psychological abuse that causes harm to a
resident.
(124)
Representative payee--A person designated by the Social Security Administration
to receive and disburse benefits, act in the best interest of the beneficiary,
and ensure that benefits will be used according to the beneficiary's
needs.
(125) Resident--Any
individual residing in a nursing facility.
(126) Resident group--A group or council of
residents who meet regularly.
(127)
Resident representative--
(A) Any of the
following:
(i) an individual chosen by the
resident to act on behalf of the resident in order to support the resident in
decision-making; access medical, social, or other personal information of the
resident; manage financial matters; or receive notifications;
(ii) a person authorized by state or federal
law (including agents under power of attorney, representative payees, and other
fiduciaries) to act on behalf of the resident in order to support the resident
in decision-making; access medical, social, or other personal information of
the resident; manage financial matters; or receive notifications;
(iii) legal representative, as used in
Section 712 of the Older Americans Act ( 40 U.S.C. §3058g ); or
(iv) the court-appointed guardian of a
resident.
(B) This
definition is not intended to expand the scope of authority of any resident
representative beyond that authority specifically authorized by the resident,
state or federal law, or a court of competent jurisdiction.
(128) Responsible party--An individual
authorized by the resident to act for him as an official delegate or agent.
Responsible party is usually a family member or relative, but may be a legal
guardian or other individual. Authorization may be in writing or may be given
orally.
(129) Restraint--A chemical
or physical restraint.
(130)
Restraint 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.
(131)
RN--Registered nurse. An individual currently licensed by the Texas Board of
Nursing as a registered nurse.
(132) RN assessment coordinator--A registered
nurse who signs and certifies a comprehensive assessment of a resident's needs,
using the RAI, including the MDS, as specified by HHSC.
(133) RUG--Resource Utilization Group. A
categorization method, consisting of 34 categories based on the MDS, that is
used to determine a recipient's service and care requirements and to determine
the daily rate HHSC pays a nursing facility for services provided to the
recipient.
(134)
Secretary--Secretary of the U.S. Department of Health and Human
Services.
(135) Services required
on a regular basis--Services which are provided at fixed or recurring intervals
and are needed so frequently that it would be impractical to provide the
services in a home or family setting. Services required on a regular basis
include continuous or periodic nursing observation, assessment, and
intervention in all areas of resident care.
(136) SNF--A skilled nursing facility or
distinct part of a facility that participates in the Medicare program. SNF
requirements apply when a certified facility is billing Medicare for a
resident's per diem rate.
(137)
Social Security Administration--Federal agency for administration of social
security benefits. Local social security administration offices take
applications for Medicare, assist beneficiaries file claims, and provide
information about the Medicare program.
(138) Social worker--A qualified social
worker is an individual who is licensed, or provisionally licensed, by the
Texas State Board of Social Work Examiners as prescribed by the Texas
Occupations Code, Chapter 505, and who has at least:
(A) a bachelor's degree in social work;
or
(B) similar professional
qualifications, which include a minimum educational requirement of a bachelor's
degree and one year experience met by supervised employment providing social
services in a health care setting.
(139) Standards--The minimum conditions,
requirements, and criteria established in this chapter with which an
institution must comply to be licensed under this chapter.
(140) State Medicaid claims
administrator--The entity under contract with HHSC to process Medicaid claims
in Texas.
(141) State
Ombudsman--Has the meaning given in §
88.2 of this title.
(142) State plan--A formal plan for the
medical assistance program, submitted to CMS, in which the State of Texas
agrees to administer the program in accordance with the provisions of the State
Plan, the requirements of Titles XVIII and XIX, and all applicable federal
regulations and other official issuances of the U.S. Department of Health and
Human Services.
(143) Stay
agreement--An agreement between a license holder and the executive commissioner
that sets forth all requirements necessary to lift a stay and rescind a license
revocation proposed under §
554.2107 of this chapter (relating
to Revocation of a License by the HHSC Executive Commissioner).
(144) Substandard quality of care
violation--A violation of §
554.401(a) or (b)
of this chapter (relating to Introduction); §
554.402(b) or (c)
of this chapter (relating to Exercise of Rights); §
554.406(d) - (h)
of this chapter (relating to Free Choice); §
554.417 of this chapter (relating
to Married Couples); §
554.504(a) of
this chapter (relating to Equal Access to Quality Care in Medicaid-certified
Facilities); §
554.601 of this chapter (relating
to Freedom from Abuse, Neglect and Exploitation); §
554.602 of this chapter (relating
to Incidents of Abuse, Neglect, and Exploitation Reportable to the Texas Health
and Human Services Commission and Law Enforcement Agencies by Facilities);
§
554.701 of this chapter (relating
to Quality of Life); §
554.703 of this chapter (relating
to Social Services General Requirements); §
554.706(a), (c), (d)(1) - (5), or (e)(7)
of this chapter (relating to Resident Group
and Family Council); §
554.801 of this chapter (relating
to Resident Assessment); §
554.901 of this chapter (relating
to Quality of Care); §
554.904(2) or (4)
of this chapter (relating to Behavioral Health Services); §
554.1501(5), (6), or
(7) of this chapter (relating to Pharmacy
Services); or §
554.1601(e)(2)
of this chapter (relating to Infection Control) that constitutes:
(A) an immediate threat to resident health or
safety;
(B) a pattern of or actual
harm that is not an immediate threat; or
(C) a widespread potential for more than
minimal harm, but less than an immediate threat, with no actual
harm.
(145)
Supervision--General supervision, unless otherwise identified.
(146) Supervision (direct)--Authoritative
procedural guidance by a qualified person for the accomplishment of a function
or activity within the qualified person's sphere of competence. If the person
being supervised does not meet assistant-level qualifications specified in this
chapter and in federal regulations, the supervisor must be on the premises and
directly supervising.
(147)
Supervision (general)--Authoritative procedural guidance by a qualified person
for the accomplishment of a function or activity within the qualified person's
sphere of competence. The person being supervised must have access to the
qualified person providing the supervision.
(148) Survey agency--HHSC is the agency that,
through contractual agreement with CMS, is responsible for Title XIX (Medicaid)
survey and certification of nursing facilities.
(149)
Texas Register--A
publication of the Texas Register Publications Section of the Office of the
Secretary of State that contains emergency, proposed, withdrawn, and adopted
rules issued by Texas state agencies.
(150) Therapeutic diet--A diet ordered by a
physician as part of treatment for a disease or clinical condition, in order to
eliminate, decrease, or increase certain substances in the diet or to provide
food which has been altered to make it easier for the resident to
eat.
(151) Threatened violation--A
situation that, unless immediate steps are taken to correct, may cause injury
or harm to a resident's health and safety.
(152) Title II--Federal Old-Age, Survivors,
and Disability Insurance Benefits of the Social Security Act (42 U.S.C. §§
401 -
434).
(153) Title XVI--Supplemental Security Income
(SSI) of the Social Security Act (42 U.S.C. §§
1381 -
1385).
(156) Total health status--Includes
functional status, medical care, nursing care, nutritional status,
rehabilitation and restorative potential, activities potential, cognitive
status, oral health status, psychosocial status, and sensory and physical
impairments.
(157) Universal
precautions--The use of barrier precautions and other precautions to prevent
the spread of blood-borne diseases.
(158) Unreasonable confinement--Involuntary
seclusion.
(159) Vaccine
preventable diseases--The diseases included in the most current recommendations
of the Advisory Committee on Immunization Practices of the Centers for Disease
Control and Prevention.
(160)
Vendor payment--Payment made by HHSC on a daily-rate basis for services
delivered to recipients in Medicaid-certified nursing facilities. Vendor
payment is based on the nursing facility's approved-to-pay claim processed by
the state Medicaid claims administrator. The Nursing Facility Billing
Statement, subject to adjustments and corrections, is prepared from information
submitted by the nursing facility, which is currently on file in the computer
system as of the billing date. Vendor payment is made at periodic intervals,
but not less than once per month for services rendered during the previous
billing cycle.
(161)
Widespread--When the problem causing a violation is pervasive in a facility or
represents systemic failure that affected or has the potential to affect a
large portion or all facility residents.
(162) Willfully interfere--To act or not act
to intentionally prevent, interfere with, or impede or to attempt to
intentionally prevent, interfere with, or impede.
(163) Working day--Any 24-hour period, Monday
through Friday, excluding state and federal holidays.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.