Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 21 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM (AHCCCS) BEHAVIORAL HEALTH SERVICES FOR PERSONS WITH SERIOUS MENTAL ILLNESS › Article 1 - GENERAL PROVISIONS › Section R9-21-101 - Definitions and Location of Definitions

Current through Register Vol. 30, No. 28, July 12, 2024
A. Location of
				definitions. Unless the context otherwise requires, terms used in this Chapter
				that are defined in A.R.S. §
									36-501 shall have the same meaning
				as in A.R.S. §
									36-501. In addition, the following
				definitions applicable to this Chapter are found in the following Section or
				Citation:
"Abuse"
R9-21-101
"ADHS"
R9-22-101
"Administration"
A.R.S. §
														36-2901
"Court"
A.R.S. §
														36-501
"Danger to others"
A.R.S. §
														36-501
"Department"
R9-21-101, A.R.S. §
														36-501
"Director"
A.R.S. §
														36-501
"Evaluation"
A.R.S. §
														36-501
"Family member"
A.R.S. §
														36-501
"Informed consent"
A.R.S. §
														36-501
"Licensed physician"
A.R.S. §
														36-501
"Mental disorder"
A.R.S. §
														36-501
"Mental health provider"
A.R.S. §
														36-501
"Outpatient treatment"
A.R.S. §
														36-501
"Persistent or acute disability"
A.R.S. §
														36-501
"Professional"
A.R.S. §
														36-501
"Proposed patient"
A.R.S. §
														36-501
"Psychiatrist"
A.R.S. §
														36-501
"Psychologist"
A.R.S. §
														36-501
"Records"
A.R.S. §
														36-501
"Regional Behavioral Health Authority
							 (RBHA)"
A.R.S. §
														36-3401
"Seriously Mentally Ill (SMI)"
A.R.S. §
														36-550
"Social worker"
A.R.S. §
														36-501
B.
				In this Chapter, unless the context otherwise requires:
"Abuse" means, with respect to a client, the infliction of,
				  or allowing another person to inflict or cause, physical pain or injury,
				  impairment of bodily function, disfigurement or serious emotional damage which
				  may be evidenced by severe anxiety, depression, withdrawal or untoward
				  aggressive behavior. Such abuse may be caused by acts or omissions of an
				  individual having responsibility for the care, custody or control of a client
				  receiving behavioral health services or community services under this Chapter.
				  Abuse shall also include sexual misconduct, assault, molestation, incest, or
				  prostitution of, or with, a client under the care of personnel of a mental
				  health agency.
"Administration" means the Arizona Health Care Cost
				  Containment System.
"Agency director" means the person primarily responsible for
				  the management of an outpatient or inpatient mental health agency, service
				  provider, health plan or the Administration, or their designees.
"AHCCCS" means the Arizona Health Care Cost Containment
				  System.
"Applicant" means an individual who:
Submits to a health
				  plan an application for behavioral health services under this Chapter or on
				  whose behalf an application has been submitted; or
Is referred to a
				  health plan for a determination of eligibility for behavioral health services
				  according to this Chapter.
"ASH" means the Arizona State Hospital.
"Authorization" means written permission for a mental health
				  agency to release or disclose a client's record or information,
				  containing:
The name of the mental
				  health agency releasing or disclosing the client's record or
				  information;
The purpose of the
				  release or disclosure;
The individual, mental
				  health agency, or entity requesting or receiving the client's record or
				  information;
A description of the
				  client's record or information to be released or disclosed;
A statement:
Of permission for the
				  mental health agency to release or disclose the client's record or information;
				  and
That permission may
				  be revoked at any time;
The date when or
				  conditions under which the permission expires;
The date the document
				  is signed; and
The signature of the
				  client or, if applicable, the client's guardian.
"Behavioral health issue" means an individual's condition
				  related to a mental disorder, personality disorder, substance abuse, or a
				  significant psychological or behavioral response to an identifiable stressor or
				  stressors.
"Behavioral health service" means the assessment, diagnosis,
				  or treatment of an individual's behavioral health issue.
"Burden of proof" means the necessity or obligation of
				  affirmatively proving the fact or facts in dispute.
"Case manager" means the person responsible for locating,
				  accessing and monitoring the provision of services to clients in conjunction
				  with a clinical team.
"Client" means an individual who has a qualifying serious
				  mental illness and is being evaluated or treated for a mental disorder by or
				  through a health plan.
"Client record" means the written compilation of information
				  that describes and documents the evaluation, diagnosis or treatment of a
				  client.
"Client who needs special assistance" means a client who has
				  been:
Deemed by a qualified
				  clinician, case manager, clinical team, or health plan to need special
				  assistance in participating in the ISP or ITDP process, which may include, but
				  is not limited to:
A client who requires
				  24-hour supervision;
A client who is, in
				  fact, incapable of making or communicating needs but is without a
				  court-appointed fiduciary; or
A client with
				  physical disabilities or language difficulties impacting the client's ability
				  to make or communicate decisions or to prepare or participate in meetings;
				  or
Otherwise deemed by a
				  program director, the Administration, or an Administrative Law Judge to need
				  special assistance to effectively file a written grievance, to understand the
				  grievance and investigation procedure, or to otherwise effectively participate
				  in the grievance process under this Chapter.
"Clinical team" refers to the interdisciplinary team of
				  persons who are responsible for providing continuous treatment and support to a
				  client and for locating, accessing and monitoring the provision of behavioral
				  health services or community services. A clinical team consists of a
				  psychiatrist, case manager, vocational specialist, psychiatric nurse, and other
				  professionals or paraprofessionals, such as a psychologist, social worker,
				  consumer case management aide, or rehabilitation specialist, as needed, based
				  on the client's needs. The team shall also include a team leader who is a
				  certified behavioral health supervisor.
"Community services" means services such as clinical case
				  management, outreach, housing and residential services, crisis intervention and
				  resolution services, mobile crisis teams, day treatment, vocational training
				  and opportunities, rehabilitation services, peer support, social support,
				  recreation services, advocacy, family support services, outpatient counseling
				  and treatment, transportation, and medication evaluation and
				  maintenance.
"Condition requiring investigation" means, within the context
				  of the grievance and investigation procedure set forth in Article 4 of this
				  Chapter, an incident or condition which appears to be dangerous, illegal, or
				  inhumane, including a client death.
"Court-ordered treatment" means treatment ordered by the
				  court under A.R.S. Title 36, Chapter 5.
"Court-ordered evaluation" means evaluation ordered by the
				  court under A.R.S. Title 36, Chapter 5.
"Crisis services" or "emergency services" means immediate and
				  intensive, time-limited, crisis intervention and resolution services which are
				  available on a 24-hour basis and may include information and referral,
				  evaluation and counseling to stabilize the situation, triage to an inpatient
				  setting, clinical crisis intervention services, mobile crisis services,
				  emergency crisis shelter services, and follow-up counseling for clients who are
				  experiencing a psychiatric emergency.
"Dangerous" as used in Article 4 of this Chapter means a
				  condition that poses or posed a danger or the potential of danger to the health
				  or safety of any client.
"Department" means the Arizona Department of Health
				  Services.
"Designated representative" means a parent, guardian,
				  relative, advocate, friend, or other person, designated in writing by a client
				  or guardian who, upon the request of the client or guardian, assists the client
				  in protecting the client's rights and voicing the client's service
				  needs.
"Determining Entity" means either the AHCCCS designee
				  authorized to make SMI determinations or a Tribal Regional Behavioral Health
				  Authority (for each TRBHA, tribal members only) authorized to make the final
				  determination of SMI eligibility.
"Discharge plan" means a hospital or community treatment and
				  discharge plan prepared according to Article 3 of these rules.
"Drug used as a restraint" means a pharmacological restraint
				  as used in A.R.S. §
										36-513 that is not standard
				  treatment for a client's medical condition or behavioral health issue and is
				  administered to:
Manage the client's
				  behavior in a way that reduces the safety risk to the client or others,
Temporarily restrict
				  the client's freedom of movement.
"DSM" means the latest edition of the "Diagnostic and
				  Statistical Manual of Mental Disorders," edited by the American Psychiatric
				  Association.
"Emergency safety situation" means unanticipated client
				  behavior that creates a substantial and imminent risk that the client may
				  inflict injury, and has the ability to inflict injury, upon:
The client, as
				  evidenced by threats or attempts to commit suicide or to inflict injury on the
				  client; or
Another individual, as
				  evidenced by threats or attempts to inflict injury on another individual or
				  individuals, previous
behavior that has caused injury to another individual or
				  individuals, or behavior that places another individual or individuals in
				  reasonable fear of sustaining injury.
"Exploitation" means the illegal or improper use of a client
				  or a client's resources for another's profit or advantage.
"Frivolous" as used in this Chapter, means a grievance that
				  is devoid of merit. Grievances are presumed not to be frivolous unless the
				  grievance:
Involves conduct that
				  is not within the scope of this Chapter,
Is impossible on its
				  face, or
Is substantially
				  similar to conduct alleged in two previous grievances within the past year that
				  have been determined to be unsubstantiated as provided in this Chapter.
"Generic services" means services other than behavioral
				  health or other services for which clients may have a need and include, but are
				  not limited to, health, dental, vision care, housing arrangements, social
				  organizations, recreational facilities, jobs, and educational
				  institutions.
"Grievance" means a complaint regarding an act, omission or
				  condition, as provided in this Chapter.
"Guardian" means an individual appointed by court order
				  according to A.R.S. Title 14, Chapter 5, or similar proceedings in another
				  state or jurisdiction where said guardianship has been properly domesticated
				  under Arizona law.
"Health Plan" means a Regional Behavioral Health Authority
				  (RBHA), health plan, or Arizona Long Term Care Plan under contract with the
				  Administration to coordinate the delivery of behavioral health services members
				  in a geographically specific service area of the state for eligible
				  persons.
"Hearing officer" refers to an impartial person designated by
				  the Office of Administrative Hearing to hear a dispute and render a written
				  decision.
"Human rights advocate" means the human rights advocates
				  appointed by the Administration under
				  R9-21-105.
"Independent Oversight committee" means the committee
				  established under A.R.S. §
										41-3803.
"Illegal" means, within the context of the grievance and
				  investigation procedure set forth in Article 4 of this Chapter, an incident or
				  occurrence which is or was likely to constitute a violation of a state or
				  federal statute, regulation, court decision or other law, including the
				  provisions of these Articles.
"Individual service plan" or "ISP" means the written plan for
				  services to a client, prepared in accordance with Article 3 of this
				  Chapter.
"Inhumane" as used in Article 4 of this Chapter means an
				  incident, condition or occurrence that is demeaning to a client, or which is
				  inconsistent with the proper regard for the right of the client to humane
				  treatment.
"Inpatient facility" means the Arizona State Hospital, the
				  County Annex, or any other inpatient treatment facility registered with or
				  funded by or through the Administration to provide behavioral health services,
				  including psychiatric health facilities, psychiatric hospitals, and psychiatric
				  units in general hospitals.
"Inpatient treatment and discharge plan" or "ITDP" means the
				  written plan for services to a client prepared and implemented by an inpatient
				  facility in accordance with Article 3 of this Chapter.
"Long-term view" means a planning statement that identifies,
				  from the client's perspective, what the client would like to be doing for work,
				  education, and leisure and where the client would like to be living for up to a
				  three-year period. The long-term view is based on the client's unique
				  interests, strengths, and personal desires. It includes predicted times for
				  achievement.
"Mechanical restraint" means any, device, article, or garment
				  attached or adjacent to a client's body that the client cannot easily remove
				  and that restricts the client's freedom of movement or normal access to the
				  client's body, but does not include a device, article, or garment:
Used for orthopedic or
				  surgical reasons, or
Necessary to allow a
				  client to heal from a medical condition or to participate in a treatment
				  program for a medical condition.
"Medical practitioner" means a
Physician,
Physician assistant,
				  or
Nurse
				  practitioner.
"Meeting" means an encounter or assembly of individuals which
				  may be conducted in person or by telephone or by video-conferencing.
"Mental health agency" includes a health plan, service
				  provider, inpatient facility, or an entity that conducts screening and
				  evaluation under Article 5.
"MIHS Behavioral Health Annex" means the Maricopa County
				  Psychiatric Annex of the Maricopa Medical Center.
"Nurse" means an individual licensed as a registered nurse or
				  a practical nurse according to A.R.S. Title 32, Chapter 15.
"Party" or "parties" as used in Articles 3 and 4 of these
				  rules means the person filing a grievance under this Chapter, the agency
				  director who issued any final resolution or decision of such a grievance, the
				  person whose conduct is complained of in the grievance, any client or applicant
				  who is the subject of the request or grievance, the legal guardian of client or
				  applicant, and, in selected cases, the appropriate Independent Oversight
				  committee.
"Personal restraint" means the application of physical force
				  without the use of any device, for the purpose of restricting the free movement
				  of a client's body.
"PRN order" or "Pro re nata medication" means medication
				  given as needed.
"Program director" means the person with the day-to-day
				  responsibility for the operation of a programmatic component of a service
				  provider, such as a specific residential, vocational, or case management
				  program.
"Qualified clinician" means a behavioral health professional
				  who is licensed or certified under A.R.S. Title 32, or a behavioral health
				  technician who is supervised by a licensed or certified behavioral health
				  professional.
"Region" means the geographical region designated by the
				  Administration in its contract with the health plan.
"Restraint" means personal restraint, mechanical restraint,
				  or drug used as a restraint.
"Seclusion" means restricting a client to a room or area
				  through the use of locked doors or any other device or method which precludes a
				  client from freely exiting the room or area or which a client reasonably
				  believes precludes his unrestricted exit. In the case of an inpatient facility,
				  confining a client to the facility, the grounds of the facility, or a ward of
				  the facility does not constitute seclusion. In the case of a community
				  residence, restricting a client to the residential site, according to specific
				  provisions of an individual service plan or court order, does not constitute
				  seclusion.
"Seriously mentally ill" means a person 18 years of age or
				  older as defined in A.R.S. §
										36-550.
"Service provider" means an agency, inpatient facility or
				  other mental health provider funded by or through, under contract or
				  subcontract with, certified by, approved by, registered with, or supervised by
				  the Administration or receiving funds under Title XIX, to provide behavioral
				  health services or community services.
"State Protection and Advocacy System" means the agency
				  designated as the Protection and Advocacy System for individuals with mental
				  illness, according to 42
				  U.S.C. 10801-10851.
"Title XIX" means Title XIX of the Social Security Act,
				  42 U.S.C.
				  1396 et seq.
"Treatment team" means the multidisciplinary team of persons
				  who are responsible for providing continuous treatment and support to a client
				  who is in an inpatient facility.