1100, Definitions

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Revision 25-1; Effective Nov. 12, 2025

These words and terms, when used in this handbook, have the following meanings unless the context clearly indicates otherwise.

Actively involved person — A person who has significant, ongoing and supportive involvement with a person receiving services, as determined by the SPT based on the person’s:
- observed interactions with the person receiving services;
- availability to the person receiving services for assistance or support when needed; and
- knowledge of, sensitivity to and advocacy for the person's needs, preferences, values and beliefs.
Acute care hospital — A facility where a person receives short-term treatment for a severe physical injury or episode of physical illness, an urgent medical condition or recovery from surgery and:
- may include a long-term acute care hospital, an emergency room within an acute care hospital or an inpatient rehabilitation hospital; and
- does not include a stand-alone psychiatric hospital or a psychiatric hospital within an acute care hospital.
Amount —The amount of a specialized service a person will receive, such as two hours.
Audio-only — An interactive, two-way audio communication that uses only sound and meets the privacy requirements of the Health Insurance Portability and Accountability Act (HIPAA). Audio-only includes the use of telephonic communication. Audio-only does not include audio-visual or in-person communication.
Audio-visual — An interactive, two-way audio and video communication that conforms to privacy requirements under HIPAA. Audio-visual does not include audio-only or in-person communication.
Behavioral support — Specialized interventions by a qualified service provider to help a person increase adaptive behaviors and to replace or modify maladaptive behaviors that prevent or interfere with the person's inclusion in home and family life or community life.
- Behavioral support includes:
  - assessing and analyzing assessment findings so that an appropriate behavior support plan is designed;
  - developing a personalized behavior support plan consistent with the outcomes identified in the Habilitation Service Plan (HSP);
  - training and consulting with family members or other providers and, as appropriate, the person; and
  - monitoring and evaluating the success of the behavior support plan and modifying the plan as needed.
- A qualified service provider of behavioral support:
  - is a licensed psychologist;
  - is licensed as a psychological associate per Texas Occupations Code, Chapter 501;
  - has been issued a provisional license to practice psychology per Texas Occupations Code, Chapter 501;
  - is a certified authorized provider as described in 26 TAC Section 304.302, Certified Authorized Provider;
  - is a licensed clinical social worker (LCSW);
  - is a licensed professional counselor (LPC); or
  - is licensed as a behavior analyst per Texas Occupations Code, Chapter 506.
Business day — Any day except Saturday, Sunday, or a national or state holiday listed in Texas Government Code Section 662.003(a) or (b).
Calendar day — Any day, including weekends and holidays.
Community living options (CLO) — A process where the LIDDA gives information to a person and their legally authorized representative (LAR) about the range of community living services, supports and programs the person may be eligible for. The LIDDA discusses services and supports the person will need to live in the community, individual preferences and barriers to community living.
Customized manual wheelchair (CMWC) — Per 26 TAC Section 554.2703, a wheelchair that consists of a manual mobility base and customized seating system. It is adapted and fabricated to meet the individualized needs of a person.
Collateral contact — A person who is knowledgeable about the person who seeks admission to a nursing facility (NF) or the resident, such as family members, previous providers or caregivers, and who may support or corroborate information provided by the person or resident.
Comprehensive care plan — Refer to the definition of NF comprehensive care plan.
Day habilitation — Aid to a person to get, retain or improve self-help, socialization and adaptive skills necessary to live successfully in the community and participate in home and community life. Day habilitation provides:
- individualized activities consistent with achieving the outcomes identified in the person's service plan;
- activities necessary to reinforce therapeutic outcomes targeted by other support providers and other specialized services;
- services in a group setting, other than the person's residence, for typically up to five days a week, six hours per day on a regularly scheduled basis;
- personal assistance for someone unable to manage personal care needs during the day habilitation activities; and
- transportation during the day habilitation activity necessary for a person to participate in the day habilitation activities.
Developmental disability (DD) — A disability that meets the criteria in the definition of persons with related conditions in 42 Code of Federal Regulations (CFR) Section 435.1010.
Determination of intellectual disability (DID) — An assessment conducted per 26 TAC Section 304.301 by an authorized provider to determine if a person meets the criteria for a diagnosis of intellectual disability.
Diversion Plan — A plan developed by the SPT that describes the activities, timetable, responsibilities, services and essential supports needed to help a person remain in the community when they may be at risk for NF or other institutional admission.
Durable medical equipment (DME) — Per 26 TAC Section 554.2703, the following items, including any accessories and adaptations needed to operate or access the item:
- a gait trainer;
- a standing board;
- a special needs car seat or travel restraint;
- a specialized or treated pressure-reducing support surface mattress;
- a positioning wedge;
- a prosthetic device; and
- an orthotic device.
Duration — How long a person will receive a specialized service, such as six months.
Employment assistance — Assistance given to a person to help them locate competitive employment in the community. This consists of a service provider performing the following:
- identifying a person's employment preferences, job skills and requirements for a work setting and work conditions;
- locating prospective employers who offer employment compatible with a person's identified preferences, skills and requirements;
- contacting a prospective employer on behalf of a person and negotiating the person's employment;
- transporting the person to help them locate competitive employment in the community; and
- participating in SPT meetings.
Enhanced community coordination (ECC) — Funding available to LIDDAs pursuant to the performance contract for assisting persons in transitioning from an NF to the community or in diverting from NF admission.
ECC coordinator — A LIDDA staff who meets the qualifications of a service coordinator per 26 TAC Section 331.17, Minimum Qualifications, and has two years of experience in providing service coordination to someone with an intellectual or developmental disability.
Essential supports — Those supports identified in a transition plan that are critical to a person’s health and safety and are directly related to the person’s successful transition to living in the community from residing in an NF.
Exempted hospital discharge — A category of NF admission that occurs when a physician has certified that a person who is being discharged from an acute care hospital is likely to require less than 30 days of NF services for the condition they were hospitalized.
Expedited admission — A category of NF admission that occurs when a person meets the criteria for one of the following categories:
- convalescent care,
- terminal illness,
- severe physical illness,
- delirium,
- emergency protective services,
- respite, or
- coma.
Extenuating circumstances — Circumstances beyond the LIDDA's, LMHA's or LBHA's control that prevent meeting in person. A disaster declared by the governor is excluded from this definition.
Frequency — How often a person receives a specialized service, such as twice a week.
Habilitation coordination — Assistance for a person living in an NF to access appropriate specialized services necessary to achieve a quality of life and level of community participation acceptable to the person and LAR on the person's behalf.
Habilitation coordinator — A LIDDA employee who provides habilitation coordination.
Habilitation Service Plan (HSP) — A plan developed by the service planning team (SPT) while a person is living in an NF that:
- is individualized and developed through a person-centered approach;
- identifies the person’s:
  - strengths;
  - preferences;
  - desired outcomes; and
  - psychiatric, behavioral, nutritional management and support needs as described in the NF comprehensive care plan or Minimum Data Set (MDS) assessment; and
- identifies the specialized services that will accomplish the desired outcomes of the person or LAR, including the amount, frequency, and duration of each service.
Habilitative therapy services — Per 26 TAC Section 554.2703, assessment and treatment to help a person learn, keep or improve skills and functioning of daily living affected by a disabling condition. Habilitative therapy services are limited to:
- physical therapy;
- occupational therapy; and
- speech therapy.
HHSC — Texas Health and Human Services Commission.
HSP year — An approximate 12-month period starting on the date of the initial or annual interdisciplinary team (IDT)/SPT meeting.
IDD — Intellectual and developmental disability.
IDD habilitative specialized services (IHSS) — The following specialized services available to a person with ID or DD:
- day habilitation;
- independent living skills training;
- behavioral support;
- employment assistance; and
- supported employment.
Independent living skills training (ILST) — Individualized activities consistent with the HSP and provided in a person's residence and at community locations, such as libraries and stores. These activities include:
- habilitation and support activities that foster or facilitate improvement or maintenance of the person's ability to perform functional living skills and other daily living activities;
- activities for the person's family that help preserve the family unit and prevent or limit out-of-home placement of the person; and
- transportation to facilitate the person's employment opportunities and participation in community activities, and between the person's residence and day habilitation site.
In-person or in person — Within the physical presence of another person. The term does not include audio-visual or audio-only communication.
Intellectual disability (ID) — As defined in 42 CFR Section 483.102(b)(3)(i).
Interdisciplinary team (IDT) — Consists of:
- a person with MI, ID or DD;
- the person's LAR, if any;
- a registered nurse (RN) from the NF with responsibility for the person;
- a representative of the:
  - LIDDA if the person has ID or DD;
  - LMHA or LBHA if the person has MI; or
  - LIDDA and the LMHA or LBHA if the person has MI and DD, or MI and ID; and
- a:
  - concerned person whom the person or LAR requests be included;
  - person specified by the person, 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
  - representative of the appropriate school district if the person is school age and the district representative the person or LAR requests.
Legally authorized representative (LAR) — A person authorized by law to act on behalf of a person 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. Refer to limitations on authority of surrogate decision maker in the definition of surrogate decision maker. Also refer to Appendix III, Legal Authority to Make Decisions.
Local authority (LA) — In this handbook, LA means a local intellectual and developmental disability authority (LIDDA), a local behavioral health authority (LBHA) or local mental health authority (LMHA).
Local behavioral health authority (LBHA) — An entity designated by the HHSC executive commissioner per Texas Health and Safety Code, Section 533.0356.
Local intellectual and developmental disability authority (LIDDA) — An entity designated by the HHSC executive commissioner per Texas Health and Safety Code, Section 533A.035.
Local mental health authority (LMHA) — An entity designated by the HHSC executive commissioner per Texas Health and Safety Code, Section 533.035.
Long-term care online portal (LTC online portal) — A web-based application used by Medicaid providers to submit forms, screenings, evaluations and other information.
Managed care organization (MCO) service coordinator — The staff person assigned by a resident’s Medicaid MCO to ensure access to, and coordination of, additional Medicaid services that are needed.
Minimum Data Set assessment or MDS assessment — A standardized collection of demographic and clinical information that describes a resident's overall condition, which a licensed NF in Texas is required to submit for a resident admitted into the facility.
Mental illness (MI) — Serious mental illness, as defined in 42 CFR Section 483.102(b)(1).
MI specialized services — Specialized services for a resident with MI, if eligible, as described in the Texas Resilience and Recovery Utilization Management Guidelines, including:
- crisis intervention services;
- day programs for acute needs;
- medication training and support services;
- psychiatric diagnostic interview examination;
- psychosocial rehabilitation services;
- routine case management; and
- skills training and development.
NF baseline care plan — A plan developed per 26 TAC Section 554.802(a), by an NF within 48 hours of a resident’s admission and that includes the minimum health care information needed to properly care for a resident, including PASRR recommendations. The NF baseline care plan is only in place until there is an NF comprehensive care plan.
NF comprehensive care plan — A plan developed per 26 TAC Section 554.2703(3) by an NF for a resident within seven days after completing the comprehensive assessment. It includes measurable short-term and long-term objectives and time frames to meet a resident's medical, nursing, rehabilitative, psychosocial, dietary, activity and resident's rights needs.
NF PASRR support activities — Consistent with 26 TAC Section 554.2703, actions an NF takes in coordination with a LIDDA, LMHA or LBHA to facilitate the successful provision of IDD habilitative specialized services or MI specialized services, including:
- arranging transportation for a resident to participate in an IDD habilitative specialized service or an MI specialized service outside the facility;
- sending a resident to a scheduled IDD habilitative specialized service or MI specialized service with food and medications required by the resident; and
- stating in the NF comprehensive care plan an agreement to avoid, when possible, scheduling NF services at times that conflict with IDD habilitative specialized services or MI specialized services.
NF specialized services — The following specialized services available to a resident with ID or DD:
- habilitative therapy services;
- CMWC; and
- DME.
Nursing facility (NF) — A Medicaid-certified facility licensed per the Texas Health and Safety Code, Chapter 242.
PASRR — Preadmission screening and resident review. Required by 42 CFR 483.100-138.
PASRR level I (PL1) screening — The process of screening a person who seeks admission to an NF to identify if the person is suspected of having MI, ID or DD.
PASRR level II evaluation (PE) — An evaluation:
- of a person who seeks admission to an NF and is suspected of having MI, ID or DD; and
- performed by a LIDDA, LMHA or LBHA to determine if the person has MI, ID or DD and, if so, to:
  - assess the person’s need for care in an NF;
  - assess the person’s need for specialized services; and
  - identify alternate placement options.
Person or Individual — A person:
- whose active PASRR evaluation (PE) or resident review is positive for ID or DD;
- who is 21 or older; and
- who is a Medicaid recipient.
Preadmission process — A category of NF admission:
- from a community setting, such as a private home, an assisted living facility, a group home, a psychiatric hospital or jail, but not an acute care hospital or another NF; and
- that is not an expedited admission or an exempted hospital discharge.
Referring entity (RE) — The entity that refers a person to an NF, such as a hospital, attending physician, LAR or other personal representative selected by the person, a family member of the person or a representative from an emergency placement source, such as law enforcement.
Registered nurse (RN) — A person licensed to practice professional nursing as an RN per Texas Occupations Code, Chapter 301.
Relocation specialist — An employee or contractor of an MCO who provides outreach and relocation activities to people in NFs who express a desire to transition to the community.
Resident — A person who resides in an NF and receives services provided by professional nursing personnel of the facility.
Resident review — An evaluation of a resident performed by a LIDDA, LMHA or LBHA:
- for a resident whose PE is positive for MI, ID or DD who experienced a significant change in condition, to:
  - assess the resident's need for continued care in an NF;
  - assess the resident's need for specialized services; and
  - identify alternate placement options; and
- for a resident suspected of having MI, ID or DD, to determine if the resident has MI, ID or DD and, if so:
  - assess the resident's need for continued care in an NF;
  - assess the resident's need for specialized services; and
  - identify alternate placement options.
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 — A LIDDA employee who provides service coordination.
Service planning team (SPT) —A team convened by a LIDDA staff person that develops, reviews and revises the HSP and the transition plan for a person. The team must include:
- the person;
- the person's LAR, if any;
- the habilitation coordinator for discussions and service planning related to specialized services or the service coordinator for discussions related to transition planning if the person is transitioning to the community;
- the MCO service coordinator, if the person does not object;
- the person who develops a permanency plan using the HHSC Permanency Planning Instrument for Children Under 22 Years of Age form and performs other permanency planning activities for a person younger than 22 years, if the person is at least 21 years old but younger than 22;
- while the person is in an NF:
  - an NF staff person familiar with the person's needs; and
  - a person who provides a specialized service for the person or a representative of a provider agency that is providing specialized services for the person;
- if the person is transitioning to the community:
  - a representative from the community program provider, if one has been selected; and
  - a relocation specialist;
- a representative from the LMHA or LBHA, if the person's PE is positive for MI;
- a concerned person the person or the LAR requests be included; and
- at the discretion of the LIDDA, a person who is directly involved in the delivery of services for people with ID or DD.
Significant change in condition — When a person experiences a major decline or improvement in status that:
- will not normally resolve itself without further intervention by NF staff or by implementing standard disease-related clinical interventions;
- has an impact on more than one area of the person’s health status; and
- requires review or revision of the NF comprehensive care plan.
Specialized services — The following specialized 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:
- NF specialized services;
- IDD habilitative specialized services; and
- MI specialized services.
Supported employment — Assistance to sustain competitive employment for a person who, because of a disability, requires intensive, ongoing support to be self-employed, work from the person's residence or perform in a work setting where people without disabilities are employed. Assistance includes the following:
- making employment adaptations, supervising and providing training related to the person's assessed needs;
- transporting the person to support them to be self-employed, work from the person's residence or perform in a work setting; and
- participating in SPT meetings.
Surrogate decision maker — An actively involved family member of a resident who has been identified by an IDT in accordance with Texas Health and Safety Code Section 313.004 and who is available and willing to consent to medical treatment on behalf of the resident. Note: A surrogate decision maker is authorized to make decisions related to NF specialized services. A surrogate decision maker is not authorized to make decisions related to IDD habilitative specialized services or decisions related to community programs or where the person lives or will live.
Transition plan — A plan developed by the SPT or MI quarterly meeting attendees that describes the activities, timetable, responsibilities, services and essential supports involved in assisting a person to transition from residing in an NF to living in the community.

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