Part 1.
TEXAS DEPARTMENT OF HUMAN SERVICES
Chapter 19.
NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION
The Texas Department of Human Services (DHS) adopts amendments to §§19.101,
19.403, 19.1913, and 19.2011; and new §19.910 and §19.911 in its
Nursing Facility Requirements for Licensure and Medicaid Certification chapter.
DHS adopts §19.101 and §19.910 with changes to the proposed text
published in the February 8, 2002, issue of the
Texas Register
(27 TexReg 882). DHS adopts §§19.403, 19.911,
19.1913, and 19.2011 as proposed without changes.
Justification for the quality assurance early warning system sections is
to respond to Senate Bill (SB) 1839, 77th Legislature. The system will identify
facilities with a history of resident-care deficiencies. Quality-of-care monitors
will function as consultants to evaluate best practices for nursing facilities
that have difficulty delivering the expected quality of care. Rapid response
teams composed of two or more quality-of-care monitors may assist in educating
the facility as to best practices, per the facility's request. The purpose
of these sections is to affect a better outcome for nursing home residents.
The adoption also includes technical amendments to current rules that correct
references, titles, and addresses.
The change to §19.101 moves the definition of medical power of attorney,
proposed as (70), to (74) to properly alphabetize the section. The change
also updates the acronym for the Texas Department of Mental Health and Mental
Retardation (TDMHMR) and moves it to (140) to properly alphabetize the section.
The change also updates the title of Preadmission Screening and Resident Review
(PASARR) in (16), (40)(A) and (97). The change also makes a grammatical correction
by changing a plural verb to singular in (51), corrects capitalization in
(131)and (135), and corrects punctuation in (95), (115), and (157). The change
to §19.910(7) restructures the sentence to improve clarity. The change
of tense to §19.910(8) makes the action future tense.
DHS received written comments from the Texas Health Care Association and
the Coalition for Nurses in Advanced Practice. A summary of the comments and
DHS's responses follows.
Comment: In §19.101 (115), the Quality-of-Care Monitor definition
is different from the statute. "Dietitian" is used in the proposed rules as
opposed to "nutritionist" in SB 1839.
Response: Throughout the Nursing Facility Requirements for Licensure and
Medicaid Certification chapter, DHS refers to a "qualified dietitian" as one
who is either registered or licensed. The term "nutritionist " is not defined
and is not used anywhere in the rules. A dietitian is actually more than a
nutritionist. A dietitian has knowledge of both nutrition and specialized
diets. DHS believes the use of the word "dietitian" rather than "nutritionist"
is more appropriate.
Comment: SB 1839 Section 7.03, Chapter 255, Section 255.001(3)(C), states
that monitors function independently of "other divisions of the department."
The proposed rule says "functions independently of DHS Long Term Care-Regulatory."
The statutory language should be used.
Response: DHS will retain the language as proposed. There are divisions
within DHS, such as Central Operations, Administrative Management, Field Operations,
Human Resources, etc. Medical Quality Assurance functions in concert with,
but not totally independent of, these other divisions. The emphasis was put
on Long Term Care-Regulatory because Medical Quality Assurance quality-of-care
monitors function independently of Long Term Care-Regulatory.
Comment: The definitions of "practitioner" and "nurse practitioner" are
out-dated, and "advanced practice nurse" should be added to the list of definitions.
Response: DHS will amend the definition of "practitioner" in §19.101
to read: "A physician, podiatrist, dentist, or an advanced practice nurse
or physician assistant to whom a physician has delegated authority to sign
a prescription order, when relating to pharmacy services."
DHS will replace the current definition of "nurse practitioner" with: "A
person licensed by the Texas Board of Nurse Examiners (BNE) as a registered
professional nurse, authorized by the BNE as an advanced practice nurse in
the role of nurse practitioner."
"Advanced practice nurse" is not a term currently used in the nursing facility
rules; therefore, it is not appropriate to add it to the list of definitions.
However, DHS will be aware of the term for use in future amendments.
Subchapter B. DEFINITIONS
40 TAC §19.101
The amendment is adopted under the Health and Safety Code,
Chapter 242, which authorizes the department to license and regulate convalescent
and nursing homes and related institutions.
The amendment implements the Health and Safety Code, §§242.001-242.268.
§19.101.Definitions.
The following words and terms, when used in this chapter, have the
following meanings, unless the context clearly indicates otherwise.
(1)
Abuse--Any act, failure to act, or incitement to act done
willfully, knowingly, or recklessly through words or physical action which
causes or could cause mental or physical injury or harm or death to a resident.
This includes verbal, sexual, mental/psychological, or physical abuse, including
corporal punishment, involuntary seclusion, or any other actions within this
definition.
(A)
"Involuntary seclusion"--Separation of a resident from
others or from his room against the resident's will or the will of the resident's
legal representative. Temporary monitored separation from other residents
will not be considered involuntary seclusion and may be permitted if used
as a therapeutic intervention as determined by professional staff and consistent
with the resident's plan of care.
(B)
"Mental/psychological abuse"--Mistreatment within the definition
of "abuse" not resulting in physical harm, including, but not limited to,
humiliation, harassment, threats of punishment, deprivation, or intimidation.
(C)
"Physical abuse"--Physical action within the definition
of "abuse," including, but not limited to, hitting, slapping, pinching, and
kicking. It also includes controlling behavior through corporal punishment.
(D)
"Sexual abuse"--Any touching or exposure of the anus, breast,
or any part of the genitals of a resident without the voluntary, informed
consent of the resident and with the intent to arouse or gratify the sexual
desire of any person and includes but is not limited to sexual harassment,
sexual coercion, or sexual assault.
(E)
"Verbal abuse"--The use of any oral, written, or gestured
language that includes disparaging or derogatory terms to a resident or within
the resident's hearing distance, regardless of the resident's age, ability
to comprehend, or disability.
(2)
Act--Chapter 242 of the Health and Safety Code.
(3)
Activities assessment--See Comprehensive Assessment and
Comprehensive Plan of Care.
(4)
Activities director--The qualified individual appointed
by the facility to direct the activities program as described in §19.702
of this title (relating to Activities).
(5)
Addition--The addition of floor space to an institution.
(6)
Administrator--Licensed nursing facility administrator.
(7)
Admission determination of medical necessity--The decision
regarding an individual's need for medical and nursing services upon his entry
into a nursing facility or upon his becoming eligible for Medicaid. The admission
determination of medical necessity is valid for up to 120 days from the effective
date assigned by the Utilization Review Committee.
(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 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 State Board of Medical Examiners, 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)
Board--Texas Board of Human Services.
(16)
CARE form--The DHS Client Assessment, Review and Evaluation
(CARE) form completed by Medicaid-certified nursing facilities which allows
for determination of medical necessity, reimbursement rate, initial level
of the Preadmission Screening and Resident Review (PASARR) and the initial
medical care determination and reassessment of the 1915(c) waivers.
(17)
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.
(18)
Case mix--A method of classifying recipients based upon
resource and service needs and paying nursing facilities a per diem rate according
to the recipient's classification.
(19)
Certification--The determination by the Texas Department
of Human Services (DHS) that a nursing facility meets all the requirements
of the Medicaid and/or Medicare programs.
(20)
CFR--Code of Federal Regulations.
(21)
CMS--Centers for Medicare & Medicaid Services, formerly
the Health Care Financing Administration (HCFA).
(22)
Complaint--Any allegation received by DHS 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.
(23)
Comprehensive assessment--An interdisciplinary description
of a resident's needs and capabilities including daily life functions and
significant impairments of functional capacity.
(24)
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 title (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.
(25)
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.
(26)
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; and
(C)
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.
(27)
Covert electronic monitoring--The placement and use of
an electronic monitoring device that is not open and obvious, and the facility
and DHS 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.
(28)
Dangerous drugs--Any drug as defined in the Texas Health
and Safety Code, Chapter 483.
(29)
Dentist--A practitioner licensed by the Texas State Dental
Examiners Board.
(30)
Department--Texas Department of Human Services.
(31)
DHS--Texas Department of Human Services.
(32)
Dietitian--A qualified dietitian is one who is qualified
based upon either:
(A)
registration by the Commission on Dietetic Registration
of the American Dietetic Association; 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.
(33)
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.
(34)
Distinct part--That portion of a facility certified to
participate in the Medicaid Nursing Facility program.
(35)
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 definition. It does not include
devices or their components, parts, or accessories.
(36)
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.
(37)
Emergency--A sudden change in a resident's condition requiring
immediate medical intervention.
(38)
Exploitation--The illegal or improper act or process of
a caretaker using the resources of an elderly or disabled person for monetary
or personal benefit, profit, or gain.
(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 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 §19.2500 of this title (relating to Preadmission
Screening and Resident Review (PASARR)).
(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)
Facility nurse assessor--The licensed nurse in the nursing
facility, who completes the Client Assessment, Review and Evaluation (CARE)
forms.
(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).
(48)
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.
(49)
Hearing--A contested case hearing held in accordance with
the Administrative Procedure Act, Texas Government Code, Chapter 2001, and
DHS's formal hearing procedures in Chapter 79 of this title (relating to Legal
Services).
(50)
HIV--Human Immunodeficiency Virus.
(51)
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 DHS.
(52)
Infection control--A program designed to prevent the transmission
of disease and infection in order to provide a safe and sanitary environment.
(53)
Inspection--Any on-site visit to or survey of an institution
by DHS for the purpose of licensing, monitoring, complaint investigation,
architectural review, or similar purpose.
(54)
Interdisciplinary care plan--See the definition of "comprehensive
care plan."
(55)
IV--Intravenous.
(56)
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.
(57)
Licensed health professional--A physician; physician assistant;
nurse practitioner; physical, speech, or occupational therapist; pharmacist;
physical or occupational therapy assistant; registered professional nurse;
licensed vocational nurse; or licensed social worker.
(58)
Licensed nursing home (facility) administrator--A person
currently licensed by the Texas Board of Nursing Facility Administrators.
(59)
Licensed vocational nurse (LVN)--A nurse who is currently
licensed by the Board of Vocational Nurse Examiners for the State of Texas.
(60)
Life Safety Code (also referred to as the Code or NFPA
101)--The Code for Safety to Life from Fire in Buildings and Structures, Standard
101, of the National Fire Protection Association (NFPA).
(61)
Life safety features--Fire safety components required
by the Life Safety Code, including, but not limited to, building construction,
fire alarm systems, smoke detection systems, interior finishes, sizes and
thicknesses of doors, exits, emergency electrical systems, and sprinkler systems.
(62)
Life support--Use of any technique, therapy, or device
to assist in sustaining life. (See §19.419 of this title (relating to
Directives and Medical Powers of Attorney)).
(63)
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.
(64)
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 Health and Safety Code, §121.021.
(65)
Long-term care-regulatory--A department in the long-term
care division of DHS responsible for surveying nursing facilities to determine
compliance with regulations for licensure and certification for Title XIX
participation.
(66)
Manager--A person, other than a licensed nursing home
administrator, having a contractual relationship to provide management services
to a facility.
(67)
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.
(68)
Medicaid applicant--A person who requests the determination
of eligibility to become a Medicaid recipient.
(69)
Medicaid nursing facility vendor payment system--Electronic
billing and payment system for reimbursement to nursing facilities for services
provided to eligible Medicaid recipients.
(70)
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.
(71)
Medical director--A physician licensed by the Texas State
Board of Medical Examiners, who is engaged by the nursing home to assist in
and advise regarding the provision of nursing and health care.
(72)
Medical necessity (MN)--The determination that a recipient
requires the services of licensed nurses in an institutional setting to carry
out the physician's planned regimen for total care. A recipient's need for
custodial care in a 24-hour institutional setting does not constitute a medical
need.
(73)
Medical necessity assessment--The process by which the
applicant's or recipient's medical condition is evaluated to determine the
need for nursing facility care based upon information supplied by the nursing
facility.
(74)
Medical power of attorney--The legal document that designates
an agent to make treatment decisions if the individual designator becomes
incapable.
(75)
Medical-social care plan--See Interdisciplinary Comprehensive
Care Plan.
(76)
Medically related condition--An organic, debilitating
disease or health disorder that requires services provided in a nursing facility,
under the supervision of licensed nurses.
(77)
Medication aide--A person who holds a current permit issued
under the Medication Aide Training Program as described in Chapter 95 of this
title (relating to Medication Aides) and acts under the authority of a person
who holds a current license under state law which authorizes the licensee
to administer medication.
(78)
Minimum data set (MDS)--See Resident Assessment Instrument
(RAI).
(79)
Misappropriation of funds--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.
(80)
Natural Death Act--Provisions of Texas Health and Safety
Code, Chapter 672.
(81)
Neglect--A deprivation of life's necessities of food,
water, or shelter, or a failure of an individual to provide services, treatment,
or care to a resident which causes or could cause mental or physical injury,
or harm or death to the resident.
(82)
NHIC--The National Heritage Insurance Corporation; the
intermediary for the Texas Medicaid program.
(83)
Nonnursing personnel--Persons not assigned to give direct
personal care to residents; including administrators, secretaries, activities
directors, bookkeepers, cooks, janitors, maids, laundry workers, and yard
maintenance workers.
(84)
Nurse aide--An individual who provides nursing or nursing-related
services to residents in a facility under the supervision of a licensed nurse.
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 and/or nursing-related services
for which a license or registration is required under state law.
(85)
Nurse aide trainee--An individual who is attending a program
teaching nurse aide skills.
(86)
Nurse practitioner-- A person licensed by the Texas Board
of Nurse Examiners (BNE) as a registered professional nurse, authorized by
the BNE as an advanced practice nurse in the role of nurse practitioner.
(87)
Nurse reviewer--A registered professional nurse employed
by the Texas Health and Human Services Commission (HHSC) to monitor the accuracy
of the CARE form assessment data.
(88)
Nursing assessment--See definition of "comprehensive assessment"
and "comprehensive care plan."
(89)
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.
(90)
Nursing facility/home--An institution that provides organized
and structured nursing care and service, and is subject to licensure under
Health and Safety Code, Chapter 242. The nursing facility may also be certified
to participate in the Medicaid Title XIX program. Depending on context, these
terms are used to represent the management, administrator, or other persons
or groups involved in the provision of care to the residents; 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.
(91)
Nursing facility/home administrator--See the definition
of "licensed nursing home (facility) administrator."
(92)
Nursing personnel--Persons assigned to give direct personal
and nursing services to residents, including registered nurses, licensed vocational
nurses, nurses aides, orderlies, and medication aides. Unlicensed personnel
function under the authority of licensed personnel.
(93)
Objectives--See definition of "goals."
(94)
OBRA--Omnibus Budget Reconciliation Act of 1987, which
includes provisions relating to nursing home reform, as amended.
(95)
Ombudsman--An advocate who is a certified representative,
staff member, or volunteer of the Office of the State Long Term Care Ombudsman,
Texas Department on Aging.
(96)
Optometrist--An individual with the profession of examining
the eyes for defects of refraction and prescribing lenses for correction who
is licensed by the Texas Optometry Board.
(97)
PASARR--Preadmission Screening and Resident Review.
(98)
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.
(99)
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.
(100)
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.
(101)
Person with a disclosable interest--A person with a disclosable
interest is any person who owns at least a 5.0% interest in any corporation,
partnership, or other business entity that is required to be licensed under
Health and Safety Code, Chapter 242. A person with a disclosable interest
does not include a bank, savings and loan, savings bank, trust company, building
and loan association, credit union, individual loan and thrift company, investment
banking firm, or insurance company, unless these entities participate in the
management of the facility.
(102)
Pharmacist--An individual, licensed by the Texas State
Board of Pharmacy to practice pharmacy, who prepares and dispenses medications
prescribed by a physician, dentist, or podiatrist.
(103)
Physical restraint--See Restraints (physical).
(104)
Physician--A doctor of medicine or osteopathy currently
licensed by the Texas State Board of Medical Examiners.
(105)
Physician assistant (PA)--
(A)
A graduate of a physician assistant training program who
is accredited by the Committee on Allied Health Education and Accreditation
of the Council on Medical Education of the American Medical Association, or
(B)
A person who has passed the examination given by the National
Commission on Certification of Physician Assistants. According to federal
requirements (42 CFR §491.2) a physician assistant is a person who meets
the applicable state requirements governing the qualifications for assistant
to primary care physicians, and who meets at least one of the following conditions:
(i)
is currently certified by the National Commission on Certification
of Physician Assistants to assist primary care physicians; or
(ii)
has satisfactorily completed a program for preparing physician
assistants that:
(I)
was at least one academic year in length;
(II)
consisted of supervised clinical practice and at least
four months (in the aggregate) of classroom instruction directed toward preparing
students to deliver health care; and
(III)
was accredited by the American Medical Association's
Committee on Allied Health Education and Accreditation; or
(C)
A person who has satisfactorily completed a formal educational
program for preparing physician assistants who does not meet the requirements
of paragraph (d)(2), 42 CFR §491.2, and has been assisting primary care
physicians for a total of 12 months during the 18- month period immediately
preceding July 14, 1978.
(106)
Podiatrist--A practitioner whose profession encompasses
the care and treatment of feet who is licensed by the Texas State Board of
Podiatry Examiners.
(107)
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 physician, are not
considered a poison, unless regulations specifically require poison labeling
by the pharmacist.
(108)
Practitioner-- A physician, podiatrist, dentist, or an
advanced practice nurse or physician assistant to whom a physician has delegated
authority to sign a prescription order, when relating to pharmacy services.
(109)
Preadmission medical necessity determination--The determination
of need for nursing facility care before the individual's admission into the
nursing facility. This determination is valid until admission into a nursing
facility or up to 30 days from the effective date.
(110)
PRN (pro re nata)--As needed.
(111)
Provider--The individual or legal business entity that
is contractually responsible for providing Medicaid services under an agreement
with DHS.
(112)
Psychoactive drugs--Drugs prescribed to control mood,
mental status, or behavior.
(113)
Qualified surveyor--An employee of DHS who has completed
state and federal training on the survey process and passed a federal standardized
exam.
(114)
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.
(115)
Quality-of-care monitor--A registered nurse, pharmacist,
or dietitian employed by DHS 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 DHS Long-Term Care-Regulatory.
(116)
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.
(117)
Registered nurse (RN)--An individual currently licensed
by the Board of Nurse Examiners for the State of Texas as a Registered Nurse
in the State of Texas.
(118)
Reimbursement methodology--The method by which DHS determines
nursing facility per diem rates.
(119)
Remodeling--The construction, removal, or relocation
of walls and partitions, the construction of foundations, floors, or ceiling-roof
assemblies, the expanding or altering of safety systems (including, but not
limited to, sprinkler, fire alarm, and emergency systems) or the conversion
of space in a facility to a different use.
(120)
Renovation--The restoration to a former better state
by cleaning, repairing, or rebuilding, including, but not limited to, routine
maintenance, repairs, equipment replacement, painting.
(121)
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.
(122)
Resident--Any individual residing in a nursing facility.
(123)
Resident assessment instrument (RAI)--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 Minimum Data Set (MDS) core elements as specified by the
Centers for Medicare & Medicaid Services (CMS); utilization guidelines;
and Resident Assessment Protocols (RAPS).
(124)
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 verbal.
(125)
Restraints (chemical)--Psychoactive drugs administered
for the purposes of discipline, or convenience, and not required to treat
the resident's medical symptoms.
(126)
Restraints (physical)--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.
(127)
Secretary--Secretary of Health and Human Services.
(128)
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.
(129)
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.
(130)
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.
(131)
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 Chapter 50 of the Human Resources Code 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 employment providing social services in a health care setting.
(132)
Standards--The minimum conditions, requirements, and
criteria established in this chapter with which an institution must comply
to be licensed under this chapter.
(133)
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.
(134)
State survey agency--The Texas Department of Human Services
is the agency, which through contractual agreement with the single state agency,
is designated as the agency responsible for Title XIX survey and certification
of nursing facilities and utilization review in the Title XIX nursing facilities.
(135)
Supervising physician--A physician who assumes responsibility
and legal liability for services rendered by a physician assistant (PA) and
has been approved by the Texas State Board of Medical Examiners to supervise
services rendered by specific PAs. A supervising physician may also be a physician
who provides general supervision of a nurse practitioner providing services
in a nursing facility.
(136)
Supervision--General supervision, unless otherwise identified.
(137)
Supervision (direct)--Authoritative procedural guidance
by a qualified person for the accomplishment of a function or activity within
his 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.
(138)
Supervision (general)--Authoritative procedural guidance
by a qualified person for the accomplishment of a function or activity within
his sphere of competence. The person being supervised must have access to
the licensed and/or qualified person providing the supervision.
(139)
Supervision (intermittent)--Authoritative procedural
guidance by a qualified person for the accomplishment of a function or activity
within his sphere of competence, with initial direction and periodic inspection
of the actual act of accomplishing the function or activity. The person being
supervised must have access to the licensed and/or qualified person providing
the supervision.
(140)
TDMHMR--Texas Department of Mental Health and Mental
Retardation.
(141)
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. The
Texas Register
was established by the Administrative Procedure and Texas Register Act of
1975.
(142)
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.
(143)
Therapy week--A seven-day period beginning the first
day rehabilitation therapy or restorative nursing care is given. All subsequent
therapy weeks for a particular individual will begin on that day of the week.
(144)
Threatened violation--A situation that, unless immediate
steps are taken to correct, may cause injury or harm to a resident's health
and safety.
(145)
TILE--Texas Index for Level of Effort; an index of 11
categories plus a default that consists of relative resource utilization groups.
The index determines where a nursing facility client fits based upon service
and care requirements. It determines the daily rate to be paid on behalf of
the client.
(146)
TILE 202 restorative nursing--Nursing care and practices,
based on a plan of care developed by the restorative team, designed to maintain
or improve on goals achieved during physical or occupational therapy. Examples
of TILE 202 restorative nursing include training and skill practice in self-feeding,
bed mobility, transfers, ambulation, dressing or grooming, and active range
of motion.
(147)
TILE error--Inaccuracies in a CARE form assessment of
a Medicaid recipient that result in an incorrect TILE classification.
(148)
Title II--Retirement Survivors' Disability Insurance
of the Social Security Act.
(149)
Title XVI--Supplemental Security Income (SSI) of the
Social Security Act.
(150)
Title XVIII--Medicare provisions of the Social Security
Act.
(151)
Title XIX--Medicaid provisions of the Social Security
Act.
(152)
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.
(153)
UAR--The Texas Health and Human Services Commission's
(HHSC's) Utilization and Assessment Review Section.
(154)
Uniform data set--See Resident Assessment Instrument
(RAI).
(155)
Universal precautions--The use of barrier and other precautions
by long-term care facility employees and/or contract agents to prevent the
spread of blood-borne diseases.
(156)
Utilization review committee--The group of health care
professionals contracted by DHS to make individual determinations of medical
necessity regarding nursing facility care. The Utilization Review Committee
consists of physicians and registered nurses.
(157)
Vendor payment--Payment made by DHS on a daily-rate basis
for services delivered to recipients in Medicaid-certified nursing facilities.
Vendor payment is based on the nursing facility's claim approval of the DHS-generated
Nursing Facility Billing Statement to DHS. 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.
(158)
Working day--Any 24-hour period, Monday through Friday,
excluding state and federal holidays.
This agency hereby certifies that the adoption has been
reviewed by legal counsel and found to be a valid exercise of the agency's
legal authority.
Filed with the Office of
the Secretary of State on March 27, 2002.
TRD-200201937
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Effective date: May 1, 2002
Proposal publication date: February 8, 2002
For further information, please call: (512) 438-3734
40 TAC §19.403
The amendment is adopted under the Health and Safety Code,
Chapter 242, which authorizes the department to license and regulate convalescent
and nursing homes and related institutions.
The amendment implements the Health and Safety Code, §§242.001-242.268.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed
with the Office of the Secretary of State on March 27, 2002.
TRD-200201938
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Effective date: May 1, 2002
Proposal publication date: February 8, 2002
For further information, please call: (512) 438-3734
40 TAC §19.910, §19.911
The new sections are adopted under the Health and Safety Code,
Chapter 255, which requires the department to establish a quality-of-care
monitoring system and rapid response teams, and Human Resources Code, Chapter
21, which authorizes the department to adopt rules.
The new sections implement the Health and Safety Code, §§255.001-255.005.
§19.910.Quality Assurance Early Warning System.
The Texas Department of Human Services (DHS) uses an early warning
system to detect conditions that could be detrimental to the health, safety,
and welfare of residents.
(1)
Quality-of-care monitors are based in regional offices
and monitor long-term care (LTC) facilities on a regular, unannounced, aperiodic
basis, including nights, weekends, and holidays.
(2)
Priority for monitoring visits is given to LTC facilities
with a history of resident care deficiencies.
(3)
Quality-of-care monitors assess:
(A)
the overall quality of life in the facility; and
(B)
specific conditions in the facility directly related to
resident care.
(4)
The quality-of-care monitor assessment visits include:
(A)
observation of the care and services rendered to residents;
and
(B)
formal and informal interviews with residents, family members,
facility staff, resident guests, volunteers, other regular staff, and resident
representatives and advocates.
(5)
The identity of a resident or a family member of a resident
interviewed by a quality-of-care monitor is confidential and may not be disclosed.
(6)
The findings of a monitoring visit, both positive and negative,
will be provided orally and in writing to the facility administrator or, in
the absence of the facility administrator, to the administrator on duty or
the director of nursing.
(7)
The quality-of-care monitor may recommend to the facility
administrator procedural and policy changes and staff training to improve
the care or quality of life of residents.
(8)
Conditions observed by the quality-of-care monitor that
may constitute an immediate threat to the health or safety of a resident will
be immediately reported to the regional office supervisor for appropriate
action and, as appropriate or as required by law, to law enforcement, adult
protective services, other divisions of DHS, or other responsible agencies.
This agency hereby certifies that the adoption has been
reviewed by legal counsel and found to be a valid exercise of the agency's
legal authority.
Filed
with the Office of the Secretary of State on March 27, 2002.
TRD-200201939
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Effective date: May 1, 2002
Proposal publication date: February 8, 2002
For further information, please call: (512) 438-3734
40 TAC §19.1913
The amendment is adopted under the Health and Safety Code,
Chapter 242, which authorizes the department to license and regulate convalescent
and nursing homes and related institutions.
The amendment implements the Health and Safety Code, §§242.001-242.268.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed
with the Office of the Secretary of State on March 27, 2002.
TRD-200201940
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Effective date: May 1, 2002
Proposal publication date: February 8, 2002
For further information, please call: (512) 438-3734
40 TAC §19.2011
The amendment is adopted under the Health and Safety Code,
Chapter 242, which authorizes the department to license and regulate convalescent
and nursing homes and related institutions.
The amendment implements the Health and Safety Code, §§242.001-242.268.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed
with the Office of the Secretary of State on March 27, 2002.
TRD-200201941
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Effective date: May 1, 2002
Proposal publication date: February 8, 2002
For further information, please call: (512) 438-3734
Chapter 183.
BOARD FOR EVALUATION OF INTERPRETERS AND INTERPRETER CERTIFICATION
Subchapter B. BOARD CERTIFICATION EVALUATION
Subchapter E. RESIDENT RIGHTS
Subchapter J. QUALITY OF CARE
Subchapter T. ADMINISTRATION
Subchapter U. INSPECTIONS, SURVEYS, AND VISITS
Part 6.
TEXAS COMMISSION FOR THE DEAF AND HARD OF HEARING