Section 212-RICR-10-05-1.2 - 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 DDO. 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 § 11-37-1et 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 also 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 participant 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. "Material abuse" means the illegal or improper use or exploitation of the participant and his/her funds, personal property or other resources. j. "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 participant.k. "Neglect" means the failure of a person to provide treatment, care, goods and services necessary to maintain the health and safety of the participant, as defined in R.I. Gen. Laws § 40.1-27-1. 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/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. l. "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 also 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; or b. the individual at the direction and in the presence of the licensed and authorized agent. 3. "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.4. "Assessment" means the process of testing, gathering information, and making a diagnostic judgment to determine an individual's health or behavioral health status, functional capability, and need for services, conducted by a qualified person. 5. "Authorization" means the service approved by BHDDH for each participant based upon the ISP. 6. "Annual accounting summary of participant funds" means documentation required by Social Security for Representative Payees.7. "Behavioral supports" means services provided to a participant who has a behavioral treatment plan in place which was developed in cooperation with professional staff to address chronic and severe behavioral problems and concerns that severely and persistently interfere with the participant's and/or others' health and safety. The implementation of behavioral supports requires behavioral professional staff to provide additional training and supervision to direct support professionals that is more extensive than the training and supervision required in the provision of Residential Support Services or Day Program Services. 8. "Behavioral treatment" means any intervention or treatment to develop and strengthen adaptive, appropriate behaviors through the application of behavioral interventions, and to simultaneously reduce the frequency of maladaptive or inappropriate behaviors. Behavioral interventions encompass behavioral analysis, psychotropic medication, or other similar interventions that refer to purposeful, clinical manipulation of behavior.9. "Best practice" means a procedure that has been shown by research and experience to produce optimal results and that is established or proposed as a standard suitable for widespread adoption.10. "Board" means the Board of Directors of the organization and/or the Advisory Board of a local DDO that is: a. A for-profit entity or b. A not-for-profit entity providing services in Rhode Island. 11. "Career development plan" means a person-centered plan that identifies the Participant's employment goals and objectives, the services and supports needed to achieve those goals, the persons, agencies, and providers assigned to assist the person attain those goals, and the obstacles to the Participant working in an individualized job in an integrated community-based employment setting at competitive wages, and seeks to identify the appropriate services and supports necessary to overcome those obstacles.12. "Caregiver" means a person who provides care for a person with disabilities without payment and is a natural support.13. "Certified services" means services operated by a DDO which the Department has evaluated and recognized as having met predetermined requirements or standards in order to demonstrate competence in a specialty program or service area.14. "Communicable disease" means an illness due to a specific infectious agent or its toxic products that arises through transmission of that agent or its products from an infected person, animal or inanimate reservoir to a susceptible host. This includes, but is not limited to, sexually transmitted diseases. 15. "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.16. "DDO health care manual" means the repository for all agency policies and procedures relating to health care practices. These manuals are developed by the agency with the input of nursing and other clinical staff and are intended to serve as a guide for health care practice within the agency. Each agency shall ensure that the DDO Health Care Manual is reviewed and approved by a Professional Nurse (R.N.) on an annual basis and when any changes are made to it. For the purposes of these regulations, "DDO Health Care Manual" can be used interchangeably with "Agency Health Care Manual."17. "Department" means the Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH).18. "Delegation" means the transferring to a competent individual the authority to perform a selected nursing activity in a selected situation. The nurse retains the accountability for the delegation. 19. "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."20. "Director" means the Director of the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH), his/her agents or assigns. 21. "Dispense" means the preparation, administration, or delivery of a medication pursuant to the lawful order of a licensed healthcare prescriber. 22. "Distribute" means to deliver a medication, other than by administering or dispensing. 23. "Evaluation" means the Professional Nurse (R.N.) will evaluate and document the person's response to interventions outlined in the plan of care; revise the plan as necessary; and, identify the degree to which the expected outcomes have been achieved. 24. "Fiscal intermediary" means a licensed DDO authorized to receive and distribute support funds or participant directed goods or services on behalf of a participant in accordance with the participant's Individualized Service Plan.25. "Functional behavioral assessment" means a process to identify the function of a person's behavior. The information collected during the assessment should be used to develop effective behavior supports and plans.26. "Household" means and includes any person, whether a family member or not, who sleeps within the home full or part-time. 27. "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 or impair the participant's liberty, or other plans and procedures that involve risks to the person's protection and rights; and c. Participating in the provider's participant grievance procedures. 28. "Incident" means a situation in which a person with a developmental disability is harmed, or is involved in an event, which causes concern for the person's health, safety and/or welfare. This includes individuals who receive services from the Department and/or a DDO licensed by the Department. 29. "Individual service plan" or "ISP" means the annual document derived from a person-centered plan which details the services for an individual supported.30. "Informed consent" means the permission given by a person who has the legal capacity to give consent to or to authorize treatment. Such person: a. Is able to exercise free power of choice without the intervention of any element of force, fraud, deceit, duress, over-reaching, or other form of constraint or coercion; and b. Has been given sufficient information about the risks and benefits of the proposed treatment or procedure and the elements involved to be able to make a knowledgeable and enlightened decision. 31. "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. 32. "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 as a result of a complaint, an adverse event or incident report, or other information that comes to the attention of the Department or the organization. 33. "Medication error(s)" means incidents involving medications which may or may not cause harm to a person's health and welfare. By way of example, and not in limitation, medication errors include: omission of a dosage(s) or failure to administer, incorrect dosage(s), incorrect medication(s), medication(s) given by incorrect administration route, medication(s) given by incorrect time, medication(s) given to wrong person, any inappropriate use of medications, failure to follow agency procedures for medication administration, and medication or treatment given without an order from a prescriber. 34. "Nursing diagnosis" means concise statements of conclusions derived from assessment data collected and include the presenting medical diagnoses and the person's unique nursing and health care needs. Nursing diagnoses are recorded in a manner that facilitates the nursing process. 35. "Nursing plan of care" means the Professional Nurse (R.N.) will develop a plan of care based upon the data obtained during the assessment. The elements of the plan of care will reflect data obtained as part of the person's initial health care screen as well as subsequent assessments and shall be congruent with the person's unique health care needs. The plan of care provides guidance for support staff in the provision of health care activities. Nursing plans of care are recorded, communicated to others, and revised as necessary according to the provider's written policy and procedure. 36. "Nursing process" means a process by which nurses deliver care to patients. The nursing process is comprised of the following essential elements: assessment/data collection; nursing diagnosis; nursing planning; intervention; and evaluation. 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. "Office of Licensure and Standards" means the unit within BHDDH that is responsible for licensing provider organizations and programs.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 by R.I. Gen. Laws § 40.1-21-4.3(5). As used in this Part, "participant" and "individual" shall have the same meaning. 41. "Person" means any individual, governmental unit, corporation, company, association, or joint stock association and the legal successor thereof. 42. "Person-centered" means the formal process that organizes services and supports around a self-directed, self-determined and goal-directed future, and includes the process by which a participant identifies the direction of his/her future activities, including future vocational and employment related activities, based on his/her skills, interests, strengths, and abilities, regardless of whether the participant has the verbal ability to express such information. 43. "Positive behavioral supports" is a systematic, person-centered approach to understanding the reasons for behavior and applying evidence-based practices for prevention, proactive intervention, teaching and responding to behavior, with the goal of achieving meaningful social outcomes, increasing learning and enhancing the quality of life across the lifespan.44. "Practical nurse" means Practical Nursing as defined in R.I. Gen. Laws § 5-34-3. 45. "Professional nursing" means Professional Nursing as defined in R.I. Gen. Laws § 5-34-3. 46. "Program" means a planned structured service delivery system structured to provide specific components that are responsive to the needs of the persons served. 47. "Residential settings subject to licensure" means any residential setting with three (3) or more unrelated participants who are eligible for Medicaid waiver or other BHDDH licensed services for adults with developmental disabilities including any category of institutions, foster homes, or group living arrangements in compliance with 42 U.S.C. § 1382(e) of the Social Security Act. Such standards shall be appropriate to the needs of such participants and the character of the facilities involved, and shall govern such matters as admission policies, safety, sanitation, and protection of civil rights. 48. "Respite care service" means direct support to participants furnished on a short-term basis because of the absence or need for relief of those persons who normally provide care for the participant. Respite care services may be provided in the participant's home or private place of residence or at the location of a respite care provider or in the community. 49. "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.50. "Restrictive intervention" means a procedure that does one or more of the following: a. Limits an individual's movement, activity or function;b. Interferes with an individual's ability to acquire positive reinforcement; c. Results in the loss of objects or activities that an individual values;d. Requires an individual to engage in a behavior that the individual would not engage in given freedom of choice.51. "Serious reportable incident" means any situation involving a person with developmental disabilities in which the person has: a. Had an injury that requires medical care or treatment beyond routine first aid; b. Been involved in an unexplained absence and whose whereabouts are unknown to anyone; d. Been personally involved (is the alleged victim or perpetrator) in a serious criminal act; e. Been involved in an event in which law enforcement has been contacted or in an event in which first responders, including, but not limited to, law enforcement, fire, and/or emergency medical personnel, have participated; f. Been the subject of a serious or repeated medication error; or g. Had any of his/her civil or human rights violated. 52. "Shared living arrangement contractor" means the adult who is not a participant's household member who has contracted with a DDO to provide residential support services in his/her home to a Participant.53. "Staff" includes but is 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.54. "Supervision" means the provision of guidance by a Professional Nurse (RN) for the accomplishment of a nursing task or activity with initial direction of the task or activity and periodic inspection and documentation of the actual act of accomplishing the task or activity. Total nursing care of an individual remains the responsibility and accountability of the licensed nurse. 55. "Support coordinator" means the individual employed by the DDO 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. 56. "Violation of human rights" means any action or inaction which deprives a participant of any of his or her civil rights, as articulated in law or in this Part. 212 R.I. Code R. 212-RICR-10-05-1.2
Adopted effective 1/7/2019