The following words and terms, when used in this subchapter,
have the following meanings, unless the context clearly indicates
otherwise.
(1) Adolescent--An individual who is at least 13 years
of age, but younger than 18 years of age.
(2) Adult--An individual who is 18 years of age or
older.
(3) APRN or Advanced practice registered nurse--A staff
member who is a registered nurse approved by the Texas Board of Nursing
as a clinical nurse specialist in psychiatric/mental health or nurse
practitioner in psychiatric/mental health, in accordance with Texas
Occupations Code, Chapter 301. The term is synonymous with "advanced
nurse practitioner."
(4) Authorization period--The duration for which the
provider has obtained authorization in accordance with §416.6(a)
of this title (relating to Service Authorization and Recovery Plan).
(5) Business day--Any day except a Saturday, Sunday,
or legal holiday listed in Texas Government Code, §662.021.
(6) CFP or Certified family partner--A person who:
(A) is 18 years of age or older;
(B) has received:
(i) a high school diploma; or
(ii) a high school equivalency certificate issued in
accordance with the laws applicable to the issuing agency;
(C) has at least one year of lived experience raising
a child or adolescent with an emotional or mental health issues as
a parent or LAR;
(D) has at least one year of experience navigating
a child-service system (e.g., mental health, juvenile justice, social
security, or special education) as a parent or LAR; and
(E) has successfully completed the certified family
partner (CFP) training and passed the certification examination recognized
by the department.
(7) CFR--The Code of Federal Regulations.
(8) Child--An individual who is at least three years
of age, but younger than 13 years of age.
(9) Crisis--A situation in which:
(A) an individual presents an immediate danger to self
or others;
(B) an individual's mental or physical health is at
risk of serious deterioration; or
(C) an individual believes that he or she presents
an immediate danger to self or others or that his or her mental or
physical health is at risk of serious deterioration.
(10) CSSP or community services specialist--A staff
member who, as of August 30, 2004:
(A) received:
(i) a high school diploma; or
(ii) a high school equivalency certificate issued in
accordance with the law of the issuing state;
(B) has had three continuous years of documented full-time
experience in the provision of MH rehabilitative services; and
(C) has demonstrated competency in the provision and
documentation of MH rehabilitative services in accordance with this
subchapter and the MH Rehabilitative Services Billing Guidelines.
(11) CSU or crisis stabilization unit--A crisis stabilization
unit licensed under the Texas Health and Safety Code, Chapter 577;
and Chapter 134 of this title (relating to Private Psychiatric Hospitals
and Crisis Stabilization Units).
(12) Day--Calendar day, unless otherwise specified.
(13) Department--The Department of State Health Services.
(14) Direct clinical supervision--An LPHA's or QMHP's
interaction with a staff member who delivers MH rehabilitative services
to ensure that MH rehabilitative services are clinically appropriate
and in compliance with this subchapter by:
(A) conducting a documented meeting with the staff
member at regularly scheduled intervals; and
(B) conducting documented observations of the staff
member providing MH rehabilitative services at a frequency determined
by the supervisor based on the staff member's skill level.
(15) Face-to-face--A contact with an individual that
occurs when the individual is in the physical presence of the staff
member who is delivering the service. Face-to-face does not include
contacts made through the use of electronic media.
(16) Group--A face-to-face service delivery modality
involving at least one staff member and:
(A) two to eight adults; or
(B) two to six children or adolescents and may include
their LARs or primary caregivers, which do not count toward the group
size limit.
(17) Health risk factors--Circumstances that contribute
to the premature death and disabling chronic diseases such as heart
disease, diabetes and cancers. They include, but are not limited to,
substance abuse or addiction, high blood pressure, tobacco use, high
blood glucose, use of and side effects of some neuroleptic medications,
physical inactivity, overweight and obesity, and unsafe sex.
(18) IMD or institution for mental diseases--Based
on 42 CFR §435.1009, a hospital, nursing facility, or other institution
of more than 16 beds that is primarily engaged in providing diagnosis,
treatment, or care of individuals with serious mental illness, including
medical attention, nursing care, and related services.
(19) Individual--A person seeking or receiving MH rehabilitative
services.
(20) In vivo--The individual's natural environment
(e.g., the individual's residence, work place, or school).
(21) LAR or legally authorized representative--A person
authorized by law to act on behalf of an adult, child, or adolescent
with regard to a matter described in this subchapter, including, but
not limited to, a parent, guardian, or managing conservator.
(22) LMFT or Licensed marriage and family therapist--An
individual who is licensed as a licensed marriage and family therapist
by the Texas State Board of Examiners of Marriage and Family Therapists
in accordance with Texas Occupations Code, Chapter 502.
(23) Licensed medical staff member--A staff member
who is:
(A) a physician (MD) or (DO);
(B) a physician assistant (PA);
(C) an APRN;
(D) a registered nurse (RN);
(E) an LVN; or
(F) a pharmacist.
(24) LPC or Licensed professional counselor--A person
who is licensed as a licensed professional counselor by the Texas
State Board of Examiners of Professional Counselors in accordance
with Texas Occupations Code, Chapter 503.
(25) LOC or level of care--A designation given to the
department's standard sets of mental health services, based on the
uniform assessment and utilization management guidelines referenced
in §416.17 of this title (relating to Guidelines), which specify
the type, amount, and duration of MH rehabilitative services to be
provided to an individual.
(26) LPHA or licensed practitioner of the healing arts--This
term shall have the meaning set forth in the §412.303 of this
title (relating to Definitions).
(27) LVN or licensed vocational nurse--A staff member
who is licensed as a vocational nurse by the Texas Board of Nursing
in accordance with Texas Occupations Code, Chapter 301.
(28) Mental health (MH) rehabilitative services--Services
that:
(A) are individualized, age-appropriate training and
instructional guidance that restore an individual's functional deficits
due to serious mental illness or SED;
(B) are designed to improve or maintain the individual's
ability to remain in the community as a fully integrated and functioning
member of that community; and
(C) consist of the following services:
(i) crisis intervention services;
(ii) medication training and support services;
(iii) psychosocial rehabilitative services;
(iv) skills training and development services; and
(v) day programs for acute needs.
(29) Medicaid provider--A Medicaid-enrolled provider
with which the department has a Medicaid provider agreement to provide
MH rehabilitative services under the State's Medicaid Program.
(30) Medical necessity or medically necessary--A clinical
determination made by an LPHA that services:
(A) are reasonable and necessary for the treatment
of a serious mental illness; or to improve, maintain, or prevent
deterioration of functioning resulting from such a disorder;
(B) are provided in accordance with accepted standards
of practice in behavioral health care;
(C) are furnished in the most appropriate and least
restrictive setting in which services can be safely provided;
(D) are at the most appropriate level or amount of
service that can be safely provided; and
(E) could not have been omitted without adversely affecting
the individual's mental and/or physical health or the quality of care
rendered.
(31) Mental health disorder--Health conditions involving
changes in thinking, mood, and/or behaviors that are associated with
distress or impaired functioning. When mental health disorders are
more severe, they are called serious mental illnesses, which includes
anxiety disorder, attention-deficit/hyperactivity disorder, depressive
and other mood disorders, eating disorders, schizophrenia, and others.
(32) Nursing services--Services provided or delegated
by an RN acting within the scope of his or her practice, as described
in Texas Occupations Code, Chapter 301.
(33) On site--At a location operated by a provider
or a person or entity under arrangement with the provider.
(34) PA or Physician assistant--A staff member who
is licensed as a physician assistant by the Texas State Board of Physician
Assistant Examiners in accordance with Texas Occupations Code, Chapter
204.
(35) Peer provider--A staff member who:
(A) has received:
(i) a high school diploma; or
(ii) a high school equivalency certificate issued in
accordance with the law of the issuing state; and
(B) has at least one cumulative year of receiving mental
health services for a disorder that is treated in the target population
for Texas.
(36) Pharmacist--A staff member who is licensed as
a pharmacist by the Texas State Board of Pharmacy in accordance with
Texas Occupations Code, Chapter 558.
(37) Physician--A staff member who is:
(A) licensed as a physician by the Texas Medical Boards
in accordance with Texas Occupations Code, Chapter 155 (Medical Doctor
or Doctor of Osteopathy); or
(B) authorized to perform medical acts under an institutional
permit at a Texas postgraduate training program approved by the Accreditation
Council on Graduate Medical Education, the American Osteopathic Association,
or the Texas Medical Board.
(38) Primary caregiver--A person 18 years of age or
older who has actual care, control, and possession of a child or adolescent.
(39) Problem-solving--The use of specific steps and
strategies to analyze and evaluate a problematic situation in order
to determine a course of action to resolve the problematic situation.
(40) Provider--An entity with which the department
has a contractual agreement to provide MH Rehabilitative Services,
including a Medicaid provider.
(41) Psychologist--A staff member who is licensed as
a psychologist by the Texas State Board of Examiners of Psychologists
in accordance with Texas Occupations Code, Chapter 501.
(42) QMHP-CS or qualified mental health professional-community
services--A staff member who meets the definition of a QMHP-CS set
forth in §412.303 of this title (relating to Definitions).
(43) Recovery--A process of change through which individuals
improve their health and wellness, live a self-directed life, and
strive to reach their full potential.
(44) Recovery plan or treatment plan--A written plan
developed with the individual and, as required, the LAR and a QMHP-CS
that specifies the individual's recovery goals, objectives, and strategies/interventions
in conjunction with the uniform assessment that guides the recovery
process and fosters resiliency as further described in §412.322(e)
of this title (relating to Provider Responsibilities for Treatment
Planning and Service Authorization).
(45) Resilience--The ability to cope with and recover
from adversity and stress.
(46) RN or registered nurse--A staff member who is
licensed as a registered nurse by the Texas Board of Nursing in accordance
with Texas Occupations Code, Chapter 301.
(47) SED or Serious emotional disturbance--A diagnosed
mental health disorder that substantially disrupts a child's or adolescent's
ability to function socially, academically, and emotionally.
(48) Serious mental illness--An illness, disease, disorder,
or condition (other than a sole diagnosis of epilepsy, dementia, substance
use disorder, or intellectual or developmental disability) that:
(A) substantially impairs an individual's thought,
perception of reality, emotional process, development, or judgment;
or
(B) grossly impairs an individual's behavior as demonstrated
by recent disturbed behavior.
(49) Staff member--Personnel of a provider including
a full-time or part-time employee, contractor, intern, or volunteer.
(50) Therapeutic team--A group of staff members who
work together in a coordinated manner for the purpose of providing
comprehensive mental health services to an individual.
(51) Uniform assessment--An assessment adopted by the
department that is used for recommending an approved level of care
(LOC).
(52) Utilization management guidelines--Guidelines
developed by the department that suggest the type, amount, and duration
of mental health services for each LOC.
Source Note: The provisions of this §416.3 adopted to be effective January 22, 2014, 39 TexReg 299
