Chapter 1: Overview

1.1 Overview of Manual

The Comprehensive Rehabilitation Services (CRS) Manual is designed to provide a framework for counselors to use when making decisions and delivering quality services to eligible consumers.

Links within this manual provide additional information, including:

  • examples;
  • tools; and
  • practical application guides.

First-time users should read the manual sequentially from beginning to end to get a broad perspective of the organization and content of policy.

In this manual, the word "you" refers to the counselor or the rehabilitation services technician, as appropriate. The term "consumer" refers to anyone who applies for or receives services through the CRS program.

This manual follows the phases of the rehabilitation process from initial contact with a potential consumer to the provision of Closure and Post-Closure services. Each chapter describes the activities that may take place during that phase of the rehabilitation process. However, the rehabilitation process may not always be linear, and you may need to repeat activities, skip activities until later in the process, or begin more than one process at the same time. For example, once the Individualized Written Rehabilitation Plan is completed and services are being provided, you may need to revisit the plan if circumstances change for the consumer.

The section below identifies important key terms used throughout this manual and describes activities associated with the CRS program.

1.2 Key Terms

The following definitions apply, unless the context clearly indicates otherwise.

Abuse – The negligent or willful infliction of injury, unreasonable confinement, intimidation, or threat thereof, or cruel punishment with resulting physical or emotional harm or pain; or sexual abuse, including any involuntary or nonconsensual sexual conduct that would constitute the offenses of indecent exposure or assault, committed by the person's caretaker, family member, or other individual who has an ongoing relationship with the person.

Agency – The Department of Assistive and Rehabilitative Services (DARS) or its successor agencies.

Ancillary services – Goods and services that support core services for CRS but are not primary interventions. Examples of ancillary services include providing a wheelchair or assistive brace.

Appeal – Timely filing of Form 1505, Request for Due Process Hearing and/or Mediation because of a consumer's dissatisfaction with a CRS decision about furnishing or denying services.

Appellant – A consumer who has filed a Form 1505, Request for Due Process Hearing and/or Mediation.

Applicant – A person who has applied for rehabilitation services but for whom an eligibility determination has not been made. As used in this procedure, the term consumer includes an applicant.  

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.

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.

Audiological services – The evaluation and treatment of disorders related to hearing and balance.

Authorized representative – The person authorized by the consumer to represent the consumer in an appeal. Completing and submitting Form 1487, Designation of Applicant or Consumer Representative, designates the representative.

Behavior management – A set of coordinated services that provide a person with specialized interventions designed to improve adaptive behaviors and reduce maladaptive or socially unacceptable behaviors, including violent dyscontrol, that prevent or interfere with the person's inclusion at home and in the community.

Case management – Services that help consumers plan, coordinate, monitor, and evaluate the services they receive, with emphasis on the quality of care, continuity of services, and cost-effectiveness.

Case manager – A case manager collaborates with the consumer’s interdisciplinary team and with external entities to assess, coordinate, implement, and evaluate all services required to meet the consumer's needs.

Certified professional – A person who has the knowledge, experience, and skills to perform a specific job and is paid to do the 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.

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 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.

Cognitive rehabilitation therapy (CRT) – A type of therapy intended to enable a person to compensate for lost cognitive functions. CRT includes reinforcing, strengthening, or re-establishing previously learned patterns of behavior, or establishing new patterns of cognitive activity or compensatory mechanisms for impaired neurological systems.

Consumer – A person who is interested in, is eligible for, or is receiving services. The term may also include consumer’s guardians or family members who are interested in or are advocating for the consumer.

Core services – Services that are provided by a licensed or certified therapist in post-acute rehabilitation and are provided in residential or non-residential settings.

CRS central office program specialist – A person who supervises CRS counselors in the field and provides them with technical assistance on program policy and procedures.

CRS program – A state-funded program that provides services to enhance the quality of life for persons who have a traumatic brain injury or traumatic spinal cord injury, or both and to enable them to function as independently as possible at home and in the community by improving their mobility, self-care, and communication skills.

Waiting list – A list of consumers who have completed and signed an Individualized Written Rehabilitation Plan, but have not started receiving services.

Dietary and nutritional services – Services that include developing a prescribed diet to meet a consumer’s basic or special therapeutic nutritional needs.

Discovery – A process by which a party may obtain evidence and other information for possible use in a hearing.

Due process hearing – A formal process conducted by an impartial hearing officer to review the allegations made by a consumer in the Form 1505, Request for Due Process Hearing and/or Mediation. The purpose of the process is to resolve a consumer's dissatisfaction with a decision made by you or by a CRS program staff member about providing or denying services.

Durable medical equipment and supplies – Items that provide therapeutic benefits to a person who has a medical condition.

Exploitation – The illegal or improper act or process of a caretaker, family member, or other individual who has an ongoing relationship with a person with a disability and uses the resources of the person, including the person’s Social Security number and other identifying information, without the person’s informed consent, for monetary or personal benefit, profit, or gain.

Family Therapy – A specialized type of psychotherapy that facilitates education, training, and support to families and caregivers to nurture healing and development. 

Functional Independence Measure (FIM) – An 18-item, 7-level functional assessment designed to measure the level of an individual’s disability and indicate how much assistance is required for the individual to carry out the activities of daily living.

Group Therapy – A type of therapy that is conducted by a therapist for two or more persons who have a common therapeutic purpose or goal.

Hearing completion date – The later of the dates set by the impartial hearing officer (IHO) that closes the period during which the parties may submit further evidence into the record, or the date that the IHO receives the hearing transcript.

HHSC Legal Services – An office of the Health and Human Services Commission that provides administrative support to the impartial hearing officer during the appeal process and is the point of contact for an appellant's questions about due process hearings.

HHSC or CRS representative – The person who represents the CRS program during a due process hearing. In the CRS program hearings, the CRS program manager is the CRS representative.

Home modification – Installing assistive or adaptive equipment or devices 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.

Impartial hearing officer (IHO) – A qualified person appointed to conduct a due process hearing.

Individual therapy – A collaborative process between a therapist and one person that is intended to facilitate change and improve the person’s quality of life.

Individualized program plan (IPP) – A document developed by a consumer’s interdisciplinary team for the consumer, based on the consumer’s individual needs. At a minimum, the IPP identifies the consumer’s long-term and short-term goals and objectives, the treatment modalities to be used in achieving the goals and objectives, the individuals responsible for each treatment modality, the target date by which each goal and objective is to be achieved, and the discharge plan.

Individualized Written Rehabilitation Plan (IWRP) – A Plan developed by CRS program staff members and the eligible consumer that outlines the goals, services, and other aspects of services provided by the CRS program. 

Inpatient comprehensive medical rehabilitation services– services as recommended by an interdisciplinary team and provided 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, traumatic spinal cord injury, or both.

Interdisciplinary team (IDT) – A team of professionals that coordinate services to achieve treatment goals that minimize a consumer's physical or cognitive disabilities and maximize the consumer’s ability to function.

Interest list – A list of the consumers who have made an initial contact with CRS program staff members about receiving services, but who have not completed or signed an Individualized Written Rehabilitation Plan.

Lawful permanent resident – A person who is not a U.S. citizen but lives in the United States and has legally recognized and lawfully recorded documentation identifying himself or herself as a lawful permanent resident. A lawful permanent resident is also known as a permanent resident alien, resident alien permit holder, or a green card holder.

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.

Limited skilled-nursing – Limited skilled nursing is a temporary service that is provided for no more than 30 days. It involves providing or delegating personal care services and administering medication according to the rules established by the Texas Board of Nursing. It also involves assessing a patient to determine the care required. Limited skilled nursing is provided for minor illnesses, for injuries, or in emergencies.

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 is for therapeutic purposes.

Mediation – A voluntary process by which an appellant and CRS representative may agree to use a trained mediator to resolve a dispute about determinations affecting rehabilitation services. 

Medical Services – Services or supplies that are needed for the diagnosis or treatment of medical conditions.

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

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.

Neglect – The failure of a caretaker or provider, through indifference or carelessness, to provide goods or services, including medical services, that are necessary to avoid physical or emotional harm or pain.

Net monthly income – Monthly take-home pay after taxes and other payroll deductions.

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 functioning of the central nervous system.

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 the Occupational Therapy Practice Act, Texas Occupations Code, Chapter 454.

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, Texas Occupations Code, Chapter 605.

Outpatient therapy services – Medical treatment without admittance to a hospital that corrects or modifies a stable or slowly progressive physical or mental impairment which constitutes a substantial impediment to independence; these services are available to people who have a traumatic brain injury, traumatic spinal cord injury, or both.

Over-the-counter medication – Medication that can be obtained without a prescription.

Paraprofessional – A person who is responsible for a particular aspect of a professional task, but is not licensed as a fully qualified professional. Paraprofessional services can be provided for all service arrays, for approved medical needs only, but are provided in the home only when necessary to enable consumer participation. Services may include assisting with medication or therapeutic regimens; preparing and serving meals; assuring that health and safety needs are met; assisting with activities of daily living, such as hygiene and laundry; providing supervision and other care to meet a consumer’s basic needs; and ensuring evacuation in case of an emergency.

Party – The appellant, CRS representative, or other person or agency named or admitted to participate in a due process hearing.

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

Physical Therapy – Type of therapy that prevents, identifies, corrects, or alleviates acute or prolonged movement dysfunction or pain of anatomical or physiological origin.

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

Post-acute brain injury (PABI) services – Services provided as recommended by an interdisciplinary team to address deficits in functional and cognitive skills based on a consumer’s assessed needs. Services may include behavior management, coping skills development, and compensatory strategies. The services may be provided in a residential or non-residential setting.

Post-acute rehabilitation services – Services for post-acute brain injury and post-acute spinal cord injury.

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

Pre-authorization – Approval by a CRS counselor before services are provided.

Prescription medication – A medicine that legally requires a medical prescription to be dispensed.

Prosthesis – A custom-fabricated or custom-fitted medical device used to replace a missing limb, appendage, or other external human body part that is not surgically implanted, as consistent with the Orthotics and Prosthetics Act, under the Texas Occupations Code, Chapter 605. Accordingly, the term includes an artificial limb, hand, or foot.

Provider type – The certified professionals, licensed professionals, and paraprofessionals who contract with the CRS program to provide services.

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 cognitive function experienced by persons who have a post-acute brain injury. For example, 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. Behavior is frequently bizarre and not purposeful relative to the patient's immediate environment.

Record – The official record of a due process hearing. HHSC Legal Services maintains the record.

Recreational therapy – A type of therapy involving recreational or leisure activities that help restore, remediate, or rehabilitate a person's level of functioning and independence, promote health and wellness, and reduce or eliminate the limitations on activity that are associated with traumatic brain injury, traumatic spinal cord injury, or both.

Rehabilitation technology – Equipment or technology designed to help persons with disabilities perform tasks that would otherwise require assistance.

ReHabWorks (RHW) – The electronic case management system for managing a case from initial contact to post closure. RHW is used to update and maintain case information, staff notes, and purchasing activities. RHW interfaces with the office of the Texas Comptroller of Public Accounts to track and authorize payments for consumer goods and services. The data that is entered in RHW is used for responding to inquiries and providing data reports for program monitoring.

Room and Board – Shelter, facilities, and food, including the customary and usual diets in residential settings and any prescribed nutritional meals or supplements.

Service Array – 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. The service arrays for traumatic brain injury and traumatic spinal cord injury are outpatient therapy, inpatient comprehensive medical rehabilitation, post-acute rehabilitation, and ancillary goods and services.

Speech-language pathology (speech therapy) – 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 Orthotics and Prosthetics Act, Texas Occupations Code, Chapter 605

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 another document approved by the Department of Assistive and Rehabilitative Services or its successor agency.

Therapeutic Pass – A planned activity used to facilitate a consumer's transition from a residential facility to the consumer's home and community. Staff members from the residential facility are available to provide guidance and instruction, usually by phone, to a consumer, a consumer's family, or others while a consumer is on a therapeutic pass.

Tier – A pre-authorized level number of hours allotted for providing core therapy services.

Transportation - Travel and related expenses.

Traumatic brain injury (TBI) -– An injury to the brain that is not degenerative or congenital and is caused by an external physical force that produces 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.

Traumatic spinal cord injury (TSCI) -– An acute, traumatic lesion of neural elements caused by an external physical force in the spinal canal resulting in any degree of temporary or permanent sensory or motor deficit, and/or bladder or bowel dysfunction.

Utilization review – An evaluation of the necessity, quality, effectiveness, or efficiency of therapeutic services, procedures, and facilities. Reviews may include prospective, concurrent, or retrospective reviews to ensure that services provided to consumers are consistent with the policies and standards for the CRS program.

Vision services – A sequence of neurosensory and neuromuscular activities individually prescribed and monitored by a doctor to develop, rehabilitate, and enhance visual skills.

Waiting list – A list of consumers who have completed and signed an Individualized Written Rehabilitation Plan, but have not started receiving services.