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28 Pa. Code § 4.2. Definitions.

§ 4.2. Definitions.

 The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:

   Agency head—The Secretary or a deputy secretary designated by the Secretary.

   Alternative financial resources

     (i)   All income subject to tax under section 61 of the Internal Revenue Code (26 U.S.C.A. §  61).

     (ii)   Funds which are available to the applicant or client by virtue of experiencing a TBI. These include, but are not limited to, court awards, insurance settlements and other financial settlements made as a result of the TBI and received by any person on behalf of or for the use of the applicant or client.

     (iii)   Funds which are available to the applicant or client through other State or Federal programs including, but not limited to, Medicaid, Medicare, Social Security Disability Insurance (Title II), Supplemental Security Income (Title XVI), veterans’ benefits, workers’ compensation insurance and unemployment compensation insurance.

   Applicant—An individual for whom a completed application for enrollment in HIP has been submitted to the Department.

   Authorized representative—An individual who is authorized by law to make a decision for, or enter into an agreement on behalf of, an applicant or client. The term does not include an employee of the provider unless the employee is appointed by a court to serve as the legal guardian of the applicant or client.

   Case management services—Services to be offered by the provider to a client during the enrollment period.

   Case manager—An individual who delivers case management services to a client through a provider.

   Client—An individual enrolled in HIP.

   Day services—Nonresidential services intended to improve the physical, cognitive, behavioral or functional abilities of the client through therapeutic intervention and supervised activities which are provided on an outpatient basis at a facility belonging to a provider.

   Department—The Department of Health of the Commonwealth.

   Division—The Division of Child and Adult Health Services.

   Enrollment period—The period of time, comprised of the rehabilitation period and the transition period, during which a client is enrolled in HIP.

   Fund—The Catastrophic Medical and Rehabilitation Fund.

   HIP—Head Injury Program—The traumatic brain injury program of the Department.

   HIP Peer Review Committee—A committee, composed of professionals and representatives of organizations offering rehabilitation services in this Commonwealth to persons with traumatic brain injury, whose members are appointed by the Department to review rehabilitation plans and services offered to clients and to recommend actions to improve services.

   HIP services—Rehabilitation and case management services for which the Department authorizes payment through HIP.

   Home facilitation—A formal rehabilitation program which provides a community reentry specialist in the client’s home to continue therapy learned by the client and to assist the client in the practice of techniques and strategies for living independently.

   Immediate family—A parent, spouse, child, brother, sister, grandparent or grandchild and, when living in the family household (or under a common roof), all other individuals related by blood or marriage.

   Peer review—A review of services and rehabilitation service plans for clients conducted by the HIP Peer Review Committee for the purpose of advising the Department on best practices to be followed in offering services to clients.

   Provider—An individual, organization or facility that delivers rehabilitation and case management services to clients under a contractual agreement with the Department.

   Rehabilitation period—The period of time that a client receives rehabilitation services through HIP.

   Rehabilitation service plan—The written plan developed by the provider, which states specific goals to be achieved and expected time frames for achievement of each goal.

   Rehabilitation services—Services provided to assist the client to recover from TBI, improve the client’s health and welfare, and realize the client’s maximum physical, social, cognitive, psychological and vocational potential for useful and productive activity. These services include neuropsychological evaluation, physical therapy, occupational therapy, speech or language therapy, behavior management, home facilitation, therapeutic recreation, prevocational services, case management services and psychological services which may include cognitive remediation.

   Secretary—The Secretary of the Department.

   TBI—traumatic brain injury—An insult to the brain, not of a degenerative or congenital nature, caused by an external physical force that may produce a diminished or altered state of consciousness, which results in impairment of cognitive abilities or physical functioning or in the disturbance of behavioral or emotional functioning. These impairments may be either temporary or permanent and cause partial or total functional disability or psychosocial maladjustment.

   Transition period—The period of time following the rehabilitation period during which a client receives case management services through HIP to guide and assist the client to make the transition out of HIP.

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