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
N.J.A.C.
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
N.J.S.A. 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
N.J.A.C.
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,
N.J.S.A.
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,
http://www.dsm5.org/Pages/Default.aspx.
"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
N.J.S.A. 26:2G-21 et seq, and/or a license pursuant to
N.J.S.A. 26:2B-7 et seq.
"Licensed clinical alcohol and drug counselor (LCADC)" means
an individual who holds a current, valid license issued pursuant to
N.J.S.A. 45:2D-4 and
45:2D-16 and
N.J.A.C.
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
N.J.S.A. 45:9-1 et seq. and N.J.A.C. 13:35, or a
medical resident or intern, or a podiatrist licensed pursuant to
N.J.S.A. 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
http://www.samhsa.gov/laws-regulations-guidelines/medical-records-privacy-confidentiality.
"SAMHSA" means the Substance Abuse and Mental Health Services
Administration within the Federal Department of Health and Human Services,
http://www.samhsa.gov.
"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,
N.J.A.C.
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,
http://www.dsm5.org/Pages/Default.aspx,
incorporated herein by reference.
"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.