Iowa Administrative Code › Agency 441 - Human Services Department › Title III - Mental Health › Chapter 25 - Disability Services Management › Rule 441-25.1 - Definitions

Current through Register Vol. 47, No. 3, July 24, 2024
"Access center"
means the coordinated
				  provision of intake assessment, screening for multi-occurring conditions, care
				  coordination, crisis stabilization residential services, subacute mental health
				  services, and substance abuse treatment for individuals experiencing a mental
				  health or substance use crisis who do not need inpatient psychiatric hospital
				  treatment, but who do need significant amounts of supports and services not
				  available in other home- and community-based settings.
"Adult"
means the same as defined in
				  441-subrule 78.27(1).
"Assertive community treatment"
or
"ACT"
means a program of comprehensive outpatient services
				  consistent with evidence-based practice standards published by the Substance
				  Abuse and Mental Health Services Administration, provided in the community and
				  directed toward the amelioration of symptoms and the rehabilitation of
				  behavioral, functional, and social deficits of individuals with severe and
				  persistent mental illness and individuals with complex symptomology who require
				  multiple mental health and supportive services to live in the community.
"Assessment and evaluation"
means the
				  clinical review by a mental health professional of the current functioning of
				  the individual using the service in regard to the individual's situation,
				  needs, strengths, abilities, desires and goals to determine the appropriate
				  level of care.
"Behavioral health inpatient treatment"
or
"mental health inpatient treatment"
means inpatient
				  psychiatric services to treat an acute psychiatric condition provided in a
				  licensed hospital with a psychiatric unit or a licensed freestanding
				  psychiatric hospital.
"Behavioral health outpatient therapy"
means
				  the same as "outpatient services" described in Iowa Code section
				  230A.106(2)
"a."
"Brain injury"
means the same as defined in
				  rule 441-83.81 (249A).
"Care coordination"
means facilitating
				  communication and ensuring provision of services among multiple professionals
				  and service providers, the individual, and family members or other natural
				  supports when designated by the individual, and ensuring the individual has the
				  information necessary to actively participate in service and discharge or
				  transition planning.
"Case management"
means service provided by
				  a case manager who assists individuals in gaining access to needed medical,
				  social, educational, and other services through assessment, development of a
				  care plan, referral, monitoring and follow-up using a strengths-based service
				  approach that helps individuals achieve specific desired outcomes leading to a
				  healthy self-reliance and interdependence with their community.
"Case manager"
means a person who has
				  completed specified and required training to provide case management through
				  the medical assistance program.
"Child"
or
"children"
means
				  a person or persons under 18 years of age.
"Children's behavioral health services"
means behavioral health services for children who have a diagnosis of serious
				  emotional disturbance.
"Children's behavioral health system"
or
"children's system"
means the behavioral health system for
				  children implemented pursuant to Iowa Code chapter 225C.
"Comprehensive assessment"
means the same as
				  "crisis assessment" defined in rule
				  441-24.20 (225C) for individuals
				  being referred to crisis stabilization residential services and means the same
				  as "assessment" defined in rule
				  481-71.2 (135G) for individuals
				  being referred to subacute mental health services.
"Crisis assessment"
means the same as
				  defined in rule 441-24.20 (225C).
"Crisis care coordination"
means a service
				  provided during an acute crisis episode that facilitates working together to
				  organize a plan and service transition programing, including working agreements
				  with inpatient behavioral health units and other community programs. The
				  service shall include referrals to mental health services and other supports
				  necessary to maintain community-based living capacity, including case
				  management as defined herein.
"Crisis evaluation"
means the process used
				  with an individual to collect information related to the individual's history
				  and needs, strengths, and abilities in order to determine appropriate services
				  or referral during an acute crisis episode.
"Crisis intervention plan"
means the same as
				  defined in rule 441-24.1 (225C).
"Crisis screening"
means a brief assessment
				  to make a determination of the presenting problem and referral to the
				  appropriate level of care.
"Crisis stabilization community-based
				  services"
or
"CSCBS"
means the same as defined in
				  rule 441-24.20 (225C).
"Crisis stabilization residential services"
or
"CSRS"
means the same as defined in rule
				  441-24.20 (225C).
"Day habilitation"
means services that
				  assist or support the individual in developing or maintaining life skills and
				  community integration. Services shall enable or enhance the individual's
				  functioning, physical and emotional health and development, language and
				  communication development, cognitive functioning, socialization and community
				  integration, functional skill development, behavior management, responsibility
				  and self-direction, daily living activities, self-advocacy skills, or
				  mobility.
"Early identification"
means the process of
				  detecting developmental delays, mental illness, or untreated conditions that
				  may indicate the need for further evaluation.
"Early intervention"
means services designed
				  to address the social, emotional, and developmental needs of children at their
				  earliest stages to decrease long-term effects and provide support in meeting
				  developmental milestones.
"Education services"
means activities that
				  increase awareness and understanding of the causes and nature of conditions or
				  factors which affect an individual's development and functioning.
"Emergency services"
means the same as
				  defined in 441-subrule 24.4(15).
"Emergency detention"
means the same as
				  "immediately detained" as described in Iowa Code section
				  229.22(1).
"Evidence-based services"
or
"evidence-based practices"
means using interventions that have
				  been rigorously tested; have yielded consistent, replicable results; and have
				  proven safe, beneficial and effective and have established standards for
				  fidelity of the practice.
"Face-to-face"
means the same as defined in
				  rule 441-24.20 (225C).
"Family psychoeducation"
means services
				  including the provision of emotional support, education, resources during
				  periods of crisis, and problem-solving skills consistent with evidence-based
				  practice standards published by the Substance Abuse and Mental Health Services
				  Administration.
"Family support"
means services provided by
				  a family support peer specialist that assist the family of an individual to
				  live successfully in the family or community including, but not limited to,
				  education and information, individual advocacy, family support groups, and
				  crisis response.
"Family support peer specialist"
means a
				  parent, primary caregiver, foster parent or family member of an individual who
				  has successfully completed standardized training to provide family support
				  through the medical assistance program.
"Group supported employment"
means the job
				  and training activities in business and industry settings for groups of no more
				  than eight workers with disabilities. Group settings include enclaves, mobile
				  crews, and other business-based workgroups employing small groups of workers
				  with disabilities in integrated, sustained, paid employment.
"HCBS"
means home- and community-based
				  services as defined in rule
				  441-78.27 (249A).
"Health homes"
means a service model that
				  facilitates access to an interdisciplinary array of medical care, behavioral
				  health care, and community-based social services and supports for both children
				  and adults with chronic conditions. Services may include comprehensive care
				  management; care coordination and health promotion; comprehensive transitional
				  care from inpatient to other settings, including appropriate follow-up;
				  individual and family support, which includes authorized representatives;
				  referral to community and social support services, if relevant; and the use of
				  health information technology to link services, as feasible and
				  appropriate.
"Home and vehicle modification"
means a
				  service that provides physical modifications to the home or vehicle that
				  directly address the medical health or remedial needs of the individual and
				  that are necessary to provide for the health, welfare, and safety of the
				  individual and to increase or maintain independence.
"Home health aide services"
means unskilled
				  medical services which provide direct personal care. This service may include
				  assistance with activities of daily living, such as helping the recipient to
				  bathe, get in and out of bed, care for hair and teeth, exercise, and take
				  medications specifically ordered by the physician.
"Homeless"
means the same as "homeless
				  person" as defined in Iowa Code section
				  48A.2.
"Illness management and recovery"
means a
				  broad set of strategies designed to help individuals with serious mental
				  illness collaborate with professionals, reduce the individuals' susceptibility
				  to the illness, and cope effectively with the individuals' symptoms consistent
				  with evidence-based practice standards published by the Substance Abuse and
				  Mental Health Services Administration.
"Individual"
means any person seeking or
				  receiving services in a regional service system.
"Individual supported employment"
means
				  services including ongoing supports needed by an individual to acquire and
				  maintain a job in the integrated workforce at or above the state's minimum
				  wage. The outcome of this service is sustained paid employment that meets
				  personal and career goals.
"Intake assessment"
means the process used
				  with an individual to collect information related to the individual's history,
				  needs, strengths, and abilities for the purpose of determining the individual's
				  need for comprehensive assessment, appropriate services or referral.
"Integrated treatment for co-occurring substance
				  abuse and mental health disorders"
means effective dual diagnosis
				  programs that combine mental health and substance abuse interventions tailored
				  for the complex needs of individuals with co-morbid disorders. Critical
				  components of effective programs include a comprehensive, long-term, staged
				  approach to recovery; assertive outreach; motivational interviews; provision of
				  help to individuals in acquiring skills and supports to manage both illnesses
				  and pursue functional goals with cultural sensitivity and competence consistent
				  with evidence-based practice standards published by the Substance Abuse and
				  Mental Health Services Administration.
"Intensive residential service homes"
or
"intensive residential services"
means intensive, community
				  based services provided 24 hours a day, 7 days a week, 365 days a year to
				  individuals with a severe and persistent mental illness who have functional
				  impairments and may also have multi-occurring conditions. Providers of
				  intensive residential service homes are enrolled with Medicaid as providers of
				  HCBS habilitation or HCBS intellectual disability waiver supported community
				  living and meet additional criteria specified in subrule 25.6(8).
"Job development"
means services that assist
				  individuals in preparing for, securing and maintaining gainful, competitive
				  employment. Employment shall be integrated into normalized work settings, shall
				  provide pay of at least minimum wage, and shall be based on the individual's
				  skills, preferences, abilities, and talents. Services assist individuals
				  seeking employment to develop or re-establish skills, attitudes, personal
				  characteristics, interpersonal skills, work behaviors, and functional
				  capacities to achieve positive employment outcomes.
"Medical assistance program"
means the same
				  as defined in Iowa Code section
				  249A.2.
"Medication management"
means services
				  provided directly to or on behalf of the individual by a licensed professional
				  as authorized by Iowa law including, but not limited to, monitoring
				  effectiveness of and compliance with a medication regimen; coordination with
				  care providers; investigating potentially negative or unintended
				  psychopharmacologic or medical interactions; reviewing laboratory reports; and
				  activities pursuant to licensed prescriber orders.
"Medication prescribing"
means services with
				  the individual present provided by an appropriately licensed professional as
				  authorized by Iowa law including, but not limited to, determining how the
				  medication is affecting the individual; determining any drug interactions or
				  adverse drug effects on the individual; determining the proper dosage level;
				  and prescribing medication for the individual for the period of time before the
				  individual is seen again.
"Mental health inpatient treatment"
or
"behavioral health inpatient treatment"
means inpatient
				  psychiatric services to treat an acute psychiatric condition that are provided
				  in a licensed hospital with a psychiatric unit or a licensed freestanding
				  psychiatric hospital.
"Mental health outpatient therapy"
means the
				  same as defined in Iowa Code section
				  230A.106(2)
"a."
"Mental health professional"
means the same
				  as defined in Iowa Code section
				  228.1(7).
"Mobile response"
means the same as defined
				  in rule 441-24.20 (225C).
"Multi-occurring conditions"
means a
				  diagnosis of a severe and persistent mental illness occurring along with one or
				  more of the following: a physical health condition, a substance use disorder,
				  an intellectual or developmental disability, or a brain injury.
"No reject, no eject"
means that an
				  individual who otherwise meets the eligibility criteria for a service shall not
				  be denied access to that service or discharged from that service based on the
				  severity or complexity of that individual's mental health and multi-occurring
				  needs.
"Outpatient competency restoration"
means a
				  community-based service to restore competency for individuals found by a court
				  not to pose a danger to the public but to be incompetent to stand trial. The
				  service includes components such as psychiatric prescribing and medication
				  management, mental health and substance use disorder treatment services,
				  competency education, and service coordination.
"Peer support services"
means a program
				  provided by a peer support specialist including but not limited to education
				  and information, individual advocacy, family support groups, crisis response,
				  and respite to assist individuals in achieving stability in the
				  community.
"Peer support specialist"
means an
				  individual who has experienced a severe and persistent mental illness and who
				  has successfully completed standardized training to provide peer support
				  services through the medical assistance program.
"Permanent supportive housing"
means
				  voluntary, flexible supports to help individuals with psychiatric disabilities
				  choose, get, and keep housing that is decent, safe, affordable, and integrated
				  into the community. Tenants have access to an array of services that help them
				  keep their housing, such as case management, assistance with daily activities,
				  conflict resolution, and crisis response consistent with evidence-based
				  practice standards published by the Substance Abuse and Mental Health Services
				  Administration.
"Personal emergency response system"
means
				  an electronic device connected to a 24-hour staffed system which allows the
				  individual to access assistance in the event of an emergency.
"Precariously housed"
means that a person
				  does not have a permanent household and is living day-today in a motel, in a
				  vehicle, with family or friends, or in some other temporary location.
"Prescreening assessment"
means a
				  face-to-face clinical interview to ascertain an individual's current and
				  previous level of functioning, potential for dangerousness, physical health,
				  and psychiatric and medical condition.
"Prevention"
means efforts to increase
				  awareness and understanding of the causes and nature of conditions or
				  situations which affect an individual's functioning in society. Prevention
				  activities are designed to convey information about the cause of conditions,
				  situations, or problems that interfere with an individual's functioning or ways
				  in which that information can be used to prevent their occurrence or reduce
				  their effect and may include, but are not limited to, training events,
				  webinars, presentations, and public meetings.
"Prevocational services"
means services that
				  focus on developing generalized skills that prepare an individual for
				  employment. Prevocational training topics include but are not limited to
				  attendance, safety skills, following directions, and staying on task.
"Reasonably close proximity"
means a
				  distance of 100 miles or less or a driving distance of two hours or less from
				  the county seat or county seats of the region.
"Region"
means a mental health and
				  disability service region that operates as the "'regional administrator' or
				  'regional administrative entity'" as defined in rule
				  441-25.11 (225C).
"Respite"
means a temporary period of relief
				  and support for individuals and their families provided in a variety of
				  settings. The intent is to provide a safe environment with staff assistance for
				  individuals who lack an adequate support system to address current issues
				  related to a disability. Respite may be provided for a defined period of time;
				  respite is either planned or provided in response to a crisis.
"Routine care"
means care which is not
				  urgent or emergent in nature and can wait for a regularly scheduled appointment
				  without risk to the individual. A condition requiring routine care is not
				  likely to substantially worsen without immediate intervention.
"Rural"
means any area that is not defined
				  as urban.
"Serious emotional disturbance"
means the
				  same as defined in Iowa Code section
				  225C.2.
"Severe and persistent mental illness"
or
"SPMI"
means a documented primary mental health disorder
				  diagnosed by a mental health professional that causes symptoms and impairments
				  in basic mental and behavioral processes that produce distress and major
				  functional disability in adult role functioning inclusive of social, personal,
				  family, educational or vocational roles. The individual has a degree of
				  impairment arising from a psychiatric disorder such that:
(1) the individual does not have the
				resources or skills necessary to maintain function in the home or community
				environment without assistance or support;
(2) the individual's judgment, impulse
				control, or cognitive perceptual abilities are compromised;
(3) the individual exhibits significant
				impairment in social, interpersonal, or familial functioning; and
(4) the individual has a documented mental
				health diagnosis. For this purpose, a "mental health diagnosis" means a
				disorder, dysfunction, or dysphoria diagnosed pursuant to the current version
				of the Diagnostic and Statistical Manual of Mental Disorders published by the
				American Psychiatric Association (published 2013, with all changes and updates
				approved by the American Psychiatric Association through September 2023
				incorporated herein), excluding neurodevelopmental disorders, substance use
				disorders, personality disorders, medication-induced movement disorders and
				other adverse effects of medication, and other conditions that may be a focus
				of clinical attention as defined in the current version of the Diagnostic and
				Statistical Manual of Mental Disorders published by the American Psychiatric
				Association (published 2013, with all changes and updates approved by the
				American Psychiatric Association through September 2023 incorporated
				herein).
"Subacute mental health services"
means the
				  same as defined in Iowa Code section
				  225C.6(4)
"c"
and includes both subacute facility-based services and
				  subacute community-based services.
"Substance use disorder"
means the same as
				  defined in rule 641-155.1 (125,135).
"Supported community living services"
means
				  services as defined in Iowa Code section
				  225C.21(1).
"Supported employment"
means an approach to
				  helping individuals participate as much as possible in competitive work in
				  integrated work settings that are consistent with the strengths, resources,
				  priorities, concerns, abilities, capabilities, interests, and informed choice
				  of the individuals. Services are targeted for individuals with significant
				  disabilities for whom competitive employment has not traditionally occurred; or
				  for whom competitive employment has been interrupted or intermittent as a
				  result of a significant disability including either individual or group
				  supported employment, or both, consistent with evidence based practice
				  standards published by the Substance Abuse and Mental Health Services
				  Administration.
"Trauma-focused services"
means services
				  provided by caregivers and professionals that recognize when an individual who
				  has been exposed to violence is in need of help to recover from adverse
				  impacts; recognize and understand the impact that exposure to violence has on
				  victims' physical, psychological, and psychosocial development and well-being;
				  and respond by helping in ways that reflect awareness of adverse impacts and
				  consistently support the individual's recovery.
"Trauma-informed care"
means services that
				  are based on an understanding of the vulnerabilities or triggers of those who
				  have experienced violence, that recognize the role violence has played in the
				  lives of those individuals, that are supportive of recovery, and that avoid
				  retraumatization including trauma-focused services and trauma-specific
				  treatment.
"Trauma-specific treatment"
means services
				  provided by a mental health professional using therapies that are free from the
				  use of coercion, restraints, seclusion and isolation; and designed specifically
				  to promote recovery from the adverse impacts of violence exposure on physical,
				  psychological, psychosocial development, health and well-being.
"Twenty-four-hour crisis response"
means the
				  same as defined in rule
				  441-24.20 (225C).
"Twenty-three-hour observation and holding"
means the same as defined in rule
				  441-24.20 (225C).
"Urban"
means a county that has a total
				  population of 50,000 or more residents or includes a city with a population of
				  20,000 or more.
"Urgent"
means the existence of conditions
				  that are not emergent in nature but that require expeditious treatment because
				  of the prospect of the condition worsening without immediate
				  intervention.
"Warm handoff"
means an approach to care
				  transitions in which a health care provider uses face-to-face or telephone
				  contact to directly link individuals being treated to other providers or
				  specialists.