New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 161B - STANDARDS FOR LICENSURE OF OUTPATIENT SUBSTANCE USE DISORDER TREATMENT FACILITIES
Subchapter 1 - DEFINITIONS AND STAFF QUALIFICATIONS AND RESPONSIBILITIES
Section 10:161B-1.3 - Definitions
Current through Register Vol. 56, No. 18, September 16, 2024
The following words and terms, when used in this chapter, shall have the following meanings, unless the context clearly indicates otherwise:
"Accrediting agencies" means those organizations recognized nationally that set standards and review providers based on these standards. These organizations provide their endorsement in the form of accreditation: the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), http://www.jointcommission.org; and the Commission on Accreditation of Rehabilitation Facilities (CARF), http://www.carf.org.
"Administrator" means an individual appointed by the governing authority to provide administrative oversight for all licensed programs and individual sites within a licensed facility.
"Admitted" means accepted for treatment at an outpatient substance use disorder treatment facility.
"Adolescent" means a person between the ages of 11 and up to the age of 18.
"ASAM" means the American Society of Addiction Medicine, 4601 North Park Avenue, Upper Arcade, Suite 101, Chevy Chase, MD 20815, http://www.asam.org.
"ASAM Client Placement Criteria" means the criteria developed by the American Society of Addiction Medicine to place clients in an appropriate level of care, as contained in "Client Placement Criteria for the Treatment of Substance Related Disorders," 2nd Edition revised (2001) (ASAM-PPC-2R), as amended and supplemented, incorporated herein by reference, which can be obtained from the ASAM Publications Center, 1-800-844-8948.
"ASAM Criteria" means the criteria developed by the American Society of Addiction Medicine to place clients in an appropriate level of care, as contained in The ASAM Criteria, Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions, Third Edition, 2013, as amended and supplemented, incorporated herein by reference, which can be obtained from the ASAM Publications Center, 1-800-844-8948.
"ASI" means the Addiction Severity Index, 5th Edition, as amended and supplemented, incorporated herein by reference, an instrument designed to provide important information about aspects of a client's life which may contribute to his or her substance use disorder, as developed by and available from the Treatment Research Institute, 600 Public Ledger Building, Philadelphia, PA 19106, (215) 399-0980, http://www.tresearch.org/tools/download-asi-instruments-manuals/.
"Assistant Commissioner" means the individual responsible to oversee the Division of Mental Health and Addiction Services.
"Available" means with respect to individuals employed by, or under contract with, an outpatient substance use disorder treatment facility, capable of being reached and able to be present in the facility within 30 minutes.
"BOCA" means the model building code of the organization formerly called the Building Officials and Code Administrators International Inc., now called the International Code Council, 4051 W. Flossmoor Road, Country Club Hills, IL 60477-5795, http://www.iccsafe.org, 1-888-422-7233, which can be obtained from the ICC Store, 1-800-786-4452.
"Buprenorphine" means the Federal Food and Drug Administration approved drug which is used as of the effective date of these rules, in the form of Suboxone and Subutex, for treatment of opiate dependence for medical maintenance and medically supervised withdrawal.
"Bylaws" means a set of rules adopted by the program for governing its operation. A charter, articles of incorporation, or a statement of policies and objectives, is an acceptable equivalent.
"CDC" means the Federal government agency, Centers for Disease Control and Prevention, http://www.cdc.gov.
"Certificate of Occupancy" means a certificate issued by a local authority indicating that a building meets building code requirements.
"Certified Alcohol and Drug Counselor (CADC)" means an individual who holds a current, valid certificate issued by the New Jersey State Board of Marriage and Family Therapy Examiners, as recommended by the Alcohol and Drug Counselor Committee, pursuant to N.J.S.A. 42:2D-5 and 13:34C-2.3; accessible at http://www.njconsumeraffairs.gov/mft/Pages/regulations.aspx, (973) 504-6415.
"Child Abuse Record Information" or "CARI" means the information in the child abuse registry as established in 9:6-8.11, which may be released to a person or agency outside the Department of Children and Families, Division of Child Protection and Permanency only as prescribed by law.
"Client" means any individual receiving treatment services in a licensed treatment facility. In the context of this chapter, client is synonymous with "patient."
"Client-centered care" means care including substance use disorder treatment, recovery support, and prevention services which reflect the client's needs, preferences and values.
"Clinical note" means a written, signed with original signature, and dated notation made by a licensed or credentialed professional, an approved counselor in training (see 10:161B-1.9(a)2) or other authorized representative of the program who renders a service to the client or records observations of the client's progress in treatment.
"Clinical record" means all records in the facility which pertain to the client's care.
"Commissioner" means the Commissioner of the New Jersey Department of Human Services.
"Communicable disease" means an illness due to a specific infectious agent or its toxic products, which occurs through transmission of that agent or its products from a reservoir to a susceptible host.
"Conditional license" means a license pursuant to N.J.A.C. 10:161B-2.7. A conditional license is not a full license and requires the licensee to comply with all specific conditions imposed by DCN&L in addition to the licensure requirements in this chapter.
"Conspicuously posted" means placed at a location within the facility accessible to and seen by clients and the public.
"Contamination" means the presence of an infectious or toxic agent in the air, on a body surface, or on/in clothes, bedding, instruments or dressings, or other inanimate articles or substances, including water, milk, and food.
"Continuum of Care Plan" means a written plan initiated at the time of the client's admission, and regularly updated throughout the course of treatment, which addresses the needs of the client after discharge; may be referred to as a Discharge Plan.
"Controlled dangerous substances" or "controlled substances" means drugs defined by and subject to the Federal Controlled Dangerous Substances Act of 1970 (Public Law 91-513; 21 U.S.C. §§ 801 et seq.) and the New Jersey Controlled Dangerous Substances Act, 24:21-1 et seq.
"Co-occurring disorder" means a concurrent substance use disorder and mental health disorder as described in the DSM-5, in which the substance use disorder and mental health disorders are both primary.
"Counseling" means the utilization of special skills and evidence based practices to assist individuals, families, significant others, and/or groups to identify and change patterns of behavior relating to substance use disorders which are maladaptive, destructive and/or injurious to health through the provision of individual, group and/or family therapy by licensed or credentialed professionals or approved counselors in training. Counseling does not include self-help support groups such as Alcoholics Anonymous, Narcotics Anonymous, and similar 12-step programs.
"CSAT" means the Federal Center for Substance Abuse Treatment, within the Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, http://csat.samhsa.gov.
"Curtailment" means an order by DCN&L which requires a licensed substance use disorder treatment facility to cease and desist all admissions and readmissions of clients to the facility.
"Daily census" means the number of clients receiving services at the facility on any given day.
"DCF" means the New Jersey Department of Children and Families.
"DCN&L" means the Division of Certificate of Need and Licensing within the Health Services Branch of the DOH.
"Deficiency" means a determination by DCN&L of one or more instances in which a State licensing regulation has been violated.
"Department" or "DHS" means the New Jersey Department of Human Services.
"Dependence" means physical and/or psychological dependence on a substance resulting from the chronic or habitual use of alcohol, tobacco, any kind of controlled substance, narcotic drug, or other prescription or non-prescription drug.
"Designated person" means, in the context of client care, the person chosen by the client to be notified if the client sustains an injury requiring medical care, an accident or incident occurs, there is deterioration in the client's physical or mental condition, the client is transferred to another facility, or the client is discharged or dies while in treatment.
"Detoxification" means the provision of care, usually short term, prescribed by a physician and conducted under medical supervision, for the purpose of withdrawing a person from a specific psychoactive substance in a safe and effective manner according to established written medical protocols.
"Detoxification treatment short-term" means detoxification treatment for a period not in excess of 30 days.
"Detoxification treatment long-term" means detoxification treatment for a period more than 30 days but not in excess of 180 days.
"DHS" means the New Jersey Department of Human Services.
"Didactic session" means a structured treatment intervention designed to instruct or teach clients about topics related to substance use disorders and treatment related issues.
"Discharge plan" means a written plan initiated at the time of the client's admission, and regularly updated throughout the course of treatment, which addresses the needs of the client after discharge; also referred to as a Continuum of Care Plan.
"DMHAS" means the Division of Mental Health and Addiction Services, a division within the New Jersey Department of Human Services.
"DOH" means the New Jersey Department of Health.
"Dosage" means, in the context of administering medication in prescribed amounts, the quantity of a drug to be taken or applied all at one time or in fractional amounts within a given period of time.
"Drug" means any article recognized in the official United States Pharmacopoeia-National Formulary (USP 31-NF26), accessible at http://www.usp.org/usp-nf, 1-800-227-8772; or the official Homeopathic Pharmacopoeia of the United States/Revision Service, at http://www.hpus.com, as amended and supplemented, incorporated herein by reference, including, but not limited to, a controlled substance, a prescription legend drug, an over the counter preparation, a vitamin or food supplement, transdermal patch or strip, or any compounded combination of any of the above intended for use in the diagnosis, cure, mitigation, treatment or prevention of disease or medical condition in humans/animals or intended to affect the structure or function of the human body.
"Drug screening test negative" means a urine or other DHS-approved specimen from a client that is tested and reports a negative result for drugs of abuse. In an opioid treatment program, the specimen is negative for drugs of abuse but shows the presence of methadone.
"Drug screening test positive" means a urine or other DHS-approved specimen from a client that is tested and reports positive for drugs of abuse, including, but not limited to, amphetamines, barbiturates, cocaine, opiates, marijuana, benzodiazepine, etc.
"DSM-5" means the Diagnostic and Statistical Manual of Mental Disorders,
Fifth Edition, as amended and supplemented, incorporated herein by reference, the standard classification of
mental disorders in the United States, published by and available from the American Psychiatric Association,
1000 Wilson Boulevard, Suite 1825, Arlington VA 22209-3901,
"DSM-IV-TR" means the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision, as amended and supplemented, incorporated herein by reference, the standard classification of mental disorders in the United States, published by and available from the American Psychiatric Association, 1000 Wilson Boulevard, Suite 1825, Arlington VA 22209-3901, http://www.dsmivtr.org.
"Evidence based practices" means interventions and approaches supported empirically through systematic research and evaluation. These are to be distinguished from best practices, which are interventions and approaches more likely to yield desired results, based on indicative studies or judgment/consensus of experts.
"Facility" means an outpatient substance use disorder treatment facility and/or program pursuant to State statute and this chapter.
"Family" means immediate kindred, domestic partner, legal guardian, legally authorized representative, executor, or an individual granted a power of attorney. The term may also be expanded to include those persons having a commitment and/or personal significance to the client.
"Floor stock" means medications from a pharmacist in a labeled container in limited quantities that are not necessarily prescribed for one or more specific individuals.
"Governing authority" means the organization, person, or persons or the board of directors or trustees of a non-profit corporation designated to assume legal responsibility for the management, operation, and financial viability of the facility.
"Handicapped" means disabled as defined in the Federal Americans with Disabilities Act, 1990, 42 U.S.C. §§ 12101 et seq.
"HIV" means human immunodeficiency virus.
"Immediate and serious threat" means a deficiency or violation that has caused or will imminently cause at any time serious injury, harm, impairment, or even death to clients of the facility.
"Incapacitated" means when a person, as a result of the use of alcohol or other drugs, is unconscious or has his or her judgment so impaired that he or she is incapable of realizing and making a rational decision with respect to his or her need for treatment even though he or she is in need of substantial medical attention.
"Integrated treatment" means the coordination of both substance use disorder and mental health interventions, preferably by one clinician; integrated services should appear coordinated to the client participating in services.
"Interpreter services" means communication services provided to a client and/or family member unable to comprehend and/or communicate without assistance by an interpreter (for example, screened by the NJ Department of Human Services, Division of the Deaf and Hard of Hearing, or similar agency responsible for such screening) due to a language barrier or another disability.
"Intoxicated" means when a person's mental or physical functioning is substantially impaired as a result of the use of alcoholic beverages or other mood-altering chemicals.
"Job description" means written specifications developed for each position in the facility, containing the qualifications, duties and responsibilities, and accountability required of employees in that position.
"Juvenile" means a person under 18 years of age.
"Legally authorized representative" means an individual or judicial or other body authorized under New Jersey law to consent on behalf of a client subject to the client's (competent) participation in the procedure.
"License" means a certificate of approval pursuant to 26:2G-21 et seq, and/or a license pursuant to 26:2B-7 et seq.
"Licensed clinical alcohol and drug counselor (LCADC)" means an individual who holds a current, valid license issued pursuant to 45:2D-4 and 45:2D-16 and 13:34C-2.2 and 2.1(c).
"Medical maintenance" means the administration and/or dispensing of opioid agonist medications and related medical services to a client who has been referred from an opioid treatment program to a designated physician providing services either in the treatment facility (that is, clinic-based) or in the private office (that is, office-based) of the physician under a formalized agreement approved by the CSAT and DMHAS.
"Medication" means a drug or medicine as defined by the New Jersey State Board of Pharmacy rules, as set forth in N.J.A.C. 13:39, which is accessible at http://www.njconsumeraffairs.gov/regulations/Chapter-39-State-Board-of-Pharmacy.pdf.
"Medication administration" means a procedure in which a prescribed medication is given to a client by an authorized person in accordance with all laws and rules governing such procedures. The complete procedure of administration includes removing an individual dose from a previously dispensed, properly labeled container (including a unit dose container), verifying it with the prescriber's orders, giving the individual dose to the client, seeing that the client takes it (if oral), and documenting the required information, including the method of administration.
"Medication dispensing" means a procedure entailing the interpretation of the original or direct copy of the prescriber's order for a medication or a biological and, pursuant to that order, the proper selection, measuring, labeling, packaging, and issuance of the drug or biological to a client or a service unit of the facility, conforming with the rules of the New Jersey Board of Pharmacy at N.J.A.C. 13:39.
"Methadone" means a synthetic narcotic (opioid) used in the treatment of opiate addiction by State and Federally approved opioid treatment programs.
"Methadone maintenance" means the dispensing of methadone at relatively stable dosage levels as part of the treatment of an individual for dependence on heroin or other opioids.
"Multidisciplinary team" means those persons, representing different professions, disciplines, and service areas, who work together to provide treatment planning and care to the client.
"New Jersey Substance Abuse Monitoring System (NJSAMS)," http://njsams.rutgers.edu/njsams/, means the client data collection information system required by DMHAS to be used for all New Jersey substance use disorder treatment facilities to record and report client data including, but not limited to, admission, status, services, discharge, and such other client information as DMHAS may require.
"NIDA" means the National Institute on Drug Abuse within the National Institutes of Health, http://www.nida.nih.gov.
"NJ" means New Jersey or the State of New Jersey.
"Nosocomial infection" means an infection acquired by a client while in an outpatient substance use disorder treatment facility.
"Office of Licensing" or "OOL" means the Office of Licensing within the DHS Office of Program Integrity and Accountability.
"Opiate" means any preparation or derivative of opium.
"Opioid" means both opiates and synthetic narcotics.
"Opioid treatment program (OTP)" means a program where there is the dispensing of an opioid agonist treatment medication, (that is methadone and other approved medications) along with a comprehensive range of medical and rehabilitative services, when clinically necessary and in compliance with State regulations, to an individual to alleviate the adverse medical, psychological, or physical effects incident to opiate addiction. This term encompasses opioid detoxification treatment, short-term detoxification treatment, long-term detoxification treatment, maintenance treatment, comprehensive maintenance treatment and interim maintenance treatment. Opioid treatment programs providing short-term detoxification (that is less than 30 days) shall comply with the provisions of the detoxification subchapter of this chapter, N.J.A.C. 10:161B-12.
"Outcomes" means client level of functioning on specific criteria post-treatment as compared with their level of functioning at intake. These criteria include drug and alcohol use, employment, criminal activity, homelessness, and social connectedness, consistent with the SAMHSA National Outcome Measures, accessible at http://integratedrecovery.org/wp-content/uploads/2010/08/SAMHSA-National-Outcome-Measures.pdf.
"Outpatient substance use disorder treatment facility" means a facility that is licensed to provide outpatient substance use disorder treatment in one or more of the following categories:
1. Outpatient (OP): A service offered at a licensed, outpatient facility, which provides regularly scheduled individual, group and/or family counseling for less than nine hours per week. This care approximates ASAM Criteria Level I.
2. Intensive outpatient (IOP): A service offered at a licensed outpatient facility that provides a range of treatment sessions. Services include clinical intensive substance abuse counseling and psycho-education (didactic) sessions. Services are provided in a structured environment for a minimum of nine hours of counseling per week for adults and six hours per week for adolescents. This care approximates ASAM Criteria Level II.1;
3. Partial care (PC): A service offered at a licensed outpatient facility that provides a broad range of clinically intensive treatment services in a structured environment for a minimum of 20 hours per week, during day or evening hours. Treatment includes substance abuse counseling, educational and community support services. Programs have ready access to psychiatric, medical and laboratory services. This care approximates ASAM Criteria Level II.5;
4. Outpatient detoxification: A service offered at a licensed outpatient facility that provides a range of services including medical and clinical interventions, laboratory testing, the dispensing and/or administration of approved medications provided to treat and monitor clients undergoing withdrawal from drugs, including alcohol. This also includes provision of concurrent assessment, and counseling support services for the purpose of placing these clients in an appropriate treatment setting for continuing care. This care approximates ASAM Criteria Level I-D or Level II-D; and
5. Opioid treatment: A service offered at a licensed outpatient facility which utilizes methadone, Suboxone or other approved medications to detoxify or maintain substance abusers who are addicted to heroin or other opiate-like drugs. Medication is provided in conjunction with medical monitoring, laboratory testing, clinical assessment, counseling and support services. This care approximates ASAM Criteria Opiate Maintenance Therapy.
"Plan of correction" means a plan developed by the facility and reviewed and approved by DCN&L which describes the actions the facility will take to correct deficiencies and specifies the timeframe in which those deficiencies will be corrected.
"Practitioner" means a person licensed to practice medicine or surgery in accordance with 45:9-1 et seq. and N.J.A.C. 13:35, or a medical resident or intern, or a podiatrist licensed pursuant to 45:5-1 et seq. and N.J.A.C. 13:35.
"Progress note" means a written, signed with original signature, and dated notation by a member of the multidisciplinary team summarizing facts about care and the client's response to care, during a given period of time.
"Provisional license" means a full license that has been reduced because the facility is not in full compliance with all licensing rules in this chapter. A provisional license holder is subject to DCN&L oversight until it comes into full compliance with this chapter.
"Reasonable efforts" means an inquiry on the employment application, reference checks, and/or criminal background checks where indicated or necessary.
"Release of Information" means a document which allows a program to
release client information to designated person(s) with the client's written consent, in compliance with the
Federal Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule at 45 CFR Parts 160 and 164,
Subparts A and E; and the Federal Confidentiality of Alcohol and Drug Abuse Patient Records regulation at 42
CFR Part 2, both of which are accessible at
"SAMHSA" means the Substance Abuse and Mental Health Services
Administration within the Federal Department of Health and Human Services,
"Self-administration" means a procedure in which any medication is taken orally, injected, inhaled, inserted, topically, or otherwise administered by a client to himself or herself.
"Signature" means at least the first initial and full surname, title and credential (for example, R.N., L.P.N., M.D., D.O., LCADC, CADC) of a person, legibly written, with his or her own hand. If electronic signatures are used, they shall be used in accordance with this chapter, 10:161B-18.4(b)1.
"Staff education plan" means a written plan that describes a coordinated program for staff education, including in-service programs and on the job training.
"Staff orientation plan" means a written plan for each new employee to learn about or get acquainted with the duties and responsibilities of the position as defined in the job description as well as the other policies of the facility and/or program.
"Substance abuse/dependence" means a maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to the repeated use of substances. There may be repeated failure to fulfill major role obligations, repeated use in situations in which it is physically hazardous, multiple legal problems, and recurrent social and interpersonal problems. For the purpose of this chapter, substance abuse/dependence also means other substance-use related disorders as defined in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV-TR) as amended and supplemented, published by and available from the American Psychiatric Association, 1000 Wilson Boulevard, Suite 1825, Arlington, Va. 22209-3901, http://dsmivtr.org, incorporated herein by reference.
"Substance use disorder" means a maladaptive pattern of substance use
manifested by recurrent and significant adverse consequences related to the repeated use of substances. For
the purpose of this chapter, substance use disorder is defined in the Diagnostic and Statistical Manual of
Mental Disorders, Fifth Edition as amended and supplemented, published and by and available from the American
Psychiatric Association, 1000 Wilson Boulevard, Suite 1825, Arlington, Va. 22209-3901,
"Supervision (direct)" means supervision of clients provided on the premises within view or through the implementation of policies and procedures which may include electronic monitoring, to provide for the safety and the accountability of clients by staff.
"Survey" means the evaluation of the quality of care and/or the fitness of the premises, staff, and services provided by the facility as conducted by DCN&L and/or its designees to determine compliance or non-compliance with these and other applicable State licensing rules or statutes.
"Waiver" means a written approval by DCN&L following a written request from a facility, to allow an alternative to any section(s) in this chapter provided that the alternative(s) proposed would not endanger the life, safety, or health of clients or the public, as described at N.J.A.C. 10:161B-2.13.
