Iowa Administrative Code › Agency 641 - Public Health Department › Chapter 155 - Licensure Standards for Substance Use Disorder and Problem Gambling Treatment Programs › Rule 641-155.1 - Definitions

Current through Register Vol. 47, No. 3, July 24, 2024
Unless otherwise indicated, the following definitions shall
				apply to the specific terms used in these rules:
"Addictive disorder"
means a substance use
				disorder and problem gambling.
"Addictive disorder professional"
means an
				individual who is qualified by virtue of certification or license and
				education, training and experience to provide program services.
"Administration"
means the direct application
				of a prescription medication to a patient by a prescriber or the prescriber's
				authorized agent.
"Admission"
means the point at which an
				initial assessment has been completed sufficient to determine the patient's
				need and eligibility for program services, and the patient has agreed to begin
				treatment.
"Admission, continued service, and discharge
				criteria"
means the AS AM criteria dimensions to be considered in
				determining the level of care appropriate for the patient.
"Applicant"
means a person, facility, or legal
				entity that has applied for an initial license, renewal of a license, or a
				license under deemed status pursuant to these rules.
"Application"
means the process through which
				an applicant requests an initial license, renewal of a license, or a license
				under deemed status pursuant to these rules.
"ASAM criteria"
means the most current version
				of the clinical guide for the treatment of addictive, substance use and
				co-occurring conditions as published by the American Society of Addiction
				Medicine (ASAM).
"Assessment"
means the ongoing process of
				evaluating a patient's strengths, resources, preferences, limitations,
				problems, and needs; determining the licensed program services needed by the
				patient; determining the patient's eligibility for program services; and
				identifying treatment plan priorities, in accordance with the ASAM criteria and
				accepted standards of practice.
"Board"
means the state board of health
				created pursuant to Iowa Code chapter 136.
"Care coordination"
or
"case
				management"
means the collaborative process which assesses, plans,
				implements, coordinates, monitors and evaluates the options and services, both
				internal and external to the program, to meet patient needs, using
				communication and available resources to promote quality care and effective
				outcomes.
"Chemical substance"
means alcohol, wine,
				spirits and beer as defined in Iowa Code chapter 123 and controlled substances
				as defined in Iowa Code section
				124.101.
"Chemical substitutes and antagonists program
				"
means an opioid treatment program that provides opioid treatment
				services in accordance with Iowa Code section
				125.21
				and rule 641-155.35(125,135).
"Clinically managed"
means that program
				services are directed by addictive disorder professionals.
"Clinically managed high-intensity residential
				treatment"
means the ASAM criteria level of care totaling at least 50
				hours of clinically managed inpatient treatment services per week.
"Clinically managed low-intensity residential
				treatment"
means the ASAM criteria level of care totaling at least
				five hours of clinically managed inpatient treatment services per week.
"Clinically managed medium-intensity residential
				treatment"
means the ASAM criteria level of care totaling at least 30
				hours of clinically managed inpatient treatment services per week.
"Clinical oversight"
means oversight provided
				by an individual who, by virtue of certification or license and education,
				training and experience is qualified to oversee treatment services in
				accordance with subrule 155.21(3).
"Committee"
means the substance abuse and
				gambling treatment program committee appointed by the state board of health
				pursuant to Iowa Code section
				136.3(13).
"Concerned person"
means an individual who is
				seeking treatment services due to problems arising from a personal relationship
				with an individual with an addictive disorder.
"Confidentiality"
means protection of patient
				information in compliance with state and federal law.
"Crisis stabilization"
means medically
				monitored subacute inpatient services for individuals with urgent addictive
				disorder needs requiring immediate intervention, assessment, and mobilization
				of family, community and program resources.
"Culturally and environmentally specific"
means integrating into assessment and treatment the customs and beliefs of a
				given population, as well as awareness and acceptance of diversity regarding
				conditions, circumstances and influences affecting an individual or
				group.
"Data reporting"
means the required submission
				of certain patient demographic and program services information to the
				department by a program.
"Department"
means the Iowa department of
				public health.
"Detoxification"
means the safe management of
				intoxication states and withdrawal states in accordance with the ASAM criteria
				and accepted standards of practice.
"Dimension"
means one of the six ASAM criteria
				patient biopsychosocial areas to be considered in the assessment process to
				identify patient needs and determine the appropriate level of care for
				admission and continued services.
"Director"
means the director of the Iowa
				department of public health.
"Discharge"
means the point at which the
				patient ceases participation in licensed program services, marking the end of a
				specific encounter or episode of care. Discharge does not require termination
				of the relationship between the patient and the program.
"Discharge planning"
means the process, begun
				at admission, of determining a patient's continued need for licensed program
				services and of developing a plan to address ongoing patient needs following
				discharge.
"Division"
means the department's division of
				behavioral health, which acts as the single state authority for the federal
				substance abuse prevention and treatment block grant and associated state of
				Iowa addictive disorder appropriations and funding.
"Early intervention"
means the ASAM criteria
				level of care which explores and addresses problems or risk factors that appear
				to be related to an addictive disorder and which helps the individual recognize
				potential harmful consequences.
"Enhanced program"
means a licensee that
				provides enhanced treatment services in accordance with paragraph
				155.2(2)
"j"
and rule
				641-155.34 (125,135).
"Enhanced treatment services"
means licensed
				program services provided in accordance with paragraph
				155.2(2)
"j"
and rule
				641-155.34 (125,135).
"Facility"
means an institution, a
				detoxification center, or an installation providing care, maintenance or
				treatment for persons with substance use disorders licensed by the department
				under Iowa Code section
				125.13,
				hospitals licensed under Iowa Code chapter 135B, or the state mental health
				institutes designated by Iowa Code chapter 226. "Facility" also means the
				physical areas such as grounds, buildings, or portions thereof under
				administrative control of the program.
"Governing body"
means the person, group, or
				legal entity that has ultimate authority and responsibility for the overall
				operation of the program.
"Inpatient"
means 24-hour licensed program
				services.
"Intensive outpatient treatment"
means the
				ASAM criteria level of care totaling a minimum of nine hours of clinically
				managed outpatient treatment services per week for adults or a minimum of six
				hours of clinically managed outpatient treatment services per week for
				juveniles.
"Level of care"
or
"level of service
				"
means the different ASAM criteria service options. "Level of care"
				also means certain licensed program services under these rules.
"Licensed program services"
means the services
				a licensee may be authorized to provide under these rules.
"Licensee"
means a program licensed by the
				department pursuant to these rules.
"Licensure"
means the issuance of a license by
				the department pursuant to these rules which validates the licensee's
				compliance with these rules and authorizes the licensee to operate a program in
				the state of Iowa.
"Licensure weighting report"
means the
				division's report that is used to determine an applicant's level of compliance
				with these rules and the length of time a license will be in effect.
"Maintenance"
means the prolonged, scheduled
				administration of an opiate agonist medication such as buprenorphine or
				methadone by an opioid treatment program in accordance with federal and state
				laws, rules and regulations.
"Management of care"
means the ongoing
				application of the ASAM criteria and the coordination of care to ensure the
				appropriate provision of licensed program services to a patient.
"May"
means a term used in the interpretation
				of a standard to reflect an acceptable method that is recognized but not
				necessarily preferred.
"Medically managed"
means that the inpatient
				program services that involve daily medical care in a hospital setting are
				directed by a prescriber.
"Medically managed intensive inpatient
				treatment"
means the ASAM criteria level of care for medically managed
				inpatient treatment services.
"Medically monitored"
means that the program
				services are directed by addictive disorder professionals with medical
				oversight by a prescriber.
"Medically monitored intensive inpatient
				treatment"
means the ASAM criteria level of care for medically
				monitored subacute inpatient treatment services.
"Medication-assisted treatment"
means the
				medically monitored use of certain substance use disorder medications in
				combination with other treatment services.
"Opioid treatment program"
means a substance
				use disorder treatment program or a substance use disorder and problem gambling
				treatment program licensed to provide opioid treatment services in accordance
				with Iowa Code section
				125.21
				and rules 641-155.2 (125,135) and
				641-155.35(125,135).
"Opioid treatment services"
means medically
				monitored outpatient maintenance services provided in accordance with federal
				and state laws, rules and regulations.
"Outpatient"
means non-24-hour licensed
				program services.
"Outpatient treatment"
means the ASAM criteria
				level of care totaling less than nine hours of clinically managed outpatient
				treatment services per week for adults and less than six hours of clinically
				managed outpatient treatment services per week for juveniles.
"OWI evaluation"
means an assessment completed
				solely for the purpose of compliance with the substance abuse evaluation
				requirements of Iowa Code chapter 321J.
"Partial/day treatment"
means the ASAM
				criteria level of care totaling 20 or more hours of clinically managed
				outpatient treatment services per week.
"Patient"
means an individual who participates
				in licensed program services.
"Placement"
means selection of an appropriate
				licensed program service, based on ongoing assessment.
"Prescriber"
means a licensed health care
				professional with the authority to prescribe medication in accordance with Iowa
				law.
"Prevention"
means activities aimed at
				minimizing the use of potentially addictive substances, lowering risk in
				at-risk individuals, or minimizing potential adverse consequences of substance
				use or gambling.
"Prime programming time"
means any period of
				the day, as determined by a program treating juveniles, when special attention
				or supervision is necessary.
"Problem gambling"
means a gambling disorder
				that results in a functional impairment of sufficient impact and duration to
				meet diagnostic criteria specified within the most current Diagnostic and
				Statistical Manual of Mental Disorders published by the American Psychiatric
				Association.
"Program"
means a person, facility,
				institution, building, agency or legal entity that provides one or more of the
				services stated in subrule 155.2(2) and is required to be licensed under these
				rules.
"Quality improvement"
means the process of
				objectively and systematically monitoring and evaluating the quality and
				appropriateness of patient care and program services and operations to resolve
				identified problems and to make continued improvements.
"Recovery"
means the process of addressing an
				addictive disorder and working toward personally defined health and
				well-being.
"Recovery supports"
means the broad range of
				nontreatment services, such as transportation, that assists patients in their
				recovery efforts.
"Region"
means the geographic grouping of
				counties for conducting the department's responsibilities under Iowa Code
				chapter 125.
"Rehabilitation"
means the restoration of an
				optimal state of health by medical, psychological, and social means, including
				peer group support.
"Residential"
means clinically managed
				inpatient treatment services.
"Resiliency-and recovery-oriented system of
				care"
means coordinated, person-centered approaches to health
				promotion, prevention, early intervention, treatment and recovery support that
				build on the protective factors and strengths of individuals to sustain or
				achieve health and well-being.
"Rule"
means each department statement of
				general applicability that implements, interprets, or prescribes law or policy,
				or that describes the procedure or practice requirements of the division. The
				term includes the amendment or repeal of existing rules as specified in the
				Iowa Code.
"Screening"
means the brief review of a
				patient's or potential patient's current risk factors for an addictive disorder
				or medical or mental health condition to determine if they indicate a need for
				immediate admission or referral. Screening is not an assessment and is not
				sufficient to develop a treatment plan, rule out an addictive disorder, or
				determine that admission to treatment or referral to other services is not
				indicated.
"Self-administration of medication"
means the
				process whereby a properly trained and qualified staff person observes a
				patient take medication prescribed by a prescriber.
"Shall"
means the term used to indicate a
				mandatory statement, the only acceptable method under these rules.
"Should"
means the term used in the
				interpretation of a standard to reflect the commonly accepted method, but
				allowing for the use of effective alternatives.
"Staff"
means any individual who conducts an
				activity on behalf of a program as an employee, agent, consultant, contractor,
				volunteer or other status.
"Standards category"
means the grouping of
				standards, such as clinical, administrative or programming, in the licensure
				weighting report.
"Subacute"
means medically monitored inpatient
				services for individuals who require management, supervision and treatment to
				reduce immediate risk of danger to self or others or severe disability or
				complication of an addictive disorder or an addictive disorder and a medical or
				mental health condition.
"Substance abuse treatment and rehabilitation
				facility"
or
"substance abuse treatment program"
means a program required to be licensed under these rules.
"Substance use disorder"
means a substance use
				disorder that results in a functional impairment of sufficient impact and
				duration to meet diagnostic criteria specified within the most current
				Diagnostic and Statistical Manual of Mental Disorders published by the American
				Psychiatric Association.
"Timeframes"
means the periods of time
				specified throughout the standards.
"Treatment"
means the broad range of planned
				services to identify and change patterns of behavior that are maladaptive,
				destructive or injurious to health; or to restore appropriate levels of
				physical, psychological or social functioning. Such services may include
				assessment; care coordination; crisis stabilization; detoxification; early
				intervention; health promotion; individual, group and family counseling;
				management of care; and medication administration, provided by addictive
				disorder professionals and a mix of medical, mental health and peer
				professionals as appropriate to the structure of the program.
"Treatment planning"
means the process, based
				on ongoing assessment, by which a patient and qualified staff identify and rank
				problems, establish agreed-upon goals, and decide on the treatment services and
				resources to be utilized.
"Waiver"
means action by the committee or
				division that suspends the requirements of a standard on a case-by-case basis
				in accordance with 641-Chapter 178.