Section 118-5-1 - DEFINITIONS1.1 Administrator: The individual appointed by the Governing Authority to act in its behalf in the overall management of the substance abuse program. The Chief Administrative Officer shall serve as the administrator of the agency. See Section 3.31.2 Advisory Board: A group that makes recommendations regarding any aspect of the agency's operations or practices, as charged by the Governing Body, but having no proprietary interest in the program or service or actual managerial or administrative authority.1.3 Agency: An incorporated firm, partnership, association, or organization licensed/certified under these regulations that provides at least one substance abuse treatment service. Agency is also known as licensee/provider.1.4 Appeal: A written request by an agency for a hearing to review any negative licensing action taken by the Licensing Authority or department as provided by the Maine Administrative Procedure Act, Title 5 M.R.S.A. §9051 et seq.1.5 Applicant: Any individual(s), partnership, corporation, association, or organization that has submitted a written application to operate a licensed/certified substance abuse program or service.1.6 Assessment (Clinical): A written record of intake data performed by a clinician to arrive at a diagnosis, determine the degree of impairment, and determine treatment needs and services.1.7 Certificate of Approval: A certificate issued by DHHS to a nonresidential program that indicates satisfactory compliance with applicable regulations.1.8 Client: Any individual who has applied for, or has received services such as an assessment, diagnosis or treatment in a substance abuse program.1.9 Client Record: A unified, comprehensive collection of documentation concerning a client in a substance abuse program. 1.10 Clinician: A person who is qualified through education, training, experience, and licensure to provide treatment services.1.11 Compliance: To be in accordance with the requirement of a regulation.1.12 Component: A category of comprehensive services within an agency, such as substance abuse services or mental health services that includes one or more treatment modules.1.13 Conditional License/Certificate: A license/certificate issued when an applicant fails to meet substantially the requirements of these regulations, or when the program cannot be maintained in legal compliance (policy), or when multiple citations are repeated from a previous review and have not been corrected. This license/ certificate shall be issued for a specific period, not to exceed one year, or the remaining period of the previous full license/certificate. The license/certificate-shall specify what and when corrections must be made in order to continue to operate.1.14 Contracted staff: Contracted staff persons are independent contractors, including but not limited to, consultants, affiliate counselors who provide clinical services for a licensed agency, and per diem staff who work on an infrequent and irregular basis.1.15 Co-occurring Disorder (COD): Clients with co-occurring disorders have any combination of any mental health problem with any substance abuse problem or gambling disorder.1.16 Co-occurring Disorder Integrated Services: Any of a broad range of appropriately matched interventions (including screening, assessment, motivational, treatment, skill building, and relapse prevention strategies) for mental health and substance use disorders.1.17 Co-occurring Disorder Program: A Co-occurring Disorder Program designs its policies, procedures, screening, assessment, program content, treatment planning, discharge planning, interagency relationships, and staff competencies to routinely provide integrated co-occurring disorder services to the individuals and families with co-occurring disorders who present for care. 1.17.1 Co-occurring Disorder Capable Program: COD-C substance abuse programs are organized to welcome, identify, engage, and serve individuals with co-occurring mental health disorders, and to incorporate attention to these issues in all aspects of program content including organized linkage with mental health providers, and staff competency and training. Such programs provide services that incorporate understanding of and approaches to mental health problems as they relate to and affect the substance abuse disorder.1.18 Counseling: The interaction between a clinician and a client for the purpose of facilitating and sustaining behavior change. Counseling results in the establishment and clarification of goals for future behavior, and is based upon an objective, individualized treatment plan derived from an assessment of the treatment needs of the client.1.19 Critical Incident: Critical incidents shall include, but not necessarily be limited to, adverse or potentially adverse occurrences that imperil life, limb or well-being, that seriously breach agency policy, or that breach client rights.1.20 Deemed Status: The Division of Licensing and Regulatory Services determines whether an accreditation body's standards are the same or similar to these licensing regulations, and whether to deem a provider to be in compliance with some or all of these licensing regulations based upon a review of the findings of an accreditation body approved by the Licensing Authority.1.21 Detoxification: A service that provides persons having acute physical problems related to alcohol or other drug withdrawal with immediate diagnosis and treatment, as well as appropriate referral and transportation to emergency health care facilities when required.1.22 Differential Substance Abuse Treatment Program (DSAT): DSAT is a program developed to address the needs of clients mandated to treatment through involvement with the criminal justice or child protection services system. The DSAT curriculum are differentiated both by individual level of need and by gender. DSAT provides manualized, motivational, and cognitive-behavioral treatment that focuses on different aspects of recovery and the development of skills needed to reduce recidivism. OSA provides training, standardized manuals, and certification for agencies and providers delivering the DSAT program.1.23 Documentation: A written record acceptable as evidence to ensure compliance with these regulations.1.24 Driver Education and Evaluation Programs (DEEP): The State of Maine OUI countermeasures program required for persons who have been convicted of operating under the influence of alcohol and other drugs and those whose licenses are administratively suspended because of drinking and driving.1.25 Elopement: The circumstance when a client leaves a residential treatment facility without staff's knowledge and consent.1.26 Facility: The physical plant where services are offered.1.27 Fee Schedule: A document that provides a list and an explanation of fees for services available from the service provider.1.28 Federal Confidentiality Regulations: Rules and regulations regarding Confidentiality of Alcohol and Drug Abuse Client Records, 42 CFR Chapter 1, Subchapter A, Part 2, et seq., dated 1986, and final rules thereof.1.29 Follow-up Treatment: Treatment offered as an extension to residential and-nonresidential rehabilitation programs to provide individual or group counseling services to clients following completion of the intensive phase of the treatment program.1.30 Freestanding Residential Detoxification Program (ASAM Level III 7-D/medically monitored inpatient detoxification): Freestanding residential detoxification programs provide care to persons whose withdrawal signs and symptoms indicate the need for 24-hour residential care. Services include a biopsychosocial evaluation, medical observation, monitoring, and treatment, counseling, and follow-up referral. However, the full resources of an acute care general hospital or a medically managed intensive inpatient treatment program are not necessary. Services must be conducted in a freestanding or other appropriately licensed healthcare or addiction treatment facility.1.31 Full License/Certificate: A license/certificate issued when an applicant is in substantial compliance with these regulations.1.32 Governing Body. The governing body is an individual or association of persons (board of directors) with ultimate managerial control and legal responsibility for the operation of the agency. The governing body is also referred to as the governing authority. See Section 3.2. 1.33 Human Subject Research: The use of clients or their treatment records in the systematic study, observation, or evaluation of factors related to the prevention, assessment, treatment, and understanding of an illness.1.34 Indicators: Measurable or definable items that can be used to demonstrate change, written in measurable and behavioral terms. The indicators are a required part of the treatment plan.1.35 Intake: The process of collecting demographic and clinical data required for admission to a treatment program.1.36 Intensive Outpatient Program (IOP) (ASAM Level II.1): A comprehensive program of substance abuse evaluation, diagnosis and treatment services in a setting that does not include an overnight stay, providing a short-term, structured treatment experience for persons who do not require a more restrictive, residential setting for effective treatment.1.37 Investigation (Licensing): A review of policies, record-keeping, and interviews by the Licensing Authority to determine an agency's or individual's appropriateness of responses in a situation from which a complaint has been generated to determine compliance with rules, regulations, and rights.1.38 License/Certificate: Authorization by DHHS to operate a substance abuse program in the State of Maine.1.39 Licensee: Any individual, partnership, corporation, association, or organization that has been granted a license/certificate to operate a substance abuse program or service. Licensee is also known as a Provider.1.40 Licensing Authority: DHHS, Division of Licensing and Regulatory Services, Community Services Programs.1.41 Licensing/Certificate Review: An on-site review of a program conducted by personnel from the Licensing Authority to determine compliance with regulations.1.42 Medical Assessment: The documentation of the physical condition of a client made by a program in accordance with a protocol established by the medical director.1.43 Medical Director: A physician (M.D. or D.O.) with knowledge of substance abuse, addiction, and co-occurring disorder issues.1.44 Medically Managed Intensive Inpatient Detoxification Program (ASAM Level IV-D):Medically managed intensive inpatient detoxification programs provide services to persons who are experiencing severe withdrawal symptoms and therefore require full medical acute care services in a twenty-four hour hospital setting. Services include a biopsychosocial evaluation, medical observation, monitoring, and treatment, counseling, and follow-up referral. Services shall be delivered in an appropriately licensed acute care inpatient setting, adhering to medically approved procedures and protocols.1.45 Medication Assisted Treatment (MAT): MAT is any treatment for addiction and COD that includes medication (e.g. psychotherapeutic medications, methadone, buprenorphine, naltrexone, accomprosate, vivitrol). MAT is intended to help stabilize addiction and COD symptoms.1.46 Module: A service category found under a licensing component. Outpatient or residential programs are examples of modules in a substance abuse component.1.47 Negative Licensing Action: Means a decision by the Licensing Authority or department as provided by the Maine Administrative Procedure Act, Title 5 M.R.S.A. §9051 et seq. to deny a license/certificate or issue a conditional license/certificate.1.48 Non-clinical Staff: Program staff who are not qualified through experience, training, and licensure to provide clinical interventions. Some examples of non-clinical staff include clerical and administrative staff, attendants, and housekeeping staff.1.49 Nonresidential: Any substance abuse treatment conducted in a setting that does not include, require, or provide that someone stay overnight in lodgings provided by the program.1.50 Opioid Treatment Program (OTP): An OTP is any treatment program certified by the federal Substance Abuse and Mental Health Services Administration (SAMHSA) in conformance with 42 Code of Federal Regulations (C.F.R.), Part 8, to provide supervised assessment and MAT for clientswho are opioid addicted.1.51 Outpatient Care (ASAM Level I): Outpatient care provides assessment and counseling services in a nonresidential setting to clients and affected others.1.52 Physician Extender: Physician extender means a nurse practitioner performing duties as defined in 32 MRSA §2102 or a physician assistant as referred to in 32 MRSA §2594-A.1.53 Plan of Correction (hereinafter POC): A section of the Statement of Deficiencies completed by the agency, detailing the plan to correct deficiencies and the completion dates.1.54 Policy: A statement of the principles that guide and govern the activities, procedures, and operations of a program.1.55 Policy and Procedures Manual: Formal documentation of a program's policies and related procedures required in these regulations, plus additional program policies and procedures that the program wishes to communicate to its staff. (See Policy, and see Procedure.)1.56 Private Non-Medical Institution (PNMI): A private non-medical institution means a substance abuse treatment program, billing under the MaineCare Benefits Manual, 10-144 CMR c. 101, Ch. II and Ch. III, Section 97, and which meets additional requirements, as outlined herein.1.57 Procedure: A series of activities designed to implement the goals or policies of a program.1.58 Program: One or more substance abuse treatment services within an agency, conducted in a residential or nonresidential setting that has a mission, philosophy, and model of treatment designed to address the needs of clients.1.59 Provisional License/Certificate: A license/certificate issued to a first-time applicant when the applicant is not eligible for a full license/certificate, but the health and well-being of clients are not jeopardized.1.60 Qualified Service Organization Agreement (QSOA): A written agreement between a treatment program and an outside organization, in compliance with 42 CFR Chapter 1, Subchapter A, Part 2 that allows disclosure of client information without the client's consent. Examples of services covered under a QSOA include data processing, dosage preparation, and accounting services.1.61 Residential Services: Any substance abuse program that requires the client to reside on the premises while receiving treatment.1.62 Residential Treatment (ASAM Level III): Residential treatment programs provide services in a full (24 hours) residential setting. The program shall provide a scheduled treatment regimen which consists of diagnostic, educational, and counseling services; and shall refer clients to support services as needed. Clients are routinely discharged to various levels of follow-up services. There are three categories of residential care: 1.62.1 Category I: Category I residential treatment programs maintain a basic focus on early recovery skills, including the negative impact of chemical dependency, tools for developing support, and relapse prevention skills. Examples of Category I programs are extended shelters and residential rehabilitation programs.1.62.2 Category II: Category II programs provide a structured residential milieu, to help clients transition from a substance abusing lifestyle to a solid recovery environment. Clients may initially receive a treatment focus similar to that of Category I programs, but will transition to a treatment focus that addresses the cultural, social, educational, and vocational needs of the client. An example of a Category II program is a halfway house.1.62.3 Category III: Category III programs provide a long-term supportive and structured environment for chemically dependent clients with extensive substance abuse debilitation. These programs provide a supervised living experience within the program. Qualified staff members teach attitudes, skills and habits conducive to facilitating the client's transition back to the community. The treatment mode may vary with the client's needs and may be in the form of individual, group or family counseling. Outcome goals may range from custodial care to further treatment services and recovery. Examples of Category III programs are adolescent long-term rehabilitation or an extended care program.1.63 Shelter: Shelter is a service that provides food, lodging and clothing for abusers of alcohol and other drugs, for the purpose of protecting and maintaining life and providing motivation for alcohol and drug treatment.1.64 Site: The physical location of a substance abuse program.1.65 Social Setting Detoxification Programs: Social setting detoxification programs provide services to persons who are experiencing withdrawal symptoms that require 24-hour structure and support but don't require full resources of Medically Managed Intensive Detoxification or Freestanding Residential Detoxification, recognizing that the emphasis is more on the counseling program as a treatment agent as opposed to professional intervention and/or medical detoxification. Services must be conducted in a licensed/certified health care or addiction treatment facility.1.66 Statement of Deficiencies (SOD): A document issued by the department, which describes deficiencies in complying with these regulations.1.67 Substance Abuse: The use of alcohol and other drugs, licit or illicit, which results in an individual's physical, mental, emotional, or social impairment.1.68 Substance Abuse Program: A public or private establishment, organization, or institution that offers, maintains, or operates one or more treatment services for the assessment, diagnosis, treatment, or rehabilitation of individuals who are suffering physically, emotionally, or psychologically from the abuse of alcohol or other drugs.1.69 Substance Abuse Treatment Service: A specific ongoing module of treatment provided by an agency as prescribed in Section 19 of these rules.1.70 Supportive Services: Additional services that assist the client to derive the maximum benefit from the program's primary services.1.71 Training: Special schools, in-service programs, workshops, and other structured opportunities for staff intended to:1.71.1 Improve administration of programs;1.71.2 Develop skills in treating substance abusers and their families;1.71.3 Increase knowledge, skills and abilities related to drug abuse, alcohol abuse, addiction, and the special populations served.1.72 Treatment: The broad range of substance abuse interventions, designed to positively influence the behavior of clients toward identified treatment goals and objectives.1.73 Treatment Plan: A written action plan, based on assessment data, that identifies the clients' clinical needs, the strategy for providing services to meet those needs, treatment goals and objectives, and the criteria for completing specific interventions, written in behavioral terms.1.74 Volunteer: A person who, without financial compensation, provides services to the program.1.75 Waiver: A waiver is a written document issued by the licensing authority that relieves either an applicant or licensee from compliance with a licensing rule that is neither mandated by state statutory or case law or federal law nor a violation of clients' rights. See Section 2.6.6. 1.76 Welcoming: Welcoming is a core clinical concept that emphasizes that no program refuses service based on the presence of a co-occurring condition alone. All individuals are proactively assisted at any door to get connected to the services that best meet their needs.