The following words or terms, when used in this part, shall have the defined meaning, unless the context clearly indicates otherwise:

1. (1) "Abuse" means the causing or permitting of harm or threatened harm to the health, safety, or welfare of a resident by a staff responsible for the resident's health, safety, or welfare, including but not limited to:

   1. (A) Nonaccidental physical injury or mental anguish;
   2. (B) Sexual abuse;
   3. (C) Sexual exploitation;
   4. (D) The use of mechanical restraints without proper authority;
   5. (E) The intentional use of excessive or unauthorized force aimed at hurting or injuring the resident; or
   6. (F) Deprivation of food, clothing, shelter, or health care by a staff responsible for providing these services to a resident;

2. (2)

   1. (A) “Adverse license action” means any:

      1. (i) Action by a licensing authority that is related to client care;
      2. (ii) Act or omission warranting exclusion under Participant Exclusion, 25 CAR pt. 30; or
      3. (iii) Act or omission that imposes any restriction on the licensee’s practice privileges.
   2. (B) The action is deemed to exist when the licensing entity imposes the adverse action except as provided in Arkansas Code § 25-15-211(c);
3. (3) “Behavioral health agency” means an entity that is certified by the Department of Human Services as meeting the requirements to be certified as a behavioral health agency;
4. (4) “Certification” means a written designation issued by the Department of Human Services declaring that the provider has demonstrated compliance as declared within and defined by this part;
5. (5) “Client” means any person for whom a therapeutic community furnishes, or has agreed or undertaken to furnish, services;
6. (6) "Co-occurring disorder" means any combination of mental health and substance use disorder symptoms or diagnoses in a client;
7. (7) "Co-occurring disorder capability" means the organized capacity within any type of program to routinely screen, identify, assess, and provide properly matched interventions to individuals with co-occurring disorders;

8. (8) “Compliance” means conformance with applicable state and federal laws, rules, and regulations including, without limitation:

   1. (A) Titles XIX and XXI of the Social Security Act and implementing regulations;
   2. (B) Other federal laws and regulations governing the delivery of health care funded in whole or in part by federal funds, for example, 42 U.S.C. § 1320c-5;
   3. (C) All state laws and rules applicable to Medicaid generally and to therapeutic community services specifically;
   4. (D) Title VI of the Civil Rights Act of 1964 as amended, and implementing regulations;
   5. (E) The Americans with Disabilities Act, as amended, and implementing regulations; and
   6. (F) The Health Insurance Portability and Accountability Act (HIPAA), as amended, and implementing regulations;

9. (9)

   1. (A) "Critical incident" means an occurrence or set of events inconsistent with the routine:

      1. (i) Operation of the facility; or
      2. (ii) Care of a client.

   2. (B) “Critical incident” specifically includes but is not necessarily limited to the following:

      1. (i) Adverse drug events;
      2. (ii) Self-destructive behavior;
      3. (iii) Deaths and injuries to clients, staff, and visitors;
      4. (iv) Medication errors;
      5. (v) Clients that are absent without leave (AWOL);
      6. (vi) Neglect or abuse of a client;
      7. (vii) Fire;
      8. (viii) Unauthorized disclosure of information;
      9. (ix) Damage to or theft of property belonging to a client or the facility;
      10. (x) Other unexpected occurrences; or
      11. (xi) Events potentially subject to litigation.
   3. (C) A critical incident may involve multiple individuals or results;
10. (10) “Deficiency” means an item or area of noncompliance;
11. (11) “DHS” means the Department of Human Services;

12. (12)

    1. (A) “Mental health professional” or “MHP” means a person who possesses an Arkansas license to provide clinical behavioral health care.
    2. (B) The license must be in good standing and not subject to any adverse license action;
13. (13) "Minor" means any person under eighteen (18) years of age;

14. (14)

    1. (A) "Performance improvement" or "PI" means an approach to the continuous study and improvement of the processes of providing healthcare services to meet the needs of clients and others.

    2. (B) Synonyms and near synonyms include:

       1. (i) “Continuous performance improvement”;
       2. (ii) “Continuous improvement”;
       3. (iii) “Organization-wide performance improvement”; and
       4. (iv) “Total quality management”;

15. (15)

    1. (A) "Persons with special needs" means any persons with a condition which is considered a disability or impairment under the Americans with Disabilities Act of 1990 including, but not limited to:

       1. (i) The deaf/hearing impaired;
       2. (ii) The visually impaired;
       3. (iii) The physically disabled;
       4. (iv) The developmentally disabled;
       5. (v) Persons with a disabling illness; and
       6. (vi) Persons with mental illness and/or substance abuse disorders.
    2. (B) See "Americans with Disabilities Handbook" published by the United States Equal Employment Opportunity Commission and the United States Department of Justice;

16. (16)

    1. (A) “Professionally recognized standard of care” means that degree of skill and learning commonly applied under all the circumstances in the community by the average prudent reputable member of the profession.
    2. (B) Conformity with Substance Abuse and Mental Health Services Administration evidence-based practice models is evidence of compliance with professionally recognized standards of care;

17. (17) "Progress notes" means:

    1. (A) A chronological description of services provided to a client;
    2. (B) The client's progress or lack of progress; and
    3. (C) Documentation of the client's response related to the intervention plan;

18. (18) “Provider” means an entity that is:

    1. (A) Certified by the Department of Human Services as a therapeutic community; and
    2. (B) Enrolled by the Division of Medical Services as a behavioral health agency;

19. (19) “Qualified behavioral health provider” means a person who:

    1. (A) Does not possess an Arkansas license to provide clinical behavioral health care;
    2. (B) Works under the direct supervision of a mental health professional;
    3. (C) Has successfully completed prescribed and documented courses of initial and annual training sufficient to perform all tasks assigned by a mental health professional; and

    4. (D) Acknowledges in writing that all qualified behavioral health provider services are:

       1. (i) Controlled by client care plans; and
       2. (ii) Provided under the direct supervision of a mental health professional;

20. (20)

    1. (A) "Restraint" refers to manual, mechanical, and chemical methods that are intended to restrict the movement or normal functioning of a portion of the individual's body.
    2. (B) Mechanical restraints shall not be used;

21. (21)

    1. (A)

       1. (i) "Sentinel event" is a type of critical incident that is an unexpected occurrence involving the death or serious physical or psychological injury to a client, or risk thereof.
       2. (ii) Serious injury specifically includes loss of limb or function.
       3. (iii) The phrase "or risk thereof" includes a variation in approved processes which could carry a significant chance of a serious adverse outcome to a client.
       4. (iv) These events signal the need for immediate investigation and response.

    2. (B) “Sentinel event” includes, but is not limited to:

       1. (i) Suicide;
       2. (ii) Homicide;
       3. (iii) Criminal activity;
       4. (iv) Assault and other forms of violence, including domestic violence or sexual assault; and
       5. (v) Adverse drug events resulting in serious injury or death; and
22. (22) "Trauma-informed" means the recognition and responsiveness to the presence of the effects of past and current traumatic experiences in the lives of all clients.

Codification Notes: Title XIX of the Social Security Act is codified at 42 U.S.C. § 1396 et seq. The Americans with Disabilities Act is codified at 42 U.S.C. § 12101 et seq. The Health Insurance Portability and Accountability Act of 1996 was enacted as Pub. L. No. 104-191.