Arizona Administrative Code
Title 9 - HEALTH SERVICES
Chapter 21 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM (AHCCCS) BEHAVIORAL HEALTH SERVICES FOR PERSONS WITH SERIOUS MENTAL ILLNESS
Article 1 - GENERAL PROVISIONS
Section R9-21-101 - Definitions and Location of Definitions

A. Location of definitions. Unless the context otherwise requires, terms used in this Chapter that are defined in A.R.S. § 36-501 shall have the same meaning as in A.R.S. § 36-501. In addition, the following definitions applicable to this Chapter are found in the following Section or Citation:

B. In this Chapter, unless the context otherwise requires:

"Abuse" means, with respect to a client, the infliction of, or allowing another person to inflict or cause, physical pain or injury, impairment of bodily function, disfigurement or serious emotional damage which may be evidenced by severe anxiety, depression, withdrawal or untoward aggressive behavior. Such abuse may be caused by acts or omissions of an individual having responsibility for the care, custody or control of a client receiving behavioral health services or community services under this Chapter. Abuse shall also include sexual misconduct, assault, molestation, incest, or prostitution of, or with, a client under the care of personnel of a mental health agency.

"Administration" means the Arizona Health Care Cost Containment System.

"Agency director" means the person primarily responsible for the management of an outpatient or inpatient mental health agency, service provider, health plan or the Administration, or their designees.

"AHCCCS" means the Arizona Health Care Cost Containment System.

"Applicant" means an individual who:

Submits to a health plan an application for behavioral health services under this Chapter or on whose behalf an application has been submitted; or

Is referred to a health plan for a determination of eligibility for behavioral health services according to this Chapter.

"ASH" means the Arizona State Hospital.

"Authorization" means written permission for a mental health agency to release or disclose a client's record or information, containing:

The name of the mental health agency releasing or disclosing the client's record or information;

The purpose of the release or disclosure;

The individual, mental health agency, or entity requesting or receiving the client's record or information;

A description of the client's record or information to be released or disclosed;

A statement:

Of permission for the mental health agency to release or disclose the client's record or information; and

That permission may be revoked at any time;

The date when or conditions under which the permission expires;

The date the document is signed; and

The signature of the client or, if applicable, the client's guardian.

"Behavioral health issue" means an individual's condition related to a mental disorder, personality disorder, substance abuse, or a significant psychological or behavioral response to an identifiable stressor or stressors.

"Behavioral health service" means the assessment, diagnosis, or treatment of an individual's behavioral health issue.

"Burden of proof" means the necessity or obligation of affirmatively proving the fact or facts in dispute.

"Case manager" means the person responsible for locating, accessing and monitoring the provision of services to clients in conjunction with a clinical team.

"Client" means an individual who has a qualifying serious mental illness and is being evaluated or treated for a mental disorder by or through a health plan.

"Client record" means the written compilation of information that describes and documents the evaluation, diagnosis or treatment of a client.

"Client who needs special assistance" means a client who has been:

Deemed by a qualified clinician, case manager, clinical team, or health plan to need special assistance in participating in the ISP or ITDP process, which may include, but is not limited to:

A client who requires 24-hour supervision;

A client who is, in fact, incapable of making or communicating needs but is without a court-appointed fiduciary; or

A client with physical disabilities or language difficulties impacting the client's ability to make or communicate decisions or to prepare or participate in meetings; or

Otherwise deemed by a program director, the Administration, or an Administrative Law Judge to need special assistance to effectively file a written grievance, to understand the grievance and investigation procedure, or to otherwise effectively participate in the grievance process under this Chapter.

"Clinical team" refers to the interdisciplinary team of persons who are responsible for providing continuous treatment and support to a client and for locating, accessing and monitoring the provision of behavioral health services or community services. A clinical team consists of a psychiatrist, case manager, vocational specialist, psychiatric nurse, and other professionals or paraprofessionals, such as a psychologist, social worker, consumer case management aide, or rehabilitation specialist, as needed, based on the client's needs. The team shall also include a team leader who is a certified behavioral health supervisor.

"Community services" means services such as clinical case management, outreach, housing and residential services, crisis intervention and resolution services, mobile crisis teams, day treatment, vocational training and opportunities, rehabilitation services, peer support, social support, recreation services, advocacy, family support services, outpatient counseling and treatment, transportation, and medication evaluation and maintenance.

"Condition requiring investigation" means, within the context of the grievance and investigation procedure set forth in Article 4 of this Chapter, an incident or condition which appears to be dangerous, illegal, or inhumane, including a client death.

"Court-ordered treatment" means treatment ordered by the court under A.R.S. Title 36, Chapter 5.

"Court-ordered evaluation" means evaluation ordered by the court under A.R.S. Title 36, Chapter 5.

"Crisis services" or "emergency services" means immediate and intensive, time-limited, crisis intervention and resolution services which are available on a 24-hour basis and may include information and referral, evaluation and counseling to stabilize the situation, triage to an inpatient setting, clinical crisis intervention services, mobile crisis services, emergency crisis shelter services, and follow-up counseling for clients who are experiencing a psychiatric emergency.

"Dangerous" as used in Article 4 of this Chapter means a condition that poses or posed a danger or the potential of danger to the health or safety of any client.

"Department" means the Arizona Department of Health Services.

"Designated representative" means a parent, guardian, relative, advocate, friend, or other person, designated in writing by a client or guardian who, upon the request of the client or guardian, assists the client in protecting the client's rights and voicing the client's service needs.

"Determining Entity" means either the AHCCCS designee authorized to make SMI determinations or a Tribal Regional Behavioral Health Authority (for each TRBHA, tribal members only) authorized to make the final determination of SMI eligibility.

"Discharge plan" means a hospital or community treatment and discharge plan prepared according to Article 3 of these rules.

"Drug used as a restraint" means a pharmacological restraint as used in A.R.S. § 36-513 that is not standard treatment for a client's medical condition or behavioral health issue and is administered to:

Manage the client's behavior in a way that reduces the safety risk to the client or others,

Temporarily restrict the client's freedom of movement.

"DSM" means the latest edition of the "Diagnostic and Statistical Manual of Mental Disorders," edited by the American Psychiatric Association.

"Emergency safety situation" means unanticipated client behavior that creates a substantial and imminent risk that the client may inflict injury, and has the ability to inflict injury, upon:

The client, as evidenced by threats or attempts to commit suicide or to inflict injury on the client; or

Another individual, as evidenced by threats or attempts to inflict injury on another individual or individuals, previous

behavior that has caused injury to another individual or individuals, or behavior that places another individual or individuals in reasonable fear of sustaining injury.

"Exploitation" means the illegal or improper use of a client or a client's resources for another's profit or advantage.

"Frivolous" as used in this Chapter, means a grievance that is devoid of merit. Grievances are presumed not to be frivolous unless the grievance:

Involves conduct that is not within the scope of this Chapter,

Is impossible on its face, or

Is substantially similar to conduct alleged in two previous grievances within the past year that have been determined to be unsubstantiated as provided in this Chapter.

"Generic services" means services other than behavioral health or other services for which clients may have a need and include, but are not limited to, health, dental, vision care, housing arrangements, social organizations, recreational facilities, jobs, and educational institutions.

"Grievance" means a complaint regarding an act, omission or condition, as provided in this Chapter.

"Guardian" means an individual appointed by court order according to A.R.S. Title 14, Chapter 5, or similar proceedings in another state or jurisdiction where said guardianship has been properly domesticated under Arizona law.

"Health Plan" means a Regional Behavioral Health Authority (RBHA), health plan, or Arizona Long Term Care Plan under contract with the Administration to coordinate the delivery of behavioral health services members in a geographically specific service area of the state for eligible persons.

"Hearing officer" refers to an impartial person designated by the Office of Administrative Hearing to hear a dispute and render a written decision.

"Human rights advocate" means the human rights advocates appointed by the Administration under R9-21-105.

"Independent Oversight committee" means the committee established under A.R.S. § 41-3803.

"Illegal" means, within the context of the grievance and investigation procedure set forth in Article 4 of this Chapter, an incident or occurrence which is or was likely to constitute a violation of a state or federal statute, regulation, court decision or other law, including the provisions of these Articles.

"Individual service plan" or "ISP" means the written plan for services to a client, prepared in accordance with Article 3 of this Chapter.

"Inhumane" as used in Article 4 of this Chapter means an incident, condition or occurrence that is demeaning to a client, or which is inconsistent with the proper regard for the right of the client to humane treatment.

"Inpatient facility" means the Arizona State Hospital, the County Annex, or any other inpatient treatment facility registered with or funded by or through the Administration to provide behavioral health services, including psychiatric health facilities, psychiatric hospitals, and psychiatric units in general hospitals.

"Inpatient treatment and discharge plan" or "ITDP" means the written plan for services to a client prepared and implemented by an inpatient facility in accordance with Article 3 of this Chapter.

"Long-term view" means a planning statement that identifies, from the client's perspective, what the client would like to be doing for work, education, and leisure and where the client would like to be living for up to a three-year period. The long-term view is based on the client's unique interests, strengths, and personal desires. It includes predicted times for achievement.

"Mechanical restraint" means any, device, article, or garment attached or adjacent to a client's body that the client cannot easily remove and that restricts the client's freedom of movement or normal access to the client's body, but does not include a device, article, or garment:

Used for orthopedic or surgical reasons, or

Necessary to allow a client to heal from a medical condition or to participate in a treatment program for a medical condition.

"Medical practitioner" means a

Physician,

Physician assistant, or

Nurse practitioner.

"Meeting" means an encounter or assembly of individuals which may be conducted in person or by telephone or by video-conferencing.

"Mental health agency" includes a health plan, service provider, inpatient facility, or an entity that conducts screening and evaluation under Article 5.

"MIHS Behavioral Health Annex" means the Maricopa County Psychiatric Annex of the Maricopa Medical Center.

"Nurse" means an individual licensed as a registered nurse or a practical nurse according to A.R.S. Title 32, Chapter 15.

"Party" or "parties" as used in Articles 3 and 4 of these rules means the person filing a grievance under this Chapter, the agency director who issued any final resolution or decision of such a grievance, the person whose conduct is complained of in the grievance, any client or applicant who is the subject of the request or grievance, the legal guardian of client or applicant, and, in selected cases, the appropriate Independent Oversight committee.

"Personal restraint" means the application of physical force without the use of any device, for the purpose of restricting the free movement of a client's body.

"PRN order" or "Pro re nata medication" means medication given as needed.

"Program director" means the person with the day-to-day responsibility for the operation of a programmatic component of a service provider, such as a specific residential, vocational, or case management program.

"Qualified clinician" means a behavioral health professional who is licensed or certified under A.R.S. Title 32, or a behavioral health technician who is supervised by a licensed or certified behavioral health professional.

"Region" means the geographical region designated by the Administration in its contract with the health plan.

"Restraint" means personal restraint, mechanical restraint, or drug used as a restraint.

"Seclusion" means restricting a client to a room or area through the use of locked doors or any other device or method which precludes a client from freely exiting the room or area or which a client reasonably believes precludes his unrestricted exit. In the case of an inpatient facility, confining a client to the facility, the grounds of the facility, or a ward of the facility does not constitute seclusion. In the case of a community residence, restricting a client to the residential site, according to specific provisions of an individual service plan or court order, does not constitute seclusion.

"Seriously mentally ill" means a person 18 years of age or older as defined in A.R.S. § 36-550.

"Service provider" means an agency, inpatient facility or other mental health provider funded by or through, under contract or subcontract with, certified by, approved by, registered with, or supervised by the Administration or receiving funds under Title XIX, to provide behavioral health services or community services.

"State Protection and Advocacy System" means the agency designated as the Protection and Advocacy System for individuals with mental illness, according to 42 U.S.C. 10801-10851.

"Title XIX" means Title XIX of the Social Security Act, 42 U.S.C. 1396 et seq.

"Treatment team" means the multidisciplinary team of persons who are responsible for providing continuous treatment and support to a client who is in an inpatient facility.