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TITLE 40SOCIAL SERVICES AND ASSISTANCE
PART 1DEPARTMENT OF AGING AND DISABILITY SERVICES
CHAPTER 19NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION
SUBCHAPTER BDEFINITIONS
RULE §19.101Definitions

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 Penal Code §21.08 (indecent exposure) or Penal Code Chapter 22 (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) Activities director--The qualified individual appointed by the facility to direct the activities program as described in §19.702 of this chapter (relating to Activities).

  (5) Addition--The addition of floor space to an institution.

  (6) Administrator--Licensed nursing facility administrator.

  (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) Affiliate--With respect to a:

    (A) partnership, each partner thereof;

    (B) corporation, each officer, director, principal stockholder, and subsidiary; and each person with a disclosable interest;

    (C) natural person, which includes each:

      (i) person's spouse;

      (ii) partnership and each partner thereof of which said person or any affiliate of said person is a partner; and

      (iii) corporation in which said person is an officer, director, principal stockholder, or person with a disclosable interest.

  (9) Agent--An adult to whom authority to make health care decisions is delegated under a durable power of attorney for health care.

  (10) 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.

  (11) APA--The Administrative Procedure Act, Texas Government Code, Chapter 2001.

  (12) Attending physician--A physician, currently licensed by the Texas Medical Board, who is designated by the resident or responsible party as having primary responsibility for the treatment and care of the resident.

  (13) 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.

  (14) Barrier precautions--Precautions including the use of gloves, masks, gowns, resuscitation equipment, eye protectors, aprons, faceshields, and protective clothing for purposes of infection control.

  (15) 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.

  (16) Certification--The determination by DADS that a nursing facility meets all the requirements of the Medicaid and/or Medicare programs.

  (17) CFR--Code of Federal Regulations.

  (18) CMS--Centers for Medicare & Medicaid Services, formerly the Health Care Financing Administration (HCFA).

  (19) Complaint--Any allegation received by DADS 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.

  (20) Completion date--The date an RN assessment coordinator signs an MDS assessment as complete.

  (21) 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 §19.801(2) of this chapter (relating to Resident Assessment).

  (22) 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 §19.802(b)(2) of this chapter (relating to Comprehensive Care Plans), 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/or

    (D) assisting in the development of appropriate coping mechanisms.

  (23) Controlled substance--A drug, substance, or immediate precursor as defined in the Texas Controlled Substance Act, Texas Health and Safety Code, Chapter 481, and/or the Federal Controlled Substance Act of 1970, Public Law 91-513.

  (24) 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.

  (25) Covert electronic monitoring--The placement and use of an electronic monitoring device that is not open and obvious, and the facility and DADS 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.

  (26) DADS--The Department of Aging and Disability Services.

  (27) Dangerous drugs--Any drug as defined in the Texas Health and Safety Code, Chapter 483.

  (28) Dentist--A practitioner licensed by the Texas State Board of Dental Examiners.

  (29) Department--Department of Aging and Disability Services.

  (30) DHS--This term referred to the Texas Department of Human Services; it now refers to DADS, unless the context concerns an administrative hearing. Administrative hearings were formerly the responsibility of DHS; they now are the responsibility of the Texas Health and Human Services Commission (HHSC).

  (31) 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, by the Texas State Board of Examiners of Dietitians. These individuals must have one year of supervisory experience in dietetic service of a health care facility.

  (32) Direct care by licensed nurses--Direct care consonant with the physician's planned regimen of total resident care includes:

    (A) assessment of the resident's health care status;

    (B) planning for the resident's care;

    (C) assignment of duties to achieve the resident's care;

    (D) nursing intervention; and

    (E) evaluation and change of approaches as necessary.

  (33) Distinct part--That portion of a facility certified to participate in the Medicaid Nursing Facility program.

  (34) 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 man;

    (C) any substance (other than food) intended to affect the structure or any function of the body of man; 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.

  (35) 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.

  (36) Emergency--A sudden change in a resident's condition requiring immediate medical intervention.

  (37) Executive Commissioner--The executive commissioner of the Health and Human Services Commission.

  (38) 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.

  (39) Exposure (infections)--The direct contact of blood or other potentially infectious materials of one person with the skin or mucous membranes of another person. Other potentially infectious materials include the following human body fluids: semen, vaginal secretions, cerebrospinal fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, and body fluid that is visibly contaminated with blood, and all body fluids when it is difficult or impossible to differentiate between body fluids.

  (40) 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 which meets the requirements of §1919(a) - (d) of the Social Security Act. 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 17 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 of, 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.

  (41) Family council--A group of family members, friends, or legal guardians of residents, who organize and meet privately or openly.

  (42) Family representative--An individual appointed by the resident to represent the resident and other family members, by formal or informal arrangement.

  (43) Fiduciary agent--An individual who holds in trust another's monies.

  (44) Free choice--Unrestricted right to choose a qualified provider of services.

  (45) 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.

  (46) Governmental unit--A state or a political subdivision of the state, including a county or municipality.

  (47) HCFA--Health Care Financing Administration, now the Centers for Medicare & Medicaid Services (CMS).

Cont'd...

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