Tenn. Comp. R. & Regs. 0940-05-01-.01 - 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.
(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 Developmental
Disabilities.
(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.
(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:
(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 care giver 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.
(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,
(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 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 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. Timeout 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.
Notes
Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-404, and Executive Order 44 (February 23, 2007).
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