Definition Of General Terms Used In All Rules

As used in Chapters 0940-05-01 through 0940-05-47 of these rules, unless the context indicates otherwise, terms have the following meaning: (1) “Alcohol and Drug Treatment Services” includes evaluation, treatment, residential personal care, habilitation, rehabilitation, counseling, or supervision of service recipients who abuse or are dependent upon alcohol or drugs; or services designed to prevent alcohol and/or drug abuse or dependence. (2) “Ambulatory Service Recipient” means a service recipient who is physically and mentally capable under emergency conditions of finding a way to safety without physical assistance from another person. An ambulatory service recipient may use a cane, wheelchair or other supportive device and may require verbal prompting. (3) “Applicant or Licensee Applicant” means the proprietorship, partnership, association, governmental agency, or corporation which makes, or is required to make, application for the licensure of a facility determined to be under the licensure jurisdiction of the Department. (4) “Assessment” means a documented evaluation of a service recipient for the purpose of determining prevention, treatment and/or rehabilitation needs. An assessment may, but does not necessarily, include examinations and tests determined to be necessary by the service staff based on the presenting problems and symptoms of the individual service recipient. (5) “Capable of Self-Preservation” means that a service recipient is capable of responding to an approved emergency signal, including prompting by voice, by following a pre-taught evacuation procedure within a reasonable time limitation whether or not the service recipient is fully aware of the reasons for the action. A service recipient is capable of self-preservation if the service recipient is able to transfer unassisted from the bed or another fixed position to an individualized means of mobility, which is continuously available, and able to demonstrate the ability to transverse a pre-defined means of egress from the facility within a reasonable time limitation. Service recipients who have imposed upon them security measures beyond their control, which prevent their egress from the facility, are not capable of self-preservation. (6) “Caregiver” means a temporary care-giving adult person with power of attorney for care of minor child as defined by T.C.A. § 34-6-302. DEFINITIONS CHAPTER 0940-05-01 (7) “Chief Executive Officer or Director” means the person appointed, designated, or hired by the governing body to be responsible for the day-to-day operation of the facility or facilities operated by the licensee. (8) “Civil Rights” means the rights of personal liberty guaranteed to citizens by the Constitutions of the United States and the State of Tennessee, and by federal and state statutes. (9) “Community Living Skills” means the array of skills which enables a service recipient to live independently in the community. These include, but are not limited to, skills in the following areas: independent living, educational/vocational, inter-personal, social, problem solving, financial, leisure time, mobility in the community and use of community resources. (10) “Conservator” means a person or persons appointed by the court to provide partial or full supervision, protection and assistance of the person or property, or both, of a disabled person as defined in T.C.A. § 34-1-101. (11) “Corporal Punishment” means the application of painful stimuli to the body in an attempt to terminate behavior or as a penalty for behavior, but does not mean aversive stimuli. (12) “Declaration for Mental Health Treatment” means a document that allows an individual sixteen (16) years of age or older or an emancipated minor with the capacity to make informed mental health treatment decisions to say how the individual wants to be treated when the individual is unable to make an informed mental health treatment decision. (13) “Department” means the Tennessee Department of Mental Health and Substance Abuse Services. (14) “DSM” means the current version of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, a handbook for mental health professionals listing different categories of mental disorders and the criteria for diagnosing them. (15) “Emotional Abuse” means any threatening behavior or statement directed toward a service recipient that causes emotional trauma or fear including, but not limited to, ridicule, gestures which subject the service recipient to humiliation or degradation, or threatening motions or noises intended to startle or frighten the service recipient. (16) “Exploitation” means any act intended to exploit, extort or defraud a service recipient including, but not limited to, misuse of authority over a service recipient, forcing or compelling a service recipient to do anything illegal or immoral, attempting to extort money from a service recipient through devious means, or stealing a service recipient’s personal possessions. (17) “Facility” means an institution, treatment resource, group residence, boarding home, sheltered workshop, activity center, rehabilitation center, hospital, community mental health center, DUI school, counseling center, clinic, halfway house, or other entity by these or other names, providing mental health, mental retardation, and/or alcohol and drug treatment services. (18) “Governing Body” means the person or persons with primary legal authority and responsibility for the overall operation of the facility and to whom a director/chief executive officer is responsible. Depending upon the organizational structure, this body may be an owner or owners; a board of directors or other governing members of the licensee; or state, city, or county officials appointed by the licensee, etc. DEFINITIONS CHAPTER 0940-05-01 (19) “Grievance Procedure” means a procedure for responding to an expression of a cause of distress believed by a service recipient, or by another acting on behalf of a service recipient, to constitute a reason for complaint. (20) “Guardian” means a person or persons appointed by the court to provide partial or full supervision, protection and assistance of the person or property, or both, of a minor as defined by T.C.A. § 34-1-101. (21) “Habilitation or Habilitative Services” means the structured process by which the service provider assists a service recipient to acquire and maintain those life skills which enables the service recipient to cope more effectively with the demands of the service recipient’s own person and environment and to raise the service recipient’s physical, mental, and social functioning. This process includes programs of formal, structured education and training referred to as “individualized program planning.” (22) “ICD” means the current version of the International Statistical Classification of Diseases and Related Health Problems, published by the World Health Organization. The ICD provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. (23) “Independent Living Skills” means the complete continuum of skills involved in increasing independence. These include, but are not limited to the following areas: grooming/personal hygiene, selection/care of clothing, responsible self-medication, personal safety, housekeeping, nutritional/meal preparation, eating/table manners, use of telephone and money/budgeting concepts. (24) “Individualized Program Plan” means a document developed by the treatment staff/team and the service recipient, which identifies the service recipient’s problems and specifies goals to be addressed in treatment and the interventions used to accomplish these goals. (25) “Isolation” means the confinement of a service recipient alone in a room or an area where the service recipient is prevented from leaving. This definition is not limited to instances in which a service recipient is confined by a locked or a closed door. Isolation does not include: (a) The segregation of a service recipient for the purpose of managing biological contagion consistent with the Centers for Disease Control Guidelines; (b) Confinement to a locked unit or ward where other service recipients are present. Isolation is not solely confinement of a service recipient to an area, but separation of the service recipient from other persons; or (c) Time-out, a behavior management procedure in which the opportunity for positive reinforcement is withheld, contingent upon the demonstration of undesired behavior. Time-out may involve the voluntary separation of an individual service recipient from others. (26) “Legend Drugs” mean any item that federal law prohibits dispensing without a prescription as defined in T.C.A. § 53-10-101. (27) “Licensed Clinical Psychologist” means a psychologist licensed to practice psychology in Tennessee with the certified competency in clinical psychology determined by the State Licensing Board for the Healing Arts and the Board of Examiners in Psychology. (28) “Licensed Practitioner” means an individual who is licensed by the Tennessee Health Related Boards as a: DEFINITIONS CHAPTER 0940-05-01 (a) Physician (medical doctor or doctor of osteopathy); (b) Certified nurse practitioner; (c) Physician assistant; (d) Nurse with a master’s degree in nursing who functions as a psychiatric nurse; (e) Psychologist with health service provider designation; (f) Licensed professional counselor; (g) Senior psychological examiner; (h) Licensed marriage and family therapist; (i) Licensed clinical social worker; (j) Licensed psychological examiner; or (k) Licensed alcohol and drug abuse counselor. (29) “Licensee” means the proprietorship, partnership, association, governmental agency, or corporation which operates a facility under the licensure jurisdiction of the Department. (30) “Medication” means drug, either prescribed or available over the counter, intended for use in the diagnosis, cure, mitigation, treatment or prevention of disease or condition. (31) “Medication Assistance” means loosening the cap on a pill bottle for oral medication or opening medication packaging and placing the medication within reach of the service recipient, but does not allow the caregiver to give the medication to the individual. Assistance includes medication reminders, and is limited to holding a service recipient’s hand steady to help them with drinking liquid medication, guiding their hand when the individual is applying eye/ear/nose drops and wiping the excess liquid, helping with a nasal cannula or mask for oxygen, or plugging the machine in and turning it on. (32) “Mental Health Services” means all services pertaining to and incidental to the prevention, diagnosis, evaluation, treatment, domiciliary care, training, habilitation, counseling, or supervision of service recipients who are mentally ill or service recipients with alcohol and/or drug abuse or dependency disorders. (33) “Mental Retardation Services” means all services pertaining to and incidental to the prevention, diagnosis, evaluation, treatment, domiciliary care, training, habilitation, counseling, or supervision of mental retardation or service recipients who have mental retardation. (34) “Mentally Ill Service Recipient” means a service recipient who has a psychiatric disorder, alcohol dependence or drug dependence, but does not mean an individual whose only disability is mental retardation or a developmental disability. (35) “Mobile Non-Ambulatory Individual” means an individual who is able, without other assistance, to transfer to and move about only with the aid of a wheelchair, walker, crutch, wheeled platform, or similar device. (36) “On-Duty and On-Site” means a staff person who is on the facility’s premises and has the obligation to carry out any job responsibilities designated in his/her job description. DEFINITIONS CHAPTER 0940-05-01 (37) “On-Site” means a staff person who is on the facility’s premises but is only required to be on duty during an emergency. (38) “Personal Care” means services provided to a service recipient who does not require chronic or convalescent medical or nursing care. Personal care is the safekeeping and supervision of the service recipient’s self-administration of prescription medication along with any of the following services: (1) responsibility for the safety of the service recipient, (2) a daily awareness by the management and staff of the service recipient’s functioning, (3) knowledge of his or her whereabouts, (4) reminding a service recipient of appointments, (5) the ability and readiness to intervene if a crisis arises for a service recipient, and/or (6) supervision in the following areas for the service recipient’s major life activities, self-care, self-direction; capacity for independent living or economic self-sufficiency. (39) “Physical Abuse” means harmful or painful physical contact including, but not limited to, the intentional striking, shoving, or pushing of a service recipient by anyone, including another service recipient. Also included is the use of excessive force when restraining a service recipient (e.g., using methods to restrain a service recipient which are not outlined in staff training) and acts which constituted sexual activity. (40) “Physician” means a graduate of an accredited medical school authorized to confer upon graduates the degree of Doctor of Medicine (M.D.) who is duly licensed in Tennessee or an osteopathic physician who is a graduate of a recognized osteopathic college authorized to confer the degree of Doctor of Osteopathy (D.O.) and who is licensed to practice osteopathic medicine in Tennessee. (41) “Physician Assistant” means an individual who renders services, whether diagnostic or therapeutic, which are acts constituting the practice of medicine and, but for the provisions of T.C.A. § 63-6-204, could only be performed by a licensed physician. (42) “Policies and Procedures Manual” means a document that describes the philosophy, services, organization, policies, and procedures for implementing services to the service recipients of a facility. (43) “PRN” means an order which is written to allow a medication or a treatment to be given on an as-needed basis. (44) “Psychiatrist” means a physician who specializes in the assessment and treatment of individuals having psychiatric disorders; is certified by the American Board of Psychiatry and Neurology or has the documented equivalent in education, training and/or experience; and who is fully licensed to practice medicine in the State of Tennessee. (45) “Psychoactive Drug” means a psychotropic medication. For a more complete definition see the definition for “psychotropic medication.” (46) “Psychotropic Medication” means a drug which exercises a direct effect upon the central nervous system and which is capable of influencing and modifying behavior. Drugs covered by these rules include but are not limited to: (a) Anti-depressants, (b) Anti-psychotics, (c) Agents for control of mania and depression, (d) Anti-anxiety agents, DEFINITIONS CHAPTER 0940-05-01 (e) Psychomotor stimulants, and (f) Hypnotics. (47) “Qualified Dietician” means a person licensed as a dietician/nutritionist by the Tennessee Board of Dietician/Nutritionist Examiners. (48) “Qualified Food Service Manager” means a qualified dietician, a graduate of a dietetic technician or assistant training program approved by the American Dietetic Association or a graduate of a state-approved course that provides ninety (90) or more hours of classroom instruction in food service supervision who has experience as a supervisor in a health care institution with consultation from a qualified dietician. (49) “Qualified Medical Records Practitioner” means a record technician (ART) currently accredited by the American Medical Records Association, or a registered record administrator (RRA) currently registered by the American Medical Record Association or others qualified by work experience. (50) “Qualified Prescribers” means individuals authorized to prescribe medications by the State of Tennessee Board of Medical Examiners or the Tennessee Board of Nursing. (51) “Quality Assurance” means a systematic procedure for the review and evaluation of the agency’s functions, quality of services and the utilization of resources in the provision of services. (52) “Recovery” means the process in which service recipients diagnosed with mental illness and/or alcohol and/or drug abuse or dependency disorders live, work, learn, and participate fully in their communities. Recovery services help service recipients live a full or productive life with a disability and may result in the reduction or complete remission of problems or abstinence from addictive behaviors. Recovery services include: basic education about mental illness or addictive disorders, case management, drug testing, employment support, family support, pastoral support/spiritual support, social activities, relapse prevention, housing, transportation, and consumer/peer support. (53) “Reputable and Responsible Character” means having a personal and/or business history which suggests that the licensee can be trusted with responsibility for individuals particularly vulnerable to neglect and financial and sexual exploitation. Personal and/or business histories involving operation of substandard facilities and an arrest record resulting in a conviction for offense relating to theft, larceny, embezzlement, rape, assault, homicide, drugs, and pornography, are inherently inconsistent with “reputable and responsible character.” (54) “Restraint” means measures taken to restrict service recipients’ freedom of movement including: (a) “Chemical Restraint” means a medication that is prescribed to restrict the service recipient’s freedom of movement for the control of extreme violent physical behavior. Chemical restraints are medications used in addition to, or in replacement of, the service recipient’s regular drug regimen to control extreme violent behavior. The medications that comprise the service recipient’s regular medical regimen (including PRN medications) are not considered chemical restraints, even if their purpose is to control ongoing behavior; (b) “Mechanical Restraint” means the application of a mechanical device, material, or equipment attached or adjacent to the service recipient’s body, including ambulatory DEFINITIONS CHAPTER 0940-05-01 restraints, which the service recipient cannot easily remove and that restricts freedom of movement or normal access to the service recipient’s body. Mechanical restraint does not include the use of: 1. Restrictive devices or manual methods employed by a law enforcement agent or other public safety officer to maintain custody, detention, or public safety during the transport of an individual under the jurisdiction of the criminal justice system or juveniles with charges in the juvenile justice system; or 2. Restraints for medical immobilization, adaptive support, or medical protection; or 3. Restrictive devices administratively authorized to ensure the safety of the service recipient or others when an involuntary committed service recipient must be transported. (c) “Physical Holding” means the use of staff body contact with a service recipient in order to restrict freedom of movement or normal access to one’s body to prevent the service recipient’s behavior from becoming dangerous to himself, others or property. Physical holding does not include the use of: 1. Physical touch associated with prompting, comforting or assisting that does not prevent the individual service recipient’s freedom of movement or normal access to his or her body; 2. Physical escort which means the temporary touching or holding of the hand, wrist, arm, shoulder or back for the purpose of inducing the individual to walk to a safe location; or 3. Physical intervention for the temporary holding of the hand(s), wrist(s), arm(s), shoulders(s), or leg(s) which does not otherwise restrict freedom of movement or access to one’s body, for the purpose of terminating unsafe behavior. (55) “Restrictive Procedure” means a treatment procedure that limits the rights of the service recipient for the purpose of modifying problem behavior, including but not limited to time-out and restraint. (56) “Schedule II Drugs” means drugs and other substances, by whatever official name, common or usual name, chemical name, or brand name designated, defined in T.C.A. § 39-17-407 or listed in T.C.A. § 39-17-408. (57) “Self Administration of Medication” means the ability of a service recipient to take prescribed or over-the-counter medications without assistance from another person. (58) “Service Recipient” means a person who is receiving services, has applied for services, or for whom someone has applied for or proposed services because the person has mental illness, serious emotional disturbance, or a developmental disability. (59) “Shall or Must” means a mandatory provision. (60) “Should or May” means a suggestion or recommendation. (61) “Standard Precautions” means an approach to infection control based on the principle that broken skin and mucus membranes as well as all blood, body fluids, and secretions (except sweat) may contain transmissible infectious agents. Standard precautions apply to all service recipients regardless of suspected or confirmed infection status, in any setting where care is DEFINITIONS CHAPTER 0940-05-01 provided. Current guidelines for Standard Precautions are published by the Centers for Disease Control and Prevention (CDC). (62) “Time-Out” means a behavior management procedure in which the opportunity for positive reinforcement is withheld, contingent upon the demonstration of undesired behavior. Time- out may involve the voluntary separation of an individual service recipient from others. (63) “Treatment Review Committee” means a committee to make decisions for a service recipient who lacks capacity as defined by T.C.A. § 33-3-218. The composition, duties and responsibilities of Treatment Review Committees are defined by T.C.A. § 33-6-107. (64) “Treatment” means a therapeutic process to reduce or eliminate the symptoms and side effects of mental illness, alcohol and/or drug abuse, or dependency disorders through direct observation, assessment, examination, and therapeutic intervention. Treatment services are screening; clinical assessment; diagnostic evaluation; treatment planning; therapeutic interventions including individual, family and group therapy; medication prescription and monitoring; and discharge planning and referral. (65) “Verbal Abuse” means insulting or coarse language directed toward a service recipient which subjects the service recipient to humiliation or degradation, including, but not limited to, swearing at a service recipient, name calling, taunting, and other inappropriate verbal behavior. (66) “Vocational Services” means the services provided to service recipients involving remunerative work experiences within the licensed facility and the provision of vocational activities of an industrial or productive vocational nature such as assembling, packaging, painting, stripping, wood or metal working, or manufacturing within the licensed facility. (67) “Volunteer” means a person who is not paid by the licensee and whose varied skills are used by the licensee to support and supplement the efforts of the paid facility staff.