Iowa Administrative Code › Agency 441 - Human Services Department › Title III - Mental Health › Chapter 24 - Accreditation of Providers of Services to Persons With Mental Illness, Intellectual Disabilities, or Developmental Disabilities › Rule 441-24.1 - Definitions

Current through Register Vol. 47, No. 3, July 24, 2024
"Accreditation"
means the decision made by
				  the division that the organization has met the applicable standards.
"Advanced registered nurse practitioner"
means a nurse who has current licensure as a registered nurse in Iowa, or
				  licensure in another state that is recognized in Iowa pursuant to Iowa Code
				  chapter 152E, and who is also registered as certified in psychiatric mental
				  health specialties pursuant to board of nursing rules in 655-Chapter 7.
"Advisory board"
means the board that
				  reviews and makes recommendations to the organization on the program being
				  accredited. The advisory board shall meet at least three times a year and shall
				  have at least three members, at least 51 percent of whom are not providers. The
				  advisory board shall include representatives who have disabilities or family
				  members of persons with disabilities. The advisory board's duties include
				  review and recommendation of policies, development and review of the
				  organizational plan for the program being accredited, review and recommendation
				  of the budget for the program being accredited, and review and recommendation
				  of the performance improvement program of the program being accredited.
"Anticipated discharge plan"
means the
				  statement of the condition or circumstances by which the individual using the
				  service would no longer need each of the specific services accredited under
				  this chapter.
"Appropriate"
means the degree to which the
				  services or supports or activities provided or undertaken by the organization
				  are suitable and desirable for the needs, situation, or problems of the
				  individual using the service.
"Assessment"
means the review of the current
				  functioning of the individual using the service in regard to the individual's
				  situation, needs, strengths, abilities, desires and goals.
"Benchmarks"
means the processes of an
				  organization that lead to implementation of the indicators.
"Chronic mental illness"
means the condition
				  present in people aged 18 and over who have a persistent mental or emotional
				  disorder that seriously impairs their functioning relative to such primary
				  aspects of daily living as personal relations, living arrangements, or
				  employment. People with chronic mental illness typically meet at least one of
				  the following criteria:
1. They have undergone psychiatric treatment more intensive
				  than outpatient care more than once in a lifetime (e.g., emergency services,
				  alternative home care, partial hospitalization or inpatient
				  hospitalization).
2. They have experienced at least one episode of continuous,
				  structured, supportive residential care other than hospitalization.
In addition, people with chronic mental illness typically
				  meet at least two of the following criteria on a continuing or intermittent
				  basis for at least two years:
1. They are unemployed, employed in a sheltered setting, or
				  have markedly limited skills and a poor work history.
2. They require financial assistance for out-of-hospital
				  maintenance and may be unable to procure this assistance without help.
3. They show severe inability to establish or maintain a
				  personal social support system.
4. They require help in basic living skills.
5. They exhibit inappropriate social behavior that results in
				  demand for intervention by the mental health or judicial system.
In atypical instances, a person who varies from these
				  criteria could still be considered to be a person with chronic mental
				  illness.
"Commission"
means the mental health and
				  disability services commission (MHDS commission) as established and defined in
				  Iowa Code section
				  225C.5.
"Community"
means a natural setting where
				  people live, learn, work, and socialize.
"Community mental health center"
or
"CMHC"
means an organization providing mental health services
				  that is established pursuant to Iowa Code chapters 225C and 230A and accredited
				  in accordance with Division III of this chapter.
"Crisis intervention plan"
means a
				  personalized, individualized plan developed with the individual using the
				  service that identifies potential personal psychiatric, environmental, and
				  medical emergencies. This plan shall also include those life situations
				  identified as problematic and the identified strategies and natural supports
				  developed with the individual using the service to enable the individual to
				  self-manage, alleviate, or end the crisis. This plan shall also include how the
				  individual can access emergency services that may be needed.
"Deemed status"
means acceptance by the
				  division of accreditation or licensure of a program or service by another
				  accrediting body in lieu of accreditation based on review and evaluation by the
				  division.
"Department"
means the Iowa department of
				  human services.
"Developmental disability"
means a severe,
				  chronic disability that:
1. Is attributable to a mental or physical impairment or
				  combination of mental and physical impairments;
2. Is manifested before the age of 22;
3. Is likely to continue indefinitely;
4. Results in substantial functional limitations in three or
				  more of the following areas of major life activity: self-care, receptive and
				  expressive language, learning, mobility, self-direction, capacity for
				  independent living, and economic self-sufficiency; and
5. Reflects the person's need for a combination and sequence
				  of special, interdisciplinary, or generic services, individualized supports, or
				  other forms of assistance that are of lifelong or extended duration and are
				  individually planned and coordinated.
A person from birth to the age of nine, inclusive, who has a
				  substantial developmental delay or specific congenital or acquired condition
				  may be considered to have a developmental disability without meeting three or
				  more of the criteria described above if the person, without services and
				  supports, has a high probability of meeting those criteria later in
				  life.
"Direct services"
means services providing
				  therapy, habilitation, or rehabilitation activities or support services such as
				  transportation.
"Division"
means the division of mental
				  health and disability services, community, of the department of human
				  services.
"Doctor of medicine or osteopathic medicine"
means a person who is licensed in the state of Iowa under Iowa Code chapter 148
				  as a physician and surgeon or under Iowa Code chapter 150A as an osteopathic
				  physician and surgeon.
"Functional assessment"
means the analysis
				  of daily living skills. The functional assessment also takes into consideration
				  the strengths, stated needs, and level and kind of disability of the individual
				  using the service.
"Goal achieving"
means to gain the required
				  skills and supports to obtain the goal of choice. For purposes of this chapter,
				  the definition and explanation are taken from the Psychiatric Rehabilitation
				  Practitioner Tools, as developed by the Boston Center for Psychiatric
				  Rehabilitation.
"Goal keeping"
means assisting the
				  individual using the service in maintaining successful and satisfying role
				  performance to prevent the emergence of symptoms associated with role
				  deterioration. For purposes of this chapter, the definition and explanation are
				  taken from the Psychiatric Rehabilitation Practitioner Tools, as developed by
				  the Boston Center for Psychiatric Rehabilitation.
"Incident,"
for the purposes of this
				  chapter, means an occurrence involving the individual using the service
				  that:
1. Results in a physical injury to or by the individual that
				  requires a physician's treatment or admission to a hospital, or
2. Results in someone's death, or
3. Requires emergency mental health treatment for the
				  individual, or
4. Requires the intervention of law enforcement, or
5. Results from any prescription medication error, or
6. Is reportable to protective services.
"Indicators"
means conditions that will
				  exist when the activity is done competently and benchmarks are achieved.
				  Indicators also provide a means to assess the activity's effect on outcomes of
				  services.
"Informed consent"
refers to time-limited,
				  voluntary consent. The individual using the service or the individual's legal
				  guardian may withdraw consent at any time without risk of punitive action.
				  "Informed consent" includes a description of the treatment and specific
				  procedures to be followed, the intended outcome or anticipated benefits, the
				  rationale for use, the risks of use and nonuse, and the less restrictive
				  alternatives considered. The individual using the service or the legal guardian
				  has the opportunity to ask questions and have them satisfactorily
				  answered.
"Intellectual disability"
means a diagnosis
				  of intellectual disability (intellectual developmental disorder), global
				  developmental delay, or unspecified intellectual disability (intellectual
				  developmental disorder) under these rules which shall be made only when the
				  onset of the person's condition was during the developmental period and shall
				  be based on an assessment of the person's intellectual functioning and level of
				  adaptive skills. A licensed psychologist or psychiatrist who is professionally
				  trained to administer the tests required to assess intellectual functioning and
				  to evaluate a person's adaptive skills shall make the diagnosis. A diagnosis of
				  intellectual disability shall be made in accordance with the criteria provided
				  in the current version of the Diagnostic and Statistical Manual of Mental
				  Disorders published by the American Psychiatric Association.
"Intensive psychiatric rehabilitation
				  practitioner"
means a person who has at least 60 contact hours of
				  training in intensive psychiatric rehabilitation and either:
1. Is certified as a psychiatric rehabilitation practitioner
				  by the United States Psychiatric Rehabilitation Association; or
2. Holds a bachelor's degree with 30 semester hours or
				  equivalent quarter hours in a human services field (including, but not limited
				  to, psychology, social work, mental health counseling, marriage and family
				  therapy, nursing, education, occupational therapy, and recreational therapy)
				  and has at least one year of experience in the delivery of services to the
				  population groups that the person is hired to serve.
"Leadership"
means the governing board, the
				  chief administrative officer or executive director, managers, supervisors, and
				  clinical leaders who participate in developing and implementing organizational
				  policies, plans and systems.
"Marital and family therapist"
means a
				  person who is licensed under Iowa Code chapter 154D in the application of
				  counseling techniques in the assessment and resolution of emotional conditions.
				  This includes the alteration and establishment of attitudes and patterns of
				  interaction relative to marriage, family life, and interpersonal
				  relationships.
"Mental health counselor"
means a person who
				  is licensed under Iowa Code chapter 154D in counseling services involving
				  assessment, referral, consultation, and the application of counseling, human
				  development principles, learning theory, group dynamics, and the etiology of
				  maladjustment and dysfunctional behavior to individuals, families, and
				  groups.
"Mental health professional"
means a person
				  who meets all of the following conditions:
1. Holds at least a master's degree in a mental health field
				  including, but not limited to, psychology, counseling and guidance, psychiatric
				  nursing and social work; or is a doctor of medicine or osteopathic medicine;
				  and
2. Holds a current Iowa license when required by the Iowa
				  professional licensure laws (such as a psychiatrist, a psychologist, a marital
				  and family therapist, a mental health counselor, an advanced registered nurse
				  practitioner, a psychiatric nurse, or a social worker); and
3. Has at least two years of postdegree experience supervised
				  by a mental health professional in assessing mental health problems, mental
				  illness, and service needs and in providing mental health services.
"Mental health service provider"
means an
				  organization whose services are established to specifically address mental
				  health services to individuals or the administration of facilities in which
				  these services are provided. Organizations included are:
1. Those contracting with a county board of supervisors to
				  provide mental health services in lieu of that county's affiliation with a
				  community mental health center (Iowa Code chapter 230A).
2. Those that may contract with a county board of supervisors
				  for special services to the general public or special segments of the general
				  public and that are not accredited by any other accrediting body.
These standards do not apply to individual practitioners or
				  partnerships of practitioners covered under Iowa's professional licensure
				  laws.
"Natural supports"
means those services and
				  supports an individual using the service identifies as wanted or needed that
				  are provided at no cost by family, friends, neighbors, and others in the
				  community, or by organizations or entities that serve the general
				  public.
"New organization"
means an entity that has
				  never been accredited under 441-Chapter 24 or an accredited entity under
				  441-Chapter 24 that makes a significant change in its ownership, structure,
				  management, or service delivery.
"Organization"
means:
1. A governmental entity or an entity that meets Iowa Code
				  requirements for a business organization as a for-profit or not-for-profit
				  business. These entities include, but are not limited to, a business
				  corporation under Iowa Code chapter 490 or a nonprofit corporation under Iowa
				  Code chapter 504 that provides a service accredited pursuant to the rules in
				  this chapter.
2. A county, consortium of counties, or the department of
				  human services that provides or subcontracts for the provision of case
				  management.
3. A division or unit of a larger entity, such as a unit
				  within a hospital or parent organization.
"Organization" does not include: an individual for whom a
				  license to engage in a profession is required under Iowa Code section
				  147.2, any
				  person providing a service if the person is not organized as a corporation or
				  other business entity recognized under the Iowa Code, or an entity that
				  provides only financial, administrative, or employment services and that does
				  not directly provide the services accredited under this chapter.
"Outcome"
means the result of the
				  performance or nonperformance of a function or process or activity.
"Policies"
means the principles and
				  statements of intent of the organization.
"Procedures"
means the steps taken to
				  implement the policies of the organization.
"Program"
means a set of related resources
				  and services directed to the accomplishment of a fixed set of goals for the
				  population of a specified geographic area or for special target
				  populations.
"Psychiatric crisis intervention plan"
means
				  a personalized, individualized plan developed with the individual using the
				  service that identifies potential personal psychiatric emergencies. This plan
				  shall also include those life situations identified as problematic and the
				  identified strategies and natural supports developed with the individual using
				  the service to enable the individual to self-manage, alleviate, or end the
				  crisis. This plan shall also include how the individual can access emergency
				  services that may be needed.
"Psychiatric nurse"
means a person who meets
				  the requirements of a certified psychiatric nurse, is eligible for
				  certification by the American Nursing Association, and is licensed by the state
				  of Iowa to practice nursing as defined in Iowa Code chapter 152.
"Psychiatrist"
means a doctor of medicine or
				  osteopathic medicine who is certified by the American Board of Psychiatry and
				  Neurology or who is eligible for certification and who is fully licensed to
				  practice medicine in the state of Iowa.
"Psychologist"
means a person who:
1. Is licensed to practice psychology in the state of Iowa or
				  meets the requirements of eligibility for a license to practice psychology in
				  the state of Iowa as defined in Iowa Code chapter 154B; or
2. Is certified by the Iowa department of education as a
				  school psychologist or is eligible for certification by the Iowa department of
				  education.
"Qualified case managers and supervisors"
means people who have the following qualifications:
1. A bachelor's degree with 30 semester hours or equivalent
				  quarter hours in a human services field (including, but not limited to,
				  psychology, social work, mental health counseling, marriage and family therapy,
				  nursing, education, occupational therapy, and recreational therapy) and at
				  least one year of experience in the delivery of services to the population
				  groups that the person is hired as a case manager or case management supervisor
				  to serve; or
2. An Iowa license to practice as a registered nurse and at
				  least three years of experience in the delivery of services to the population
				  group the person is hired as a case manager or case management supervisor to
				  serve.
People employed as case management supervisors on or before
				  August 1, 1993, who do not meet these requirements shall be considered to meet
				  these requirements as long as they are continuously employed by the same case
				  management provider.
"Readiness assessment"
means a process of
				  involving the individual using the service in clarifying motivational readiness
				  to participate in the recovery process. For purposes of this chapter, the
				  definition and explanation are taken from the Psychiatric Rehabilitation
				  Practitioner Tools, as developed by the Boston Center for Psychiatric
				  Rehabilitation.
"Readiness development"
means services
				  designed to develop or increase an individual's interest, motivation, and
				  resolve to engage in the rehabilitation services process, as a means of
				  enhancing independent functioning and quality of life. For purposes of this
				  chapter, the definition and explanation are taken from the Psychiatric
				  Rehabilitation Practitioner Tools, as developed by the Boston Center for
				  Psychiatric Rehabilitation.
"Registered nurse"
means a person who is
				  licensed to practice nursing in the state of Iowa as defined in Iowa Code
				  chapter 152.
"Rehabilitation services"
means services
				  designed to restore, improve, or maximize the individual's optimal level of
				  functioning, self-care, self-responsibility, independence and quality of life
				  and to minimize impairments, disabilities and dysfunction caused by a serious
				  and persistent mental or emotional disability.
"Rights restriction"
means limitations not
				  imposed on the general public in the areas of communication, mobility,
				  finances, medical or mental health treatment, intimacy, privacy, type of work,
				  religion, place of residence, and people with whom the individual using the
				  service may share a residence.
"Serious emotional disturbance"
means a
				  diagnosable mental, behavioral, or emotional disorder that (1) is of sufficient
				  duration to meet diagnostic criteria for the disorder specified by the current
				  version of the Diagnostic and Statistical Manual of Mental Disorders (DSM)
				  published by the American Psychiatric Association; and (2) has resulted in a
				  functional impairment that substantially interferes with or limits a consumer's
				  role or functioning in family, school, or community activities. "Serious
				  emotional disturbance" shall not include neurodevelopmental disorders,
				  substance-related disorders, or conditions or problems classified in the
				  current version of the DSM as "other conditions that may be a focus of clinical
				  attention," unless those conditions co-occur with another diagnosable serious
				  emotional disturbance.
"Service plan"
means an individualized
				  goal-oriented plan of services written in language understandable by the
				  individual using the service and developed collaboratively by the individual
				  and the organization.
"Staff"
means people paid by the
				  organization to perform duties and responsibilities defined in the
				  organization's policies and procedures.