The following key terms are important and used throughout this manual. These terms are used to describe activities, services, and processes associated with the CRS program and defined by the Texas Administrative Code (TAC) for CRS, 40 TAC §107, or are program specific definitions.

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. 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 – Texas Health and Human Services Commission (HHSC) or its successor agencies

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

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 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 increase self-esteem.

Assistive Technology – Device is any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified or customized, that is used to increase, maintain, or improve functional capabilities of a person with a disability.

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

Authorized representative – The person authorized by the participant to act as their representative for rehabilitation services including applying for services, developing Individualized Treatment Plan (ITP) and Individual Written Rehabilitation Plan (IWRP), authorizing the release of confidential information, representing the participant in an appeal, and other specified needs focused on the participant rehabilitation. Completing and submitting Form 1487, Designation of Representative, designates the representative.

Behavior management – A set of coordinated services that provide a person with specialized forms of 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 participants 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 participant’s interdisciplinary team and with external entities to assess, coordinate, implement, and evaluate all of the services required to meet the participant's needs.

Certified Brain Injury Specialist (CBIS) – A person with advanced training and work experience in brain injury services. The completion of the certification process demonstrates the applicant has a high school diploma or equivalent, has had 500 hours of verifiable direct contact experience with an individual or individuals with a brain injury with formal supervision or under a professional license.

Certified professional – A professional who has the knowledge, experience, and skills to do 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 alcohol to restore appropriate levels of physical, psychological and social functioning. Services include identifying and changing behavior patterns that are maladaptive, destructive, or injurious to health and relate to or result from substance-related disorders.

Community Independence Supports (CIS) – Provides the participant with assistance for Activity of Daily Living Skills (ADLs), while facilitating the participant’s independence and integration in to the community. The training in skills related to ADLs may include meal preparation, phone use or other communication, grocery or household shopping, laundry, light housework, medication or therapeutic regiments, assuring health and safety needs are met and socialization, if these skills are affected by the participant’s brain injury. CIS may also promote communication, relationship-building skills, and integration into community activities. These supports may serve to reinforce skills or lessons taught by the licensed therapist for the core Post-Acute Rehabilitation Services (PARS) non-residential and must be provided to the participant, based on the individual treatment plan and goals. CIS can be provided in a facility or community setting.

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.

Comparable benefits – Benefits that are like services provided by the CRS program but are provided or paid for by another entity such as employers, Medicaid programs and waivers, Medicare, private health insurance, workers compensation or another agencies or services.

Competitive bid – An offer to contract with the state to provide specific services or products that are available for purchase through multiple dealers or distributors for the manufacturer or owner of the services.

Compliance – Adhering to the state laws, regulations, guidelines, and specifications that are outlined in this manual, CRS Standards for Providers Manual, Contracting Processes and Procedures Manual, and HHS Procurement Manual.

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.

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

Durable medical equipment and supplies – Any equipment  that provides therapeutic benefits to a person with 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 a person’s disability and indicate how much assistance is required for the person to carry out the activities of daily living.

Glasgow Coma Scale (GCS) – A neurological scale which aims to give a reliable and objective way of recording the conscious state of a participant for initial discharge and six-months post-discharge. A person is assessed against the criteria of the scale and the resulting points give a score between three and 15.

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.

Home modification – Installing assistive or adaptive equipment or devices in a person's home to enable the person to perform household tasks. This equipment or device must be removable 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.

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 participant’s interdisciplinary team for the participant, based on the participant’s individual needs. At a minimum, the IPP identifies the participant’s long-term and short-term goals and objectives, the treatment modalities to be used in achieving the goals and objectives, the people 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 that outlines the goals, services, and other aspects of the services provided by the CRS program. A participant’s IWRP may include elements of the Individualized Program Plan developed by the provider and other members of the interdisciplinary team.

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

Lawful permanent resident – Any person who is not a U.S. citizen but lives in the United States and has legally recognized and lawfully recorded documentation identifying themselves as a lawful permanent resident. A lawful permanent resident is also known as a permanent resident alien, resident alien permit holder and 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 their competence to practice in that field. Examples of licensed professionals include a registered nurse, physician and social worker.

Massage therapy – A type of therapy involving the manipulation of soft tissue by hand or through a mechanical or electrical apparatus that constitutes a health care service, if it is for therapeutic purposes.

Medical Team Conference – Also known as the interdisciplinary team meeting. Members of the interdisciplinary team meet to review treatment goals, progress or lack of progress, identify ongoing needs, address barriers to treatment as well as discharge planning. This can occur with the participant or family member present or not present.

Mental health counseling – Limited or short term psychiatric services, including treatment and psychotherapy, for mental conditions that impact the participant’s ability to progress in therapy or independence (defined as mental restoration services 40 TAC §107).

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, 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.

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

Paraprofessional – A person who is responsible for an aspect of a professional task, but who is not licensed as a fully qualified professional. Paraprofessional services can be provided in all service arrays, for approved medical needs only, and are provided in the home or facility (non-residential only) when necessary to enable participant involvement. 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 participant’s basic needs, and ensuring evacuation in case of an emergency. For non-residential services the paraprofessional must have at least one year of experience working with people with Traumatic Brain Injury (TBI) or Traumatic Spinal Cord Injury (TSCI). The intent of using paraprofessionals is to supplement the work of the licensed provider.

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

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

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

Preauthorization – 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 but that is not surgically implanted, 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 the 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 their own internal confusion. Behavior is frequently bizarre and not purposeful relative to the patient's immediate environment.

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, promotes health and wellness, and reduces or eliminates the limitations on activities 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.

Representative – A participant may designate someone to serve as their representative in all or part of the rehabilitation process. The representative may be authorized to sign documents, speak on the participant’s behalf, or serve in other capacities indicated on Form 1487, Designation of Representative.

Room and board – Shelter, facilities, and food, including the customary and usual meal plans offered 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. This includes speech, voice, language, oral pharyngeal function or cognitive processes, for the purpose of evaluating, preventing or modifying, those disorders and conditions in an individual or a group, consistent with the Orthotics and Prosthetics Act, under the Texas Occupations Code, Chapter 605.

Texas Identification Number (TIN) – A 14-digit number issued to entities (i.e., sole owner, individual recipient, partnership, corporation or other organization) billing the CRS program for goods or services. The state comptroller requires the TIN on requests from any party receiving payment from the state of Texas.

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 HHSC or its successor agency.

Third-party payer – A company, organization, insurer, or government agency other than HHSC or its successor agency that pays for the goods and services provided to a participant.

Tier – A preauthorized 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 or physical functioning and partial or total functional disability or psychosocial maladjustment.

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

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