Definitions Relating to

the Crippled Children’s Service (CCS) PURPOSE: This rule defines terminology used throughout this chapter. (1) Administrator means the administrator of CCS as designated in section 201.050, RSMo (1986). (2) Advisory committee means the general advisory committee, as defined in section 201.110, RSMo 1986. This committee shall be comprised of a majority of physicians, as licensed under Chapter 334, RSMo 1986, and the remainder of consumers, other health care personnel and interested parties. It shall meet at least once a year and shall select a chairperson among its members to voice the committee’s collective advice. (3) Care means specialized treatment services and does not include general medical care, which remains the responsibility of the client or the client’s family and the referring health provider. Care does not include education or domiciliary care. (4) Case finding means a method of locating children who can benefit from CCS. This shall be accomplished through close cooperation of local physicians, hospitals, other health providers, schools, official and voluntary agencies, parents and other interested individuals. (5) Case management means management of resources across agency and professional lines to develop and attain the client’s care plan with optimal participation of the client or the client’s family or both. (6) Central office means that portion of the CCS which has the responsibility and authority to administer the statewide program. (7) Diagnostic services means services which include, but are not limited to, medical, social, psychological and other services necessary to identify the presence of a handicapping disability, its cause and complications and to determine the extent to which the disability limits or is likely to limit an individual’s daily living and work activities. (8) District and subdistrict office means that portion of CCS which includes case managers and personnel who interact directly with individual clients and providers of care. (9) Financial eligibility means eligibility for those health services offered by CCS, based on the financial status of the client or the client’s family or the client’s guardians. Categories of financial eligibility have been established by CCS in 19 CSR 40-1.040. (10) Habilitation means the continuous development of skills and abilities. (11) Individual care plan (ICP) means a written statement developed by a provider of care, interdisciplinary team, case manager, parents or guardians and the child, if possible, which analyzes the child’s achievement level, lists short-range and annual goals, describes specific services needed to meet those goals and develops a schedule for monitoring progress. (12) Interdisciplinary team means a team of professionals representing a variety of disciplines which provides services to persons with physical handicaps. (13) Services means services in hospitals, convalescent homes and clinics by physicians, chiropractors, dentists, nurses, medical social workers, nutritionists, dietitians, physical therapists, occupational therapists, speech pathologists and audiologists, technicians and other personnel whose services are needed in the CCS programs. (14) Medical eligibility means eligibility for those health services offered by CCS as based on medical condition. Categories of medical conditions acceptable for services have been established in 19 CSR 40-1.030. (15) Crippled Children’s Service or CCS is the agency of the Department of Health for facilitating the early identification of physically handicapped children and of individuals who have the potential of producing physically handicapped children; the provision of preventive, diagnostic and treatment services, including case management services, for the restoration of optimum health for physically handicapped children; the development, strengthening and improvement of standards and techniques relating to the provision of those services; the training of personnel engaged in the provision of those services or the strengthening and improvement of services; and the necessary administration to provide services to physically handicapped children and individuals at risk of having physically handicapped children. (16) Physically handicapped child means an individual below the age of twenty-one (21) years who has a disease, defect or condition which may hinder the achievement of normal physical growth and development. (17) Pre-authorization means written permission obtained from CCS in advance of an action which would result in either the obligation or expenditure of funds or the performance of an activity. (18) Program administrator means the person responsible for planning, developing, implementing and monitoring the program of special health services on a statewide basis for handicapped children. (19) Program coordinator means the person responsible for coordinating a segment of the CCS and the duties assigned to that segment. (20) Provider of care means an individual who is regulated under Chapters 331, 332, 334–338 and 344–346, RSMo Supp. 1988; or an organization licensed under Chapter 197, RSMo Supp. 1988 or approved by the Joint Commission on Accreditation of Hospitals or the American Osteopathic Association. (21) Rehabilitation means the process of improving or reestablishing an individual’s skill or level of adjustment by increasing the ability to maintain an optimum level of independent functioning. (22) Third-party payer means any person, corporation, trust, association, the state of Missouri, any governmental subdivision or agency or any other legal entity which pays directly or indirectly for health care services provided to another person or reimburses or pays a benefit to or on behalf of another person for health care services in conformance to a contract, plan, employee benefit or member benefit. AUTHORITY: sections 192.005.2 and 201.060, RSMo 1986.* This rule was previously filed as 13 CSR 50-160.010. Emergency rule filed Dec. 12, 1984, effective Dec. 22, 1984, expired April 20, 1985. Original rule filed Dec. 12, 1984, effective April 11, 1985. Amended: Filed June 2, 1987, effective Aug. 13, 1987. Amended: Filed Jan. 18, 1989, effective April 27, 1989. *Original authority: 192.005, RSMo 1985 and 201.060, RSMo 1959.