Section R9-21-101. Definitions

A.       In this Chapter, unless the context otherwise requires, the terms defined in A.R.S. § 36-501 shall have the same meaning as in A.R.S. § 36-501.

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

1.        “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, disfigure- ment or serious emotional damage which may be evi- denced by severe anxiety, depression, withdrawal or untoward aggressive behavior. Such abuse may be caused by acts or omissions of an individual having responsibil- ity 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.

2.        “Agency director” means the person primarily responsi- ble for the management of an outpatient or inpatient men- tal health agency, service provider, regional authority or the deputy director of the division, or their designees.

3.        “AHCCCSA” means the Arizona Health Care Cost Con- tainment System Administration.

4.        “Applicant” means an individual who:

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

b.        Is referred to a regional authority for a determination of eligibility for behavioral health services accord- ing to this Chapter.

5.        “ASH” means the Arizona State Hospital.

6.        “Authorization” means written permission for a mental health agency to release or disclose a client’s record or information, containing:

a.        The name of the mental health agency releasing or disclosing the client’s record or information;

b.        The purpose of the release or disclosure;

c.        The individual, mental health agency, or entity requesting or receiving the client’s record or infor- mation;

d.        A description of the client’s record or information to be released or disclosed;

e.        A statement:

i.         Of permission for the mental health agency to release or disclose the client’s record or infor- mation; and

ii.        That permission may be revoked at any time;

f.         The date when or conditions under which the per- mission expires;

g.        The date the document is signed; and

h.        The signature of the client or, if applicable, the cli- ent’s guardian.

7.        “Behavioral health issue” means an individual’s condi- tion related to a mental disorder, personality disorder, substance abuse, or a significant psychological or behav- ioral response to an identifiable stressor or stressors.

8.        “Behavioral health service” means the assessment, diag- nosis, or treatment of an individual’s behavioral health issue.

9.        “Burden of proof” means the necessity or obligation of affirmatively proving the fact or facts in dispute.

10.     “Case manager” means the person responsible for locat- ing, accessing and monitoring the provision of services to clients in conjunction with a clinical team.

11.     “Client” means an individual who is seriously mentally ill and is being evaluated or treated for a mental disorder by or through a regional authority.

12.     “Client record” means the written compilation of infor- mation that describes and documents the evaluation, diagnosis or treatment of a client.

13.     “Client who needs special assistance” means a client who has been:

a.        Deemed by a qualified clinician, case manager, clin- ical team, or regional authority to need special assis- tance in participating in the ISP or ITP process, which may include, but is not limited to:

i.         A client who requires 24-hour supervision;

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

iii.      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

b.        Otherwise deemed by a program director, the deputy director of the Division, or a hearing officer to need special assistance to effectively file a written griev- ance, to understand the grievance and investigation procedure, or to otherwise effectively participate in the grievance process under this Chapter.

14.     “Clinical team” refers to the interdisciplinary team of per- sons who are responsible for providing continuous treat- ment and support to a client and for locating, accessing and monitoring the provision of behavioral health ser- vices or community services. A clinical team consists of a psychiatrist, case manager, vocational specialist, psychi- atric 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 supervi- sor under Laws 1992, Ch. 310.

15.     “Community services” means services required to be pro- vided under A.R.S. Title 36, Chapter 5, Article 10 such as clinical case management, outreach, housing and residen- tial 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 sup- port services, outpatient counseling and treatment, trans- portation, and medication evaluation and maintenance.

16.     “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.

17.     “County Annex” means the Maricopa County Psychiatric Annex of the Maricopa Medical Center.

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

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

20.     “Crisis services” or “emergency services” means imme- diate 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.

21.     “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.

22.     “Department” means the Arizona Department of Health Services.

23.     “Designated representative” means a parent, guardian, relative, advocate, friend, or other person, designated 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

24.     “Discharge plan” means a hospital or community treat- ment and discharge plan prepared according to Article 3 of these rules.

25.     “Division” means the Division of Behavioral Health Ser- vices of the Department.

26.     “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:

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

b.        Temporarily restrict the client’s freedom of move- ment.

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

28.     “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:

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

b.        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 reason- able fear of sustaining injury.

29.     “Enrolled Children” means persons under the age of 18 who receive behavioral health services by or through a regional authority.

30.     “Exploitation” means the illegal or improper use of a cli- ent or a client’s resources for another’s profit or advan- tage.

31.     “Frivolous,” as used in this Chapter, means a grievance that is devoid of merit. Grievances are presumed not to be frivolous unless the program director has good reason to believe that the grievance:

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

b.        Is impossible on its face, or

c.        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.

32.     “Generic services” means services other than behavioral health services or community services for which clients may have a need and includes, but is not limited to, health, dental, vision care, housing arrangements, social organizations, recreational facilities, jobs, and educa- tional institutions.

33.     “Grievance” means a complaint regarding an act, omis- sion or condition, as provided in this Chapter.

34.     “Guardian” means an individual appointed by court order according to A.R.S. Title 14, Chapter 5, or similar pro- ceedings in another state or jurisdiction where said guard- ianship has been properly domesticated under Arizona law.

35.     “Hearing officer” refers to an impartial person designated by the director to hear a dispute and render a written deci- sion.

36.     “Human rights advocate” means the human rights advo- cates appointed by the director under R9-21-105.

37.     “Human rights committee” means the human rights com- mittee established under R9-21-106 by the Department.

38.     “Illegal” means, within the context of the grievance and investigation procedure set forth in Article 4 of this Chap- ter, an incident or occurrence which is or was likely to constitute a violation of a state or federal statute, regula- tion, court decision or other law, including the provisions of these Articles.

39.     “Individual service plan” or “ISP” means the written plan for services to a client, prepared in accordance with Arti- cle 3 of this Chapter.

40.     “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.

41.     “Inpatient facility” means the Arizona State Hospital, the County Annex, or any other inpatient treatment facility licensed or funded by or through the Department to pro- vide behavioral health services, including psychiatric health facilities, licensed psychiatric hospitals, licensed psychiatric units in general hospitals, and licensed inpa- tient or behavioral health facilities in jails.

42.     “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.

43.     “Long-term view” means a planning statement that iden- tifies, 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.

44.     “Mechanical restraint” means any, device, article, or gar- ment attached or adjacent to a client’s body that the client cannot easily remove and that restricts the client’s free- dom of movement or normal access to the client’s body, but does not include a device, article, or garment:

a.        Used for orthopedic or surgical reasons, or

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

45.     “Medical practitioner” means a:

a.        Physician, licensed according to A.R.S. Title 32, Chapter 13 or 17;

b.        Physician  assistant,  licensed   according  to  A.R.S.

Title 32, Chapter 25; or

c.        Nurse practitioner, licensed according to A.R.S. Title 32, Chapter 15.

46.     “Meeting” means an encounter or assembly of individu- als which may be conducted in person or by telephone or by video-conferencing.

47.     “Mental health agency” includes a regional authority, ser- vice provider, inpatient facility, or an agency licensed to conduct screening, evaluation and treatment under this Chapter.

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

49.     “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 resolu- tion 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 human rights committee.

50.     “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, but for a behavioral health agency licensed as a level 1 RTC or a Level I sub-acute agency according to A.A.C. R9-20-102 does not include:

a.        Holding a client for no longer than five minutes, without undue force, in order to calm or comfort the client; or

b.        Holding a client’s hand to escort the client from one area to another.

51.     “PRN order” or “Pro re rata medication” means medica- tion given as needed.

52.     “Program director” means the person with the day-to-day responsibility for the operation of a programmatic com- ponent of a service provider, such as a specific residen- tial, vocational, or case management program.

53.     “Qualified clinician” means a behavioral health profes- sional 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.

54.     “Region” means the geographical region designated by the Department in its contract with the regional authority.

55.     “Regional authority” means the regional behavioral health authority under contract with the Department to organize and administer the delivery of behavioral health services or community services to clients and enrolled children within a defined geographic area.

56.     “Restraint” means personal restraint, mechanical restraint, or drug used as a restraint.

57.     “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 pre- cludes 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, restrict- ing a client to the residential site, according to specific provisions of an individual service plan or court order, does not constitute seclusion.

58.     “Seriously mentally ill” means a person 18 years of age or older who is either seriously mentally ill or chronically mentally ill as those terms are defined in A.R.S. § 36-550.

59.     “Service provider” means an agency, inpatient facility or other mental health provider funded by or through, under contract or subcontract with, licensed by, certified by, approved by, registered with, or supervised by, the Department, or receiving funds under Title XIX, to pro- vide behavioral health services or community services.

60.     “State Protection and Advocacy System” means the agency designated as the Protection and Advocacy Sys- tem for individuals with mental illness, according to 42

U.S.C. 10801-51.

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

62.     “Treatment team” means the multidisciplinary team of persons who are responsible for providing continuous treatment and support to a client who is a current resident of an inpatient facility.

Historical Note

Adopted under an exemption from A.R.S. Title 41, Chap- ter 6 pursuant to Laws 1992, Ch. 301, § 61, effective October 7, 1992; received in the Office of the Secretary of State October 14, 1992 (Supp. 92-4). Amended under an exemption from A.R.S. Title 41, Chapter 6 pursuant to Laws 1992, Ch. 301, § 61, effective September 30, 1993 (Supp. 93-3). Amended by exempt rulemaking at 7

A.A.R. 3469, effective July 17, 2001 (Supp. 01-3). Amended by exempt rulemaking at 9 A.A.R. 3296, effec-

tive June 30, 2003 (Supp. 03-2).