N.M. Admin. Code § 8.370.10.7

Current through Register Vol. 35, No. 23, December 10, 2024

Section 8.370.10.7 - DEFINITIONS

A."Abuse" including verbal abuse, means:

(1) knowingly, intentionally, and without justifiable cause inflicting physical pain, injury or mental anguish;

(2) the intentional deprivation by a caretaker or other person of services necessary to maintain the mental and physical health of a person; or

(3) sexual abuse, including criminal sexual contact, incest, and criminal sexual penetration.

B."Abuse, neglect, exploitation, or report of death form" means the reporting format issued by the division for the reporting of incidents which may relate to abuse, neglect, or exploitation of a consumer, including suspicious injuries, or for reporting any death.

C."Case manager" means the staff person designated to coordinate and monitor the individual service plan for persons receiving community-based services.

D."Community-based service providers" means any person, organization, or legal entity, including mi via consultants, providing the following services, and having any provider agreement with the health care authority:

(1)"developmental disability waiver services" means a medicaid funded home or community-based services for persons with intellectual and developmental disabilities; and

(2)"medically fragile waiver services" means medicaid funded home or community-based services for persons with intellectual and developmental disabilities who are medically fragile.

E."Consultant" means the person or entity supporting the mi via consumer to make informed choices among the services offered through the mi via waiver, develop service and support plans (SSP), and providing on-going assistance with SSP implementation.

F."Consumer" means any recipient of services from a community-based service provider.

G."Division" means the health care authority, division of health improvement, incident management bureau.

H."Employee" means any person whose employment or contractual service with a community-based service provider, or with a consumer, which includes direct care or routine and unsupervised physical or financial access to any care recipient served.

I."Environmental hazard" means a condition in the physical environment which creates an immediate threat to health or safety of the individual.

J."Exploitation" means an unjust or improper use of a person's money or property for another person's profit or advantage, financial, or otherwise.

K."Immediate access" means physical or in-person direct and unobstructed access to electronic or other access needed by employees, consumers, family members, or legal guardians to the community-based service program's incident management reporting procedures or access to the division's abuse, neglect, exploitation or report of death form.

L."Immediate jeopardy" means a provider's non-compliance with one or more requirements of medicaid participation or the provider agreement which causes, or is likely to cause, serious injury, harm, impairment, or death to a consumer.

M."Immediate reporting" means reporting that is done immediately. A report may only be delayed while the provider is taking immediate action to prevent harm to a consumer.

N."Incident" means any known, alleged, or suspected event of abuse, neglect, exploitation, suspicious injury, or any death.

O."Incident management system" means the written policies and procedures adopted or developed by the community-based service provider for reporting abuse, neglect, exploitation, suspicious injuries, or for making a report of death as required in Subsection A of 8.370.10.8 NMAC.

P."Mental anguish" means a relatively high degree of mental pain and distress that is more than mere disappointment, anger, resentment, or embarrassment, although it may include all of these, and is objectively manifested by the recipient of care or services by significant behavioral or emotional changes or physical symptoms.

Q."Natural support" means an uncompensated person such as a family member, friend, or any person in a supportive relationship with the consumer.

R."Neglect" means the failure of the caretaker to provide basic needs of a person, such as clothing, food, shelter, supervision, and care for the physical and mental health of that person. Neglect causes, or is likely to cause, harm to a person.

S."Non-responsible provider" means any reporter who is reporting an incident of abuse, neglect, exploitation, suspicious injury or death in which they are not the responsible community-based service provider during the time of the incident.

T."Quality assurance" means a systematic approach to the continuous study and improvement of the efficiency and efficacy of organizational, administrative, and clinical practices in meeting the needs of persons served as well as achieving the community-based service provider's mission, values and goals.

U."Quality improvement system" means the community-based service provider's policies and procedures for reviewing and documenting all alleged incidents of abuse, neglect, exploitation, suspicious injuries, and all deaths for the continuous study and improvement of the efficiency and efficacy of organizational, administrative, and preventative practices in employee training and reporting.

V."Report" means any assertion or allegation of abuse, neglect, exploitation, suspicious injuries, or report of death made by a reporter to the incident management bureau and includes any incident that a community-based service provider is required to report under applicable law.

W."Reporter" means any person who, or any entity that, reports possible abuse, neglect, exploitation, suspicious injury, or makes a report of death to the authority's incident management bureau.

X."Restraints" means use of a mechanical device or chemical restraints imposed, for the purposes of discipline or convenience, to physically restrict a consumer's freedom of movement, performance of physical activity, or normal access to his body.

Y."Sanction" means a measure imposed by the authority on a provider, pursuant to these requirements, in response to a finding of deficiency, with the intent of obtaining increased compliance with these requirements.

Z."Sexual abuse" means the inappropriate touching of a recipient of care or services for sexual purpose or in a sexual manner, and includes kissing, touching the genitals, buttocks, or breasts, causing the recipient of care or services to touch another for sexual purpose, or promoting or observing for sexual purpose any activity or performance involving play, photography, filming, or depiction of acts considered pornographic. Sexual conduct engaged in by an employee with a person for whom they are providing care or services is sexual abuse per se.

AA."Substantiated" means the verification of an allegation of abuse, neglect, or exploitation based upon a preponderance of reliable evidence obtained from an investigation of an allegation of abuse, neglect, or exploitation.

BB."Training curriculum" means the instruction manual or pamphlet adopted or developed by the community-based service provider containing policies and procedures for reporting abuse, neglect, exploitation, suspicious injury, or any death.

CC."Unsubstantiated" means that an allegation of abuse, neglect, and exploitation could not be verified based upon a preponderance of reliable evidence obtained from an investigation of a complaint of abuse, neglect, or exploitation.

DD."Verbal abuse" means profane, threatening, derogatory, or demeaning language, spoken or conveyed with the intent to cause mental anguish.

EE."Volunteer" means any person who is not a natural support who works without compensation for a community-based service provider and whose services includes direct care or routine physical or financial access to any consumer serviced by that community-based service provider.

N.M. Admin. Code § 8.370.10.7

Adopted by New Mexico Register, Volume XXXV, Issue 12, June 25, 2024, eff. 7/1/2024