W. Va. Code R. § 64-11-3

Current through Register Vol. XLI, No. 36, September 6, 2024

Section 64-11-3 - Definitions

3.1. Abuse. -- The willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or mental anguish. Abuse also includes the deprivation by an individual, including a caretaker, of goods or services that are necessary to attain or maintain physical, mental, and psychosocial wellbeing. Instances of abuse of all residents, irrespective of any mental or physical condition, cause physical harm, pain, or mental anguish. It includes verbal abuse, sexual abuse, physical abuse, and mental abuse, including abuse facilitated or enabled through the use of technology. Willful, as used in this definition of abuse, means the individual must have acted deliberately, not that the individual must have intended to inflict injury or harm.

3.2. Addiction. -- A disease characterized by the individual's pursuing reward, relief, or both, by substance use or other behaviors. Addiction is characterized by impairment in behavioral control, craving, inability to consistently abstain, and diminished recognition of significant problems with one's behaviors and interpersonal relationships; likely to involve cycles of relapse and remission.

3.3. Adult Basic Skills Coaching. -- Coaching or prompting of individuals in their home or group home environment in areas including, but not limited to, money management, safety, housekeeping, personal care, nutrition, cooking, and medication education. This is a supportive service.

3.4. Advocate. -- A person or agency that acts on behalf of a consumer to establish, expand, protect, and enforce his or her human, legal, and civil rights in a consumer's best interest.

3.5. Alteration. -- A change to a provider location that affects the usability of the building or facility or any part thereof. Alterations include, but are not limited to, remodeling, renovation, rehabilitation, reconstruction, historic restoration, changes or rearrangement in structural parts or elements, and changes or rearrangements in the plan configuration of walls and full-height partitions. Normal maintenance, reroofing, painting, wallpapering, carpeting, flooring, or changes to mechanical and electrical systems are not alternations unless they affect the usability of the building or facility. Administrative offices and buildings are not included.

3.6. Assessment. - An evaluation of a consumer by a qualified person working within his or her scope of practice using skills of examination including appraisal and analysis of data collected to provide care and services.

3.7. Aversive Procedures. -- Restrictive procedures that impose consequences a consumer finds undesirable in a treatment program to decrease inappropriate behaviors. What is undesirable varies with each consumer but generally includes such measures as fines or loss of privileges. Aversive procedures include, but are not limited to, physical and chemical restraint, time-out, and seclusion.

3.8. Behavioral Health Center. -- A provider, entity, or facility that provides behavioral health services, supports, or both.

3.9. Behavioral Health Services. -- A direct service provided as an inpatient, residential or outpatient service to an individual with mental health, addictive, behavioral, or adaptive challenges that is intended to improve or maintain functioning in the community. The service is designed to provide treatment, habilitation, or rehabilitation.

3.10. Behavioral Intervention. -- A written behavior support plan approved by the service planning team, the consumer, and the designated legal representative if applicable. A behavioral intervention must be based on a functional assessment of the targeted behavior and must be specific and measurable.

3.11. Case Management. -- A skilled, non-clinical service that links appropriate services and supports to a specific population. Case management is a collaborative process of assessment, planning, facilitation, evaluation, and advocating of available services to meet a consumer's assessed need promoting consumer safety, quality of care, and cost-effective outcomes. The case manager is a trained professional who coordinates a team process which assesses the needs of the consumer and consumer's family, when appropriate, and arranges, coordinates, monitors, evaluates, and advocates for a package of multiple services in collaboration with appropriate and available provider agencies to meet the specific consumer's complex needs. This service may involve, but is not limited to, assistance with completion of applications and forms; transportation; assistance with making appointments for medical, other care, or both; telephone calls; and other linkage activities to meet the consumer's specific needs. This service involves the preparation of a detailed, person-centered service plan with specific person-centered goals and objectives and designated outcomes and timeframes. Case management is not a behavioral health or supportive service requiring licensure as a behavioral health center if that is the only service being provided.

3.12. Chemical Restraint. -- A medication used to control behavior or to restrict the consumer's freedom of movement when the medication is not a standard treatment for the consumer's medical or psychological condition. Doses of any medication prescribed at levels beyond that recommended for normal clinical use shall also be evaluated for inclusion as a chemical restraint.

3.13. Chief Executive Officer. -- The individual designated by the governing body to be responsible for the provider's daily operations. The chief executive officer may also be referred to as the provider's president, executive director, or chief administrative officer. The chief executive officer may designate requirements within this rule but will retain the responsibility that the designated requirements are met.

3.14. Civil Rights. -- The rights of personal liberty guaranteed by the Constitutions of the United States and the state of West Virginia, by federal and state law.

3.15. Comprehensive Plans of Services. -- A written description of the behavioral health services and supports provided to the consumer accompanied by a description of the measurable goals of the supports the consumer is receiving. These services may be provided by more than one agency acting in coordination. The comprehensive plan is utilized for consumers receiving both behavioral health services and supports.

3.16. Consumer. -- An individual who receives services, supports, or both, from a provider licensed under this rule.

3.17. Critical Incident. -- The alleged, suspected, or actual occurrence of any of the following involving a consumer:

3.17.1. Abuse;

3.17.2. Neglect;

3.17.3. Death due to any cause;

3.17.4. Attempted suicide;

3.17.5. Behavior that will likely lead to serious injury or significant property damage;

3.17.6. Fire resulting in injury, relocation, or an interruption of services;

3.17.7. Any incident with law enforcement authorities;

3.17.8. Injury that requires hospitalization or results in permanent physical damage;

3.17.9. Life-threatening reaction because of a drug or food;

3.17.10. A serious consequence resulting from an apparent error in medication or dietary administration;

3.17.11. Extended and unauthorized absence of a consumer that exceeds his or her treatment plan provision for community access; or

3.17.12. Removal of a consumer from either residential or program services without the consent of a consumer or his or her legal representative.

3.18. Critical Treatment Juncture. -- The occurrence of an unusual or significant event which may have an impact on the process of treatment. A critical treatment juncture will result in a documented meeting between the provider and the consumer, Designated Legal Representative (DLR), or both, and may cause a revision of the plan of services.

3.19. Designated Legal Representative (DLR) or Legal Representative. -- Parent of a minor child, conservator, full or limited legal guardian, health care surrogate, medical power of attorney, power of attorney, or other individual authorized to make certain decisions on behalf of a consumer and operating within the scope of his or her authority.

3.20. Emergency. -- A situation or set of circumstances which presents immediate risk of death or serious injury to a consumer.

3.21. Employee. -- All persons who work or provide services at or for the provider. Employees include owners, associates, and contracted agents.

3.22. Expanded Plan of Service. -- A description of the treatment, habilitation, or rehabilitation goal or goals of the behavioral health services provided to the consumer stated in measurable terms, accompanied by a brief description of any supportive services to be provided. The expanded plan of service is developed at the conclusion of the assessment process and may be preceded by an initial plan of service.

3.23. Governing Body. -- A clearly identified group of persons or partnership, when applicable, which ensures accountability, exercises authority over, and has responsibility for the provider's operation and approval and review of policies and practices. The provider shall designate the governing body at the time of licensure. If an entity is a corporation with an out-of-state ownership or management structure, the provider shall identify the governing body in conjunction with the Inspector General.

3.24. Habilitation. -- A direct service to enhance the functional level of individuals by promoting the acquisition of skills or emotional or behavioral self-management abilities that the person did not develop at an appropriate developmental phase.

3.25. Human Rights Committee. -- A committee or committees whose primary function is to assist the provider in the promotion and protection of a consumer's rights, and to review, approve, and monitor individual programs designed to manage inappropriate behaviors and other programs that are intrusive or involve risks to a consumer's protection and rights.

3.26. Inappropriate Behavior. -- A behavior that is disruptive or increases the risk of harm to a consumer or individuals in his or her environment; a maladaptive behavior that interferes in the ability of the consumer to lead an integrated life in the community to an optimally independent degree.

3.27. Incapacitated Adult. -- Any person who, by documented reason of physical, mental, or other infirmity, is unable to independently carry on the daily activities of life necessary to sustaining life and reasonable health.

3.28. Initial Plan of Service. -- The plan developed during the admissions process that describes the services, supports, or both the consumer is to receive until the assessment process is complete and the expanded plan of service is developed.

3.29. Interdisciplinary Team. -- A group including a consumer, his or her legal representative, or both, and representatives from the disciplines and services that design a consumer's treatment plan.

3.30. Linkage. -- Establishment of a relationship between a committed individual and appropriate mental health resources while the consumer is still in the hospital; subsequent case management and provision of services designed to prevent rehospitalization and promote stabilization and maintenance of function.

3.31. Medication Error. -- Failure to follow the six rights of medication administration, as follows:

3.31.1. Right client;

3.31.2. Right route;

3.31.3. Right drug;

3.31.4. Right dose;

3.31.5. Right time; and

3.31.6. Right documentation.

3.32. Neglect. -- The failure of the facility, its employees, or service providers to provide goods and services to a resident that are necessary to avoid physical harm, pain, mental anguish, or emotional distress.

3.33. Non-Critical Incident. -- Any unusual event or injury of unknown origin involving a consumer that needs to be recorded and investigated for risk management or quality improvement purposes but does not meet the definition of abuse, neglect, or critical incident.

3.34. Personal Attendant. -- A supportive service in which a provider assists a consumer with the activities of daily living, which may include prompting. The service may assist the individual to maintain his or her skills and abilities but does not carry the expectation of habilitation or rehabilitation as the result of the receipt of the service.

3.35. Physician Extender. -- A medical professional including an advanced practice registered nurse or a physician assistant functioning within his or her legal scope of practice.

3.36. Plan of Service. -- A written description of the behavioral health services, supports, or both that the consumer is to receive.

3.37. Provider. -- An entity, including, but not limited to, staff and individuals employed or contracted to provide consumer services on behalf of the entity, that provides behavioral health services, supportive services, or both under this rule for a licensed behavioral health center location.

3.38. Rehabilitation. -- A direct service that promotes re-acquisition of skills or emotional or behavioral self-management abilities that the person has lost due to mental illness, traumatic brain injury, institutionalization, or long-term addiction.

3.39. Respite. -- A supportive service designed to provide temporary substitute care for an individual whose primary care is normally provided by the family of a consumer. The services are to be used on a short-term basis due to the absence of or need for relief of the primary caregiver, consumer, or both. Respite consists of temporary care services and supervision for an individual who cannot provide for all of his or her own needs and may be provided in the consumer's home location, in the community, or in a location owned, rented, or leased by the respite provider.

3.40. Restraint. -- Any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a consumer to move his or her arms, legs, body, or head freely, or a drug or medication that is used as a restriction to manage the consumer's behavior or restrict the consumer's freedom of movement and is not a standard treatment or dosage for the consumer's condition. A restraint does not include devices used to treat a medical condition.

3.41. Seclusion. -- The involuntary confinement of a consumer alone in a room or area from which the consumer is physically prevented from leaving.

3.42. Student. -- A student of a community or technical college, college, or university; health services intern; medical student; or medical intern or resident for the purposes of this rule.

3.43. Supportive Service. -- A service provided exclusively to individuals with intellectual disabilities, developmental disabilities, ongoing mental health or addictive challenged, or traumatic brain injury. This service is designed to assist the individual to live in the community in a manner that is socially inclusive, optimally independent, and self-directed while preserving his or her health, safety, and quality of life. These services are not designed to change behavior or emotional functioning to support the individual in his or her community-based settings. Supportive services may include coaching or prompting of age appropriate living skills.

3.44. Treatment. -- A direct medical, behavioral, or psychotherapeutic service designed to ameliorate the effects of a mental illness, addiction, or behavioral disorder or sustain the positive effects of interventions.

3.45. Variance. -- A declaration that compliance with a rule may be accomplished in a manner different from the manner set forth in the rule.

3.46. Volunteer. An individual who offers to provide assistance and support for consumers without pay. Natural support systems such as friends, neighbors, and family members are not to be considered volunteers.

3.47. Waiver. -- A declaration that a certain rule is inapplicable in a particular circumstance.

W. Va. Code R. § 64-11-3