New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 161B - STANDARDS FOR LICENSURE OF OUTPATIENT SUBSTANCE USE DISORDER TREATMENT FACILITIES › Subchapter 1 - DEFINITIONS AND STAFF QUALIFICATIONS AND RESPONSIBILITIES › Section 10:161B-1.3 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
The following words and terms, when used in this chapter,
				  shall have the following meanings, unless the context clearly indicates
				  otherwise:
"Accrediting agencies" means those organizations recognized
				  nationally that set standards and review providers based on these standards.
				  These organizations provide their endorsement in the form of accreditation: the
				  Joint Commission on Accreditation of Healthcare Organizations (JCAHO),
http://www.jointcommission.org
;
				  and the Commission on Accreditation of Rehabilitation Facilities (CARF),
http://www.carf.org
.
"Administrator" means an individual appointed by the
				  governing authority to provide administrative oversight for all licensed
				  programs and individual sites within a licensed facility.
"Admitted" means accepted for treatment at an outpatient
				  substance use disorder treatment facility.
"Adolescent" means a person between the ages of 11 and up to
				  the age of 18.
"ASAM" means the American Society of Addiction Medicine, 4601
				  North Park Avenue, Upper Arcade, Suite 101, Chevy Chase, MD 20815,
http://www.asam.org
.
"ASAM Client Placement Criteria" means the criteria developed
				  by the American Society of Addiction Medicine to place clients in an
				  appropriate level of care, as contained in "Client Placement Criteria for the
				  Treatment of Substance Related Disorders," 2nd Edition revised (2001)
				  (ASAM-PPC-2R), as amended and supplemented, incorporated herein by reference,
				  which can be obtained from the ASAM Publications Center, 1-800-844-8948.
"ASAM Criteria" means the criteria developed by the American
				  Society of Addiction Medicine to place clients in an appropriate level of care,
				  as contained in The ASAM Criteria, Treatment Criteria for Addictive,
				  Substance-Related, and Co-Occurring Conditions, Third Edition, 2013, as amended
				  and supplemented, incorporated herein by reference, which can be obtained from
				  the ASAM Publications Center, 1-800-844-8948.
"ASI" means the Addiction Severity Index, 5th Edition, as
				  amended and supplemented, incorporated herein by reference, an instrument
				  designed to provide important information about aspects of a client's life
				  which may contribute to his or her substance use disorder, as developed by and
				  available from the Treatment Research Institute, 600 Public Ledger Building,
				  Philadelphia, PA 19106, (215) 399-0980,
				  http://www.tresearch.org/tools/download-asi-instruments-manuals/.
"Assistant Commissioner" means the individual responsible to
				  oversee the Division of Mental Health and Addiction Services.
"Available" means with respect to individuals employed by, or
				  under contract with, an outpatient substance use disorder treatment facility,
				  capable of being reached and able to be present in the facility within 30
				  minutes.
"BOCA" means the model building code of the organization
				  formerly called the Building Officials and Code Administrators International
				  Inc., now called the International Code Council, 4051 W. Flossmoor Road,
				  Country Club Hills, IL 60477-5795,
http://www.iccsafe.org
, 1-888-422-7233,
				  which can be obtained from the ICC Store, 1-800-786-4452.
"Buprenorphine" means the Federal Food and Drug
				  Administration approved drug which is used as of the effective date of these
				  rules, in the form of Suboxone and Subutex, for treatment of opiate dependence
				  for medical maintenance and medically supervised withdrawal.
"Bylaws" means a set of rules adopted by the program for
				  governing its operation. A charter, articles of incorporation, or a statement
				  of policies and objectives, is an acceptable equivalent.
"CDC" means the Federal government agency, Centers for
				  Disease Control and Prevention,
http://www.cdc.gov
.
"Certificate of Occupancy" means a certificate issued by a
				  local authority indicating that a building meets building code
				  requirements.
"Certified Alcohol and Drug Counselor (CADC)" means an
				  individual who holds a current, valid certificate issued by the New Jersey
				  State Board of Marriage and Family Therapy Examiners, as recommended by the
				  Alcohol and Drug Counselor Committee, pursuant to N.J.S.A. 42:2D-5 and
13:34C-2.3
; accessible at
http://www.njconsumeraffairs.gov/mft/Pages/regulations.aspx
,
				  (973) 504-6415.
"Child Abuse Record Information" or "CARI" means the
				  information in the child abuse registry as established in
9:6-8.11
, which may be
				  released to a person or agency outside the Department of Children and Families,
				  Division of Child Protection and Permanency only as prescribed by law.
"Client" means any individual receiving treatment services in
				  a licensed treatment facility. In the context of this chapter, client is
				  synonymous with "patient."
"Client-centered care" means care including substance use
				  disorder treatment, recovery support, and prevention services which reflect the
				  client's needs, preferences and values.
"Clinical note" means a written, signed with original
				  signature, and dated notation made by a licensed or credentialed professional,
				  an approved counselor in training (see
				  10:161B-1.9(a)2)
				  or other authorized representative of the program who renders a service to the
				  client or records observations of the client's progress in treatment.
"Clinical record" means all records in the facility which
				  pertain to the client's care.
"Commissioner" means the Commissioner of the New Jersey
				  Department of Human Services.
"Communicable disease" means an illness due to a specific
				  infectious agent or its toxic products, which occurs through transmission of
				  that agent or its products from a reservoir to a susceptible host.
"Conditional license" means a license pursuant to
				  N.J.A.C.
				  10:161B-2.7. A conditional license is not a
				  full license and requires the licensee to comply with all specific conditions
				  imposed by DCN&L in addition to the licensure requirements in this
				  chapter.
"Conspicuously posted" means placed at a location within the
				  facility accessible to and seen by clients and the public.
"Contamination" means the presence of an infectious or toxic
				  agent in the air, on a body surface, or on/in clothes, bedding, instruments or
				  dressings, or other inanimate articles or substances, including water, milk,
				  and food.
"Continuum of Care Plan" means a written plan initiated at
				  the time of the client's admission, and regularly updated throughout the course
				  of treatment, which addresses the needs of the client after discharge; may be
				  referred to as a Discharge Plan.
"Controlled dangerous substances" or "controlled substances"
				  means drugs defined by and subject to the Federal Controlled Dangerous
				  Substances Act of 1970 (Public Law 91-513;
				  21
				  U.S.C. §§
										801 et seq.) and the New
				  Jersey Controlled Dangerous Substances Act,
				  24:21-1 et seq.
"Co-occurring disorder" means a concurrent substance use
				  disorder and mental health disorder as described in the DSM-5, in which the
				  substance use disorder and mental health disorders are both primary.
"Counseling" means the utilization of special skills and
				  evidence based practices to assist individuals, families, significant others,
				  and/or groups to identify and change patterns of behavior relating to substance
				  use disorders which are maladaptive, destructive and/or injurious to health
				  through the provision of individual, group and/or family therapy by licensed or
				  credentialed professionals or approved counselors in training. Counseling does
				  not include self-help support groups such as Alcoholics Anonymous, Narcotics
				  Anonymous, and similar 12-step programs.
"CSAT" means the Federal Center for Substance Abuse
				  Treatment, within the Department of Health and Human Services, Substance Abuse
				  and Mental Health Services Administration, http://csat.samhsa.gov.
"Curtailment" means an order by DCN&L which requires a
				  licensed substance use disorder treatment facility to cease and desist all
				  admissions and readmissions of clients to the facility.
"Daily census" means the number of clients receiving services
				  at the facility on any given day.
"DCF" means the New Jersey Department of Children and
				  Families.
"DCN&L" means the Division of Certificate of Need and
				  Licensing within the Health Services Branch of the DOH.
"Deficiency" means a determination by DCN&L of one or
				  more instances in which a State licensing regulation has been violated.
"Department" or "DHS" means the New Jersey Department of
				  Human Services.
"Dependence" means physical and/or psychological dependence
				  on a substance resulting from the chronic or habitual use of alcohol, tobacco,
				  any kind of controlled substance, narcotic drug, or other prescription or
				  non-prescription drug.
"Designated person" means, in the context of client care, the
				  person chosen by the client to be notified if the client sustains an injury
				  requiring medical care, an accident or incident occurs, there is deterioration
				  in the client's physical or mental condition, the client is transferred to
				  another facility, or the client is discharged or dies while in
				  treatment.
"Detoxification" means the provision of care, usually short
				  term, prescribed by a physician and conducted under medical supervision, for
				  the purpose of withdrawing a person from a specific psychoactive substance in a
				  safe and effective manner according to established written medical
				  protocols.
"Detoxification treatment short-term" means detoxification
				  treatment for a period not in excess of 30 days.
"Detoxification treatment long-term" means detoxification
				  treatment for a period more than 30 days but not in excess of 180 days.
"DHS" means the New Jersey Department of Human
				  Services.
"Didactic session" means a structured treatment intervention
				  designed to instruct or teach clients about topics related to substance use
				  disorders and treatment related issues.
"Discharge plan" means a written plan initiated at the time
				  of the client's admission, and regularly updated throughout the course of
				  treatment, which addresses the needs of the client after discharge; also
				  referred to as a Continuum of Care Plan.
"DMHAS" means the Division of Mental Health and Addiction
				  Services, a division within the New Jersey Department of Human Services.
"DOH" means the New Jersey Department of Health.
"Dosage" means, in the context of administering medication in
				  prescribed amounts, the quantity of a drug to be taken or applied all at one
				  time or in fractional amounts within a given period of time.
"Drug" means any article recognized in the official United
				  States Pharmacopoeia-National Formulary (USP 31-NF26), accessible at
http://www.usp.org/usp-nf
,
				  1-800-227-8772; or the official Homeopathic Pharmacopoeia of the United
				  States/Revision Service, at
http://www.hpus.com
, as amended and
				  supplemented, incorporated herein by reference, including, but not limited to,
				  a controlled substance, a prescription legend drug, an over the counter
				  preparation, a vitamin or food supplement, transdermal patch or strip, or any
				  compounded combination of any of the above intended for use in the diagnosis,
				  cure, mitigation, treatment or prevention of disease or medical condition in
				  humans/animals or intended to affect the structure or function of the human
				  body.
"Drug screening test negative" means a urine or other
				  DHS-approved specimen from a client that is tested and reports a negative
				  result for drugs of abuse. In an opioid treatment program, the specimen is
				  negative for drugs of abuse but shows the presence of methadone.
"Drug screening test positive" means a urine or other
				  DHS-approved specimen from a client that is tested and reports positive for
				  drugs of abuse, including, but not limited to, amphetamines, barbiturates,
				  cocaine, opiates, marijuana, benzodiazepine, etc.
"DSM-5" means the Diagnostic and Statistical Manual of Mental
				  Disorders, Fifth Edition, as amended and supplemented, incorporated herein by
				  reference, the standard classification of mental disorders in the United
				  States, published by and available from the American Psychiatric Association,
				  1000 Wilson Boulevard, Suite 1825, Arlington VA 22209-3901,
http://www.dsm5.org/Pages/Default.aspx
.
"DSM-IV-TR" means the Diagnostic and Statistical Manual of
				  Mental Disorders, 4th Edition, Text Revision, as amended and supplemented,
				  incorporated herein by reference, the standard classification of mental
				  disorders in the United States, published by and available from the American
				  Psychiatric Association, 1000 Wilson Boulevard, Suite 1825, Arlington VA
				  22209-3901, http://www.dsmivtr.org.
"Evidence based practices" means interventions and approaches
				  supported empirically through systematic research and evaluation. These are to
				  be distinguished from best practices, which are interventions and approaches
				  more likely to yield desired results, based on indicative studies or
				  judgment/consensus of experts.
"Facility" means an outpatient substance use disorder
				  treatment facility and/or program pursuant to State statute and this
				  chapter.
"Family" means immediate kindred, domestic partner, legal
				  guardian, legally authorized representative, executor, or an individual granted
				  a power of attorney. The term may also be expanded to include those persons
				  having a commitment and/or personal significance to the client.
"Floor stock" means medications from a pharmacist in a
				  labeled container in limited quantities that are not necessarily prescribed for
				  one or more specific individuals.
"Governing authority" means the organization, person, or
				  persons or the board of directors or trustees of a non-profit corporation
				  designated to assume legal responsibility for the management, operation, and
				  financial viability of the facility.
"Handicapped" means disabled as defined in the Federal
				  Americans with Disabilities Act, 1990,
				  42 U.S.C. §§
										12101 et seq.
"HIV" means human immunodeficiency virus.
"Immediate and serious threat" means a deficiency or
				  violation that has caused or will imminently cause at any time serious injury,
				  harm, impairment, or even death to clients of the facility.
"Incapacitated" means when a person, as a result of the use
				  of alcohol or other drugs, is unconscious or has his or her judgment so
				  impaired that he or she is incapable of realizing and making a rational
				  decision with respect to his or her need for treatment even though he or she is
				  in need of substantial medical attention.
"Integrated treatment" means the coordination of both
				  substance use disorder and mental health interventions, preferably by one
				  clinician; integrated services should appear coordinated to the client
				  participating in services.
"Interpreter services" means communication services provided
				  to a client and/or family member unable to comprehend and/or communicate
				  without assistance by an interpreter (for example, screened by the NJ
				  Department of Human Services, Division of the Deaf and Hard of Hearing, or
				  similar agency responsible for such screening) due to a language barrier or
				  another disability.
"Intoxicated" means when a person's mental or physical
				  functioning is substantially impaired as a result of the use of alcoholic
				  beverages or other mood-altering chemicals.
"Job description" means written specifications developed for
				  each position in the facility, containing the qualifications, duties and
				  responsibilities, and accountability required of employees in that
				  position.
"Juvenile" means a person under 18 years of age.
"Legally authorized representative" means an individual or
				  judicial or other body authorized under New Jersey law to consent on behalf of
				  a client subject to the client's (competent) participation in the
				  procedure.
"License" means a certificate of approval pursuant to
				  26:2G-21 et seq, and/or a license
				  pursuant to
				  26:2B-7 et seq.
"Licensed clinical alcohol and drug counselor (LCADC)" means
				  an individual who holds a current, valid license issued pursuant to
				  45:2D-4 and
				  45:2D-16 and
				  13:34C-2.2 and 2.1(c).
"Medical maintenance" means the administration and/or
				  dispensing of opioid agonist medications and related medical services to a
				  client who has been referred from an opioid treatment program to a designated
				  physician providing services either in the treatment facility (that is,
				  clinic-based) or in the private office (that is, office-based) of the physician
				  under a formalized agreement approved by the CSAT and DMHAS.
"Medication" means a drug or medicine as defined by the New
				  Jersey State Board of Pharmacy rules, as set forth in
N.J.A.C.
				  13:39
, which is accessible at
http://www.njconsumeraffairs.gov/regulations/Chapter-39-State-Board-of-Pharmacy.pdf
.
"Medication administration" means a procedure in which a
				  prescribed medication is given to a client by an authorized person in
				  accordance with all laws and rules governing such procedures. The complete
				  procedure of administration includes removing an individual dose from a
				  previously dispensed, properly labeled container (including a unit dose
				  container), verifying it with the prescriber's orders, giving the individual
				  dose to the client, seeing that the client takes it (if oral), and documenting
				  the required information, including the method of administration.
"Medication dispensing" means a procedure entailing the
				  interpretation of the original or direct copy of the prescriber's order for a
				  medication or a biological and, pursuant to that order, the proper selection,
				  measuring, labeling, packaging, and issuance of the drug or biological to a
				  client or a service unit of the facility, conforming with the rules of the New
				  Jersey Board of Pharmacy at N.J.A.C. 13:39.
"Methadone" means a synthetic narcotic (opioid) used in the
				  treatment of opiate addiction by State and Federally approved opioid treatment
				  programs.
"Methadone maintenance" means the dispensing of methadone at
				  relatively stable dosage levels as part of the treatment of an individual for
				  dependence on heroin or other opioids.
"Multidisciplinary team" means those persons, representing
				  different professions, disciplines, and service areas, who work together to
				  provide treatment planning and care to the client.
"New Jersey Substance Abuse Monitoring System (NJSAMS),"
http://njsams.rutgers.edu/njsams/
,
				  means the client data collection information system required by DMHAS to be
				  used for all New Jersey substance use disorder treatment facilities to record
				  and report client data including, but not limited to, admission, status,
				  services, discharge, and such other client information as DMHAS may
				  require.
"NIDA" means the National Institute on Drug Abuse within the
				  National Institutes of Health,
http://www.nida.nih.gov
.
"NJ" means New Jersey or the State of New Jersey.
"Nosocomial infection" means an infection acquired by a
				  client while in an outpatient substance use disorder treatment facility.
"Office of Licensing" or "OOL" means the Office of Licensing
				  within the DHS Office of Program Integrity and Accountability.
"Opiate" means any preparation or derivative of opium.
"Opioid" means both opiates and synthetic narcotics.
"Opioid treatment program (OTP)" means a program where there
				  is the dispensing of an opioid agonist treatment medication, (that is methadone
				  and other approved medications) along with a comprehensive range of medical and
				  rehabilitative services, when clinically necessary and in compliance with State
				  regulations, to an individual to alleviate the adverse medical, psychological,
				  or physical effects incident to opiate addiction. This term encompasses opioid
				  detoxification treatment, short-term detoxification treatment, long-term
				  detoxification treatment, maintenance treatment, comprehensive maintenance
				  treatment and interim maintenance treatment. Opioid treatment programs
				  providing short-term detoxification (that is less than 30 days) shall comply
				  with the provisions of the detoxification subchapter of this chapter,
				  N.J.A.C.
				  10:161B-12.
"Outcomes" means client level of functioning on specific
				  criteria post-treatment as compared with their level of functioning at intake.
				  These criteria include drug and alcohol use, employment, criminal activity,
				  homelessness, and social connectedness, consistent with the SAMHSA National
				  Outcome Measures, accessible at
				  http://integratedrecovery.org/wp-content/uploads/2010/08/SAMHSA-National-Outcome-Measures.pdf.
"Outpatient substance use disorder treatment facility" means
				  a facility that is licensed to provide outpatient substance use disorder
				  treatment in one or more of the following categories:
1. Outpatient (OP): A service offered at a
				licensed, outpatient facility, which provides regularly scheduled individual,
				group and/or family counseling for less than nine hours per week. This care
				approximates ASAM Criteria Level I.
2. Intensive outpatient (IOP): A service
				offered at a licensed outpatient facility that provides a range of treatment
				sessions. Services include clinical intensive substance abuse counseling and
				psycho-education (didactic) sessions. Services are provided in a structured
				environment for a minimum of nine hours of counseling per week for adults and
				six hours per week for adolescents. This care approximates ASAM Criteria Level
				II.1;
3. Partial care (PC): A
				service offered at a licensed outpatient facility that provides a broad range
				of clinically intensive treatment services in a structured environment for a
				minimum of 20 hours per week, during day or evening hours. Treatment includes
				substance abuse counseling, educational and community support services.
				Programs have ready access to psychiatric, medical and laboratory services.
				This care approximates ASAM Criteria Level II.5;
4. Outpatient detoxification: A service
				offered at a licensed outpatient facility that provides a range of services
				including medical and clinical interventions, laboratory testing, the
				dispensing and/or administration of approved medications provided to treat and
				monitor clients undergoing withdrawal from drugs, including alcohol. This also
				includes provision of concurrent assessment, and counseling support services
				for the purpose of placing these clients in an appropriate treatment setting
				for continuing care. This care approximates ASAM Criteria Level I-D or Level
				II-D; and
5. Opioid treatment: A
				service offered at a licensed outpatient facility which utilizes methadone,
				Suboxone or other approved medications to detoxify or maintain substance
				abusers who are addicted to heroin or other opiate-like drugs. Medication is
				provided in conjunction with medical monitoring, laboratory testing, clinical
				assessment, counseling and support services. This care approximates ASAM
				Criteria Opiate Maintenance Therapy.
"Plan of correction" means a plan developed by the facility
				  and reviewed and approved by DCN&L which describes the actions the facility
				  will take to correct deficiencies and specifies the timeframe in which those
				  deficiencies will be corrected.
"Practitioner" means a person licensed to practice medicine
				  or surgery in accordance with
				  45:9-1 et seq. and N.J.A.C. 13:35,
				  or a medical resident or intern, or a podiatrist licensed pursuant to
				  45:5-1 et seq. and N.J.A.C.
				  13:35.
"Progress note" means a written, signed with original
				  signature, and dated notation by a member of the multidisciplinary team
				  summarizing facts about care and the client's response to care, during a given
				  period of time.
"Provisional license" means a full license that has been
				  reduced because the facility is not in full compliance with all licensing rules
				  in this chapter. A provisional license holder is subject to DCN&L oversight
				  until it comes into full compliance with this chapter.
"Reasonable efforts" means an inquiry on the employment
				  application, reference checks, and/or criminal background checks where
				  indicated or necessary.
"Release of Information" means a document which allows a
				  program to release client information to designated person(s) with the client's
				  written consent, in compliance with the Federal Health Insurance Portability
				  and Accountability Act (HIPAA) Privacy Rule at 45 CFR Parts 160 and 164,
				  Subparts A and E; and the Federal Confidentiality of Alcohol and Drug Abuse
				  Patient Records regulation at 42 CFR Part 2, both of which are accessible at
http://www.samhsa.gov/laws-regulations-guidelines/medical-records-privacy-confidentiality
.
"SAMHSA" means the Substance Abuse and Mental Health Services
				  Administration within the Federal Department of Health and Human Services,
http://www.samhsa.gov
.
"Self-administration" means a procedure in which any
				  medication is taken orally, injected, inhaled, inserted, topically, or
				  otherwise administered by a client to himself or herself.
"Signature" means at least the first initial and full
				  surname, title and credential (for example, R.N., L.P.N., M.D., D.O., LCADC,
				  CADC) of a person, legibly written, with his or her own hand. If electronic
				  signatures are used, they shall be used in accordance with this chapter,
				  10:161B-18.4(b)1.
"Staff education plan" means a written plan that describes a
				  coordinated program for staff education, including in-service programs and on
				  the job training.
"Staff orientation plan" means a written plan for each new
				  employee to learn about or get acquainted with the duties and responsibilities
				  of the position as defined in the job description as well as the other policies
				  of the facility and/or program.
"Substance abuse/dependence" means a maladaptive pattern of
				  substance use manifested by recurrent and significant adverse consequences
				  related to the repeated use of substances. There may be repeated failure to
				  fulfill major role obligations, repeated use in situations in which it is
				  physically hazardous, multiple legal problems, and recurrent social and
				  interpersonal problems. For the purpose of this chapter, substance
				  abuse/dependence also means other substance-use related disorders as defined in
				  the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition
				  (DSM-IV-TR) as amended and supplemented, published by and available from the
				  American Psychiatric Association, 1000 Wilson Boulevard, Suite 1825, Arlington,
				  Va. 22209-3901, http://dsmivtr.org, incorporated herein by reference.
"Substance use disorder" means a maladaptive pattern of
				  substance use manifested by recurrent and significant adverse consequences
				  related to the repeated use of substances. For the purpose of this chapter,
				  substance use disorder is defined in the Diagnostic and Statistical Manual of
				  Mental Disorders, Fifth Edition as amended and supplemented, published and by
				  and available from the American Psychiatric Association, 1000 Wilson Boulevard,
				  Suite 1825, Arlington, Va. 22209-3901,
http://www.dsm5.org/Pages/Default.aspx
,
				  incorporated herein by reference.
"Supervision (direct)" means supervision of clients provided
				  on the premises within view or through the implementation of policies and
				  procedures which may include electronic monitoring, to provide for the safety
				  and the accountability of clients by staff.
"Survey" means the evaluation of the quality of care and/or
				  the fitness of the premises, staff, and services provided by the facility as
				  conducted by DCN&L and/or its designees to determine compliance or
				  non-compliance with these and other applicable State licensing rules or
				  statutes.
"Waiver" means a written approval by DCN&L following a
				  written request from a facility, to allow an alternative to any section(s) in
				  this chapter provided that the alternative(s) proposed would not endanger the
				  life, safety, or health of clients or the public, as described at
				  N.J.A.C.
				  10:161B-2.13.