Revision 19-0; Effective July 7, 2019

 

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

CLO or community living options — A process by which the LIDDA provides information to an individual and legally authorized representative (LAR) about the range of community living services, supports and programs the individual may be eligible for, and discusses services and supports the individual will need to live in the community, as well as individual preferences and barriers to community living.

Collateral contact — A person who is knowledgeable about the individual seeking admission to an NF or the resident, such as family members, previous providers or caregivers, and who may support or corroborate information provided by the individual or resident.

Habilitation coordination — Assistance for an individual residing in a nursing facility to access appropriate specialized services necessary to achieve a quality of life and level of community participation acceptable to the individual and LAR on the individual’s behalf.

Habilitation Coordinator — An employee of a local intellectual and developmental disability authority (LIDDA) who provides habilitation coordination.

HHSC — The Texas Health and Human Services Commission.

HSP or Habilitation Service Plan — A plan developed by the service planning team (SPT) while an individual is residing in an NF that:

  1. is individualized and developed through a person-centered approach;
  2. identifies the individual’s:
    1. strengths;
    2. preferences;
    3. desired outcomes; and
    4. psychiatric, behavioral, nutritional management, and support needs as described in the comprehensive care plan or Minimum Date Set (MDS) assessment; and
  3. identifies the specialized services that will accomplish the desired outcomes of the individual, or the LAR’s on behalf of the individual, including amount, frequency and duration for each service.

ID or intellectual disability — Defined in 42 Code of Federal Regulations (CFR) §483.102(b)(3)(i).

IDD habilitative specialized services — The following specialized services that are available to an individual:

  1. habilitation coordination;
  2. day habilitation;
  3. independent living skills training;
  4. behavioral support;
  5. employment assistance; and
  6. supported employment.

IDT or interdisciplinary team — A team consisting of:

  1. a resident with MI, ID or DD;
  2. the resident's LAR, if any;
  3. a registered nurse from the NF with responsibility for the resident;
  4. a representative of:
    1. the LIDDA, if the resident has ID or DD;
    2. the LMHA or LBHA, if the resident has MI; or
    3. the LIDDA and the LMHA or LBHA, if the resident has MI and DD, or MI and ID; and
  5. others as follows:
    1. a concerned person whose inclusion is requested by the resident or LAR;
    2. a person specified by the resident, LAR, NF, LIDDA, LMHA or LBHA, as applicable, who is professionally qualified, certified, or licensed with special training and experience in the diagnosis, management, needs, and treatment of people with MI, ID or DD; and
    3. a representative of the appropriate school district if the resident is school age and inclusion of the district representative is requested by the resident or LAR.

Individual — A person:

  1. whose active PASRR evaluation (PE) or resident review is positive for ID or DD;
  2. who is 21 years of age or older; and
  3. who is a Medicaid recipient.

LAR or legally authorized representative — A person authorized by law to act on behalf of an individual seeking admission to an NF or resident about a matter described by this chapter, and who may be the parent of a minor child, the legal guardian or the surrogate decision maker. (See limitations on authority of surrogate decision maker in the definition of “surrogate decision maker.”

LIDDA or local intellectual and developmental disability authority — An entity designated by the executive commissioner of HHSC, in accordance with Texas Health and Safety Code §533A.035.

LMHA or local mental health authority — An entity designated to provide mental health services in accordance with Texas Health and Safety Code §533.035(a).

LBHA or local behavioral health authority — An entity designated to provide mental health and chemical dependency services in accordance with Texas Health and Safety Code §533.0356(a).

Nursing facility (NF) — A Medicaid-certified facility that is licensed in accordance with Texas Health and Safety Code, Chapter 242.

Nursing facility specialized services — The following NF specialized services that are available to an individual:

  1. therapy services;
  2. customized manual wheelchair; and
  3. durable medical equipment.

PASRR or Preadmission Screening and Resident Review — required by 42 CFR 483.100-138.

PASRR Level II Evaluation (PE) — A face-to-face evaluation:

  1. of an individual seeking admission to an NF who is suspected of having MI, ID or DD; and
  2. performed by a LIDDA, LHMA or LBHA to determine if the individual has MI, ID or DD and, if so, to:
    1. assess the individual's need for care in a nursing facility;
    2. assess the individual's need for specialized services; and
    3. identify alternate placement options.

PASRR Level 1 (PL1) — The process of screening an individual seeking admission to an NF to identify whether the person is suspected of having MI, ID or DD.

QIDP or qualified intellectual disability professional — A person who meets the qualifications described in 42 CFR §483.430(a).

Service coordination — Assistance in accessing medical, social, educational and other appropriate services and supports, including alternate placement assistance that will help a person achieve a quality of life and community participation acceptable to the person and LAR on the person's behalf.

Service coordinator — An employee of a LIDDA who provides service coordination.

Specialized services — The following support services, other than NF services, that are identified through the PE or resident review and may be provided to a resident who has a PE or resident review that is positive for MI, ID or DD: a. NF specialized services; b. IDD habilitative specialized services; and c. MI specialized services.

SPT or service planning team — A team convened by a LIDDA staff member that develops, reviews and revises the HSP and the Transition Plan for an individual.

  1. The team must include:
    1. the individual;
    2. the individual’s LAR, if any;
    3. the habilitation coordinator for discussions and service planning related to specialized services or the service coordinator for discussions related to transition planning if the individual is transitioning to the community;
    4. the managed care organization (MCO) service coordinator, if the individual does not object;
    5. while the individual is in a nursing facility:
      1. a nursing facility staff member familiar with the individual’s needs; and
      2. a person providing a specialized service to the individual or a representative of a provider agency that is providing specialized services for the individual;
    6. if the individual is transitioning to the community:
      1. a representative from the community program provider, if one has been selected; and
      2. a relocation specialist; and (vii) a representative from the LMHA/LBHA, if the individual has MI.
  2. Other participants on the SPT may include:
    1. a concerned person whose inclusion is requested by the individual or the LAR; and
    2. at the discretion of the LIDDA, a person who is directly involved in the delivery of services to people with ID or DD.

Transition Plan — A plan developed by the SPT that describes the activities, timetable, responsibilities, services and essential supports involved in assisting an individual to transition from residing in a nursing facility to living in the community.