Texas Administrative Code
Title 26 - HEALTH AND HUMAN SERVICES
Part 1 - HEALTH AND HUMAN SERVICES COMMISSION
Chapter 352 - COMPREHENSIVE REHABILITATION SERVICES
Section 352.5 - Definitions

(1) Ancillary services--Goods and services that support core CRS services but are not primary interventions. Examples of ancillary services include supplies, medications, and transportation.

(2) Aquatic therapy--A type of therapy that involves an exercise method in water to improve a person's range of motion, flexibility, muscular strength and toning, cardiovascular endurance, fitness, and/or mobility.

(3) Art therapy--A type of therapy in which persons use art media, the creative process, and the resulting artwork to explore their feelings, reconcile emotional conflicts, foster self-awareness, manage behavior, develop social skills, improve reality orientation, reduce anxiety, and/or increase self-esteem.

(4) Audiological services--Evaluation and treatment of hearing, balance, or related disorders.

(5) Basic Living Requirements (BLR)--A framework for determining whether the consumer should pay any of the cost of services which considers the family's net monthly income, liquid assets, and expenses an eligible consumer can reasonably be expected to incur including but not limited to home mortgage or rent payments, prescribed diet or medicine expenses, and other medical or disability related expenses.

(6) Behavior management--A set of coordinated services that provide a person with specialized interventions designed to increase adaptive behaviors and to reduce maladaptive or socially unacceptable behaviors, up to and including violent dyscontrol, that prevent or interfere with the person's inclusion within the home environment and the community.

(7) Case management--Services that assist consumers in the planning, coordination, monitoring, and evaluation of services with emphasis on quality of care, continuity of services, and cost-effectiveness.

(8) Certified professional--A person with the knowledge, experience, and skills to perform a specific job who is paid for performing that job. The person's expertise is verified by a certificate earned by passing an exam that is accredited by an organization or association that monitors and upholds prescribed standards for the profession involved. Examples of certified professionals include a certified brain injury specialist, certified nursing assistant, certified medical assistant, certified medication aide, and certified nurse aide.

(9) Chemical dependency services--Planned services that are structured to help a person abstain from using drugs and/or alcohol. Services include identifying and changing behavior patterns that are maladaptive, destructive, or injurious to health and which are related to or result from substance-related disorders, and identifying and changing behavior patterns to restore appropriate levels of physical, psychological, and social functioning.

(10) Cognitive rehabilitation therapy (CRT)--A type of therapy that helps a person to learn or relearn cognitive skills that have been lost or altered due to a traumatic brain injury. Services will enable the person to compensate for lost cognitive functions and include reinforcing, strengthening, or reestablishing previously learned patterns of behavior, or establishing new patterns of cognitive activity or compensatory mechanisms for impaired neurological systems.

(11) Consumer participation--A monthly contribution the consumer (client) may be required to pay for participation in the Comprehensive Rehabilitation Services (CRS) Program.

(12) Core services--A set of fundamental services that are essential to rehabilitation of persons who have a traumatic brain injury or traumatic spinal cord injury or both. Specific core services are based on assessed individualized needs.

(13) CRS Program--Comprehensive Rehabilitation Services Program.

(14) Dietary and nutritional services--Services that develop a prescribed diet to meet basic or special therapeutic nutritional needs.

(15) Durable medical equipment and supplies--Equipment that provides therapeutic benefits to a person whose medical conditions require the equipment and supplies.

(16) Family and caregiver education and training services--Information that provides a foundation for relationships with a person who has a traumatic brain injury or traumatic spinal cord injury, or both.

(17) Family therapy--A specialized type of psychotherapy that helps families and caregivers in intimate relationships to nurture healing and development.

(18) Group therapy--A type of therapy with two or more persons in addition to a therapist who have a common therapeutic purpose or to achieve a common goal.

(19) Home modification--The use of assistive or adaptive equipment or devices that may be installed in a person's home to enable the person to perform household tasks. This equipment must be removable from the residence without causing permanent damage to the property. Examples include grab bars in bathrooms or portable ramps for persons who use wheelchairs or who have other mobility impairments.

(20) Interdisciplinary team (IDT)--A team of professionals that closely coordinates services to achieve treatment goals in order to minimize a consumer's physical or cognitive disabilities and to maximize functional capacity.

(21) Individual therapy--A collaborative process between a therapist and person that is intended to facilitate change and improve quality of life.

(22) Inpatient comprehensive medical rehabilitation--Services provided, as recommended by an interdisciplinary team in a hospital setting, to address medical and rehabilitation issues that require 24-hour-a-day nursing services. These services are available to people who have a traumatic brain injury or traumatic spinal cord injury, or both.

(23) Individualized written rehabilitation plan (IWRP)--A plan developed by CRS staff, which outlines the goals, services, and other aspects of service provision in the CRS Program. It may include elements of the individualized program plan developed by the provider and other members of the interdisciplinary team.

(24) Lawful permanent resident--Any person not a citizen of the United States who is residing in the United States per legally recognized and lawfully recorded documentation identifying them as such. A lawful permanent resident is also known as a "Permanent Resident Alien," "Resident Alien Permit Holder," and "Green Card Holder."

(25) Licensed professional--A person who has completed a prescribed program of study in a health field, and who has obtained a license indicating his or her competence to practice in that field. Examples of licensed professionals include a registered nurse, physician, and social worker.

(26) Limited skilled-nursing--Skilled-nursing for a limited time. This service involves providing or delegating personal care services and medication administration consistent with rules established by the Texas Board of Nursing; assessing a patient to determine the care required; and delivering temporary skilled nursing services for minor illness, injury, or emergency for a period not to exceed 30 days.

(27) Liquid assets--Cash and assets from savings or other accounts.

(28) Massage therapy--A type of therapy involving the manipulation of soft tissue by hand or through a mechanical or electrical apparatus for therapeutic purposes. Massage therapy constitutes a health care service if the massage therapy is for therapeutic purposes.

(29) Medical services--Services or supplies that are needed for the diagnosis or treatment of medical conditions.

(30) Mental restoration services--Limited or short term psychiatric services, including treatment and psychotherapy, for mental conditions that are stable or slowly progressive.

(31) Music therapy--A type of therapy using musical or rhythmic interventions to restore, maintain, or improve a person's social or emotional functioning, mental processing, or physical health.

(32) Net Monthly Income--Monthly take-home pay after taxes and other payroll deductions.

(33) Neuropsychological and neuropsychiatric services--A comprehensive battery of tests to evaluate neurocognitive, behavioral, and emotional strengths and weaknesses and their relationship to normal and abnormal central nervous system functioning.

(34) Occupational therapy--A type of therapy using evaluation and treatment to develop, recover, or maintain the daily living skills of persons who have a physical, mental, and/or cognitive disorder consistent with Occupational Therapy Practice Act, Occupations Code.

(35) Orthosis--A custom-fabricated or custom-fitted medical device designed to provide for the support, alignment, prevention, or correction of a neuromuscular or musculoskeletal disease, injury, or deformity, consistent with the Orthotics and Prosthetics Act, Occupations Code.

(36) Outpatient services--Medical treatment, without admittance to a hospital that corrects or modifies a stable or slowly progressive physical or mental impairment that constitutes a substantial impediment to independence. These services are available to people who have a traumatic brain injury or traumatic spinal cord injury, or both.

(37) Over-the-counter medication--Medication that can be obtained without a prescription.

(38) PABI--Post-acute brain injury--A brain injury at the post-acute stage, which is when the patient is medically stable and deemed ready to engage in intensive rehabilitation.

(39) Paraprofessional--A person to whom a particular aspect of a professional task is delegated, but who is not licensed as a fully qualified professional. A paraprofessional is qualified, through experience, training, or a combination thereof, to provide services. Paraprofessionals must have, at a minimum, a high school diploma or its equivalent.

(40) Personal assistance services--Services provided in a residential setting to a person who needs prompts and hands-on supports to participate in services. Services may include, but are not limited to, providing order, safety, and cleanliness assistance; assisting with medication or therapeutic regimens; preparing and serving meals; assisting with laundry; providing supervision and care to meet basic needs; and ensuring evacuation in case of an emergency.

(41) Personal attendant care services--Services provided in a home setting to persons with approved medical needs only, and only when provision of services in the home setting is necessary to enable the person to participate in CRS service arrays, which may include assistance with toileting routines, transferring, bathing, dressing, medications, meals, and activities of daily living.

(42) Physical restoration services--Services that correct or substantially modify, within a reasonable period of time, a physical condition that is stable or slowly progressive.

(43) Physical therapy--A type of therapy that prevents, identifies, corrects, or alleviates acute or prolonged movement dysfunction or pain of anatomical or physiological origin.

(44) Post-acute brain injury services--Services provided as recommended by an interdisciplinary team to address deficits in functional and cognitive skills based on individualized assessed needs. Services may include behavior management, the development of coping skills, and compensatory strategies. These services may be provided on a residential or non-residential basis.

(45) Post-acute rehabilitation services--Post-acute brain injury services and post-acute spinal cord injury services.

(46) Post-acute spinal cord injury services--Services provided as recommended by an interdisciplinary team to address deficits in functional skills based on individualized assessed needs. These services are provided in the home and in the community (non-residential settings).

(47) Prescription medication--A medicine that legally requires a medical prescription to be dispensed.

(48) Prosthesis--A custom-fabricated or custom-fitted medical device used to replace a missing limb, appendage, or other external human body part but that is not surgically implanted, consistent with the Orthotics and Prosthetics Act, Occupations Code. Accordingly, the term includes an artificial limb, hand, or foot.

(49) Provider--An entity under contract with DARS to provide Comprehensive Rehabilitation Services.

(50) Provider type--A term that refers to the types of service providers within the CRS Program, consisting of certified professionals, licensed professionals, and paraprofessionals.

(51) Rancho Los Amigos Levels of Cognitive Functioning Scale--A scale developed at the Rancho Los Amigos Hospital in Downey, California, that describes eight levels of post-brain injury cognitive function. At "Level IV - Confused/Agitated," the patient is in a heightened state of activity with severely decreased ability to process information. The patient is detached from the present and responds primarily to his or her own internal confusion and behavior is frequently bizarre and non-purposeful relative to the patient's immediate environment.

(52) Recreational therapy--A type of therapy involving recreational or leisure activities that assist in the restoration, remediation, or rehabilitation of a person's level of functioning and independence in life activities, and that promote health and wellness and reduce or eliminate the activity limitations associated with traumatic brain injury, traumatic spinal cord injury, or both.

(53) Rehabilitation technology--Equipment or technology designed to help persons with disabilities perform tasks that would otherwise require assistance.

(54) Room and board--Shelter, facilities and food, including the customary and usual diets in residential settings and prescribed nutritional meals or supplements.

(55) Service arrays--A set of services provided to eligible persons who have a traumatic brain injury, traumatic spinal cord injury, or both; services are based on assessed individualized rehabilitation needs that consist of outpatient services, inpatient comprehensive medical rehabilitation services, post-acute brain injury services, and post-acute spinal cord injury services.

(56) Speech-language pathology--The application of nonmedical principles, methods, and procedures for measurement, testing, evaluation, prediction, counseling, habilitation, rehabilitation, or instruction related to the development and disorders of communication, including speech, voice, language, oral pharyngeal function, or cognitive processes, for the purpose of evaluating, preventing, or modifying or offering to evaluate, prevent, or modify those disorders and conditions in an individual or a group, consistent with the Occupations Code.

(57) Texas resident--A person who lives in Texas as evidenced by one of the following unexpired documents: a Texas driver's license, an identification card with an address issued by a governmental entity, a utility bill with an address, a voter registration card, a vehicle registration receipt, or other document approved by the Department of Assistive and Rehabilitative Services.

(58) Third-party payer--A company, organization, insurer, or government agency other than DARS that makes payment for goods and services provided to a consumer.

(59) Transportation--Travel and related expenses.

(60) Traumatic brain injury (TBI)--An injury to the brain that is not degenerative or congenital; and caused by an external physical force, which may produce a diminished or altered state of consciousness, resulting in temporary or permanent impairment of cognitive abilities and/or physical functioning, and partial or total functional disability and/or psychosocial maladjustment.

(61) Traumatic spinal cord injury (SCI)--An acute, traumatic lesion of neural elements in the spinal canal resulting in any degree of temporary or permanent sensory or motor deficit, and/or bladder or bowel dysfunction.

(62) Vision services--A sequence of neurosensory and neuromuscular activities individually prescribed and monitored by the doctor to develop, rehabilitate, and enhance visual skills.