As used in this part:

1. (1) “Abuse” means any of the acts or omissions defined under Arkansas Code § 12-18-103;
2. (2) “Accreditation” means official notification given to the provider of compliance to standards established by The Joint Commission, formerly known as the Joint Commission on Accreditation of Healthcare Organizations, for psychiatric residential treatment facilities;
3. (3) “Active treatment” means implementation of a professionally developed and supervised individual plan of care that is developed no later than seven (7) days after admission and designed to achieve the recipient’s discharge from inpatient status at the earliest possible time;
4. (4) “Administrator” means a person licensed as a psychiatric residential treatment facility administrator, by the Office of Long-Term Care who administers, manages, supervises, or is in general administrative charge of a psychiatric residential treatment facility;
5. (5) “Centers for Medicare & Medicaid Services” means the United States Department of Health and Human Services, Centers for Medicare & Medicaid Services;
6. (6) “C.F.R” means the Code of Federal Regulations;
7. (7) “Controlled substance” means a drug, substance, or immediate precursor in Schedules I through V of the Controlled Substances Act;
8. (8) “CPR” means cardiopulmonary resuscitation;
9. (9) “Department” means the Department of Human Services;

10. (10)

    1. (A) “Drug administration” means an act restricted to nursing personnel as defined in the Nurse Practice Act, Acts 1971, No. 432, in which a single dose of a prescribed drug or biological is given to a patient.
    2. (B) This activity includes the removal of the dose from a previously dispensed, properly labeled container, verifying it with the prescriber's orders, giving the individual dose to the proper patient, and recording the time and dose given;

11. (11) “Drug used as a restraint” means any drug that:

    1. (A) Is administered to manage a resident’s behavior in a way that reduces the safety risk to the resident or others;
    2. (B) Has the temporary effect of restricting the resident’s freedom of movement; and
    3. (C) Is not a standard treatment for the resident’s medical or psychiatric condition;
12. (12) “Emergency” means a situation, physical condition, or one (1) or more practices, methods, or operations which threatens the health, security, safety, or welfare of residents;

13. (13)

    1. (A) “Emergency safety intervention” means the use of physical or chemical restraint as an immediate response to an emergency safety situation which is defined as an unanticipated behavior from a resident that places the resident or others at serious threat of violence or injury if no intervention occurs.
    2. (B) Interventions shall not be preventative in nature.
    3. (C) Emergency safety intervention shall only be used as the last resort after all less-restrictive alternatives are exhausted;
14. (14) “Existing facilities” means psychiatric residential treatment facilities which were in operation and previously licensed by the Child Welfare Agency Review Board for the purpose of operating as a psychiatric residential treatment facility or beds that were fully constructed and could be used for the purpose of operating a psychiatric residential treatment facility as of January 1, 2025;
15. (15) “Facility” means a psychiatric residential treatment facility which is required to be licensed pursuant to Arkansas Code § 20-10-224;
16. (16) “Governing body” or “management team” means the individuals or group in whom the ultimate authority and legal responsibility is vested for conduct of the psychiatric residential treatment facility;
17. (17) “Guardian” means a court-appointed person who, by law, is responsible for a resident’s affairs;
18. (18) “HIPAA” means the Health Insurance Portability and Accountability Act of 1996;

19. (19) “Incidents” include, but are not limited to:

    1. (A) Resident injuries;
    2. (B) Abuse;
    3. (C) Neglect;
    4. (D) Maltreatment;
    5. (E) Accidents;
    6. (F) Unusual deaths or deaths from violence;
    7. (G) Suicide attempts; and
    8. (H) Significant changes in resident condition, location, or property;
20. (20) “Mechanical restraint” means any device attached or adjacent to the resident’s body that he or she cannot easily remove that restricts freedom of movement or normal access to his or her body;
21. (21) “Neglect” means as defined under Arkansas Code § 12-18-103;
22. (22) “New construction” means those psychiatric residential treatment facilities which are constructed or renovated for the purpose of a psychiatric residential treatment facility after January 1, 2025, and require prior approval from the Health Services Permit Agency;

23. (23)

    1. (A) “Personal restraint” means the application of physical force without the use of any device for the purposes of restraining the free movement of a resident’s body.
    2. (B) ”Personal restraint” does not include briefly holding without undue force a resident in order to calm or comfort him or her or holding a resident’s hand to safely escort a resident from one (1) area to another;
24. (24) “PRN” means "as needed" or "as circumstances arise" (from the Latin, pro re nata) and is used when referring to medication administration or patient care;

25. (25) “Psychiatric residential treatment facility” means a standalone, nonhospital facility with a provider agreement with the Arkansas Medicaid Program to provide inpatient service benefits to individuals who are under twenty-one (21) years of age and that:

    1. (A) Is accredited by The Joint Commission or any other accrediting organization with comparable standards recognized by this state;
    2. (B) Attests to meeting the conditions of participation found at 42 C.F.R. pt. 483, subpt. G (2001); and
    3. (C) Attests that all of the residents in the facility meet the certification of need for services requirements as identified under 42 C.F.R. pt. 441, subpt. D (2019);
26. (26) “Responsible party” means the person who is accountable for the resident’s affairs but who has not been appointed by the court;

27. (27)

    1. (A) “Restraint” means any device or instrument used to limit, restrict, or hold patients under control, not including safety vests or other instruments such as bed rails used for the safety and positioning of patients.
    2. (B) Personal safety devices and postural support devices that restrict movement are considered restraints.
    3. (C) “Restraint” means a personal restraint, mechanical restraint, or drug used as a restraint as defined in this section;
28. (28) “Seclusion” means the involuntary confinement of a resident alone in a room or an area from which the resident is physically prevented from leaving;
29. (29) “Sending state” means the state where the out-of-state resident’s guardian or responsible party resides;

30. (30)

    1. (A) “Serious injury” means physical harm or a physical injury that caused any significant impairment of the physical condition of the resident as determined by qualified medical personnel.
    2. (B) This includes, but is not limited to, burns, lacerations, bone fractures, substantial hematoma, and injuries to internal organs, whether self-inflicted or inflicted by someone else;
31. (31) “Serious physical harm” means physical injury that creates a substantial risk of death or that causes protracted disfigurement, protracted impairment of health, or loss or protracted impairment of the function of any bodily member or organ;
32. (32) “Sexual abuse” means the same as defined under Arkansas Code § 12-18-103;
33. (33) “Sexual act” means where a resident is coerced or manipulated to participate in any form of sexual activity for which the resident did not give affirmative permission;

34. (34)

    1. (A) “Staff for ratio” means those individuals with responsibility for managing a resident’s health or participating in an emergency safety intervention and who are employed by the facility on a full-time, part-time, or contract basis.
    2. (B) This includes, but is not limited to, a licensed nurse, physician, licensed therapist, or other healthcare professional licensed, registered, or certified to practice in the State of Arkansas, as well as paraprofessionals who meet requirements.
    3. (C) All staff must comply with all staffing sections in this part;

35. (35) “Suicide attempt” means:

    1. (A) Self-inflicted harm in an attempt to end an individual’s own life; (B) A potentially self-injurious act with the wish to die;
    2. (C) An act of self-harm that is intended to result in death but does not;
36. (36) “Time out” means the restriction of a resident for a period of time to a designated area from which the resident is not physically prevented from leaving, for the purpose of providing the resident an opportunity to regain self-control;
37. (37) “Transfer” means the movement of the resident from one (1)psychiatric residential treatment facility to another psychiatric residential treatment facility; and

38. (38) “Violation” means:

    1. (A) Class A violations create a condition or occurrence relating to the operation and maintenance of a psychiatric residential treatment facility resulting in death or serious physical harm to a resident or creating a substantial probability that death or serious physical harm to a resident will result therefrom;
    2. (B) Class B violations create a condition or occurrence relating to the operation and maintenance of a psychiatric residential treatment facility which directly threatens the health, safety, or welfare of a resident;
    3. (C) Class C violations shall relate to administrative and reporting requirements that do not directly threaten the health, safety, or welfare of a resident; or

    4. (D)

       1. (i) Class D violations shall relate to the timely submittal of statistical and financial reports to the office.
       2. (ii) The failure to timely submit a statistical or financial report shall be considered a separate Class D classified violation during any month or part thereof of noncompliance.
       3. (iii) In addition to any civil money penalty which may be imposed, the director is authorized after the first month of a Class D violation to withhold any further reimbursement to the psychiatric residential treatment facility until the statistical and financial report is received by the office.

Codification Notes: The Controlled Substances Act is codified at 21 U.S.C. § 801 et seq. The Health Insurance Portability and Accountability Act of 1996 is Pub. L. No. 104-191, 110 Stat. 1936 (codified as amended in scattered sections of 18 U.S.C., 26 U.S.C., 29 U.S.C., and 42 U.S.C.).