ADHS/DBHS Definitions List

ARIZONA DEPARTMENT OF HEALTH SERVICES/ DIVISION OF BEHAVIORAL HEALTH SERVICES (ADHS/DBHS)

ADHS/DBHS Definitions List

Effective 02/28/2016

Table of Contents

TABLE OF CONTENTS _______________________ 1

A ________________________________________________ 5

Abuse _____________________ 5

Abuse (of child/minor) _______ 5

Abuse (of incapacitated or vulnerable adult)

5

Abuse (Policy 1106) __________ 5

Abuse (Policy 1703) __________ 5

Action _____________________ 5

Acute Health Plan and Provider Coordinator

5

ADHS/DBHS Documents ______ 6

ADHS/DBHS Medical Policies __ 6

ADHS/DBHS Designee ________ 6

ADHS/DBHS Drug List ________ 6

ADHS/ DBHS Office of Grievance and Appeals 6

ADHS/DBHS Office of Human Rights

6

ADHS/DBHS Policy Committee_ 6

ADHS/DBHS Public Comment__ 6

Addiction __________________ 6

Adjudication Hearing ________ 7

Administrative Hearing _______ 7

Administrative Review _______ 7

Adult Group ________________ 7

Adult Recovery Team (Adult Clinical Team)

7

Advance Directive ___________ 7

Adverse Action or Decision____ 7

Adverse Drug Event (ADE) ____ 7

Adverse Drug Reaction (ADR)__ 7

Alcohol and Drug Abuse Program8

American Indian Tribal Member 8

Annual Update______________ 8

Appeal Arizona State Hospital (ASH)

8

Appeal Resolution ___________ 8

Appeal Section (Policy 1803) __ 9

Appeal Section (Policy 1801) __ 9

Appeal Section (Policy 1804) __ 9

Appealable Agency Action ____ 9

Applicant __________________ 9

Approval___________________ 9

Arizona Department of Housing (ADOH) 9

Assessment ________________ 9

Assisted Living Facility________ 9

Attachment (relationship) ____ 9

Attachment Behavior ________ 9

B______________________________________________ 10

Behavioral Health Category Assignment 10

Behavioral Health Medical Practitioner 10

Behavioral Health Inpatient Facility

10

Behavioral Health Medical Professional 10

Behavioral Health Paraprofessional

10

Behavioral Health Professional 10

Behavioral Health Recipient __ 10

Behavioral Health Related Field11

Behavioral Health Representative

11

Behavioral Health Residential Facility 11

Behavioral Health Status _____11

Behavioral Health Work Experience

11

Bonding ___________________ 11

C ______________________________________________ 11

Caregiver __________________ 11

Care Management Program (CMP)

11

Certification of Need (CON)___12

Certified Nurse Midwife (CNM)12

Change ___________________12

Child _____________________12

Child and Adolescent Service Intensity Instrument (CASII) 12

Child and Family Team_______12

Child and Family Team (CFT) Facilitator 12

CLAS Standards_____________13

Clean Claim ________________13

Clinical Teams______________13

Closure ___________________13

Commonly Encountered LEP Groups

14

Community-Based Services ___14

Complaint _________________14

Complementary and Alternative Medicine (CAM) 14

Comprehensive Medical Record14

Condition Requiring Investigation14

Confidential HIV Information _14

Corrective Action ___________15

Corrective Action Plan (CAP) __15

Cost avoidance _____________15

Cost sharing _______________15

Court Ordered Evaluation ____15

Court Ordered Treatment (COT)15

Covered Behavioral Health Services Guide 15

Credentialing ______________16

Crisis _____________________16

Crisis Episode ______________16

Crisis Intervention Services ___16

Crisis Intervention Services (Inpatient Stabilization, Facility Based)

__________________________ 16

Crisis Intervention Services (Mobile, Community Based) 16

Culture ___________________17

Culturally based ____________17

Culturally Competent Agencies and Individuals 17

Culturally Competent Care ___17

Cultural Need ______________17

Culturally relevant __________18

D ______________________________________________ 18

Danger to Others (DTO) ______18

Danger to Self (DTS) _________18

Dangerous _________________ 18

Day ______________________18

De-Identified Health Information18

Demographics ______________ 18

Denial ____________________18

Arizona Department of Health Services/ Division of Behavioral Health Services (ADHS/DBHS) | 1 Revised 02/28/2016

Dependent Adult ___________ 18

Fraud _____________________24

Dental Services ____________ 18

G ______________________________________________ 24

Dental Periodicity Schedule __ 18

Gatekeeper ________________24

Depo-medications __________ 19 Descriptive Characteristics ___ 19

General Consent____________24 Geographic Service Area (GSA) 24

Designated Child Psychiatric Provider 19 Designated T/RBHA_________ 19

Gravely Disabled (GD) _______24 Grievance or Request for Investigation 24

Designated Record Set ______ 19 Detention _________________ 19

Guardian __________________24 Guilty Except Insane (GEI) ____25

Disability _________________ 19

H ______________________________________________ 25

Discharge Pending List ______ 19

Habilitation Provider ________25

Disease Management _______ 20

HB 2003 Permanent Housing Programs 25

Disenrollment _____________ 20

Health Care Decision-Maker __25

Disposition Hearing _________ 20

Health Care Power of Attorney 25

Documents Incorporated by Reference 20

Health Care Professional _____25

Domestication or Recognition of Tribal Court Order

20 Health Care Provider ________25

Drug used as a Restraint, Sub-Acute Agency

20

Health Disparities___________25

Dual eligible _______________ 20

High-risk pregnancy _________26

Durable Medical Equipment (DME)

20

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

E ______________________________________________ 21

__________________________ 26

Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) HITECH Act ________________26

Services __________________ 21

HIV-Related Information (A.R.S. ? 36-661) 26

Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Home Care Training to Home Care Client (HCTC) Provider 26

Periodicity Schedule ________ 21 Early Intervention __________ 21

Home T/RBHA _____________26 Homeless _________________26

Electronic Signature ________ 21 Emergency Behavioral Health Services 21

Housing ___________________27 Housing Administrator_______27

Emergency Safety Situation __ 21 Emerging Family Leaders ____ 21

Housing Referral____________27 Human Rights Committees ___27

Emotional abuse ___________ 21 Empowerment _____________ 22 Encounter_________________ 22 Engagement _______________ 22 Enrolled Person ____________ 22 Enrollment ________________ 22 Episode of Care ____________ 22 Evidence Based ____________ 22 Experimental or Investigational Therapies 22 Explanation of Benefits______ 22 Exploitation _______________ 22 Exploitation (of incapacitated or vulnerable adult) 22

F ______________________________________________ 22

Family ____________________ 23

I _______________________________________________ 27

Illegal _____________________ 27

Immediate Response ________27

In-network services _________27

Incapacitated Person ________27

Incident, Accident or Death___27

Independent Community Housing

27

Independent Licensed Practitioners

28

Independent Living Setting ___28

Individual _________________28

Individually Identifiable Health Information

28

Individual Service Plan (ISP) __28

Infant and Early Childhood Mental Health 28

Informed Consent __________28

Family-Driven Care _________ 23 Family Finding Techniques ___ 23

Inhumane _________________28 Inpatient Services___________28

Family-focused Therapy _____ 23 Family Involvement_________ 23

Inpatient treatment and discharge plan or "ITDP" 28 Institution for Mental Disease (IMD) 28

Family Leaders _____________ 23 Family Member ____________ 23

Institutionalized individual ___29 Intake / Enrollment _________29

Family of Choice ___________ 23 Family-Professional Partnerships23

Integrated Health Care Services/Integrated Care 29 Integrated Regional Behavioral Health Authority (RBHA) 29

Family-Run Organizations____ 24 Fee-for-Service_____________ 24

Inter-class Polypharmacy_____29 Inter-Rater Reliability (IRR) ___29

Filed _____________________ 24 Flex funds _________________ 24

Interpretation ______________ 29 Interventions ______________29

Arizona Department of Health Services/ Division of Behavioral Health Services (ADHS/DBHS) | 2 Revised 02/28/2016

Intra-class Polypharmacy ____ 29

L ______________________________________________ 29

Lawful Presence____________ 29 Letter of Authorization (LOA) _ 30 Licensed Midwife___________ 30 Limited Authorization _______ 30 Limited English Proficiency (LEP)30 Linguistic Competence ______ 30 Linguistic Need ____________ 30 Lived Experience ___________ 30

M _____________________________________________ 30

Material Change ___________ 30 Maternity care _____________ 30 Maternity care coordination _ 30 Mechanical Restraint _______ 31 Mechanical Restraint, Sub-Acute Agency 31 Medical Behavioral Health Practitioner 31 Medical Institution _________ 31 Medical Management _______ 31 Medically Necessary Covered Services 31 Medical Necessity Criteria (MNC)31 Medical Practitioner ________ 31 Medical Records ___________ 31 Medicare Advantage Prescription Drug Plan (MA-PD) Medicare Part A____________ 32 Medicare Part B ____________ 32 Medicare Part C ____________ 32 Medicare Part D____________ 32 Medication Error ___________ 32 Member Information Materials32 Mental Disorder ___________ 32 Mental Health Agency_______ 33 Mental Health Care Power of Attorney 33 Mental Health Provider _____ 33 Mental Retardation (MR)1 ___ 33 Mistreatment______________ 33

N______________________________________________ 33

Natural Support____________ 33 Neglect ___________________ 34 Non-QMB dual_____________ 34 Notice of Privacy Practices (NPP)34 Nursing Facility (NF) ________ 34 Nursing Facility (Policy 115) __ 34

O______________________________________________ 34

Office of Human Rights (OHR) 34 Older adult ________________ 34 Opiate Dependency_________ 34 Opiate Withdrawal _________ 35 Outcome _________________ 35 Outcome Measures _________ 35 Outreach _________________ 35 Out-of-Area Service_________ 35 Out of network services _____ 35 Over-Utilization ____________ 35

P ______________________________________________ 35

PASRR ____________________35

Payment Records ___________35

Peace officers ______________36

Peer ______________________36

Peer-Delivered Services ______36

Peer/Recovery Support ______36

Peer Review _______________36

Peer Reviewed Literature ____36

Peer-run Organization _______36

Peer Support Services _______36

Peer / Recovery Support Specialist

36

Peer Worker _______________37

Pending Admission List ______37

Permanent housing _________37

Persistently or Acutely Disabled (PAD) 37

Person Centered Planning ____37

Personal Restraint __________37

Personal Restraint- Level I Psychiatric Acute Hospital Programs

__________________________ 37

Personal Restraint- Residential Treatment Centers Providing Services

to Persons under the Age of 21 38

Personal Restraint, Sub-Acute Agency 38

32 Physical injury______________38 Postpartum care____________38

Post Stabilization Services ____38

Practitioner ________________ 38

Preconception Counseling Services

38

Pregnancy Termination ______38

Pre-petition Screening _______38

Preliminary Protective Hearing (PPH) 39

Preponderance of Evidence___39

Prescriber _________________39

Prescription Drug Plan (PDP)__39

Prevention Activity _________39

Primary Care Physician ______39

Primary Source Verification___39

Prior Period Coverage _______39

Privileging _________________39

Program Abuse _____________40

Program Director ___________40

Protected Health Information_40

Protective factor____________40

Provider Preventable Conditions40

Provisional Credentialing_____41

Prudent Layperson __________41

Public Housing Authority (PHA)41

Psychiatric Acute Hospital ____41

Q ______________________________________________ 41

QMB dual _________________41

Qualified Assessor __________41

Qualified Clinician __________41

Qualified Interpreter/Translator41

Qualified Service Organization 41

Quality of Care Concern (QOC) 42

Arizona Department of Health Services/ Division of Behavioral Health Services (ADHS/DBHS) | 3 Revised 02/28/2016

R______________________________________________ 42

Supported Housing Services __47

RBHA Drug List_____________ 42 Recertification of Need (RON) 42

Supportive Housing _________47 Suspension of Service _______48

Recovery _________________ 42

T ______________________________________________ 48

Recovery Goal _____________ 42

Team _____________________48

Reduction of Service ________ 42

Technology ________________48

Re-engagement ____________ 42

Telemedicine ______________48

Behavioral Health Services Referrals 42

Temporary/provisional credentialing 48

Region ___________________ 42

Tenant-Based Housing _______48

Regional Behavioral Health Authority (RBHA) 43

Termination of Service_______48

Regulatory Agency _________ 43

Liability of any individual, entity, or program to pay all or part of the

Remittance Advice _________ 43

expenditure for services covered under Title XIX/XXI.

48

Residence _________________ 43

Tier I Rehabilitation and Support Services 48

Resident Review ___________ 43

Title 14 Guardian with Mental Health Powers (T-14+)

49

Residential Services_________ 43

Title XIX___________________49

Residential Treatment Center (RTC)

43

Title XIX Member ___________49

Resilience _________________ 43

Title XIX Waiver Group (TWG)_49

Restraint__________________ 43

Title XXI Member ___________49

Retro-eligibility Claim _______ 43

Transfer ___________________ 50

Risk factors________________ 43

Transitional Housing ________50

Routine Response __________ 44

Translation ________________50

S ______________________________________________ 44

Treatment _________________ 50

Sanction __________________ 44

Treatment (Policy 114) ______50

Schizophrenic Spectrum Disorder44

Tribal/ Regional Behavioral Health Authorities (T/RBHA) 50

Seclusion ? Individuals Determined to have a Serious Mental IllnesTs/RBHA Designee ___________50

_________________________ 44 Seclusion- Level I Programs __ 44

T/RBHA Formulary __________50

Tribal Regional Behavioral Health Authority (TRBHA)

50

Seclusion, Sub-Acute Agency _ 44

Tribal sovereignty in the United States 50

Serious Emotional Disturbance (SED) 44

U ______________________________________________ 50

Serious Injury ______________ 45

Under-Utilization ___________50

Serious Occurrence _________ 45

Unsecured Protected Health Information 51

Serious physical injury ______ 45

U.S. Citizen ________________51

Service Authorization Request 45

U.S. Department of Housing and Urban Development (HUD)

Service Plan _______________ 45

__________________________ 52

Sexual Abuse ______________ 45 Shelter Plus Care ___________ 45 Single Case Agreement ______ 46

V ______________________________________________ 52

Violation of Rights __________52 Voluntary Evaluation ________52

Sound Methodology ________ 46

Vulnerable adult____________52

Specialized Services_________ 46 Sponsor-based Rental Assistance46 State Placing Agencies ______ 46 Statistical Significance_______ 46 Stigma ___________________ 46 Study Indicator ____________ 47 Sub-Acute Facility __________ 47 Substance abuse ___________ 47 Substance Use _____________ 47

W _____________________________________________ 53

Waste ____________________53

Waived physician prescriber __53

Y ______________________________________________ 53

Young Child________________53

Youth/Young Adult-Delivered Support 53

# ______________________________________________ 53

834 Transaction Enrollment/Disenrollment

53

Support and Rehabilitation Services Provider

47

Arizona Department of Health Services/ Division of Behavioral Health Services (ADHS/DBHS) | 4 Revised 02/28/2016

A Abuse The infliction of, or allowing another person to inflict or cause physical pain or injury, impairment of bodily function, disfigurement or serious emotional damage which may be evidenced by severe anxiety, depression, withdrawal or untoward aggressive behavior. Such abuse may be caused by acts or omissions of an individual having responsibility for the care, custody or control of a client receiving behavioral health services or community services. Abuse shall also include sexual misconduct, assault, molestation, incest, or prostitution of, or with, a client under the care of personnel of a mental health agency, which may occur under circumstances outside of a licensed sponsored activity.

Abuse (of child/minor) The infliction or allowing of physical injury, impairment of bodily function or disfigurement or the infliction of or allowing another person to cause serious emotional damage as evidenced by severe anxiety, depression, withdrawal or untoward aggressive behavior and which emotional damage is diagnosed by a medical doctor or psychologist pursuant to section A.R.S. ? 8-821 and is caused by the acts or omissions of an individual having care, custody and control of a child. Abuse includes:

(a) Inflicting or allowing sexual abuse pursuant to section A.R.S. ? 13-1404, sexual conduct with a minor pursuant to section A.R.S. ? 13-1405, sexual assault pursuant to section A.R.S. ? 13-1406, molestation of a child pursuant to section A.R.S. ? 13-1410, commercial sexual exploitation of a minor pursuant to section A.R.S. ? 13-3552, sexual exploitation of a minor pursuant to section A.R.S. ? 13-3553, incest pursuant to section A.R.S. ? 13-3608 or child prostitution pursuant to section A.R.S. ? 13-3212.

(b) Physical injury to a child that results from abuse as described in section A.R.S. ? 13-3623, subsection C.

Abuse (of incapacitated or vulnerable adult) (a) Intentional infliction of physical harm. (b) Injury caused by negligent acts or omissions. (c) Unreasonable confinement. (d) Sexual abuse or sexual assault.

Abuse (Policy 1106) For purposes of ADHS/ DBHS Policy and Procedure 1106 abuse includes both physical and sexual abuse

Abuse (Policy 1703) The infliction of, or allowing another person to inflict or cause physical pain or injury, impairment of bodily function, disfigurement or serious emotional damage which may be evidenced by severe anxiety, depression, withdrawal or untoward aggressive behavior. Such abuse may be caused by acts or omissions of an individual having responsibility for the care, custody or control of a client receiving behavioral health services or community services. Abuse shall also include sexual misconduct, assault, molestation, incest, or prostitution of, or with, a client under the care of personnel of a mental health agency, which may occur under circumstances outside of a licensed sponsored activity.

Action The denial or limited authorization of a requested service, including the type or level of service;

? The reduction, suspension or termination of a previously authorized service; ? The denial, in whole or in part, of payment of service; ? The failure to provide covered services in a timely manner; ? The failure to act within established timeframes for resolving an appeal or complaint and providing

notice to affected parties; and ? The denial of the Title XIX/XXI eligible person's request to obtain covered services outside the network.

Acute Health Plan and Provider Coordinator A person or persons identified by the T/RBHA to act as a single point of contact to respond to coordination of care inquiries from AHCCCS Health Plans, PCP's and other involved clinicians.

Arizona Department of Health Services/ Division of Behavioral Health Services (ADHS/DBHS) | 5 Revised 02/28/2016

This coordinator will be supervised by and have direct priority access to a Behavioral Health Professional (BHP) as described in R9-20-204 and performs the functions as described in the ADHS/RBHA Contracts and ADHS/Tribal IGA's.

ADHS/DBHS Documents Include contracts, policies, plans, manuals, and clinical guidance documents that collectively describe all behavioral health system requirements and expectations.

ADHS/DBHS Medical Policies Describe required clinical and medical functions pertaining to the direct provision of behavioral health services. The ADHS/DBHS Medical Director designates and signs all policies contained in DBHS Policy and Procedures Manual.

ADHS/DBHS Designee The ADHS/DBHS designated contractor authorized in GSA 6 to conduct final eligibility determinations for Serious Mental Illness upon receiving a referral from a RBHA or other ADHS approved entity.

ADHS/DBHS Drug List A list of minimum medications covered for Title XIX/XXI and Non-Title XIX/XXI eligible persons that must be included on each T/RBHA formulary.

ADHS/ DBHS Office of Grievance and Appeals The Office of Grievance and Appeals is responsible for the administration and oversight of the administrative grievance and appeal processes. In addition, the Office of Grievance and Appeals investigates allegations of sexual abuse, physical abuse or the death of individuals determined to have a Serious Mental Illness (SMI). The purpose of the grievance and appeal processes is to resolve case specific issues and to remedy any systematic concerns that are identified.

ADHS/DBHS Office of Human Rights The Office of Human Rights (OHR), established within ADHS/DBHS, is responsible for assisting individuals who have been determined to have a Serious Mental Illness (SMI) with understanding, exercising and protecting their rights through outreach and education, addressing systemic issues and direct advocacy assistance. OHR advocates assist individuals, in need of Special Assistance, with individual service planning and inpatient treatment/discharge planning and the grievance/investigation and appeal processes. The Office of Human Rights is also responsible for providing general oversight, addressing systemic issues and maintaining a list of all individuals in need of Special Assistance to help ensure that their needs are met.

ADHS/DBHS Policy Committee Is the body responsible for the review and development of ADHS/DBHS policy. The ADHS/DBHS Policy Committee includes, at a minimum, ADHS/DBHS division and office representatives, family members, peers and other representatives as necessary.

ADHS/DBHS Public Comment Means a stage of draft (ADHS/DBHS) documents whereby suggestions for revisions are elicited from providers, behavioral health recipients, family members, state agencies and other stakeholders. ADHS/DBHS considers suggested revisions collected during the public comment stage when finalizing ADHS/DBHS documents.

Addiction Compulsion and craving to use alcohol or other drugs regardless of negative or adverse consequences.

Arizona Department of Health Services/ Division of Behavioral Health Services (ADHS/DBHS) | 6 Revised 02/28/2016

Adjudication Hearing In juvenile proceedings ? during a fact finding session, the court determines whether or not there is sufficient evidence to sustain the allegations found in a petition. An adjudication hearing is the juvenile counterpart to an adult trial.

Administrative Appeal An appeal to the ADHS/DBHS of a decision made by the Arizona State Hospital or a T/RBHA as the result of a grievance.

Administrative Hearing A hearing conducted by the Office of Administrative Hearings under A.R.S. Title 41, Chapter 6, Article 10.

Administrative Review The portion of the appeal process beginning with the initial filing of a formal written appeal by the provider with the TRBHA or ADHS/DBHS and concluding with the issuance of a final decision by a RBHA or ADHS/DBHS that advises of formal hearing rights under A.R.S 41-1092 et seq.

Adult Group An AHCCCS group that includes persons who used to be in the AHCCCS Care Program with income up to 100% of the Federal Poverty Level (FDL) and persons who are 19-64 years old with income up to 133% of the FPL, who are not pregnant, and who do not have Medicare (The AHCCCS Care Program provided AHCCCS coverage for adults with income up to 100% of the FPL who did not have an eligible deprived child living with them, who were not pregnant, who were not 65 years or older, and who were not disabled. The AHCCCS Care Program no longer exists.)

Adult Recovery Team (Adult Clinical Team) A group of individuals, that following the nine Guiding Principles for Recovery-Oriented Adult Behavioral Health Services and Systems, work in collaboration and are actively involved in a person's assessment, service planning and service delivery. At a minimum, the team consists of the person, his/her guardian (if applicable), advocates (if assigned), and a qualified behavioral health representative. The team may also include members of the enrolled person's family, physical health, mental health or social service providers, representatives or other agencies serving the person, professionals representing various areas of expertise related to the person's needs, designated representatives or other persons identified by the enrolled person.

Advance Directive Federal regulations define an advance directive as a written instruction, such as a living will or durable power of attorney for health care, recognized under State law (whether statutory or as recognized by the courts of the State), relating to the provision of health care when the individual is incapacitated.

Adverse Action or Decision For purposes of this section means an action or decision taken by a T/RBHA or ADHS/DBHS for which a provider may file an appeal. This does not include disputes between a prospective service provider and a T/RBHA in connection to the T/RBHA's contract process.

Adverse Drug Event (ADE) Any incident in which the use of a medication (drug or biologic) at any dose, a medical device, or a special nutritional product (for example, dietary supplement, infant formula, medical food) may have resulted in an adverse outcome in a consumer.

Adverse Drug Reaction (ADR) An undesirable response associated with use of a drug that either compromises therapeutic efficacy, enhances toxicity, or both.

Age Groups The following age groups have been defined to provide consistency

Arizona Department of Health Services/ Division of Behavioral Health Services (ADHS/DBHS) | 7 Revised 02/28/2016

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