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) Use of mechanical restraints without proper authority;
   5. (E) 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) “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;
4. (4) “Client” means any person for whom a crisis stabilization unit furnishes, or has agreed or undertaken to furnish, services;

5. (5) "Clinical privileging" means an organized method for treatment facilities to authorize an individual permission to provide specific care and treatment services to clients within well-defined limits, based on the evaluation of the individual's:

   1. (A) License;
   2. (B) Education;
   3. (C) Training;
   4. (D) Experience;
   5. (E) Competence;
   6. (F) Judgment; and
   7. (G) Other credentials;

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

   1. (A) Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq., Title XXI of the Social Security Act, 42 U.S.C. § 1397aa et seq., 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 crisis stabilization unit services specifically;
   4. (D) Title VI of the Civil Rights Act of 1964, 42 U.S.C. § 2000d et seq., 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;
7. (7) "Co-occurring disorder" means any combination of mental health and substance use disorder symptoms or diagnoses in a client;
8. (8) "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;
9. (9) "Crisis intervention" means an immediately available service to meet the psychological, physiological, and environmental needs of individuals who are experiencing a mental health and/or substance abuse crisis;

10. (10) "Crisis stabilization" means emergency psychiatric and substance abuse services for the resolution of crisis situations and may include:

    1. (A) Placement of an individual into a protective environment;
    2. (B) Basic supportive care; and
    3. (C) Medical assessment and referral;

11. (11)

    1. (A) "Crisis stabilization unit" means a program of emergency services for mental health and substance use disorder crisis stabilization including, but not limited to, observation, evaluation, and emergency treatment and referral, when necessary, for inpatient psychiatric or substance use disorder treatment services.

    2. (B) Crisis stabilization units must adhere to the following:

       1. (i) Have sixteen (16) beds or less; and
       2. (ii) Be independently certified by the Department of Human Services;

12. (12)

    1. (A) "Critical incident" means an occurrence or set of events inconsistent with the routine operation of the facility or the routine care of a client.

    2. (B) “Critical incidents” specifically include but are 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 who 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;

13. (13)

    1. (A) "Emergency examination" means the examination of a person who appears to be a mentally ill person, an alcohol-dependent person, or drug-dependent person and a person requiring treatment, and whose condition is such that it appears that emergency detention may be warranted by a licensed mental health professional to determine if emergency detention of the person is warranted.
    2. (B) The examination must occur within twelve (12) hours of being taken into protective custody;
14. (14) "Initial assessment" means examination of current and recent behaviors and symptoms of an individual who appears to be mentally ill or substance dependent;
15. (15) "Intervention plan" means a description of services to be provided in response to the presenting crisis situation that incorporates the identified problem or problems, strengths, abilities, needs, and preferences of the individual served;
16. (16) "Licensed mental health professional" or "LMHP" as defined;
17. (17) "Linkage services" means the communication and coordination with other service providers that ensure timely appropriate referrals between the crisis stabilization unit and other providers;

18. (18)

    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;

19. (19)

    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 (SAMHSA) evidence-based practice models is evidence of compliance with professionally recognized standards of care;

20. (20) "Progress notes" means:

    1. (A) A chronological description of services provided to a client;
    2. (B) The client's progress, or lack of; and
    3. (C) Documentation of the client's response related to the intervention plan;
21. (21) “Provider” means an entity that is certified by the Department of Human Services as a crisis stabilization unit and enrolled by the Division of Medical Services as a behavioral health agency;
22. (22) "Psychosocial evaluations" are in-person interviews conducted by professionally trained personnel designed to elicit historical and current information regarding the behavior and experiences of an individual and are designed to provide sufficient information for problem formulation and intervention;

23. (23) “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 controlled by client care plans and provided under the direct supervision of a mental health professional;

24. (24)

    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 utilized within a certified crisis stabilization unit;

25. (25)

    1. (A)

       1. (i) "Sentinel event" means 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 events” include, but are 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;
26. (26) "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; and
27. (27) "Triage" means a dynamic process of evaluating and prioritizing the urgency of crisis intervention needed based on the nature and severity of clients' presenting situations.

Codification Notes: The Health Insurance Patient Affordability Act was enacted as Pub. L. No. 104-191. The Americans with Disabilities Act is codified generally at 42 U.S.C. § 12101 et seq.