As used in this subpart:

1. (1)

   1. (A) “Acceptable macronutrient distribution range (AMDR)” means the range of intake for a particular energy source that is associated with reduced risk of chronic disease while providing intakes of essential nutrients.
   2. (B) If an individual consumes in excess of the AMDR, there is a potential of increasing the risk of chronic diseases and/or insufficient intakes of essential nutrients;

2. (2)

   1. (A) “Activities of daily living” means tasks performed regularly, daily, or multiple times daily which are necessary for self-care and/or independent living (eating, dressing, bathing, toileting, and transferring in and out of bed).
   2. (B) See also “instrumental activities of daily living”;

3. (3)

   1. (A) “Adequate intake (AI)” means the recommended average daily nutrient intake level based on observed or experimentally determined approximations or estimates of mean nutrient intake by a group or groups of apparently healthy people.
   2. (B) The AI is used when the estimated average requirement cannot be determined;

4. (4)

   1. (A) “Assistive technology” means technology, engineering methods, or scientific principles appropriate to meet the needs of, and address barriers confronted by, persons with functional limitations.
   2. (B) Nutrition-related examples: devices that allow such persons to feed themselves or prepare their own meal or the devices or processes used to modify food to allow a person to consume food by mouth;

5. (5)

   1. (A) “Certified dietary manager” means the designation used by persons who have completed a twelve-month to eighteen-month food service manager's course approved by the Association of Nutrition and Foodservice Professionals or have an associate’s or bachelor’s degree in a food­related field, and successfully completed a national registration exam.
   2. (B) The course includes sections of training in nutrition and food service management;

6. (6) “Comprehensive and coordinated system” means an organized, interactive network for providing all necessary supportive services, including nutrition services to older individuals in the service area in a manner designed to:

   1. (A) Facilitate access to and use of supportive services and nutrition services available from public or private agencies or organizations within the service area;
   2. (B) Develop and make the most efficient use of such services and resources with minimum duplication in meeting the needs of older individuals; and
   3. (C) Encourage and assist public and private entities that have unrealized potential for meeting the service needs of older individuals to assist the older individuals on a voluntary basis;

7. (7)

   1. (A) “Congregate meal” means a hot or other appropriate meal served to an eligible person at a congregate meal site.

   2. (B) Meals comply with Division of Aging, Adult, and Behavioral Health Services of the Department of Human Services Title III Nutrition Service Standards, and Dietary Guidelines for Americans, and provide a minimum of:

      1. (i) Thirty-three and one-third percent (33 1/3%) of the DRIs if one (1) meal is served;
      2. (ii) Sixty-six and two-thirds percent (66 2/3%) of the DRIs if two (2) meals are served; and
      3. (iii) One hundred percent (100%) of the DRIs if three (3) meals are served, with the second and third meals balanced proportionally in calories and nutrients;

8. (8)

   1. (A) “Congregate meal site” means the generic name of a facility where meals are served in a group setting and comprehensive supportive services, including transport to the site, are provided to older adults.
   2. (B) The facility is located as close to residences of the majority of eligible persons as feasible and may be a multipurpose senior center, school, church, or other appropriate community facility;

9. (9)

   1. (A) “Dietary Guidelines for Americans” means the recommended dietary practices for healthy Americans published jointly every five (5) years since 1980 by the United States Department of Health and Human Services and the United States Department of Agriculture.
   2. (B) The guidelines provide authoritative advice for people two (2) years and older about how good dietary habits can promote health and reduce risk for major chronic diseases.
   3. (C) They serve as the basis for federal food and nutrition education programs;

10. (10)

    1. (A) “Dietary reference intakes (DRIs)” means a set of nutrient-based reference values that expand upon and replace the former recommended dietary allowances (RDAs).

    2. (B) They are actually a set of four (4) reference values:

       1. (i) Estimated average requirements;
       2. (ii) RDAs;
       3. (iii) Adequate intake; and
       4. (iv) Tolerable upper intake levels;

11. (11) “Disability” means a loss of functional capacity due to physical or mental impairment, or both, resulting in substantial functional limitations in one (1) or more of these areas of major life activity:

    1. (A) Self-care;
    2. (B) Receptive and expressive language;
    3. (C) Learning;
    4. (D) Mobility;
    5. (E) Self-direction;
    6. (F) Capacity to live independently;
    7. (G) Economic self-sufficiency;
    8. (H) Cognitive functioning; and
    9. (I) Emotional adjustment;

12. (12)

    1. (A) “Disease prevention and health promotion services” means activities that:

       1. (i) Identify risk for, or presence of, disease or health problems;
       2. (ii) Encourage behaviors that reduce effects of, or prevent, chronic disabling conditions (mental or physical) or injuries; or
       3. (iii) Provide information on preventative health services available.

    2. (B) Nutrition-related activities in this service include, but are not limited to:

       1. (i) Nutrition screening;
       2. (ii) Nutrition assessment;
       3. (iii) Nutrition counseling;
       4. (iv) Nutrition education; and
       5. (v) Referral to other appropriate services;
13. (13) “Education and training services” means supportive services designed to assist older individuals to better cope with their economic, health, and personal needs through such services as consumer education, continuing education, preretirement education, financial planning, and other education and training services, which will advance the objectives of the Older Americans Act, 42 U.S.C. § 3001 et seq.;
14. (14) “Estimated average requirements” means the average daily nutrient intake level estimated to meet the requirement of half the healthy individuals in a particular life stage and gender group;
15. (15) “Food service vendor” means a restaurant, hospital, school, or commercial organization that contracts with an area agency on aging service provider to supply prepared meals, usually at a fixed price per meal, to the provider who contracts with the area agency on aging to provide nutrition and other services;

16. (16) “Frail”, with respect to older individuals, means one who is determined to be functionally impaired because the individual:

    1. (A) Is unable to perform two (2) or more activities of daily living without substantial human assistance, including:

       1. (i) Verbal reminders;
       2. (ii) Physical cues; or
       3. (iii) Supervision; or
    2. (B) Due to cognitive or other mental impairment, requires substantial supervision because the individual behaves in a manner that poses a serious health or safety hazard to himself or herself or another individual;
17. (17) “Greatest economic need (poverty)” means the need resulting from an income at or below the poverty line established each year by the Office of Management and Budget, and adjusted by the United States Secretary of Health and Human Services in accordance with subsection 673(2) of the Community Services Block Grant Act (42 U.S.C. § 9902(2));

18. (18) “Greatest social need” means need caused by noneconomic factors including:

    1. (A) Physical and mental disabilities;
    2. (B) Language barriers; and
    3. (C) Cultural, social, and geographical isolation, including isolation caused by racial or ethnic status which restricts the ability of the person to perform normal daily tasks or threatens a person's capacity to live independently;

19. (19)

    1. (A) “Homebound” means unable to leave the home without assistance, physical or mental, from another person.

    2. (B) For nutrition services, the person is:

       1. (i) Frail;
       2. (ii) Homebound by reason of illness, incapacitation, or disability; or
       3. (iii) Otherwise isolated;

20. (20)

    1. (A) “Home-delivered meal (HDM)” means a hot or other appropriate meal delivered to the residence of an eligible homebound person.

    2. (B) Meals must follow the Dietary Guidelines for Americans, meet Title III and Division of Aging, Adult, and Behavioral Health Services of the Department of Human Services Nutrition Service Standards, and contain:

       1. (i) One-third (1/3) of the DRIs if one (1) meal is provided;
       2. (ii) Sixty-six and two-thirds percent (66 2/3%) of the DRIs if two (2) meals are provided; and
       3. (iii) One hundred percent (100%) of the DRIs if three (3) meals are provided.
    3. (C) Second and third meals are proportionally balanced in calories and nutrients;

21. (21)

    1. (A) “Instrumental activities of daily living” means regularly performed tasks necessary for independent living (preparing meals, shopping for personal items, medication management, managing money, using a telephone, doing heavy housework, doing light housework, etc.).
    2. (B) See also “activities of daily living”, subdivision (2) of this section;
22. (22) “Menu cycle” means a preplanned written sequence of menus repeated over a specified timeframe;

23. (23)

    1. (A) “Nutrition assessment” means an in-depth evaluation of both objective and subjective data related to an individual's:

       1. (i) Food and nutrient intake;
       2. (ii) Lifestyle; and
       3. (iii) Medical history.
    2. (B) Nutrition assessments are performed by registered dieticians to assess and evaluate individual nutritional status.
    3. (C) The assessment leads to nutrition counseling or other nutrition intervention designed to help the individual either maintain the assessed status or attain a healthier status;

24. (24)

    1. (A) “Nutrition counseling” means individualized guidance to:

       1. (i) Individuals who are at nutritional risk because of their:

          1. (a) (a) Health or nutrition history;
          2. (b) (b) Dietary intake;
       2. (c) (c) Chronic illnesses; or
       3. (d) (d) Medication use; or
       4. (ii) Caregivers.
    2. (B) Counseling is provided one-on-one by a registered dietician and addresses the options and methods for improving nutrition status;
25. (25) “Nutrition education” means a service or program that promotes better health by providing accurate and culturally sensitive nutrition, physical fitness, or health (as it relates to nutrition) information and instruction to participants and caregivers in a group or individual setting overseen by a registered dietitian or individual of comparable expertise;
26. (26) “Nutrition outreach” means an activity designed to seek out and identify, on an ongoing basis, the maximum number of the hard-to-reach, isolated, and withdrawn target group of eligible individuals throughout the program area, and to encourage them to make use of existing services and benefits;

27. (27)

    1. (A) “Nutrition screening” means the process of identifying individuals with multiple risk factors (easily identified characteristics known to be linked with increased likelihood of nutritional problems).
    2. (B) This serves to identify individuals at nutritional risk;

28. (28)

    1. (A) “Nutrition services” must include, but is not limited to, the provision of congregate and home-delivered meals, nutrition education, nutrition screening, and nutrition outreach which meet the funding source, Division of Aging, Adult, and Behavioral Health Services of the Department of Human Services, and other applicable requirements.
    2. (B) Services may also include special diets, nutrition assessment, and counseling if appropriate and feasible;

29. (29)

    1. (A) “Nutrition Services Incentive Program (NSIP)” means the program that provides supplemental funding for the Older Americans Act Nutrition Program to states, territories, and eligible tribal organizations to purchase domestic food only.
    2. (B) This funding may not be used to pay for other nutrition-related services or state or local administrative costs.

    3. (C) States may choose to receive the grant as:

       1. (i) Cash;
       2. (ii) Commodities from the United States Department of Agriculture; or
       3. (iii) A combination of cash and commodities;
30. (30) “Older individual” means an individual age sixty (60) years or older;

31. (31)

    1. (A) “Project” means a provider of nutrition services for purposes of this subpart.
    2. (B) The provider may contract with the area agency on aging to provide services at more than one (1) location;
32. (32) “Recommended dietary allowance (RDA)” means the dietary intake level that is sufficient to meet the nutrient requirement of nearly all (ninety-seven to ninety-eight percent (97% – 98%)) healthy individuals in a particular life stage and gender group;

33. (33)

    1. (A) “Registered dietitian (RD)” means an individual registered by the Commission on Dietetic Registration (CDR).

    2. (B) CDR registration requires that the dietitian has:

       1. (i) Completed at least a four-year course of study in a specified curriculum at a college or university accredited by the Accreditation Council for Education in Nutrition and Dietetics (ACEND);
       2. (ii) Successfully completed an ACEND-accredited dietetic internship; and
       3. (iii) Passed the CDR national registration exam.
    3. (C) Ongoing continuing education is required.
    4. (D) In Arkansas, persons using the title of dietitian must be licensed;
34. (34) “Severe disability” means a major, chronic loss in functional capacity due to mental or physical impairment, or both, likely to continue indefinitely and causing substantial functional limitation in three (3) or more major life activities;
35. (35) “Special menu” means a meal plan that meets the particular dietary needs arising from health requirements, religious requirements, or ethnic backgrounds of eligible individuals (see also “therapeutic diet”, subdivision (38) of this section);
36. (36) “Subcontractor” means a recipient of state or federal funds by grant, reimbursement, or other means from an area agency on aging in exchange for services specified by contract (area agency on aging service provider);

37. (37)

    1. (A) “Targeted group” means a segment of the population of the service area toward which services are directed.
    2. (B) Nutrition services' target population is unserved older persons with the greatest economic and social need (including low-income minority individuals) and frail individuals likely to be at high nutritional risk;

38. (38)

    1. (A) “Therapeutic diet” means a diet designed to treat a specific health problem.
    2. (B) A therapeutic diet requires a physician's diet prescription and must be written under supervision and/or consultation of a registered dietitian; and

39. (39)

    1. (A) “Tolerable upper intake level (UL)” means the highest average daily nutrient intake level likely to pose no risk of adverse health effects for nearly all individuals in a particular life stage and gender group.
    2. (B) As intake increases above the UL, the potential risk of adverse health effects increases.

Codification Notes: This section as promulgated prior to codification into the Code of Arkansas Rules provided as follows: “1-1-96”