Section 212-RICR-10-00-1.3 - DefinitionsA. Wherever used in this Part, the following terms shall be construed to mean:1. "Abuse" means the treatment or act toward any person with developmental disabilities, as defined in R.I. Gen. Laws § 40.1-27-1 on the part of anyone, including an employee, intern, volunteer, consultant, contractor, visitor, family member, caregiver, neighbor, citizen or other person with a disability, whether or not the person is or appears to be injured or harmed. The failure to exercise one's responsibility to intercede on behalf of a person receiving services also constitutes abuse. Abuse includes: a. "Physical abuse" may include, but is not limited to: physical assault, battery and/or actions such as: hitting, kicking, biting, pinching, burning, strangling, shoving, shaking, dragging, yanking, punching, slapping, pulling hair, grabbing or pushing, or using more force than is necessary for the safety of the person.(1) For incidents involving a caregiver, abuse is defined as the willful subjection of an adult with developmental disabilities to willful infliction of physical pain, willful deprivation of services necessary to maintain physical or mental health, or to unreasonable confinement.(2) For incidents of physical abuse involving two people with disabilities, only an attack resulting in injury in which one person needs medical care beyond routine first aid or a series of deliberate acts (i.e. hitting, kicking, slapping, pulling hair, etc.) displayed by one person with a disability towards another person with a disability should be reported to the Office of Quality Assurance. Other incidents should be documented and handled by the agency's internal Incident Management Committee.b. "Sexual abuse" means any sexual contact, consensual or otherwise, between a person receiving services and a paid employee, consultant or contractor of the Organization. Any sexual contact between a person receiving services and an immediate blood relative is incest and is sexual abuse. Any non-consensual sexual contact between a person with a disability and another person with a disability is also sexual abuse. This includes but is not limited to oral/genital contact, sexual penetration or fondling and any other assault as defined in R.I. Gen. Laws § 11-37.1-1 et seq.c. "Sexual contact" means the touching, fondling or intrusion of the genitals or other intimate parts of the person or offender directly or through clothing for the purpose of sexual arousal or gratification.d. "First degree sexual assault" means any forced or coerced intrusion, however slight, of the vagina, anus, or mouth, by part of another person's body or by an object, including cunnilingus or fellatio.e. "Second degree sexual assault" means any forced or coerced or intentional touching or sexual contact (not penetration) clothed or unclothed, with a person's genital area, anal area, groin, buttocks, or the breasts of a female for the purpose of sexual arousal, gratification or assault.f. "Third degree sexual assault" means penetration where one person is 18 years of age or older and the other is over the age of 14 years, but under the age of consent (age 16 years).g. "Sexual exploitation" may include, but is not limited to, causing a person to expose or touch themselves or anyone else for the purpose of demeaning the person, for the sexual arousal or personal gratification, taking sexually explicit photographs, forcing or encouraging a person to view pornographic materials encouraging a person to use sexually explicit language which he/she may not fully understand, the use of harmful genital practices such as creams, enemas, etc. to meet the idiosyncratic needs of an offender, etc.h. "Psychological/verbal abuse" means intentionally engaging in a pattern of harassing conduct which causes or is likely to cause emotional harm. This includes the use of verbal or non-verbal expression that subjects a person to ridicule, humiliation, contempt, manipulation, or is otherwise threatening, socially stigmatizing and fails to respect the dignity of the individual, including name-calling or swearing at a person, intimidating or condescending actions, behaviors, or demeaning tone of voice or any other pattern of harassing conduct.i. "Mistreatment" means the inappropriate use of medications, isolation, or use of physical or chemical restraints as punishment, for staff convenience, as a substitute for treatment or care, in conflict with a physician's order, or in quantities, which inhibit effective care or treatment, which harms or is likely to harm the individual.j. "Neglect" means the failure of a person to provide treatment, care, goods and services necessary to maintain the health and safety of the individual, as defined in R.I. Gen. Laws § 40.1-27-1, and other laws. For the purposes of this Part, "Neglect" shall also include the failure to report or act on health problems of the person or changes in his or her health conditions as indicated within a plan approved by the Department. Neglect also includes lack of attention to the physical needs of the person including personal care, cleanliness and personal hygiene, meals and/or failure to provide appropriate nutrition or a safe and sanitary environment; failure to carry out a plan of treatment or care prescribed by a physician and/or other health care professional; failure to provide services/supports as indicated within an ISP approved by the Department; and failure to provide proper supervision to the persons as required within an ISP or by a court.k. "Financial exploitation" means the use of funds, personal property or resources of a person receiving services by an individual for their own monetary or personal benefit, profit or gain with or without the informed consent of the person, including but not limited to the coercion or manipulation of a person to spend their own personal funds for something they may or may not have use for or soliciting of gifts, funds or favors. This includes any suspected theft of or missing property or funds of a person. For incidents involving a caregiver, financial exploitation is defined as an act or process of taking pecuniary advantage of a person with a developmental disability by use of undue influence, harassment, duress, deception, false misrepresentation, false pretenses, or misappropriation of funds.2. "Administer" means the direct application of a medication, whether by injection, inhalation, ingestion, or any other means, to the body of an individual by a. a licensed and authorized agent and under his or her direction; orb. the individual at the direction and in the presence of the licensed and authorized agent.3. "Admission" means acceptance into a program or service, after an initial biopsychosocial assessment has been conducted and includes opening a treatment record for the person, orienting him or her to the organization, and assigning his or her treatment to an appropriate staff person or team. Individuals shall be admitted to the organization no later than their third consecutive face-to-face clinical service.4. "Advocate" means a: b. an individual acting in support of or on behalf of a person in a manner consistent with the interests of the person.5. "Assessment" means the process of testing, gathering biopsychosocial information, and making a diagnostic judgment to determine an individual's behavioral health status and need for services, conducted by a qualified staff person.6. "Assistive technology" means specialized medical equipment and supplies to include devices, controls, or appliances, specified in the individualized service plan, that enable individuals to increase their ability to perform activities of daily living; devices, controls, or appliances that enable the individual to perceive, control, or communicate with others in the environment in which they live; including such other durable and nondurable medical equipment not available under the state plan that is necessary to address individual functional limitations. Items reimbursed with waiver funds are in addition to any medical equipment and supplies furnished under the state plan and exclude those items that are not of direct medical or remedial benefit to the individual. All items shall meet applicable standards of manufacture, design and installation and are subject to prior approval on an individual basis by the Department.7. "Authorization" means the service approved by BHDDH for everyone based upon the ISP or treatment plan.8. "Behavioral healthcare" means the umbrella term that encompasses all mental health and substance use related assessment, treatment, prevention, and support services.9. "Behavioral healthcare organization" or "BHO" means a public or private establishment primarily constituted, staffed, and equipped to deliver mental health and/or substance use services to the public.10. "Board" means the Board of Directors of the organization and/or the Advisory Board of a local Organization that is: a. a for profit entity or b. a not for profit entity providing services in Rhode Island.11. "Caregiver" means a person who provides care for a person with disabilities without payment, natural support.12. "Certification" shall have the meaning as defined under § 05-1.2(A)(15) of this Chapter and Subchapter 10 Part 1 of this Chapter depending on the program being utilized.13. "Change in operator" means a transfer of the authority of the Board of Directors, by the Board of an organization, to any other person or group of persons (excluding delegations of authority to the medical or administrative staff of the Organization).14. "Change in owner" means: a. When an Organization is a partnership: the removal, addition, or substitution of a partner that results in the new partner acquiring a controlling interest in the Organization.b. When an Organization is an unincorporated sole proprietorship: the transfer of the title and property to another person.c. When an Organization is a corporation: (1) A sale, lease, exchange, or other disposition of all, or substantially all the property and assets of the corporation.(2) A merger of the corporation into another corporation.(3) The consolidation of two (2) or more corporations resulting in the creation of a new corporation.d. When an Organization is a for profit corporation: any transfer of corporate stock that results in a new person acquiring a controlling interest in such corporation.e. When an Organization is a non-profit corporation: any change in membership that results in a person acquiring a controlling vote in such corporation.15. "CMHC" or "CMHO" means a private, non-profit community mental health center organization designated by the Director of the Department and licensed as such to ensure services are available through program delivery, local planning, service coordination, and monitoring outcomes within a specified geographical area according to R.I. Gen. Laws Chapter 40.1-8.5 for the Department's priority targeted populations within eight (8) areas according to R.I. Gen. Laws § 40.1-5.4-7(3).16. "Cognitive disability organization" or "CDO" means an organization licensed by BHDDH to provide services to adults with cognitive disorders. As used herein, CDOs shall have the same meaning as "providers" or "Organizations" and shall meet the licensing requirements of DDOs.17. "Community residence" means a facility that operates twenty-four (24) hours a day to provide room, board, supervision and supportive services to three (3) or more people who have developmental, mental and/or substance related disabilities.18. "Complaint" means a formal, written request for further review of an unresolved concern or an allegation against a licensed organization or provider regarding an alleged violation of ethical standards, regulations, or law.19. "Concern" means an issue that is perceived as interfering with a person receiving adequate treatment.20. "Controlled medications" or "controlled substances" means substances pursuant to R.I. Gen. Laws Chapter 21-28 that have a high potential for abuse which may lead to severe psychological or physical dependence.21. "Co-occurring disorder" is the coexistence of two or more behavioral health conditions, existing simultaneously and often independently of each other.22. "Day program service" means a service offered at a center-based day program or a community-based day program by a licensed developmental disability organization. The service includes the provision of education, training and opportunity to acquire the skills and experience needed to participate in the community. This may include activities to support individuals with building problem solving skills, social skills, adaptive skills, daily living skills, and leisure skills. Other services include assistance in establishing friendships, using public transportation, participating in community events, or otherwise undertaking activities to promote community integration. 23. "Department" means the Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH).24. "Developmental disability organizations" or "DDOs" means an organization licensed by BHDDH to provide services to adults with disabilities, as provided herein. As used herein, DDOs shall have the same meaning as "providers" or "Organizations."25. "Director" means the Director of the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH).26. "Evidence-based practice" is an intervention or service for which there is strong research demonstrating effectiveness in assisting persons to achieve desired outcomes.27. "Facility" means the physical plant where programs and services are provided and/or overseen, or could be provided, and as defined in R.I. Gen. Laws § 4 0.1-24-1(6) and other laws as applicable.28. "Human rights committee" or "HRC" means any duly constituted group of people with developmental disabilities, advocates, volunteers, and professionals who have training or experience in the area of behavioral treatment, and other citizens who have been appointed to a provider's human rights committee for the purposes of a. promoting human rights;b. reviewing, approving and monitoring individuals' plans designed to modify behavior which utilize restrictive interventions techniques or impair the individual's liberty, or other plans and procedures that involve risks to the person's protection and rights; and,c. participating in the provider's individual grievance procedures.29. "Incident" means a situation in which a person who receives services from the Department and/or an Organization licensed by the Department is harmed, or is involved in an event, which causes concern for the person's health, safety and/or welfare. It also refers to any adult, whether or not the person is receiving services from the Department, with developmental disabilities who is harmed or is involved in an event, which causes concern for the person's health, safety and/or welfare.30. "Independent contractor" means a person who is not an employee of the Organization and provides and/or contributes to the direct service to and/or has responsibility for an individual.31. "Individual" or "individual served" means a person who receives services or is assessed to need services based on the results of an initial assessment. The term "person served" shall be synonymous herein with the term "individual" or "individual served."32. "Individual service plan" or "ISP" means the annual document derived from a person-centered plan which details the services for an individual supported.33. "Integration" means: a. The use by individuals with developmental disabilities of the same community resources that are used by and available to other persons in the community;b. Participation in the same community activities in which persons without a developmental disability participate, together with regular contact with persons without a developmental disability; and c. Individuals with developmental disabilities who live in homes that are in proximity to community resources and foster contact with persons in their community.34. "Investigation" means a systematic review and search for facts. It is objective in nature and is intended to identify facts, sequence and chronology of events, active failure(s), latent failure(s) and assessment of risk as pertinent to a specific adverse event. An investigation may be undertaken because of a complaint, an adverse event or incident report, or other information that comes to the attention of the Department or the organization.35. "Non-congregant residential support services" means services provided in residential settings other than a host family that are not Community Residences as defined herein. The service includes residential support services and may include specialized residential support services. Non-congregant residential support services do not include payments for room and board. Payments for non-congregant residential support services are based on residential resource levels.36. "Office of Licensure and Standards" means the unit within BHDDH that is responsible for licensing provider organizations and programs.37. "Office of Quality Assurance" or "OQA" shall have the same meaning as the office described in R.I. Gen. Laws § 40.1-26-10.38. "Orientation" means a process to provide initial information about the BHO and DDO and its services to persons served and to staff of the organization. For staff, orientation includes an assessment of their competence relative to their job responsibilities and the organization's mission, vision, and values.39. "Outcome" means the result(s) of the performance or the non-performance of a function or process.40. "Participant" means an adult who has a developmental disability as defined herein. As used in this Part, "individual" shall have the same meaning, in addition to its meaning in § 1.3(A)(31) of this Part.41. "Person" means any individual, governmental unit, corporation, company, association, or joint stock association and the legal successor thereof.42. "Person-centered" shall have the meaning as defined in the BHO or DDO regulations, depending on the program being utilized.43. "Premises" means a tract of land and the buildings thereon where direct services are provided.44. "Program" means a planned structured service delivery system structured to provide specific components that are responsive to the needs of the persons served.45. "Provider" means a person or organization that manages or delivers clinical and/or support services.46. "Residential services" shall have the meaning as defined in the BHO and DDO regulations, depending on the program being utilized.47. "Restraint" means restricting the movement of the whole or a portion of a person's body as a means of controlling a person's physical activity to protect the person or others from injury. a. "Chemical or pharmacological restraint" means medication that is given for the emergency control of behavior when the medication is not standard treatment for the individual's medical or psychiatric condition.b. "Mechanical restraint" means the use of an approved mechanical device that restricts the freedom of movement or voluntary functioning of a limb or a portion of a person's body as a means to control his or her physical activities.c. "Physical restraint" means the use of approved physical interventions or "hands on" holds to prevent an individual from moving his or her body to engage in a behavior that places him, her or others at risk of physical harm.48. "Services" mean individually planned interventions intended to reduce or ameliorate the symptoms of mental disorders or substance dependence or abuse through treatment, training, rehabilitation, or other supports. Services also refer to person-centered interventions provided to developmentally disabled adults.49. "Significant others" mean and include individuals who are important to the person served, as identified by the person served.50. "Staff" means, including but not limited to, any employee, intern, trainee, or volunteer performing a service or activities for the organization and for meeting the needs of individuals served for which competent performance is expected.51. "Support coordinator" means the individual employed by the Organization who delivers Support Coordination services. The term is synonymous with Case Manager in these regulations and includes, but is not limited to, the external coordination and monitoring of the Shared Living Arrangements.52. "Treatment" or "Care" means a set of individually planned interventions or supports that help an individual work towards his or her recovery goals and obtain or maintain an optimal level of functioning, reduce the effects of disability or discomfort, or ameliorate symptoms, undesirable changes or conditions specific to physical, mental, behavioral or social functions.53. "Violation of human rights" means any action or inaction which deprives an individual of any of his or her civil rights, as articulated in federal or state law or in this Part.212 R.I. Code R. 212-RICR-10-00-1.3
Adopted effective 1/7/2019