1200, Definitions

Revision 23-1; Effective July 26, 2023

The following words and terms, when used in this handbook, have the following meanings unless the context clearly indicates otherwise. See related 26 TAC Section 711.3.

A

Administrator: The person in charge of a provider or that person's designee. The term does not apply to the assistant commissioner of state supported living centers or the assistant commissioner for mental health substance abuse services.

Adult: A person 18 years or older, or a person under 18 years old who is or has been married or who has had the disabilities of minority removed for general purposes.

Agency: State agencies including Texas Health and Human Services Commission, Texas Department of State Health Services, and the Texas Department of Family and Protective Services.

Agent: A person not employed by but working under the auspices of a service provider or contractor. For example, a student or volunteer.

Allegation: A report by someone that an individual receiving services has been or is being abused, neglected, or exploited.

Allegation type: The type of allegation investigated under 26 TAC Chapter 711. The Provider Investigation program investigates the following allegation types:

  • exploitation;
  • neglect;
  • physical abuse;
  • sexual abuse; and
  • verbal or emotional abuse.

Alleged Perpetrator: A person alleged to have abused, neglected, or exploited an individual receiving services.

Alleged Victim: An individual receiving services who is alleged to have been abused, neglected, or exploited.

B

Behavioral Health Services (BHS):

  • services related to research, prevention, and detection of mental disorders and disabilities;
  • services necessary to treat, care for, control, supervise, and rehabilitate persons who have a mental disorder or disability, including persons whose mental disorders or disabilities result from a substance abuse disorder, alcoholism, or drug addiction; and
  • interventions to treat:
    • abuse of alcohol or a controlled substance;
    • psychological or physical dependence on alcohol or a controlled substance; or
    • addiction to alcohol or a controlled substance.

C

Child: A minor person under 18 years old who has not been married and has not had the disabilities of minority removed for general purposes.

Child Care Regulation (CCR): A division of HHSC that licenses and regulates 24-hour child care programs, including residential treatment centers and emergency shelters.

Children's Advocacy Center (CAC): Centers located throughout Texas designated to provide specialized forensic interviews conducted by trained, neutral professionals using research and practice-informed techniques as part of a larger investigative process. The services of the CACs are intended to minimize the need for multiple interviews by community agencies involved in serving victims of abuse.

Clinical practice: A licensed professional's demonstration of professional competence, as described by the licensing professional board.

Collateral witness: Any person who can provide either direct or circumstantial information about the alleged incident who is not either the alleged victim or alleged perpetrator.

Community center: Serves people with mental health or intellectual disabilities and is established under the Texas Health and Safety Code Chapter 534, Subchapter A. 

Community provider: Excluding HCS and TxHmL waiver program providers and home and community support services agency, a community provider includes the following:

  • a person who contracts with a health and human services agency or managed care organization to provide home and community-based services;
  • a person who contracts with a Medicaid managed care organization to provide behavioral health services;
  • a managed care organization;
  • an officer, employee, agent, contractor, or subcontractor of a person or entity listed in the bullets above; and
  • an employee, fiscal agent, case manager, or service coordinator of an individual employer participating in the consumer directed service option, as defined by Texas Government Code Section 531.051(a)(3).

Confirmed: Term used to describe an allegation in which a preponderance of credible evidence exists to support that abuse, neglect or exploitation occurred.

Consumer Directed Services (CDS): A service delivery option in which a person receiving services or their legally authorized representative employs and retains service providers and directs the delivery of program services.

Contractor: Any organization, entity or person who contracts with a provider to provide services directly to a person with physical, mental or intellectual disabilities. The term includes:

  • a foster care provider; and
  • a local independent school district with which a facility, local authority, or community center has a memorandum of understanding for educational services.

Contractor Chief Executive Officer (CEO): The person in charge of a contractor that has one or more employees, excluding the CEO.

D

Designated Perpetrator: A direct provider determined by PI in a confirmed finding to have abused, neglected, or exploited a person receiving services.

Direct provider: The person, employee, agent, contractor or subcontractor responsible for providing services to the individual receiving services.

DSHS: Texas Department of State Health Services.

E

Exploitation: When the alleged perpetrator is a direct provider to a person receiving services, exploitation is defined as the illegal or improper act or process of using a person receiving services or the resources of a person receiving services for monetary or personal benefit, profit or gain, and excludes:

  • theft as defined in the Texas Penal Code Chapter 31;
  • allegations less than $25; and
  • a loan, which includes money or property given to someone to use for a period with an understanding that it will be paid back or returned, made by a person receiving services to a direct provider of a community provider.

See examples of exploitation allegations in Section 2150.

See related 26 TAC Section 711.21.

F

Facility: This term refers to any of the following:

  • HHSC central offices, state supported living centers, state hospitals, the Rio Grande State Center, the Waco Center for Youth and the El Paso Psychiatric Center, including community services operated by Health and Specialty Care System.
  • A person contracting with a health and human services agency to provide inpatient mental health services.
  • Intermediate care facilities for people with an intellectual disability or related conditions licensed under the Texas Health and Safety Code Chapter 252.

Financial Management Services Agency (FMSA): An agency contracting with HHSC or an MCO that provides financial management services for an employer who participates in the CDS option.

See related 40 TAC Section 49.102.

H

HHSC: Texas Health and Human Services Commission.

HHSC Complaint and Incident Intake (CII): A program within the HHSC Regulatory Services Division that protects the rights of people receiving services.

HHSC Provider inspector or investigator: An employee of the Texas Health and Human Services Commission who:

  • investigates allegations of abuse, neglect, and exploitation according to HRC Chapter 48, Subchapter F and Texas Family Code Chapter 261;
  • has expertise and demonstrated competence in conducting investigations; and
  • has received training on techniques for communicating effectively with individuals with a disability.

Home and Community-based Services (HCBS): Services provided in the home or community in accordance with 42 U.S.C. Section 1315, 42 U.S.C. Section 1315a, 42 U.S.C. Section 1396a or 42 U.S.C. Section 1396n. See related HRC Section 48.251(a)(5).

Home and Community-based Services – Adult Mental Health Program (HCBS-AMH): A program authorized under Section 1915(i) of the Social Security Act (42 U.S.C. Section 1396n) that provides HCBS to Medicaid and non-Medicaid people with serious mental illness who have extended tenure in state mental health facilities.

Home and Community-based Services (HCS) Waiver Program: Medicaid program authorized under Section 1915(c) of the federal Social Security Act (42 U.S.C. Section 1396n(c)) for the provision of services to persons with an intellectual or developmental disability described by Texas Government Code Section 534.001(11)(B) and Title 40 TAC, Chapter 9, Subchapter D.

I

ICF/IID: A licensed intermediate care facility for people with an intellectual disability or related conditions, as described in Texas Health and Safety Code, Chapter 252.

Incitement: To spur to action or instigate into activity. This term implies responsibility for initiating another person's actions.

Inconclusive: Term used to describe that there is not a preponderance of credible evidence to indicate that abuse, neglect, or exploitation did or did not occur due to lack of witnesses or other available evidence.

Individual or person receiving services: This term refers to:

  • an adult or child who receives services from a provider, as that term is defined below; or
  • an adult or child who lives in a residence that is owned, operated, or controlled by an HCS waiver program provider, regardless of whether the individual is receiving HCS waiver program services.

L

Limited Service Provider (LSP): The company or person that provides only certain services meaning a specialty provider. An MCO, HCS, or TxHmL provider may contract with an LSP to provide certain services to a person receiving services.

Local Authority: This term refers to either a local mental health authority, local behavioral authority, or a local intellectual and developmental disability authority.

Local Behavioral Health Authority (LBHA): Local behavioral health authorities provide services to a specific geographic area of the state, called the local service area. A LBHA may be designated by DSHS, in accordance with Texas Health and Safety Code Section 533.0356, and has all the responsibilities and duties of a local mental health authority, as provided by Texas Health and Safety Code Section 533.035.

Local Intellectual and Developmental Disability Authority (LIDDA): Designated by the HHSC executive commissioner in accordance with Texas Health and Safety Code Section 533A.035 and as defined by Texas Health and Safety Code Section 531.002(12). LIDDAs serve as the point of entry for publicly funded intellectual and developmental disability programs, whether the program is provided by a public or private entity. For more information about LIDDAs, please see LIDDA Statutes and Rules.

Local Mental Health Authority (LMHA): Designated by the HHSC executive commissioner in accordance with Section 533.035, Texas Health and Safety Code and as defined by Section 531.002(13), Texas Health and Safety Code. LMHAs provide services to a specific geographic area of the state, called the local service area. 

M

Managed Care Organization (MCO): A health care provider or a group or organization of medical service providers who offers managed care health plans. Texas Medicaid uses managed care to provide health care services to most clients.

Medical intervention or treatment: Intervention or treatment by a licensed medical doctor, osteopath, podiatrist, dentist, physician's assistant or advanced practice nurse. Medical intervention or treatment does not include first aid, an examination, diagnostics (such as an x-ray or blood test), or the prescribing of oral or topical medication.

Mental health services provider: A person, licensed or unlicensed, who performs or claims to perform mental health services, including a:

See related Texas Civil Practice and Remedies Code, Section 81.001.

N

Neglect: When the alleged perpetrator is a direct provider to a person receiving services in or from a facility, local authority, community center, or HCS or TxHmL waiver program provider, neglect is defined as a negligent act or omission which caused or may have caused physical or emotional injury or death to a person receiving services or which placed a person receiving services at risk of physical or emotional injury or death.

Examples of neglect, if such failure results in physical or emotional injury or death to a person receiving services or which placed a person receiving services at risk of physical or emotional injury or death include, but are not limited to, the failure to:

  • establish or carry out an appropriate individual program plan or treatment plan for a specific person receiving services;
  • provide adequate nutrition, clothing, or health care to a specific person receiving services in a residential or inpatient program; or
  • provide a safe environment for a specific person receiving services, including the failure to maintain adequate numbers of appropriately trained staff.

When the alleged perpetrator is a direct provider to a person receiving services from a community provider, neglect is defined as a negligent act or omission which caused physical or emotional injury or death to a person receiving services.

See examples of neglect allegations in Section 2140.

See related 26 TAC Section 711.19.

Non-serious physical injury:

  • In state supported living centers and state hospitals — any injury requiring minor first aid and determined not to be serious by a registered nurse, advanced practice nurse, or physician.
  • For all other service providers — any injury determined not to be serious by the appropriate medical personnel. Examples of a non-serious physical injury may include:
    • a superficial laceration;
    • a contusion two and one-half inches in diameter or smaller; or
    • an abrasion.

Non-serious verbal or emotional abuse: Direct provider has used derogatory language that may be demoralizing or humiliating to the alleged victim.

P

Peer or Professional Review: A review of clinical and professional practices by peer professionals.

Physical abuse: When the alleged perpetrator is a direct provider, physical abuse is defined as:

See examples of physical abuse allegations in Section 2110. See related 26 TAC Section 711.11.

Physical force: Pressure applied to a person's body.

Preponderance of evidence: The greater weight of evidence, or evidence more credible and convincing to the mind.

Provider: This term includes:

  • a facility;
  • a community center, local authority;
  • a person who contracts with a health and human services agency or managed care organization to provide home and community-based services, except an HCSSA;
  • a person who contracts with a Medicaid managed care organization to provide behavioral health services;
  • a managed care organization;
  • an officer, employee, agent, contractor or subcontractor of a person or entity listed above; and
  • an employee, fiscal agent, case manager or service coordinator of an individual employer participating in the Consumer Directed Service option, as defined by Texas Government Code Section 531.051.

See related HRC Section 48.251(a)(9).

R

Reasonable person: A hypothetical person who exercises average care, skill and judgment.

Reporter: The person who makes an allegation.

S

Serious physical injury:

  • In state supported living centers and state hospitals — Any injury requiring medical intervention or hospitalization or determined to be serious by a physician or advanced practice nurse. Medical intervention is treatment by a licensed medical doctor, osteopath, podiatrist, dentist, physician assistant or advanced practice nurse. Medical intervention does not include first aid, an examination, diagnostics (such as an x-ray or blood test), or the prescribing of oral or topical medication.
  • For all other service providers — any injury determined to be serious by the appropriate medical personnel who examined the person. Examples of serious physical injuries include:
    • a fracture;
    • a dislocation of any joint;
    • an internal injury;
    • a contusion larger than two and one-half inches in diameter;
    • a concussion;
    • a second or third-degree burn; or
    • any laceration requiring sutures.

Serious verbal or emotional abuse: Serious threats by a direct provider to harm or kill an alleged victim.

Service provider: The provider that employs, contracts with, or supervises the direct provider of services to a person receiving services.

Sexually transmitted infection: Any infection with or without symptoms or clinical manifestations that can be transmitted from one person to another by sexual contact. Also referred to as sexually transmitted disease.

Sexual abuse: When the alleged perpetrator is a direct provider, sexual abuse is defined as:

  • any sexual activity, including:
    • kissing a person receiving services with sexual intent;
    • hugging a person receiving services with sexual intent;
    • stroking a person receiving services with sexual intent;
    • fondling a person receiving services with sexual intent;
  • engaging in sexual conduct as defined in the Texas Penal Code, Section 43.01 or any activity that is obscene as defined in the Texas Penal Code, Section 43.21;
  • requesting, soliciting or compelling a person receiving services to engage in:
  • while in the presence of a person receiving services:
  • committing sexual exploitation as defined in 26 TAC Section 711.13, against a person receiving services;
  • committing sexual assault as defined in the Texas Penal Code Section 22.011, against a person receiving services;
  • committing aggravated sexual assault as defined in the Texas Penal Code, Section 22.021, against a person receiving services; and
  • causing, permitting, encouraging, engaging in, or allowing the photographing, filming, videotaping or depicting of a person receiving services if the direct provider knew or should have known that the resulting photograph, film, videotape, or depiction of the person receiving services is obscene as defined in the Texas Penal Code, Section 43.21, or is pornographic.

Consensual sexual activity between a direct provider and an adult receiving services is not considered sexual abuse if the consensual sexual relationship began prior to the direct provider becoming a direct provider.

See examples of sexual abuse allegations in Section 2120.

See related 26 TAC Section 711.13.

Significant impairment: When a person experiences a negative physical, emotional or mental effect or decline in their social, occupational, or other areas of daily functioning, such as independence, self-care, or activities of daily living, as determined through observation, diagnosis, evaluation or assessment.

State hospitals: State hospitals provide patient-focused, inpatient psychiatric services for people of all ages. Additional information can be found on the HHS website.

State Supported Living Center (SSLC): State supported living centers provide campus-based direct services and support to people with intellectual and developmental disabilities. Additional information can be found on the HHS website.

T

Texas Administrative Code (TAC): The Texas Administrative Code is a compilation of state agency rules in Texas.

Texas Home Living Waiver Program (TxHmL): Medicaid waiver program authorized for the provision of community-based services and supports to eligible individuals with an intellectual or developmental disability who live in their own homes or the homes of their families. TxHmL is authorized under Section 1915(c) of the federal Social Security Act (42 U.S.C. Section 1396n(c)), Texas Government Code Section 534.001(11)(D), and 26 TAC Chapter 566.

U

Unconfirmed: Term used to describe an allegation in which a preponderance of evidence exists to prove that it did not occur.

Unfounded: Term used to describe an allegation that is spurious or patently without factual basis.

V

Verbal or emotional abuse: When the alleged perpetrator is a direct provider, verbal or emotional abuse is the willful infliction of an act or repeated acts of verbal or other communication, including gestures, to harass, intimidate, humiliate or degrade a person receiving services or threaten them with physical or emotional harm. The act or communication must:

  • result in an individual receiving services experiencing:
    • significant impairment to their physical, mental or emotional health; or
    • substantial physical or emotional distress as identified by an appropriate medical professional; or
  • be of such a serious nature that a reasonable person would consider it causing significant impairment to the physical, mental or emotional health of the alleged victim.

See examples of verbal or emotional abuse allegations in Section 2130.

See related 26 TAC 711.17.

Y

Youth Empowerment Services Waiver: A waiver authorized under Section 1915(c) of the Social Security Act, which prevents or reduces institutionalization of children and adolescents with severe emotional disturbance, enables more flexibility in providing intensive community-based services for children and adolescents with SED, and provides support for their families by improving access to services.