Virginia Administrative Code › Title 12 - HEALTH › Agency 35 - DEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES › Chapter 105 - RULES AND REGULATIONS FOR LICENSING PROVIDERS BY THE DEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES › Part I - General Provisions › Article 2 - Definitions › Section 12VAC35-105-20 - Definitions

Current through Register Vol. 40, No. 24, July 15, 2024
The following words and terms when used in this chapter
						shall have the following meanings unless the context clearly indicates
						otherwise:
"Abuse" means, as defined by §
											37.2-100 of the Code of
						Virginia, any act or failure to act by an employee or other person responsible
						for the care of an individual in a facility or program operated, licensed, or
						funded by the department, excluding those operated by the Virginia Department
						of Corrections, that was performed or was failed to be performed knowingly,
						recklessly, or intentionally, and that caused or might have caused physical or
						psychological harm, injury, or death to an individual receiving care or
						treatment for mental illness, developmental disabilities, or substance abuse.
						Examples of abuse include acts such as:
1. Rape, sexual assault, or other criminal
					 sexual behavior;
2. Assault or
					 battery;
3. Use of language that
					 demeans, threatens, intimidates, or humiliates the individual;
4. Misuse or misappropriation of the
					 individual's assets, goods, or property;
5. Use of excessive force when placing an
					 individual in physical or mechanical restraint;
6. Use of physical or mechanical restraints
					 on an individual that is not in compliance with federal and state laws,
					 regulations, and policies, professional accepted standards of practice, or the
					 individual's individualized services plan; or
7. Use of more restrictive or intensive
					 services or denial of services to punish an individual or that is not
					 consistent with the individual's individualized services plan.
"Activities of daily living" or "ADLs" means personal
						care activities and includes bathing, dressing, transferring, toileting,
						grooming, hygiene, feeding, and eating. An individual's degree of independence
						in performing these activities is part of determining the appropriate level of
						care and services.
"Addiction" means a primary, chronic disease of brain
						reward, motivation, memory, and related circuitry. Addiction is defined as the
						inability to consistently abstain, impairment in behavioral control,
						persistence of cravings, diminished recognition of significant problems with
						one's behaviors and interpersonal relationships, and a dysfunctional emotional
						response. Like other chronic diseases, addiction often involves cycles of
						relapse and remission. Without treatment or engagement in recovery activities,
						addiction is progressive and can result in disability or premature
						death.
"Admission" means the process of acceptance into a
						service as defined by the provider's policies.
"Allied health professional" means a professional who is
						involved with the delivery of health or related services pertaining to the
						identification, evaluation, and prevention of diseases and disorders, such as a
						certified substance abuse counselor, certified substance abuse counseling
						assistant, peer recovery support specialist, certified nurse aide, or
						occupational therapist.
"ASAM" means the American Society of Addiction
						Medicine.
"Assertive community treatment service" or "ACT" means a
						self-contained interdisciplinary community-based team of medical, behavioral
						health, and rehabilitation professionals who use a team approach to meet the
						needs of an individual with severe and persistent mental illness. ACT
						teams:
1. Provide person-centered
					 services addressing the breadth of an individual's needs, helping the
					 individual achieve his personal goals;
2. Serve as the primary provider of all the
					 services that an individual receiving ACT services needs;
3. Maintain a high frequency and intensity of
					 community-based contacts;
4.
					 Maintain a very low individual-to-staff ratio;
5. Offer varying levels of care for all
					 individuals receiving ACT services and appropriately adjust service levels
					 according to each individual's needs over time;
6. Assist individuals in advancing toward
					 personal goals with a focus on enhancing community integration and regaining
					 valued roles, such as worker, family member, resident, spouse, tenant, or
					 friend;
7. Carry out planned
					 assertive engagement techniques, including rapport-building strategies,
					 facilitating meeting basic needs, and motivational interviewing
					 techniques;
8. Monitor the
					 individual's mental status and provide needed supports in a manner consistent
					 with the individual's level of need and functioning;
9. Deliver all services according to a
					 recovery-based philosophy of care; and
10. Promote self-determination, respect for
					 the individual receiving ACT as an individual in such individual's own right,
					 and engage peers in promoting recovery and regaining meaningful roles and
					 relationships in the community.
"Authorized representative" means a person permitted by
						law or 12VAC35-115 to authorize the disclosure of information or consent to
						treatment and services or participation in human research.
"Behavior intervention" means those principles and
						methods employed by a provider to help an individual receiving services to
						achieve a positive outcome and to address challenging behavior in a
						constructive and safe manner. Behavior intervention principles and methods
						shall be employed in accordance with the individualized services plan and
						written policies and procedures governing service expectations, treatment
						goals, safety, and security.
"Behavioral treatment plan," "functional plan," or
						"behavioral support plan" means any set of documented procedures that are an
						integral part of the individualized services plan and are developed on the
						basis of a systematic data collection, such as a functional assessment, for the
						purpose of assisting individuals to achieve the following:
1. Improved behavioral functioning and
					 effectiveness;
2. Alleviation of
					 symptoms of psychopathology; or
3.
					 Reduction of challenging behaviors.
"Board" or "state board" means, as defined by §
											37.2-100 of the Code of
						Virginia, the State Board of Behavioral Health and Developmental Services. The
						board has statutory responsibility for adopting regulations that may be
						necessary to carry out the provisions of Title 37.2 of the Code of Virginia and
						other laws of the Commonwealth administered by the commissioner or the
						department.
"Brain injury" means any injury to the brain that occurs
						after birth that is acquired through traumatic or nontraumatic insults.
						Nontraumatic insults may include anoxia, hypoxia, aneurysm, toxic exposure,
						encephalopathy, surgical interventions, tumor, and stroke. Brain injury does
						not include hereditary, congenital, or degenerative brain disorders or injuries
						induced by birth trauma.
"Care," "treatment," or "support" means the individually
						planned therapeutic interventions that conform to current acceptable
						professional practice and that are intended to improve or maintain functioning
						of an individual receiving services delivered by a provider.
"Case management service" or "support coordination
						service" means services that can include assistance to individuals and their
						family members in accessing needed services that are responsive to the
						individual's needs. Case management services include identifying potential
						users of the service; assessing needs and planning services; linking the
						individual to services and supports; assisting the individual directly to
						locate, develop, or obtain needed services and resources; coordinating services
						with other providers; enhancing community integration; making collateral
						contacts; monitoring service delivery; discharge planning; and advocating for
						individuals in response to their changing needs. "Case management service" does
						not include assistance in which the only function is maintaining service
						waiting lists or periodically contacting or tracking individuals to determine
						potential service needs.
"Clinical experience" means providing direct services to
						individuals with mental illness or the provision of direct geriatric services
						or special education services. Experience may include supervised internships,
						practicums, and field experience.
"Clinically managed high-intensity residential care" or
						"Level of care 3.5" means a substance use treatment program that offers 24-hour
						supportive treatment of individuals with significant psychological and social
						problems by credentialed addiction treatment professionals in an
						interdisciplinary treatment approach. A clinically managed high-intensity
						residential care program provides treatment to individuals who present with
						significant challenges, such as physical, sexual, or emotional trauma; past
						criminal or antisocial behaviors, with a risk of continued criminal behavior;
						an extensive history of treatment; inadequate anger management skills; extreme
						impulsivity; and antisocial value system.
"Clinically managed low-intensity residential care" or
						"Level of care 3.1" means providing an ongoing therapeutic environment for
						individuals requiring some structured support in which treatment is directed
						toward applying recovery skills; preventing relapse; improving emotional
						functioning; promoting personal responsibility; reintegrating the individual
						into work, education, and family environments; and strengthening and developing
						adaptive skills that may not have been achieved or have been diminished during
						the individual's active addiction. A clinically managed low-intensity
						residential care program also provides treatment for individuals suffering from
						chronic, long-term alcoholism or drug addiction and affords an extended period
						of time to establish sound recovery and a solid support system.
"Clinically managed population specific high-intensity
						residential services" or "Level of care 3.3" means a substance use treatment
						program that provides a structured recovery environment in combination with
						high-intensity clinical services provided in a manner to meet the functional
						limitations of individuals. The functional limitations of individuals who are
						placed within this level of care are primarily cognitive and can be either
						temporary or permanent.
"Commissioner" means the Commissioner of the Department
						of Behavioral Health and Developmental Services.
"Community-based crisis stabilization" means services
						that are short term and designed to support an individual and the individual's
						natural support system following contact with an initial crisis response
						service or as a diversion to a higher level of care. Providers deliver
						community-based crisis stabilization services in an individual's natural
						environment and provide referrals and linkage to other community-based services
						at the appropriate level of care. Interventions may include mobile crisis
						response, brief therapeutic and skill-building interventions, engagement of
						natural supports, interventions to integrate natural supports in the
						de-escalation and stabilization of the crisis, and coordination of follow-up
						services. Coordination of specialized services to address the needs of
						co-occurring developmental disabilities and substance use disorders are also
						available through this service. Services include advocacy and networking to
						provide linkages and referrals to appropriate community-based services and
						assist the individual and the individual's family or caregiver in accessing
						other benefits or assistance programs for which the individual may be eligible.
						Community-based crisis stabilization is a non-center, community-based service.
						The goal of community-based crisis stabilization services is to stabilize the
						individual within the community and support the individual or the individual's
						support system (i) as part of an initial mobile crisis response; (ii) during
						the period between an initial mobile crisis response and entry into an
						established follow-up service at the appropriate level of care; (iii) as a
						transitional step-down from a higher level of care if the next level of care
						service is identified but not immediately available for access; or (iv) as a
						diversion to a higher level of care.
"Community gero-psychiatric residential services" means
						24-hour care provided to individuals with mental illness, behavioral problems,
						and concomitant health problems who are usually 65 years of age or older in a
						geriatric setting that is less intensive than a psychiatric hospital but more
						intensive than a nursing home or group home. Services include assessment and
						individualized services planning by an interdisciplinary services team, intense
						supervision, psychiatric care, behavioral treatment planning and behavior
						interventions, nursing, and other health-related services.
"Complaint" means an allegation of a violation of this
						chapter or a provider's policies and procedures related to this chapter.
"Co-occurring disorders" means the presence of more than
						one and often several of the following disorders that are identified
						independently of one another and are not simply a cluster of symptoms resulting
						from a single disorder: mental illness, a developmental disability, substance
						abuse (substance use disorders), or brain injury.
"Co-occurring services" means individually planned
						therapeutic treatment that addresses in an integrated concurrent manner the
						service needs of individuals who have co-occurring disorders.
"Corrective action plan" means the provider's pledged
						corrective action in response to cited areas of noncompliance documented by the
						regulatory authority.
"Correctional facility" means a facility operated under
						the management and control of the Virginia Department of Corrections.
"Credentialed addiction treatment professional" means a
						person who possesses one of the following credentials issued by the appropriate
						health regulatory board:
(i) an
					 addiction-credentialed physician or physician with experience or training in
					 addiction medicine;
(ii) a licensed
					 nurse practitioner or a licensed physician assistant with experience or
					 training in addiction medicine;
(iii) a licensed psychiatrist;
(iv) a licensed clinical
					 psychologist;
(v) a licensed
					 clinical social worker;
(vi) a
					 licensed professional counselor;
(vii) a licensed nurse practitioner with
					 experience or training in psychiatry or mental health;
(viii) a licensed marriage and family
					 therapist;
(ix) a licensed substance
					 abuse treatment practitioner;
(x) a
					 resident who is under the supervision of a licensed professional counselor
					 (18VAC115-20-10), licensed marriage
					 and family therapist (18VAC115-50-10), or
					 licensed substance abuse treatment practitioner (18VAC115-60-10) and is registered
					 with the Virginia Board of Counseling;
(xi) a resident in psychology who is under
					 supervision of a licensed clinical psychologist and is registered with the
					 Virginia Board of Psychology (18VAC125-20-10);
					 or
(xii) a supervisee in social
					 work who is under the supervision of a licensed clinical social worker and is
					 registered with the Virginia Board of Social Work (18VAC140-20-10).
"Crisis" means a deteriorating or unstable situation
						often developing suddenly or rapidly that produces acute, heightened,
						emotional, mental, physical, medical, or behavioral distress.
"Crisis education and prevention plan" or "CEPP" means a
						department-approved, individualized, client-specific document that provides a
						concise, clear, and realistic set of supportive interventions to prevent or
						de-escalate a crisis and assist an individual who may be experiencing a
						behavioral loss of control. The goal of the CEPP is to identify problems that
						have arisen in the past or are emergent in order to map out strategies that
						offer tools for the natural support system to assist the individual in
						addressing and de-escalating problems in a healthy way and provide teaching
						skills that the individual can apply independently.
"Crisis planning team" means the team who is consulted to
						plan the individual's safety plan or crisis ISP. The crisis planning team
						consists, at a minimum, of the individual receiving services, the individual's
						legal guardian or authorized representative, and a member of the provider's
						crisis staff. The crisis planning team may include the individual's support
						coordinator, case manager, the individual's family, or other identified
						persons, as desired by the individual, such as the individual's family of
						choice.
"Crisis receiving center," "CRC," or "23-hour crisis
						stabilization" means a community-based, nonhospital facility providing
						short-term assessment, observation, and crisis stabilization services for up to
						23 hours. This service is accessible 24 hours per day, seven days per week, 365
						days per year, and is indicated when an individual requires a safe environment
						for initial assessment and intervention. This service includes a thorough
						assessment of an individual's behavioral health crisis, psychosocial needs, and
						supports in order to determine the least restrictive environment most
						appropriate for stabilization. Key service functions include rapid assessment,
						crisis intervention, de-escalation, short-term stabilization, and appropriate
						referrals for ongoing care. This distinct service may be co-located with other
						services such as crisis stabilization units.
"Crisis stabilization" means direct, intensive
						nonresidential or residential care and treatment to nonhospitalized individuals
						experiencing an acute crisis that may jeopardize their current community living
						situation. Crisis stabilization is intended to avert hospitalization or
						rehospitalization; provide normative environments with a high assurance of
						safety and security for crisis intervention; stabilize individuals in crisis;
						and mobilize the resources of the community support system, family members, and
						others for ongoing rehabilitation and recovery.
"Crisis stabilization unit," "CSU," or "residential
						crisis stabilization unit" is a community-based, short-term residential
						treatment unit. CSUs serve as primary alternatives to inpatient hospitalization
						for individuals who are in need of a safe, secure environment for assessment
						and crisis treatment. CSUs also serve as a step-down option from psychiatric
						inpatient hospitalization and function to stabilize and reintegrate individuals
						who meet medical necessity criteria back into their communities.
"Day support service" means structured programs of
						training, assistance, and specialized supervision in the acquisition,
						retention, or improvement of self-help, socialization, and adaptive skills for
						adults with a developmental disability provided to groups or individuals in
						nonresidential community-based settings. Day support services may provide
						opportunities for peer interaction and community integration and are designed
						to enhance the following: self-care and hygiene, eating, toileting, task
						learning, community resource utilization, environmental and behavioral skills,
						social skills, medication management, prevocational skills, and transportation
						skills. The term "day support service" does not include services in which the
						primary function is to provide employment-related services, general educational
						services, or general recreational services.
"Department" means the Virginia Department of Behavioral
						Health and Developmental Services.
"Developmental disability" means a severe, chronic
						disability of an individual that (i) is attributable to a mental or physical
						impairment or a combination of mental and physical impairments other than a
						sole diagnosis of mental illness; (ii) is manifested before the individual
						reaches 22 years of age; (iii) is likely to continue indefinitely; (iv) 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, or economic
						self-sufficiency; and (v) reflects the individual'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. An individual from birth
						to nine years of age, 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 in clauses (i) through (v) if the individual without services and
						supports has a high probability of meeting those criteria later in life.
"Developmental services" means planned, individualized,
						and person-centered services and supports provided to individuals with
						developmental disabilities for the purpose of enabling these individuals to
						increase their self-determination and independence, obtain employment,
						participate fully in all aspects of community life, advocate for themselves,
						and achieve their fullest potential to the greatest extent possible.
"Diagnostic and Statistical Manual of Mental Disorders"
						or "DSM" means the Diagnostic and Statistical Manual of Mental Disorders, 5th
						Edition, DSM-5, of the American Psychiatric Association.
"Direct care position" means any position that includes
						responsibility for (i) treatment, case management, health, safety, development,
						or well-being of an individual receiving services or (ii) immediately
						supervising a person in a position with this responsibility.
"Discharge" means the process by which the individual's
						active involvement with a service is terminated by the provider, individual, or
						individual's authorized representative.
"Discharge plan" means the written plan that establishes
						the criteria for an individual's discharge from a service and identifies and
						coordinates delivery of any services needed after discharge.
"Dispense" means to deliver a drug to an ultimate user by
						or pursuant to the lawful order of a practitioner, including the prescribing
						and administering, packaging, labeling, or compounding necessary to prepare the
						substance for that delivery (§
											54.1-3400 et seq. of the Code of
						Virginia).
"Emergency service" means unscheduled and sometimes
						scheduled crisis intervention, stabilization, and referral assistance provided
						over the telephone or face-to-face, if indicated, available 24 hours a day and
						seven days per week. Emergency services also may include walk-ins, home visits,
						jail interventions, and preadmission screening activities associated with the
						judicial process.
"Group home or community residential service" means a
						congregate service providing 24-hour supervision in a community-based home
						having eight or fewer residents. Services include supervision, supports,
						counseling, and training in activities of daily living for individuals whose
						individualized services plan identifies the need for the specific types of
						services available in this setting.
"HCBS Waiver" means a Medicaid Home and Community Based
						Services Waiver.
"Home and noncenter based" means that a service is
						provided in the individual's home or other noncenter-based setting. This
						includes noncenter-based day support, supportive in-home, and intensive in-home
						services.
"Individual" or "individual receiving services" means a
						current direct recipient of public or private mental health, developmental, or
						substance abuse treatment, rehabilitation, or habilitation services and
						includes the terms "consumer," "patient," "resident," "recipient," or "client".
						When the term is used in this chapter, the requirement applies to every
						individual receiving licensed services from the provider.
"Individualized services plan" or "ISP" means a
						comprehensive and regularly updated written plan that describes the
						individual's needs, the measurable goals and objectives to address those needs,
						and strategies to reach the individual's goals. An ISP is person-centered,
						empowers the individual, and is designed to meet the needs and preferences of
						the individual. The ISP is developed through a partnership between the
						individual and the provider and includes an individual's treatment plan,
						habilitation plan, person-centered plan, or plan of care, which are all
						considered individualized service plans.
"Informed choice" means a decision made after considering
						options based on adequate and accurate information and knowledge. These options
						are developed through collaboration with the individual and the individual's
						authorized representative, as applicable, and the provider with the intent of
						empowering the individual and the individual's authorized representative to
						make decisions that will lead to positive service outcomes.
"Informed consent" means the voluntary written agreement
						of an individual or that individual's authorized representative to surgery,
						electroconvulsive treatment, use of psychotropic medications, or any other
						treatment or service that poses a risk of harm greater than that ordinarily
						encountered in daily life or for participation in human research. To be
						voluntary, informed consent must be given freely and without undue inducement;
						any element of force, fraud, deceit, or duress; or any form of constraint or
						coercion.
"Initial assessment" means an assessment conducted prior
						to or at admission to determine whether the individual meets the service's
						admission criteria; what the individual's immediate service, health, and safety
						needs are; and whether the provider has the capability and staffing to provide
						the needed services.
"Inpatient psychiatric service" means intensive 24-hour
						medical, nursing, and treatment services provided to individuals with mental
						illness or substance abuse (substance use disorders) in a hospital as defined
						in §
											32.1-123 of the Code of Virginia
						or in a special unit of a hospital.
"Instrumental activities of daily living" or "IADLs"
						means meal preparation, housekeeping, laundry, and managing money. A person's
						degree of independence in performing these activities is part of determining
						appropriate level of care and services.
"Intellectual disability" means a disability originating
						before 18 years of age, characterized concurrently by (i) significant
						subaverage intellectual functioning as demonstrated by performance on a
						standardized measure of intellectual functioning administered in conformity
						with accepted professional practice that is at least two standard deviations
						below the mean and (ii) significant limitations in adaptive behavior as
						expressed in conceptual, social, and practical adaptive skills.
"Intensity of service" means the number, type, and
						frequency of staff interventions and other services provided during treatment
						at a particular level of care.
"Intensive in-home service" means family preservation
						interventions for children and adolescents who have or are at risk of serious
						emotional disturbance, including individuals who also have a diagnosis of
						developmental disability. Intensive in-home service is usually time-limited and
						is provided typically in the residence of an individual who is at risk of being
						moved to out-of-home placement or who is being transitioned back home from an
						out-of-home placement. The service includes 24-hour per day emergency response;
						crisis treatment; individual and family counseling; life, parenting, and
						communication skills; and case management and coordination with other
						services.
"Intermediate care facility/individuals with intellectual
						disability" or "ICF/IID" means a facility or distinct part of a facility
						certified by the Virginia Department of Health as meeting the federal
						certification regulations for an intermediate care facility for individuals
						with intellectual disability and persons with related conditions and that
						addresses the total needs of the residents, which include physical,
						intellectual, social, emotional, and habilitation, providing active treatment
						as defined in 42 CFR
						435.1010 and
						42 CFR
						483.440.
"Investigation" means a detailed inquiry or systematic
						examination of the operations of a provider or its services regarding an
						alleged violation of regulations or law. An investigation may be undertaken as
						a result of a complaint, an incident report, or other information that comes to
						the attention of the department.
"Licensed mental health professional" or "LMHP" means a
						physician, licensed clinical psychologist, licensed professional counselor,
						licensed clinical social worker, licensed substance abuse treatment
						practitioner, licensed marriage and family therapist, certified psychiatric
						clinical nurse specialist, licensed behavior analyst, or licensed
						psychiatric/mental health nurse practitioner.
"Location" means a place where services are or could be
						provided.
"Mandatory outpatient treatment order" means an order
						issued by a court pursuant to §
											37.2-817 of the Code of
						Virginia.
"Medical detoxification" means a service provided in a
						hospital or other 24-hour care facility under the supervision of medical
						personnel using medication to systematically eliminate or reduce the presence
						of alcohol or other drugs in the individual's body.
"Medical evaluation" means the process of assessing an
						individual's health status that includes a medical history and a physical
						examination of an individual conducted by a licensed medical practitioner
						operating within the scope of his license.
"Medically managed intensive inpatient service" or "Level
						of care 4.0" means an organized service delivered in an inpatient setting,
						including an acute care general hospital, psychiatric unit in a general
						hospital, or a freestanding psychiatric hospital. This service is appropriate
						for individuals whose acute biomedical and emotional, behavioral, and cognitive
						problems are so severe that they require primary medical and nursing care.
						Services at this level of care are managed by a physician who is responsible
						for diagnosis, treatment, and treatment plan decisions in collaboration with
						the individual.
"Medically monitored intensive inpatient treatment" or
						"Level of care 3.7" means a substance use treatment program that provides
						24-hour care in a facility under the supervision of medical personnel. The care
						provided includes directed evaluation, observation, medical monitoring, and
						addiction treatment in an inpatient setting. The care provided may include the
						use of medication to address the effects of substance use. This service is
						appropriate for an individual whose subacute biomedical, emotional, behavioral,
						or cognitive problems are so severe that they require inpatient treatment but
						who does not need the full resources of an acute care general hospital or a
						medically managed intensive inpatient treatment program.
"Medication" means prescribed or over-the-counter drugs
						or both.
"Medication administration" means the legally permitted
						direct application of medications, as enumerated by §
											54.1-3408 of the Code of
						Virginia, by injection, inhalation, ingestion, or any other means to an
						individual receiving services by (i) persons legally permitted to administer
						medications or (ii) the individual at the direction and in the presence of
						persons legally permitted to administer medications.
"Medication assisted opioid treatment" or "opioid
						treatment service" means an intervention of administering or dispensing of
						medications, such as methadone, buprenorphine, or naltrexone approved by the
						federal Food and Drug Administration for the purpose of treating opioid use
						disorder.
"Medication assisted treatment" or "MAT" means the use of
						U.S. Food and Drug Administration approved medications in combination with
						counseling and behavioral therapies to provide treatment of substance use
						disorders. Medication assisted treatment includes medications for opioid use
						disorder as well as medications for treatment of alcohol use disorder.
"Medication error" means an error in administering a
						medication to an individual and includes when any of the following occur:
(i) the wrong medication is given to
					 an individual,
(ii) the wrong
					 individual is given the medication,
(iii) the wrong dosage is given to an
					 individual,
(iv) medication is given
					 to an individual at the wrong time or not at all, or
(v) the wrong method is used to give the
					 medication to the individual.
"Medication storage" means any area where medications are
						maintained by the provider, including a locked cabinet, locked room, or locked
						box.
"Mental Health Community Support Service" or "MCHSS"
						means the provision of recovery-oriented services to individuals with
						long-term, severe mental illness. MHCSS includes skills training and assistance
						in accessing and effectively utilizing services and supports that are essential
						to meeting the needs identified in the individualized services plan and
						development of environmental supports necessary to sustain active community
						living as independently as possible. MHCSS may be provided in any setting in
						which the individual's needs can be addressed, skills training applied, and
						recovery experienced.
"Mental health intensive outpatient service" means a
						structured program of skilled treatment services focused on maintaining and
						improving functional abilities through a time-limited, interdisciplinary
						approach to treatment. This service is provided over a period of time for
						individuals requiring more intensive services than an outpatient service can
						provide and may include individual, family, or group counseling or
						psychotherapy; skill development and psychoeducational activities; certified
						peer support services; medication management; and psychological assessment or
						testing.
"Mental health outpatient service" means treatment
						provided to individuals on an hourly schedule, on an individual, group, or
						family basis, and usually in a clinic or similar facility or in another
						location. Mental health outpatient services may include diagnosis and
						evaluation, screening and intake, counseling, psychotherapy, behavior
						management, psychological testing and assessment, laboratory, and other
						ancillary services, medical services, and medication services. Mental health
						outpatient service specifically includes:
1. Mental health services operated by a
					 community services board or a behavioral health authority established pursuant
					 to Chapter 5 (§
											37.2-500 et seq.) or Chapter 6
					 (§
											37.2-600 et seq.) of Title 37.2
					 of the Code of Virginia;
2. Mental
					 health services contracted by a community services board or a behavioral health
					 authority established pursuant to Chapter 5 (§
											37.2-500 et seq.) or Chapter 6
					 (§
											37.2-600 et seq.) of Title 37.2
					 of the Code of Virginia; or
3.
					 Mental health services that are owned, operated, or controlled by a corporation
					 organized pursuant to the provisions of either Chapter 9 (§
											13.1-601 et seq.) or Chapter 10
					 (§
											13.1-801 et seq.) of Title 13.1
					 of the Code of Virginia.
"Mental health partial hospitalization service" means
						time-limited active treatment interventions that are more intensive than
						outpatient services, designed to stabilize and ameliorate acute symptoms and
						serve as an alternative to inpatient hospitalization or to reduce the length of
						a hospital stay. Partial hospitalization is provided through a minimum of 20
						hours per week of skilled treatment services focused on individuals who require
						intensive, highly coordinated, structured, and interdisciplinary ambulatory
						treatment within a stable environment that is of greater intensity than
						intensive outpatient, but of lesser intensity than inpatient.
"Mental illness" means, as defined by §
											37.2-100 of the Code of
						Virginia, a disorder of thought, mood, emotion, perception, or orientation that
						significantly impairs judgment, behavior, capacity to recognize reality, or
						ability to address basic life necessities and requires care and treatment for
						the health, safety, or recovery of the individual or for the safety of
						others.
"Missing" means a circumstance in which an individual is
						not physically present when and where he should be and his absence cannot be
						accounted for or explained by his supervision needs or pattern of
						behavior.
"Mobile crisis response" means a type of community-based
						crisis stabilization service that is available 24 hours per day, seven days per
						week, 365 days per year to provide rapid response, assessment, and early
						intervention to individuals experiencing a behavioral health crisis. Services
						are deployed in real time to the location of the individual experiencing a
						behavioral health crisis. The purpose of this service is to (i) de-escalate the
						behavioral health crisis and prevent harm to the individual or others; (ii)
						assist in the prevention of the individual's acute exacerbation of symptoms;
						(iii) develop an immediate plan to maintain safety; and (iv) coordinate care
						and linking to appropriate treatment services to meet the needs of the
						individual.
"Motivational enhancement" means a person-centered
						approach that is collaborative, employs strategies to strengthen motivation for
						change, increases engagement in substance use services, resolves ambivalence
						about changing substance use behaviors, and supports individuals to set goals
						to change their substance use.
"Neglect" means, as defined by §
											37.2-100 of the Code of
						Virginia, the failure by a person or a program or facility operated, licensed,
						or funded by the department, excluding those operated by the Department of
						Corrections, responsible for providing services to do so, including
						nourishment, treatment, care, goods, or services necessary to the health,
						safety, or welfare of an individual receiving care or treatment for mental
						illness, developmental disabilities, or substance abuse.
"Neurobehavioral services" means the assessment,
						evaluation, and treatment of cognitive, perceptual, behavioral, and other
						impairments caused by brain injury that affect an individual's ability to
						function successfully in the community.
"Office of Human Rights" means the Department of
						Behavioral Health and Developmental Services Office of Human Rights.
"Person-centered" means focusing on the needs and
						preferences of the individual; empowering and supporting the individual in
						defining the direction for his life; and promoting self-determination,
						community involvement, and recovery.
"Provider" means, as defined by §
											37.2-403 of the Code of
						Virginia, any person, entity, or organization, excluding an agency of the
						federal government by whatever name or designation, that delivers (i) services
						to individuals with mental illness, developmental disabilities, or substance
						abuse (substance use disorders) or (ii) residential services for individuals
						with brain injury. The person, entity, or organization shall include a hospital
						as defined in §
											32.1-123 of the Code of
						Virginia, community services board, behavioral health authority, private
						provider, and any other similar or related person, entity, or organization. It
						shall not include any individual practitioner who holds a license issued by a
						health regulatory board of the Department of Health Professions or who is
						exempt from licensing pursuant to §§
											54.1-2901,
						54.1-3001,
						54.1-3501,
						54.1-3601, and
						54.1-3701 of the Code of
						Virginia.
"Psychosocial rehabilitation service" means a program of
						two or more consecutive hours per day provided to groups of adults in a
						nonresidential setting. Individuals must demonstrate a clinical need for the
						service arising from a condition due to mental, behavioral, or emotional
						illness that results in significant functional impairments in major life
						activities. This service provides education to teach the individual about
						mental illness, substance abuse, and appropriate medication to avoid
						complication and relapse and opportunities to learn and use independent skills
						and to enhance social and interpersonal skills within a consistent program
						structure and environment. Psychosocial rehabilitation includes skills
						training, peer support, vocational rehabilitation, and community resource
						development oriented toward empowerment, recovery, and competency.
"Qualified developmental disability professional" or
						"QDDP" means a person who possesses at least one year of documented experience
						working directly with individuals who have a developmental disability and who
						possesses one of the following credentials:
(i) a doctor of medicine or osteopathy
					 licensed in Virginia,
(ii) a
					 registered nurse licensed in Virginia,
(iii) a licensed occupational therapist,
					 or
(iv) completion of at least a
					 bachelor's degree in a human services field, including sociology, social work,
					 special education, rehabilitation counseling, or psychology.
"Qualified mental health professional" or "QMHP" means a
						person who by education and experience is professionally qualified and
						registered by the Board of Counseling in accordance with 18VAC115-80 to provide
						collaborative mental health services for adults or children. A QMHP does not
						engage in independent or autonomous practice. A QMHP provides services as an
						employee or independent contractor of the department or a provider licensed by
						the department.
"Qualified mental health professional-adult" or "QMHP-A"
						means a person who by education and experience is professionally qualified and
						registered with the Board of Counseling in accordance with 18VAC115-80 to
						provide collaborative mental health services for adults. A QMHP-A provides
						services as an employee or independent contractor of the department or a
						provider licensed by the department. A QMHP-A may be an occupational therapist
						who by education and experience is professionally qualified and registered with
						the Board of Counseling in accordance with 18VAC115-80.
"Qualified mental health professional-child" or "QMHP-C"
						means a person who by education and experience is professionally qualified and
						registered with the Board of Counseling in accordance with 18VAC115-80 to
						provide collaborative mental health services for children. A QMHP-C provides
						services as an employee or independent contractor of the department or a
						provider licensed by the department. A QMHP-C may be an occupational therapist
						who by education and experience is professionally qualified and registered with
						the Board of Counseling in accordance with 18VAC115-80.
"Qualified mental health professional-trainee" or
						"QMHP-T" means a person receiving supervised training in order to qualify as a
						QMHP in accordance with 18VAC115-80 and who is registered with the Board of
						Counseling.
"Qualified paraprofessional in mental health" or "QPPMH"
						means a person who meets at least one of the following criteria:
(i) is registered with the United States
					 Psychiatric Association (USPRA) as an Associate Psychiatric Rehabilitation
					 Provider (APRP);
(ii) has an
					 associate degree in a related field (social work, psychology, psychiatric
					 rehabilitation, sociology, counseling, vocational rehabilitation, human
					 services counseling) and at least one year of experience providing direct
					 services to individuals with a diagnosis of mental illness;
(iii) is licensed as an occupational therapy
					 assistant, and supervised by a licensed occupational therapist, with at least
					 one year of experience providing direct services to individuals with a
					 diagnosis of mental illness; or
(iv)
					 has a minimum of 90 hours classroom training and 12 weeks of experience under
					 the direct personal supervision of a QMHP-A providing services to individuals
					 with mental illness and at least one year of experience, including the 12 weeks
					 of supervised experience.
"Quality improvement plan" means a detailed work plan
						developed by a provider that defines steps the provider will take to review the
						quality of services it provides and to manage initiatives to improve quality. A
						quality improvement plan consists of systematic and continuous actions that
						lead to measurable improvement in the services, supports, and health status of
						the individuals receiving services.
"Recovery" means a journey of healing and transformation
						enabling an individual with a mental illness to live a meaningful life in a
						community of his choice while striving to achieve his full potential. For
						individuals with substance abuse (substance use disorders), recovery is an
						incremental process leading to positive social change and a full return to
						biological, psychological, and social functioning. For individuals with a
						developmental disability, the concept of recovery does not apply in the sense
						that individuals with a developmental disability will need supports throughout
						their entire lives although these may change over time. With supports,
						individuals with a developmental disability are capable of living lives that
						are fulfilling and satisfying and that bring meaning to themselves and others
						they know.
"REACH crisis therapeutic home" or "REACH CTH" means a
						residential home with crisis stabilization REACH service for individuals with a
						developmental disability and who are experiencing a mental health or behavior
						crisis.
"REACH mobile crisis response" means a REACH service that
						provides mobile crisis response for individuals with a developmental disability
						and who are experiencing a mental health or behavior crisis.
"Referral" means the process of directing an applicant or
						an individual to a provider or service that is designed to provide the
						assistance needed.
"Regional education assessment crisis services
						habilitation" or "REACH" means the statewide crisis system of care that is
						designed to meet the crisis support needs of individuals who have a
						developmental disability and are experiencing mental health or behavior crisis
						events that put the individuals at risk for homelessness, incarceration,
						hospitalization, or danger to self or others.
"Residential" or "residential service" means providing
						24-hour support in conjunction with care and treatment or a training program in
						a setting other than a hospital or training center. Residential services
						provide a range of living arrangements from highly structured and intensively
						supervised to relatively independent and requiring a modest amount of staff
						support and monitoring. Residential services include residential treatment,
						group homes, supervised living, community gero-psychiatric residential,
						ICF/IID, sponsored residential homes, medical and social detoxification, and
						neurobehavioral services.
"Residential crisis stabilization service" means
(i) providing short-term, intensive treatment
					 to nonhospitalized individuals who require multidisciplinary treatment in order
					 to stabilize acute psychiatric symptoms and prevent admission to a psychiatric
					 inpatient unit;
(ii) providing
					 normative environments with a high assurance of safety and security for crisis
					 intervention; and
(iii) mobilizing
					 the resources of the community support system, family members, and others for
					 ongoing rehabilitation and recovery.
"Residential treatment service" means providing an
						intensive and highly structured clinically based mental health, substance
						abuse, or neurobehavioral service for co-occurring disorders in a residential
						setting other than an inpatient service.
"Respite care service" means providing for a short-term,
						time-limited period of care of an individual for the purpose of providing
						relief to the individual's family, guardian, or regular caregiver. Persons
						providing respite care are recruited, trained, and supervised by a licensed
						provider. These services may be provided in a variety of settings including
						residential, day support, in-home, or a sponsored residential home.
"Restraint" means the use of a mechanical device,
						medication, physical intervention, or hands-on hold to prevent an individual
						receiving services from moving his body to engage in a behavior that places him
						or others at imminent risk. There are three kinds of restraints:
1. Mechanical restraint means the use of a
					 mechanical device that cannot be removed by the individual to restrict the
					 individual's freedom of movement or functioning of a limb or portion of an
					 individual's body when that behavior places him or others at imminent
					 risk.
2. Pharmacological restraint
					 means the use of a medication that is administered involuntarily for the
					 emergency control of an individual's behavior when that individual's behavior
					 places him or others at imminent risk and the administered medication is not a
					 standard treatment for the individual's medical or psychiatric
					 condition.
3. Physical restraint,
					 also referred to as manual hold, means the use of a physical intervention or
					 hands-on hold to prevent an individual from moving his body when that
					 individual's behavior places him or others at imminent risk.
"Restraints for behavioral purposes" means using a
						physical hold, medication, or a mechanical device to control behavior or
						involuntarily restrict the freedom of movement of an individual in an instance
						when all of the following conditions are met:
(i) there is an emergency;
(ii) nonphysical interventions are not
					 viable; and
(iii) safety issues
					 require an immediate response.
"Restraints for medical purposes" means using a physical
						hold, medication, or mechanical device to limit the mobility of an individual
						for medical, diagnostic, or surgical purposes, such as routine dental care or
						radiological procedures and related post-procedure care processes, when use of
						the restraint is not the accepted clinical practice for treating the
						individual's condition.
"Restraints for protective purposes" means using a
						mechanical device to compensate for a physical or cognitive deficit when the
						individual does not have the option to remove the device. The device may limit
						an individual's movement, for example, bed rails or a gerichair, and prevent
						possible harm to the individual or it may create a passive barrier, such as a
						helmet to protect the individual.
"Restriction" means anything that limits or prevents an
						individual from freely exercising his rights and privileges.
"Risk management" means an integrated system-wide program
						to ensure the safety of individuals, employees, visitors, and others through
						identification, mitigation, early detection, monitoring, evaluation, and
						control of risks.
"Root cause analysis" means a method of problem solving
						designed to identify the underlying causes of a problem. The focus of a root
						cause analysis is on systems, processes, and outcomes that require change to
						reduce the risk of harm.
"Screening" means the process or procedure for
						determining whether the individual meets the minimum criteria for initial
						assessment.
"Seclusion" means the involuntary placement of an
						individual alone in an area secured by a door that is locked or held shut by a
						staff person, by physically blocking the door, or by any other physical means
						so that the individual cannot leave the area.
"Serious incident" means any event or circumstance that
						causes or could cause harm to the health, safety, or well-being of an
						individual. The term "serious incident" includes death and serious
						injury.
"Level I serious incident" means a serious incident that
						occurs or originates during the provision of a service or on the premises of
						the provider and does not meet the definition of a Level II or Level III
						serious incident. Level I serious incidents do not result in significant harm
						to individuals but may include events that result in minor injuries that do not
						require medical attention or events that have the potential to cause serious
						injury, even when no injury occurs.
"Level II serious incident" means a serious incident that
						occurs or originates during the provision of a service or on the premises of
						the provider that results in a significant harm or threat to the health and
						safety of an individual that does not meet the definition of a Level III
						serious incident. "Level II serious incident" includes a significant harm or
						threat to the health or safety of others caused by an individual. Level II
						serious incidents include:
1. A
					 serious injury;
2. An individual
					 who is or was missing;
3. An
					 emergency room visit;
4. An
					 unplanned psychiatric or unplanned medical hospital admission of an individual
					 receiving services other than licensed emergency services, except that a
					 psychiatric admission in accordance with an individual's wellness plan shall
					 not constitute an unplanned admission for the purposes of this
					 chapter;
5. Choking incidents that
					 require direct physical intervention by another person;
6. Ingestion of any hazardous material;
					 or
7. A diagnosis of:
a. A decubitus ulcer or an increase in
					 severity of level of previously diagnosed decubitus ulcer;
b. A bowel obstruction; or
c. Aspiration pneumonia.