Code of Massachusetts Regulations › 115 CMR - DEPARTMENT OF DEVELOPMENTAL SERVICES › Title 115 CMR 2.00 - DEFINITIONS › Section 2.01 - Definitions

Current through Register 1525, July 5, 2024
As used in 115 CMR, the following terms shall have the
				following meanings:
Adaptive Behavior
. The quality of
				everyday performance in coping with environmental demands (what people do to
				take care of themselves and to relate to others in daily living).
Adequate
. With respect to services or
				supports, that they are in compliance with the regulations of the Department or
				of the agency of the Commonwealth with legal responsibility for licensure or
				regulation.
Adult Supports
. A variety of support
				models designed to support individuals with intellectual disability that have
				informal and generic supports available to them and who do not need intensive
				or community living supports, as defined in 115 CMR 2.01, to live in the
				community.
Adult Supports
includes supports to assist
				the individual to develop and acquire work skills, assist the family or
				caregiver to coordinate informal or generic supports (service coordination),
				community-based day support, individualized home supports, respite, adult
				companion and assistive technology.
Adult Supports
includes the supports identified in the
Adult Supports Waiver for
				Adults with Intellectual Disability
approved by the Centers for
				Medicare and Medicaid Services under the Social Security Act, §
				1915(c).
Antipsychotic Medication
. Medication
				that is used to treat a thought disorder of psychotic proportions as defined in
				the
Diagnostic and Statistical Manual of Mental Disorders
,
				5th edition, as revised or in subsequent editions
				and revisions, of the American Psychiatric Association, and which has been
				designated by medical authorities as belonging to the class of medications
				categorized as antipsychotic medication.
Appropriate
. With respect to a
				service or support or facility, that it is sufficient to provide the quality
				and quantity of staff, assistance, intervention, and environment to meet the
				individual's needs or objectives indicated in his or her Individual Service
				Plan (ISP). With respect to an intervention strategy,
Appropriate
means designed to achieve the desired goal
				or objective.
Area of Service
. The geographical
				area determined by the Department to be the locality for the organization,
				coordination, and provision of services and supports to an individual. The
				principle consideration is the preference of the individual. Other factors
				considered in determining an individual's area of service are:
(a) the individual's needs;
(b) the availability of appropriate services or supports within
				a given locality;
(c) the location of the individual's family and friends;
				and
(d) if the individual is younger than 22 years old, the
				location of the city or town in Massachusetts responsible for providing special
				education under M.G.L. c. 71B.
Area Office
. The locally based office
				of the Department, and the employees therein, responsible for the organization,
				coordination, and provision of services or supports to individuals whose area
				of service falls within that office's geographical scope as designated by the
				Department.
Arranged by the Department
. With
				respect to services or supports, made available to the individual through
				referral by the Department to agencies, organizations, or persons other than
				facilities, services or supports operated, licensed, certified, or contracted
				by the Department.
Autism Spectrum Disorder
. Has the
				same meaning as in the
Diagnostic and Statistical Manual of Mental
				Disorders,
5th edition.
Available
. With respect to a
				facility, service or support, that the provider has the staff, resources,
				assistance, and space to meet the needs or objectives indicated in an
				individual's ISP and has not been designated for another individual with a
				higher priority of need for services or supports.
Capable of Evacuation
. The capability
				of an individual to exit his or her residence to grade level within 2½
				minutes with or without assistance.
Certification
. Verification by the
				Department of the quality of providers' services and supports described at
				115 CMR
				8.01(3):
Certification
based upon their compliance with certification
				standards and quality outcomes for individuals set forth at
				115 CMR
				7.04:
Standards for Services and
				Supports
or the approval issued by the Department to a licensed
				provider with respect to certain behavior modification treatments in accordance
				with 115 CMR 5.14A:
Level III Interventions
.
Chemical Restraint
.
See
115 CMR 5.02:
Definitions
.
Children's Supports
. Family support
				services provided to individuals younger than 22 years old who reside in their
				family home, or enhanced or specialized family supports which are available
				upon referral and assessment by the Department.
Closely Related Developmental
				Conditions
. Genetic, neuro developmental or physical disorders
				that have a significant overlap with intellectual disability, and result in
				similar support needs. For the purposes of
				115 CMR
				6.06(1), closely related
				developmental conditions may include:
(a) Williams Syndrome;
(b) Lesch-Nyhan Syndrome;
(c) Angelman Syndrome;
(d)
Cri du Chat
Syndrome;
(e) Down Syndrome;
(f) Fragile X Syndrome;
(g) Cerebral Palsy;
(h) Rett's Syndrome
(i)
Spina Bifida
(Myelomeningocele type
				MMC);
(j) Tuberous Sclerosis;
(k) Fetal Alcohol Syndrome; or
(l) any other developmental disorder that the Department
				determines to be a closely related developmental condition.
Commissioner
. The Commissioner of the
				Department of Developmental Services.
Community
. A city, town, district,
				neighborhood, or other commonly recognized geographical or political
				area.
Community Developmental Disability
				Supports
. A variety of support models designed to support
				individuals with Developmental Disability (Autism Spectrum Disorder,
				Prader-Willi Syndrome, or Smith-Magenis Syndrome) who are living in the
				community. Community Developmental Disability Supports may include day and
				employment services, family supports, individualized home supports to an
				individual residing in his or her home or family home and, based upon an
				individual's assessed need, support to stabilize the individual in his or her
				own home, family home or in the home of another. The availability of these
				services is subject to appropriation, and the types of services may be changed
				based on further assessment of the needs of such persons.
Community Living Supports
. A variety
				of support models designed to support individuals with intellectual disability
				that need a moderate level of support that is less than 24 hours per day living
				in the community. Community Living Supports may include those supports
				identified in the Community Living Supports Waiver for Adults with Intellectual
				Disability approved by the Centers for Medicare and Medicaid Services under the
				Social Security Act, § 1915(c).
Community Resources
. Workplaces,
				businesses, places of worship, social groups, consultants, health care
				facilities or professionals, places for recreation or entertainment, and other
				facilities, professionals, or supports generally available to the
				population-at-large within a community.
Department
. The Department of
				Developmental Services (DDS).
Designated Representative
. A person
				who has come forward as an advocate for the individual's interests, or whom the
				individual has, through consent, chosen as a representative, in connection with
				the development and review of the ISP, who is not otherwise disqualified from
				taking an appeal therefrom, and who is acknowledged by the Department to be the
				designated representative for the individual in connection with such service
				planning, in accordance with
				115 CMR
				6.20:
Introduction to Individual
				Support Planning
.
Developmental Disability
. For persons
				who are five years of age or older, a severe, chronic disability that:
(a) is attributable to a mental or physical impairment
				resulting from Intellectual Disability, Autism Spectrum Disorder, Smith-Magenis
				Syndrome or Prader-Willi Syndrome;
(b) is manifested before the individual attains 22 years of
				age;
(c) is likely to continue indefinitely; and
(d) results in substantial functional limitations.
Emergency Restraint
. "Restraint" as
				that term is used in M.G.L. c. 123B, § 1, and defined at
				115 CMR 5.02:
Definitions
.
Facility
. (Formerly referred to as a
				"state school" and referenced in M.G.L. c. 19B, §§ 7 through 10 and
				12 as such.) Unless otherwise specified, any of the facilities operated by the
				Department listed in
				115 CMR
				3.03:
Designation of Facilities/State
				Schools
. This definition does not apply within the context of
				115 CMR
				3.06:
Charges for Care - Department
				Facilities
governing charges for care or within the context of 115 CMR
				2.01:
Community Resources
.
Facility Director
. The chief
				executive officer of a facility, and also is intended to mean the
				"superintendent" referenced in M.G.L. c. 19B, §§ 8 and 10 and
				throughout M.G.L. c. 123B.
Family
. Parents, foster parents,
				spouses, siblings, and others who perform the roles and functions of family
				members in the life of an individual, including persons in a relationship of
				mutual support with an individual that is exclusive and expected to endure over
				time.
Family Supports
. A variety of
				supports designed to assist individuals and their families that include
				services such as respite, family training and leadership development, support
				to assist the individual to participate in the community, social or
				recreational activities, and home modifications.
Generic Service
. Services, supports,
				or treatment options generally available to the population-at-large with or
				without special accommodations for persons with Intellectual Disability or
				Developmental Disability.
Goals. Long-range outcomes generally expected to be achieved by
				an individual within five years and stated in measurable terms so that their
				attainment can be determined. Goals are developed from an evaluation of the
				individual's present performance, abilities and desires as these relate to what
				society expects of persons of the same age and culture who do not have
				disabilities.
Governing Board
. The group of
				individuals that constitute the governing body of a provider.
Guardian
. With respect to persons
				younger than 18 years old, a natural or adoptive parent, or the individual or
				agency with legal guardianship of the person; and with respect to persons 18
				years of age and older, the individual, organization or agency, if any, that
				has been appointed legal guardian of the person by a court of competent
				jurisdiction.
Habilitation
. The process by which an
				individual is assisted to acquire and maintain those life skills necessary to
				cope more effectively with personal and environmental demands or to improve
				physical, mental, and social competencies.
Head of the Provider
. The person with
				executive responsibility for the operation of the provider's agency, services,
				or supports. Where a provider operates at more than one location, "head of the
				provider" includes the person with responsibility for the operation at a
				particular location. Where the provider is a facility, the head of the provider
				is the facility director.
Individual
. Except where otherwise
				specified, a person receiving services or supports provided, purchased, or
				arranged by the Department.
Individual Support Plan
or
ISP
. A written plan of services or supports for an
				individual, which is developed, implemented, reviewed, and modified according
				to the requirements of the Department's regulations on individual support
				plans.
Individualized Home Supports (Individual
				Supports)
. A variety of services and supports that are provided
				regularly, but that are less than 23 hours per day, and that are determined
				necessary to prevent institutionalization. This service may include teaching
				and fostering the acquisition, retention or improvement of skills related to
				personal finance, health, shopping, use of community resources, community
				safety, and other social and adaptive skills to live in the community as
				specified in the Service Plan.
Intellectual Disability
. Consistent
				with the standard contained in the
American Association of Intellectual
				and Developmental Disabilities: Definition, Classification, and Systems of
				Supports
(2010), 11th edition,
				significantly sub-average intellectual functioning existing concurrently with
				and related to significant limitations in adaptive functioning. Intellectual
				Disability originates before 18 years of age. A person with Intellectual
				Disability may be considered to be mentally ill as defined in 104 CMR:
Department of Mental Health
, provided that no person with
				Intellectual Disability shall be considered to be mentally ill solely by reason
				of his or her Intellectual Disability. The determination of the presence or
				absence of Intellectual Disability requires the exercise of clinical
				judgment.
Intellectual Disability Supports
. A
				variety of support models, including Adult Supports, Community Living Supports
				or Intensive Supports that are designed to support individuals with
				Intellectual Disability living in the community. The availability of these
				supports is subject to appropriation, and the types of services included under
				these support models may be changed based on further assessment of the needs of
				such persons.
Intensive Supports
. A variety of
				support models designed to support individuals with Intellectual Disability
				that need supervision and support provided 24 hours per day seven days per week
				to an individual living in an out-of-home setting or in their family home, or
				in the family home less than 24 hours per day.
Intensive
				Supports
includes those supports identified in the Intensive
				Support Waiver for Adults with Intellectual Disability approved by the Centers
				for Medicare and Medicaid Services under § 1915(c) of the Social Security
				Act.
Intervention Strategy
. Training or
				teaching procedure, a manipulation or change of environment or the provision of
				supports designed to teach or assist an individual to achieve a goal or a
				specific objective. Depending on its content, an intervention strategy may also
				fall within the definition of a Level III Intervention set forth under 115 CMR
				5.14A(2):
Level III Interventions
.
Knowing Objection
. The act of an
				individual in rejecting a choice, made with a reasonable degree of awareness of
				the likely consequences of his or her act.
Least Restrictive
. Those settings,
				modes of service, and styles of living or working that are most similar to and
				most integrated with what is typical and age-appropriate in the community, and
				which interfere the least with the individual's independence.
Legal Representative
or
Legally Authorized Representative
. With respect to an
				individual, an attorney representing the individual in connection with a
				particular matter, a court appointed trustee, conservator, or guardian
ad litem
representing the interests of the individual in
				connection with particular matters, or the individual's guardian.
Legally Competent
or
Presumed Competent
. For individuals 18 years of age or
				older, not having been declared by a court to be incapable of making informed
				decisions with respect to the conduct of one's personal and/or financial
				affairs.
License
. The legal authorization to
				provide services or supports described in
				115 CMR
				8.02(1)  to persons with
				Intellectual Disability or Developmental Disability required by M.G.L. c.
				19B.
Licensee
. The individual, agency, or
				other legal entity licensed by the Department.
Mechanical Restraint
.
See
115 CMR 5.02:
Definitions
.
Medication Incidental to Treatment
.
				Sedatives or anti-anxiety medication prescribed by a qualified practitioner for
				the sole purpose of relaxing or calming an individual so he or she may receive
				medical treatment.
Minor. A person younger than 18 years old.
Non-self-medicating
. Personally using
				medication in the manner directed by the prescribing practitioner only with
				assistance or direction by program or facility staff, in accordance with
				Department standards (
see
Self-medicating).
Objective
. Short term outcomes stated
				in behavioral or otherwise measurable terms, expected to be achieved through
				the provision of a particular service or support, the implementation of a
				particular intervention strategy, or a change of modification of the
				environment.
Physical Restraint
.
See
115 CMR 5.02:
Definitions
.
Prader-Willi Syndrome
. Consistent
				with the definition of the National Institute of Health, a neurologic condition
				that typically results from a specific genetic abnormality affecting the
				regulation of gene expression; for purposes of 115 CMR, the diagnosis of
				Prader-Willi Syndrome must be supported by a medical diagnosis based upon
				genetic testing.
PRN. With respect to the prescription and administration of a
				prescribed medication, "
pro re nata
", meaning "as
				circumstances arise" or "as needed".
Provided by the Department
. Made
				available to the individual directly through employees of the Department at
				Department expense.
Provider
. The individual, agency or
				other legal entity with day-to-day responsibility for the operation of services
				or supports or facilities regulated by the Department by law or contract. In
				accordance with the foregoing definition, a provision which applies to
				"providers" applies with equal force to the Department's service, supports, or
				facilities, unless otherwise specified.
Purchased by the Department
. Made
				available to an individual through a contract between the Department and a
				private or other non-Departmental entity.
Region
. Depending on the
				context:
(a) a grouping of area offices as determined by the
				Commissioner;
(b) the geographic area represented by such a grouping;
				or
(c) the office established by the Commissioner as appropriate
				to supervise area offices within a grouping of area offices and to perform
				administrative or service functions for the geographic area represented by the
				grouping.
Research
. A systematic investigation
				designed to develop or contribute to generalizable knowledge and involving
				access to human subjects or private information, with the exceptions set forth
				in
				115 CMR
				10.00:
Research
.
Self-medicating
. Personally using
				medication in the manner directed by a health care provider, without assistance
				or direction by program or facility staff, in accordance with Department
				standards. A verbal reminder that the time for taking a dose of medication has
				arrived or providing mechanical assistance under the direction of the
				individual in order that he or she can self-medicate does not constitute
				assistance or direction by program staff.
Service Coordinator
. The person
				designated by the Department to arrange, coordinate, or monitor, or to remain
				informed about, services or supports provided, purchased, or arranged by the
				Department for a particular individual and to be responsible for the
				development of an ISP for the individual.
Services
. A system of formalized
				supports, generic or specialized.
Severe Functional Impairments
.
				Functional impairments in at least three specified areas of adaptive
				functioning, based upon normative expectations of the types of skills normally
				acquired as the child develops, as measured by standardized assessment or
				comparable data. The areas of adaptive functioning considered are: self-care,
				communication (receptive or expressive language), learning, mobility, and
				self-direction and, for individuals 14 years of age or older, capacity for
				independent living and economic self-sufficiency.
Significant Limitations in Adaptive
				Functioning
. For purposes of establishing intellectual disability,
				an overall composite adaptive functioning limitation that is approximately two
				standard deviations below the mean or approximately two standard deviations
				below the mean in one of the three domains of the appropriate norming sample
				determined from the findings of assessment using a comprehensive, standardized
				measure of adaptive behavior, interpreted by a qualified practitioner. The
				domains of adaptive functioning that are assessed shall be:
(a) areas of independent living/practical skills;
(b) cognitive, communication, and academic/conceptual skills;
				and
(c) social competence/social skills.
Significantly Sub-average Intellectual
				Functioning
. An intelligence test score that is indicated by a
				score of approximately 70 or below as determined from the findings of
				assessment using valid and comprehensive, individual measures of intelligence
				that are administered in standardized formats and interpreted by qualified
				practitioners.
Smith-Magenis Syndrome
. Consistent
				with the definition of the National Institute of Health, a neurodevelopmental
				disorder characterized by a well-defined pattern of anomalies typically due to
				a common deletion in chromosome 17 found by genetic testing; for purposes of
				115 CMR 2.01, the diagnosis of Smith-Magenis Syndrome must be supported by a
				medical diagnosis and based upon genetic testing.
Substantial Functional
				Limitations
:
(a) for an individual five years of age or older:
1. functional limitations in three or more of the following
				areas of major life activity:
a. self-care;
b. receptive and expressive language;
c. learning;
d. mobility;
e. self-direction; and for individuals 14 years of age or older
				only;
f. capacity for independent living;
g. economic self-sufficiency; and
2. reflects the individual's need for a combination and
				sequence of special, interdisciplinary or generic services, supports or other
				assistance that is of a lifelong or extended duration and is individually
				planned and coordinated; or
(b) for an individual younger than five years old, a
				substantial developmental delay or specific congenital or acquired condition
				with a high probability that the condition will result in a developmental
				disability if services are not provided.
Supports
. Those resources and
				strategies that promote the interests and causes of individuals with or without
				disabilities; that enable them to access resources, information, and
				relationships inherent in integrated work and living environments; and that
				result in their enhanced independence, productivity, community integration, and
				satisfaction.
Vision Statement
. A statement of what
				is important to the individual in his or her life. It describes the
				individual's preferences on how he or she wishes to live, work, and spend his
				or her leisure time and it identifies interests, relationships, and activities
				he or she would like to continue or explore. If the individual is unable to
				fully express him or herself, the ISP team will assist in the development of
				the individual's vision statement. The vision statement expresses the
				individual's vision; it does not create any enforceable rights and is not
				binding on the department. An individual's vision statement is not subject to
				appeal under
				115 CMR 6.30:
Scope and Purpose
.