Section 0940-03-07-.03 - PROCESS FOR DESIGNATION TO PROVIDE SERVICES TO PERSONS WITH SEVERE IMPAIRMENTS(1) Requirements for Application: The applicant must provide documentation that the facility is a treatment resource as defined under TCA § 33-1-101(24) and is licensed by the Department of Health and/or Department of Mental Health and Developmental Disabilities.(2) Organizational Documentation: The applicant must provide the following: (a) The name, address, and other background and identifying information of the applicant including type of agency, background and history of agency, services currently provided and statement of agency values;(b) The name, address, and other background and identifying information of the person or persons responsible for the operation of the service to include present position in the agency, educational history, credentials, and work experience;(c) A description of the location, facility lay out, and type of facility where the service will be operated;(d) Evidence of license, certificate of need (as appropriate), and authorization from Secretary of State to do business in Tennessee;(e) The signature of the applicant, or of the person charged by the applicant, for certifying the correctness and completeness of the application, and for ensuring compliance with the service standards;(f) The proposed organization and the organizational relationship to the facility's overall administrative structure;(g) Relationship of the service location to other medical or psychiatric services provided;(h) Plan for or evidence of on site psychiatric services, 24-hour crisis services, supervised observation beds and participation in mandatory prescreening;(3) Service Description: The applicant must provide a proposed service description, which addresses: (a) A three year plan, updated annually, that includes measurable goals and objectives that are targeted toward providing services to service recipients in the most effective and least restrictive treatment environment possible;(b) How this service links to other providers of psychiatric services in the community, including mandatory prescreening agents;(c) Policy for coordinating transfer to involuntary in-patient treatment resources;(d) Staffing plan that indicates the types of staff, qualifications and numbers of staff by shift to be employed by the treatment resource for this purpose;(e) Plan for adequately training all staff to perform designated job responsibilities including orientation and ongoing training. Plan must include training that is relative to services to persons with severe impairment as defined in TCA § 33-6-301;(f) Plan for transitioning and follow up activities for service recipients who are released from the program or referred to other services to include assurance of continuity of care;(g) A plan or agreement with law enforcement (or other transporting agent, if appropriate) to transport candidates for mental health emergency services;(h) Policy to ensure safety of service recipient and staff between arrival at site and admission (include behavioral management and medical emergency);(i) Policy to ensure that the rights of service recipients are protected as indicated under Title 33, Tennessee Code Annotated;(4) Policy and Procedures: The applicant must provide written policies and procedures on the following:(a) Policy on notice of rights including those indicated under Title 33, Tennessee Code Annotated;(b) Policies on ensuring physician assessments are completed within the specific time period as set out in Title 33, Chapter 6, Part 3, Tennessee Code Annotated;(c) Policy which addresses the procedures for the prescription, procurement, storage and administration of medication, including procedures for verbal and phone orders;(d) Policy for determining capacity to consent to treatment.(e) Policy on admission authorization for individuals who lack capacity to consent to treatment including when emergency commitment or other referral is appropriate.(f) Policy on the program's conflict resolution procedure (both licensees and non DMHDD licensees must comply with the requirements of Title 33, Chapter 2, Part 6, Tennessee Code Annotated);(g) Policy on Treatment Review Committee responsibilities under TCA § 33-6-107 if the facility is an inpatient provider;(h) Policy for arranging transportation of service recipients to aftercare placements, alternative treatment sites or voluntary hospitalization;(i) Policy for addressing medical emergencies including transportation to another treatment service when necessary;(j) Policy for transportation of a service recipient in need of emergency psychiatric hospitalization;(k) Release procedures including provision for when a service recipient initiates the release;(l) Policy on use of isolation and restraint;(m) Policy on service recipient records including documentation requirements and provisions for ensuring confidentiality;(n) Policy on notification of persons designated by the service recipient in case of an emergency;(o) Policy on use of Declarations for Mental Health Treatment, (TCA § 33-2-1202), conservator and attorney-in fact under a durable power of attorney for health care.(p) Procedure for addressing service recipient complaints.(5) The applicant must include a letter of support from the appropriate mental health regional planning council.Tenn. Comp. R. & Regs. 0940-03-07-.03
Original rule filed October 3, 2002; effective December 17, 2002.Authority: T.C.A. §§ 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-6-3.