Connecticut Administrative Code › Title 17a - Social and Human Services and Resources › 453a - General Assistance Behavioral Health Program › Section 17a-453a-2 - Definitions

Current through July 10, 2024
As used in sections
				17a-453a-1 to
				17a-453a-19,
				inclusive, of the Regulations of Connecticut State Agencies:
(1) "Acute care services" means short-term
			 inpatient treatment for a psychiatric disability, substance use disorder or
			 both and includes the following covered behavioral health services: acute
			 psychiatric hospitalization, medically managed inpatient detoxification and
			 medically monitored residential detoxification;
(2) "ASAM PPC-2R" means the American Society
			 of Addictions Medicine Patient Placement Criteria, Second Revision;
(3) "Authorized representative" means a
			 person designated by an individual or a person authorized by law to act on
			 behalf of an individual;
(4)
			 "Behavioral health services" means services designed for the treatment of
			 persons with psychiatric disabilities, substance use disorders or
			 both;
(5) "CARF" means the
			 Commission on Accreditation of Rehabilitation Facilities;
(6) "Certified alcohol and drug counselor"
			 means a person that meets and maintains all applicable licensing and
			 certification requirements of federal and state statutes or
			 regulations;
(7) "CFR" means the
			 Code of Federal Regulations;
(8)
			 "Clinical contact" means communication with direct observation of an individual
			 in order to establish a therapeutic relationship and assist with the
			 amelioration of identified problems;
(9) "Clinical risk" means the potential for
			 injury or harm to self, others or property;
(10) "Commissioner" means the commissioner of
			 the Department of Mental Health and Addiction Services (DMHAS);
(11) "Contracted provider" means a provider
			 that is credentialed and has a contract with DMHAS to provide a covered
			 behavioral health service under the general assistance behavioral health
			 program as established pursuant to section 17a-453a of the Connecticut General
			 Statutes;
(12) "Co-occurring
			 disorder" means a concurrent psychiatric disability and substance use
			 disorder;
(13) "Critical incident"
			 means any event that has serious effects on an individual or others;
(14) "Designated agent" means an organization
			 under contract with DMHAS to provide utilization management, process providers'
			 claims for payment or provide other support services necessary for the
			 operation of the general assistance behavioral health program established
			 pursuant to section 17a-453a of the Connecticut General Statutes;
(15) "Discharge plan" means the written
			 summary of an individual's behavioral health services needs, developed in order
			 to arrange for appropriate care after discharge or upon transfer from one level
			 of care to another;
(16) "DMHAS" or
			 "department" means the state of Connecticut Department of Mental Health and
			 Addiction Services;
(17) "DPH"
			 means the state of Connecticut Department of Public Health;
(18) "DSS" means the state of Connecticut
			 Department of Social Services;
(19)
			 "DSM-IV" means the Diagnostic and Statistical Manual of Mental Disorders,
			 Fourth Edition;
(20) "EMS-ID" means
			 the unique identifier assigned to each individual applying for or receiving
			 general assistance under Department of Social Services' (DSS)
			 programs;
(21) "Eligible recipient"
			 means an individual eligible for medical services under the state-administered
			 general assistance program, pursuant to section
			 17b-192 of the
			 Connecticut General Statutes, and in need of behavioral health services, as
			 determined by DMHAS;
(22)
			 "Emergency medical services" means services delivered to individuals suffering
			 from medical emergencies, including psychiatric or substance use disorder
			 emergencies. Emergency medical services include the detection and reporting of
			 medical emergencies; initial care, transportation and care for individuals en
			 route to health care facilities; medical treatment for the acutely ill and
			 severely injured within emergency departments and referrals to continued
			 care;
(23) "Facility" means the
			 physical structure, building or portions thereof in which mental health or
			 substance use treatment services or both are delivered;
(24) "GABHP" means the general assistance
			 behavioral health program established pursuant to section 17a-453a of the
			 Connecticut General Statutes;
(25)
			 "General hospital" means a facility that meets and maintains all applicable
			 licensing and certification requirements of federal and state statutes or
			 regulations;
(26) "Individualized
			 treatment" means treatment designed to meet a particular individual's needs,
			 guided by a recovery plan that is directly related to a specific assessment of
			 the individual;
(27) "Joint
			 Commission" means the entity formerly known as the Joint Commission on
			 Accreditation of Healthcare Organizations (JCAHO);
(28) "Level of care" means a discrete set of
			 behavioral health services as specified in the ASAM PPC-2R or other
			 DMHAS-authorized level-of-care placement criteria;
(29) "Licensed behavioral health
			 professional" means a person that meets and maintains all applicable licensing
			 and certification requirements of federal and state statutes or regulations and
			 who has experience in the treatment of psychiatric disabilities, substance use
			 disorders or both.
(30) "Medical
			 coverage" means a plan or program that pays for medically necessary behavioral
			 health services;
(31) "Medical
			 necessity" or "medically necessary" means appropriate and necessary for the
			 symptoms, diagnosis or treatment of a psychiatric disability or substance use
			 disorder or both, as specified in DSM-IV or its successor, ASAM PPC-2R or its
			 successor or other DMHAS authorized level-of-care placement criteria;
(32) "Panel or profile test" means certain
			 multiple laboratory tests performed on a single specimen;
(33) "Prior authorization" means the process
			 of obtaining prior approval from the designated agent to deliver a covered
			 behavioral health service;
(34)
			 "Private freestanding mental health day treatment facility" means a facility
			 that meets and maintains all applicable licensing and certification
			 requirements of federal and state statutes or regulations;
(35) "Private freestanding psychiatric
			 hospital" means a facility that meets and maintains all applicable licensing
			 and certification requirements of federal and state statutes or
			 regulations;
(36) "Provider" means
			 a person or entity that delivers behavioral health services;
(37) "Psychiatrist" means an individual that
			 meets and maintains all applicable licensing and certification requirements of
			 federal and state statutes or regulations;
(38) "Psychologist" means an individual that
			 meets and maintains all applicable licensing and certification requirements of
			 federal and state statutes or regulations;
(39) "Recovery" means a process of restoring
			 or developing a positive and meaningful sense of identity apart from one's
			 psychiatric disability or substance use disorder and then rebuilding one's life
			 within the limitations imposed by that disability or disorder;
(40) "Recovery plan" means a written plan
			 that directly relates to an individual's biopsychosocial assessment and that is
			 developed with the involvement of the individual or his or her authorized
			 representative as specified in section
			 17a-453a-9
			 of the Regulations of Connecticut State Agencies. A recovery plan also may be
			 referred to as a treatment plan;
(41) "Rehabilitation" means the restoration
			 of an optimum state of health by medical, psychological and social means for
			 the specific purpose of reducing the use of substances or mitigating the
			 effects of substance use disorders;
(42) "Relapse" means a recurrence of
			 psychoactive substance use by an individual who has previously achieved and
			 maintained abstinence for a significant period of time beyond
			 withdrawal;
(43) "SAMHSA" means the
			 Substance Abuse and Mental Health Services Administration of the U.S.
			 Department of Health and Human Services;
(44) "State-operated facility" means a
			 hospital or other facility that meets and maintains all applicable licensing
			 and certification requirements of federal and state statutes or regulations,
			 that delivers treatment for individuals with psychiatric disabilities or
			 substance use disorders or both and that is operated in whole or in part by the
			 state of Connecticut; and
(45)
			 "Substance use disorders services" means services delivered for the care and
			 treatment of individuals with substance use disorders that include medical,
			 psychiatric and biopsychosocial assessments; individual, group and family
			 counseling; peer counseling; vocational counseling and education
			 groups.