TITLE 9. HEALTH SERVICES

CHAPTER 20. DEPARTMENT OF HEALTH SERVICES
BEHAVIORAL HEALTH SERVICE AGENCIES: LICENSURE

The Office of the Secretary of State publishes all Chapters on white paper (Supp. 01-3).

New Title 9, Chapter 20 was adopted and amended by the Department of Health Services pursuant to an exemption from the provisions of A.R.S. Title 41, Chapter 6 (Laws 1992, Ch. 301, § 61). Exemption from A.R.S. Title 41, Chapter 6 means that the Department did not submit notice of this rulemaking to the Secretary of State's Office for publication in the Arizona Administrative Register; the Department did not submit these rules to the Governor's Regulatory Review Council for review; the Department was not required to hold public hearings on these rules; and the Attorney General has not certified these rules. Because this Chapter contains rules which are exempt from the regular rulemaking process, the Chapter is printed on blue paper.

Former Title 9, Chapter 20 renumbered and repealed as follows: Article 1 renumbered to Title 18, Chapter 7, Article 1; Article 2, consisting of Sections R9-20-201 through R9-20-226, repealed effective September 27, 1989 (Supp. 89-3); Article 3 was reserved; Article 4 renumbered to Title 18, Chapter 9, Article 7; and Article 5 renumbered to Title 18, Chapter 4, Article 1.

ARTICLE 1. GENERAL

Section

R9-20-101. Definitions

R9-20-102. Agency Subclasses and Required and Authorized Services

R9-20-103. Initial License Application

R9-20-104. License Renewal

R9-20-105. Time-frames

R9-20-106. Changes Affecting a License

R9-20-107. Enforcement Actions

R9-20-108. Denial, Revocation, or Suspension of a License

R9-20-109. Repealed

R9-20-110. Repealed

R9-20-111. Repealed

R9-20-112. Repealed

R9-20-113. Repealed

R9-20-114. Repealed

ARTICLE 2. UNIVERSAL RULES

Section

R9-20-201. Administration

R9-20-202. Required Reports

R9-20-203. Client Rights

R9-20-204. Staff Member and Employee Qualifications and Records

R9-20-205. Clinical Supervision

R9-20-206. Orientation and Training

R9-20-207. Staffing Requirements

R9-20-208. Admission Requirements

R9-20-209. Assessment and Treatment Plan

R9-20-210. Discharge

R9-20-211. Client Records

R9-20-212. Transportation

R9-20-213. Outings

R9-20-214. Environmental Standards

R9-20-215. Time Out

R9-20-216. Emergency Safety Response

ARTICLE 3. OUTPATIENT CLINIC REQUIREMENTS

Section

R9-20-301. Universal Outpatient Clinic Requirements

R9-20-302. Supplemental Requirements for Counseling

R9-20-303. Supplemental Requirements for Medication Services

R9-20-304. Repealed

R9-20-305. Repealed

R9-20-306. Repealed

R9-20-307. Repealed

R9-20-308. Repealed

R9-20-309. Repealed

R9-20-310. Repealed

R9-20-311. Repealed

ARTICLE 4. RESIDENTIAL AGENCY REQUIREMENTS

Section

R9-20-401. Supplemental Admission Requirements

R9-20-402. Supplemental Requirements for Social, Recreational, or Rehabilitative Activities

R9-20-403. Supplemental Requirements for Client Funds

R9-20-404. Supplemental Requirements for an Agency that Provides Behavioral Health Services to Children

R9-20-405. Environmental Standards

R9-20-406. Fire Safety Standards

R9-20-407. Food Service Requirements

R9-20-408. Assistance in the Self-Administration of Medication

R9-20-409. Supplemental Requirements for a Level 2 Behavioral Health Residential Agency

R9-20-410. Supplemental Requirements for a

Level 3 Behavioral Health Residential Agency

R9-20-411. Repealed

R9-20-412. Repealed

R9-20-413. Repealed

ARTICLE 5. INPATIENT TREATMENT PROGRAM REQUIREMENTS

Section

R9-20-501. Universal Inpatient Treatment Program Requirements

R9-20-502. Supplemental Requirements for a Level 1 Psychiatric Acute Hospital

R9-20-503. Supplemental Requirements for Crisis Services

R9-20-504. Supplemental Requirements for Detoxification Services

R9-20-505. Supplemental Requirements for a Level 1 RTC

R9-20-506. Supplemental Requirements for a Level 1 Sub-Acute Agency

ARTICLE 6. USE OF RESTRAINT OR SECLUSION

Section

R9-20-601. Definitions

R9-20-602. Requirements for Use of Restraint or Seclusion

R9-20-603. Repealed

R9-20-604. Repealed

R9-20-605. Repealed

ARTICLE 7. LEVEL 1 SPECIALIZED TRANSITIONAL AGENCY

Section

R9-20-701. Supplemental Requirements for a Level 1 Specialized Transitional Agency

R9-20-702. Repealed

ARTICLE 8. COURT-ORDERED SERVICES

Section

R9-20-801. Supplemental Requirements for Pre-Petition Screening

R9-20-802. Supplemental Requirements for Court-Ordered Evaluation

R9-20-803. Supplemental Requirements for Court-Ordered Treatment

ARTICLE 9. DUI SERVICES

Section

R9-20-901. Exceptions for a Licensee of an Agency That Only Provides DUI Screening or DUI Education or Both

R9-20-902. Supplemental Requirements for DUI Screening

R9-20-903. Supplemental Requirements for DUI Education

R9-20-904. Supplemental Requirements for DUI Treatment

ARTICLE 10. OPIOID TREATMENT

Section

R9-20-1001. Definitions

R9-20-1002. Administration

R9-20-1003. Admission

R9-20-1004. Assessment and Treatment Plan

R9-20-1005. Dosage

R9-20-1006. Drug Screening

R9-20-1007. Take-Home Medication

R9-20-1008. Withdrawal Treatment

R9-20-1009. Counseling and Medical Services

R9-20-1010. Diverse Populations

R9-20-1011. Preparedness Planning

R9-20-1012. Client Records

R9-20-1013. Community Relations

R9-20-1014. Diversion Control

ARTICLE 11. MISDEMEANOR DOMESTIC VIOLENCE OFFENDER TREATMENT

Section

R9-20-1101. Misdemeanor Domestic Violence Offender Treatment Standards

R9-20-1102. Repealed

ARTICLE 12. LEVEL 4 TRANSITIONAL AGENCY

Section

R9-20-1201. Definitions

R9-20-1202. Standards for a Level 4 Transitional Agency

ARTICLE 13. SHELTER FOR VICTIMS OF DOMESTIC VIOLENCE

Section

R9-20-1301. Standards for a Shelter for Victims of Domestic Violence

R9-20-1302. Repealed

R9-20-1303. Repealed

R9-20-1304. Repealed

R9-20-1305. Repealed

R9-20-1306. Repealed

R9-20-1307. Repealed

R9-20-1308. Repealed

R9-20-1309. Repealed

R9-20-1310. Repealed

R9-20-1311. Repealed

R9-20-1312. Repealed

R9-20-1313. Repealed

R9-20-1314. Repealed

ARTICLE 14. RURAL SUBSTANCE ABUSE TRANSITIONAL AGENCY

Section

R9-20-1401. Standards for a Rural Substance Abuse Transitional Agency

R9-20-1402. Repealed

R9-20-1403. Repealed

ARTICLE 15. ADULT THERAPEUTIC FOSTER HOME

Section

R9-20-1501. Management

R9-20-1502. Licensee Qualifications and Requirements

R9-20-1503. Supervision

R9-20-1504. Admission

R9-20-1505. Assessment and Treatment Plan

R9-20-1506. Client Records

R9-20-1507. Environmental Standards

R9-20-1508. Food Services

ARTICLE 16. REPEALED

Section

R9-20-1601. Repealed

R9-20-1602. Repealed

R9-20-1603. Repealed

ARTICLE 17. REPEALED

Section

R9-20-1701. Repealed

R9-20-1702. Repealed

R9-20-1703. Repealed

R9-20-1704. Repealed

R9-20-1705. Repealed

R9-20-1706. Repealed

R9-20-1707. Repealed

R9-20-1708. Repealed

R9-20-1709. Repealed

R9-20-1710. Repealed

R9-20-1711. Repealed

R9-20-1712. Repealed

R9-20-1713. Repealed

ARTICLE 18. REPEALED

Section

R9-20-1801. Repealed

R9-20-1802. Repealed

R9-20-1803. Repealed

R9-20-1804. Repealed

Exhibit A. Repealed

R9-20-1805. Repealed

R9-20-1806. Repealed

R9-20-1807. Repealed

R9-20-1808. Repealed

R9-20-1809. Repealed

R9-20-1810. Repealed

R9-20-1811. Repealed

R9-20-1812. Repealed

R9-20-1813. Repealed

R9-20-1814. Repealed

R9-20-1815. Repealed

R9-20-1816. Repealed

R9-20-1817. Repealed

Exhibit A. Repealed

ARTICLE 19. REPEALED

Part A. Repealed

Section

R9-20-A1901. Repealed

R9-20-A1902. Repealed

Part B. Repealed

Section

R9-20-B1901. Repealed

R9-20-B1902. Repealed

R9-20-B1903. Repealed

R9-20-B1904. Repealed

R9-20-B1905. Repealed

R9-20-B1906. Repealed

R9-20-B1907. Repealed

R9-20-B1908. Repealed

R9-20-B1909. Repealed

ARTICLE 1. GENERAL

R9-20-101. Definitions

The following definitions apply in this Chapter unless otherwise specified:

1. "Abuse" means:

a. For an adult:

i. The intentional infliction of physical harm or allowing another individual to inflict physical harm;

ii. Causing injury by negligent acts or omissions;

iii. Unreasonable or unlawful confinement;

iv. Sexual abuse, sexual assault, sexual misconduct, molestation, incest or prostitution;

v. A pattern of ridiculing or demeaning, making derogatory remarks to, verbally harassing, or threatening to inflict physical harm on a client; or

vi. Pharmacological abuse; or

b. For a child:

i. The infliction of, or allowing another individual to inflict, physical harm;

ii. Causing injury or impairment of bodily functions by negligent acts or omissions;

iii. A pattern of ridiculing or demeaning, making derogatory remarks to, verbally harassing, or threatening to inflict physical harm on a client;

iv. Inflicting or allowing another to inflict sexual misconduct, sexual assault, molestation of a child, commercial sexual exploitation of a minor, incest, or child prostitution; or

v. Pharmacological abuse.

2. "Administrative office" means a designated area in a building used for operating an agency that is at a separate location from the agency's premises.

3. "Administrator" means an individual designated according to R9-20-201(A)(5).

4. "Admission" means the written acceptance by an agency to provide behavioral health services to an individual.

5. "Adult" means an individual 18 years of age or older.

6. "Adult therapeutic foster home" means an agency that provides behavioral health services and ancillary services to at least one and no more than three adults and where the clients live in the home with, and are integrated into the family of, the individuals providing behavioral health services to the clients.

7. "Agency" means a behavioral health service agency, a classification of a health care institution, including a mental health treatment agency defined in A.R.S. § 36-501, that is licensed to provide behavioral health services according to A.R.S. Title 36, Chapter 4.

8. "Agent" means an adult who has been designated to act for a client who is an adult in a mental health care power of attorney completed by the client according to A.R.S. Title 36, Chapter 32, Article 6.

9. "Ancillary services" means items or activities that are not behavioral health services but are necessary to ensure a client's health, safety, and welfare, such as food, housing, laundry, or transportation.

10. "Assessment" means the collection and analysis of an individual's information required in R9-20-209 to determine the individual's treatment needs.

11. "Assistance in the self-administration of medication" means aid provided to a client in:

a. Storing the client's medication to facilitate compliance with subsections (A)(11)(b) through (e);

b. Reminding the client to take a medication;

c. Verifying that the medication is taken as directed by the client's medical practitioner by:

i. Confirming that a medication is being taken by the client for whom it is prescribed,

ii. Checking the dosage against the label on the container, and

iii. Confirming that the client is taking the medication as directed;

d. Opening a medication container; or

e. Observing the client while the client removes the medication from the container or takes the medication.

12. "Behavioral health issue" means an individual's condition related to a mental disorder, personality disorder, substance abuse, or a significant psychological or behavioral response to an identifiable stressor or stressors.

13. "Behavioral health medical practitioner" means an individual licensed and authorized by law to use and prescribe medication and devices defined in A.R.S. § 32-1901, and who is one of the following with at least one year of full-time behavioral health work experience:

a. A physician,

b. A physician assistant, or

c. A nurse practitioner.

14. "Behavioral health paraprofessional" means an individual who meets the applicable requirements in R9-20-204 and has:

a. An associate's degree,

b. A high school diploma, or

c. A high school equivalency diploma.

15. "Behavioral health professional" means an individual who meets the applicable requirements in R9-20-204 and is a:

a. Psychiatrist,

b. Behavioral health medical practitioner,

c. Psychologist,

d. Social worker,

e. Counselor,

f. Marriage and family therapist,

g. Substance abuse counselor, or

h. Registered nurse with at least one year of full-time behavioral health work experience.

16. "Behavioral health service" means the assessment, diagnosis, or treatment of an individual's behavioral health issue.

17. "Behavioral health technician" means an individual who meets the applicable requirements in R9-20-204 and:

a. Has a master's degree or bachelor's degree in a field related to behavioral health;

b. Is a registered nurse;

c. Is a physician assistant who is not working as a medical practitioner;

d. Has a bachelor's degree and at least one year of full-time behavioral health work experience;

e. Has an associate's degree and at least two years of full-time behavioral health work experience;

f. Has a high school diploma or high school equivalency diploma and:

i. 18 credit hours of post-high school education in a field related to behavioral health completed no more than four years before the date the individual begins providing behavioral health services and two years of full-time behavioral health work experience; or

ii. Four years of full-time behavioral health work experience; or

g. Is licensed as a practical nurse, according to A.R.S. Title 32, Chapter 15, with at least two years of full-time behavioral health work experience.

18. "Behavioral health work experience" means providing behavioral health services:

a. In an agency,

b. To an individual, or

c. In a field related to behavioral health.

19. "Branch office" means an agency's secondary facility that is open and functioning 20 or fewer hours each week and that provides counseling.

20. "Child" means an individual younger than 18 years of age.

21. "Client" means an individual who is accepted by an agency for the provision of behavioral health services.

22. "Client record" means the collected documentation of the behavioral health services provided to and the information gathered regarding a client, maintained as required in R9-20-211 or as otherwise provided in this Chapter.

23. "Clinical director" means an individual designated by the licensee according to R9-20-201(A)(6).

24. "Clinical supervision" means review of skills and knowledge and guidance in improving or developing skills and knowledge.

25. "Communicable disease" has the same meaning as in A.A.C. R9-6-101.

26. "Conspicuously posted" means displayed in a facility at a location that is accessible and visible to a client and the public.

27. "Contiguous grounds" means real property that can be enclosed by a single unbroken boundary line that does not enclose property owned or leased by another.

28. "Co-occurring disorder" means a combination of a mental disorder or a personality disorder and one or more of the following:

a. Substance abuse, or

b. A developmental disability.

29. "Correctional facility" has the same meaning as in A.R.S. § 31-341.

30. "Counseling" means the therapeutic interaction between a client, clients, or a client's family and a behavioral health professional or behavioral health technician intended to improve, eliminate, or manage one or more of a client's behavioral health issues and includes:

a. Individual counseling provided to a client,

b. Group counseling provided to more than one client or more than one family, or

c. Family counseling provided to a client or the client's family.

31. "Counselor" means:

a. Before July 1, 2004, an individual who is certified as an associate counselor or a professional counselor according to A.R.S. Title 32, Chapter 33, Article 6;

b. On or after July 1, 2004, an individual who is licensed as an associate counselor or professional counselor according to A.R.S. Title 32, Chapter 33;

c. Until October 3, 2003, an individual who is certified by the National Board of Certified Counselors; or

d. Until July 1, 2004, an individual who is licensed or certified to provide counseling by a government entity in another state if the individual:

i. Has documentation of submission of an application for certification as a professional counselor or associate counselor according to A.R.S. Title 32, Chapter 33, Article 6; and

ii. Is certified as a professional counselor or associate counselor according to A.R.S. Title 32, Chapter 33, Article 6 within two years after submitting the application and before July 1, 2004.

32. "Court-ordered alcohol treatment" means detoxification services or treatment provided according to A.R.S. Title 36, Chapter 18, Article 2.

33. "Court-ordered alcohol treatment evaluation" has the same meaning as "evaluation" in A.R.S. § 36-2021.

34. "Court-ordered evaluation" or "evaluation" has the same meaning as "evaluation" in A.R.S. § 36-501.

35. "Court-ordered treatment" means treatment provided according to A.R.S. Title 36, Chapter 5.

36. "CPR" means cardiopulmonary resuscitation.

37. "Crisis services" means immediate and unscheduled behavioral health services provided:

a. In response to an individual's behavioral health issue to prevent imminent harm or to stabilize or resolve an acute behavioral health issue; and

b. At a Level 1 psychiatric acute hospital or a Level 1 sub-acute agency.

38. "Current" means up-to-date, extending to the present time.

39. "Custodian" means a person, other than a parent or legal guardian, who stands in loco parentis to the child or a person to whom legal custody of the child has been given by order of the juvenile court.

40. "Danger to others" means that the judgement of a person who has a mental disorder is so impaired that he is unable to understand his need for treatment and as a result of his mental disorder his continued behavior can reasonably be expected, on the basis of a competent medical opinion, to result in serious physical harm.

41. "Danger to self" means:

a. Behavior which, as a result of a mental disorder, constitutes a danger of inflicting serious physical harm upon oneself, including attempted suicide or the serious threat thereof, if the threat is such that, when considered in the light of its context and in light of the individual's previous acts, it is substantially supportive of an expectation that the threat will be carried out.

b. Behavior which, as a result of a mental disorder, will, without hospitalization, result in serious physical harm or serious illness to the person, except that this definition shall not include behavior which establishes only the condition of gravely disabled.

42. "Day" means calendar day.

43. "Department" means the department of health services.

44. "Designated representative" means an individual identified in writing by a client or the client's parent, guardian, or custodian to assist the client in protecting the client's rights.

45. "Detoxification services" means behavioral health services and medical services provided:

a. To reduce or eliminate a client's dependence on, or to provide treatment for a client's signs and symptoms of withdrawal from, alcohol or other drugs; and

b. At a Level 1 psychiatric acute hospital or a Level 1 sub-acute agency.

46. "Diagnosis" means a determination and labeling of a client's behavioral health issue according to the:

a. American Psychiatric Association, DSM-IV: Diagnostic and Statistical Manual of Mental Disorders (4th ed. 1994), incorporated by reference and on file with the Department and the Office of the Secretary of State and including no future editions or amendments, available from American Psychiatric Press, Inc., Order Department, 1400 K Street, N.W., Suite 1101, Washington, DC 20005; or

b. National Center for Health Statistics, U.S. Department of Health and Human Services, ICD-9-CM: International Classification of Diseases, 9th Revision, Clinical Modification (5th ed. 2000), incorporated by reference and on file with the Department and the Office of the Secretary of State and including no future editions or amendments, available from Practice Management Information Corporation, 4727 Wilshire Boulevard, Suite 300, Los Angeles, CA 90010 and from the National Technical Information Service, 5285 Port Royal Road, Springfield, VA 22161.

47. "Discharge" means the written termination of a client's affiliation with an agency, according to R9-20-210.

48. "Discharge summary" means an analysis of the treatment provided to a client and the client's progress in treatment.

49. "Documentation" means written or electronic supportive evidence.

50. "Drug used as a restraint" means pharmacological restraint as used in A.R.S. § 36-513 that is not standard treatment for a client's medical condition or behavioral health issue and is administered:

a. To manage a client's behavior in a way that reduces the safety risk to the client or others, and

b. To temporarily restrict the client's freedom of movement.

51. "DSM-IV" means DSM-IV: Diagnostic and Statistical Manual of Mental Disorders (4th ed. 1994), incorporated by reference in subsection (46)(a).

52. "DUI client" means an individual who is ordered by the court to receive DUI screening, DUI education, or DUI treatment as a result of an arrest or conviction for a violation of A.R.S. §§ 28-1381, 28-1382, or 28-1383.

53. "DUI education" has the same meaning as "education" in A.R.S. § 28-1301(3).

54. "DUI screening" has the same meaning as "screening" in A.R.S. § 28-1301(6).

55. "DUI treatment" has the same meaning as "treatment" in A.R.S. § 28-1301(7).

56. "Emergency safety response" means physically holding a client to safely manage a sudden, intense, or out-of-control behavior to prevent harm to the client or another individual.

57. "Employee" means an individual who receives compensation from an agency for work performed, but who does not provide behavioral health services.

58. "Exploitation" means the illegal use of a client's resources for another individual's profit or advantage according to A.R.S. Title 46, Chapter 4 or Title 13, Chapter 18, 19, 20, or 21.

59. "Facilities" means buildings used by a health care institution for providing any of the types of services as defined in this Chapter.

60. "Family member" means:

a. A client's parent, step-parent, foster parent, spouse, sibling, child, grandparent, grandchild, aunt, uncle, niece, nephew, or significant other; or

b. For pre-petition screening, court-ordered evaluation, or court-ordered treatment, the same as defined in A.R.S. § 36-501.

61. "Field related to behavioral health" means an academic discipline or area of study that explores human development, responses, or interactions, such as psychology or sociology.

62. "Full time" means 40 hours a week or more.

63. "General consent" means a written agreement for an individual to receive a behavioral health service signed by the individual or if applicable, the individual's parent, guardian, custodian, or agent.

64. "General client supervision" means guidance of a client by a staff member and includes:

a. Being aware of a client's general whereabouts;

b. Monitoring a client's activities on the premises or on an agency-sponsored activity off the premises to ensure the health, safety, and welfare of the client; or

c. Interacting with a client to assist the client in achieving a treatment goal.

65. "Governing authority" means the individual, agency, group or corporation, appointed, elected or otherwise designated, in which the ultimate responsibility and authority for the conduct of the health care institution are vested.

66. "Gravely disabled" means a condition evidenced by behavior in which a person, as a result of a mental disorder, is likely to come to serious physical harm or serious illness because he is unable to provide for his basic physical needs.

67. "Grievance" means a client's documented expression of dissatisfaction to a licensee about an act, omission, or condition of the licensee's agency.

68. "Guardian" means an individual or entity appointed to be responsible for the treatment or care of an individual according to A.R.S. Title 14, Chapter 5 or a similar provision in another state or jurisdiction.

69. "Hazard" means a condition or situation from which a client may suffer physical injury or illness.

70. "High school equivalency diploma" means:

a. The document issued by the Arizona Department of Education under A.R.S. § 15-702 to an individual who passes a general educational development test or meets the requirements of A.R.S. § 15-702(B);

b. The document issued by another state to an individual who passes a general educational development test or meets the requirements of a state statute equivalent to A.R.S. § 15-702(B); or

c. The document issued by another country to an individual who has completed that country's equivalent to a 12th grade education, as determined by the Department.

71. "Immediate" means without delay.

72. "Incident" means an occurrence or event that has the potential to cause harm or has caused harm to a client.

73. "Informed consent" has the same meaning as in A.R.S. § 36-501.

74. "Initial assessment" means the assessment of a client made by a behavioral health professional or a behavioral health technician under the supervision of a behavioral health professional between the client's first visit with the behavioral health professional or behavioral health technician and the completion of the initial treatment plan.

75. "Initial treatment plan" means a document that identifies the behavioral health services and ancillary services an agency shall provide a client until the agency develops a treatment plan according to R9-20-209(J).

76. "Inpatient treatment program" means a behavioral health service agency that:

a. Provides medical services and continuous onsite or on-call availability of a behavioral health medical practitioner,

b. Provides accommodations for a client to stay overnight at the agency, and

c. May provide restraint or seclusion.

77. "Intern" means an individual who is enrolled in an academic program of a college or university and who provides behavioral health services at an agency as part of the academic program's requirements.

78. "Level 1 psychiatric acute hospital" means an inpatient treatment program that:

a. Is located in a general hospital, rural general hospital, or special hospital licensed according to 9 A.A.C. 10, unless:

i. The agency was licensed as a Level 1 psychiatric acute care behavioral health facility before the effective date of this Chapter, and

ii. The agency does not receive Medicaid funds under Title XIX of the Social Security Act;

b. Has continuous onsite or on-call availability of a psychiatrist; and

c. Provides continuous treatment to an individual who is experiencing a behavioral health issue that causes the individual:

i. To be a danger to self, a danger to others, or gravely disabled; or

ii. To suffer severe and abnormal mental, emotional, or physical harm that significantly impairs judgment, reason, behavior, or the capacity to recognize reality.

79. "Level 1 residential treatment center" means an inpatient treatment program that provides treatment to an individual under the age of 21 who needs inpatient psychiatric services.

80. "Level 1 RTC" means a Level 1 residential treatment center.

81. "Level 1 specialized transitional agency" means an agency that provides treatment to an individual determined to be a sexually violent person according to A.R.S. Title 36, Chapter 37.

82. "Level 1 sub-acute agency" means an inpatient treatment program that provides continuous treatment to an individual experiencing a behavioral health issue that causes the individual:

a. To have a limited or reduced ability to meet the individual's basic physical and age-appropriate needs;

b. To be a danger to self, a danger to others, or gravely disabled; or

c. To suffer severe and abnormal mental, emotional, or physical harm that impairs judgment, reason, behavior, or the capacity to recognize reality.

83. "Level 2 behavioral health residential agency" means a residential agency that provides:

a. Counseling;

b. Continuous onsite or on-call availability of a behavioral health professional; and

c. Continuous treatment to an individual who is experiencing a behavioral health issue that limits the individual's independence but who is able to participate in all aspects of treatment and to meet the individual's basic physical and age-appropriate needs.

84. "Level 3 behavioral health residential agency" means a residential agency that provides continuous protective oversight and treatment to an individual who is able to participate in all aspects of treatment and to meet the individual's basic physical and age-appropriate needs but who needs treatment to maintain or enhance independence.

85. "Level 4 transitional agency" means an agency that provides accommodations where a client receives:

a. Support to assist the client in managing a crisis situation, or

b. An opportunity to enhance the client's independent living skills.

86. "Level 4 transitional staff member" means an individual who meets the requirements in R9-20-1202(C) and who provides supportive intervention and general client supervision at a Level 4 transitional agency.

87. "Licensed capacity" means the total number of persons for whom the health care institution is authorized by the Department to provide services as required pursuant to this Chapter if the person is expected to stay in the health care institution for more than twenty-four hours. For a hospital, licensed capacity means only those beds specified on the hospital license.

88. "Licensee" means a person authorized by the Department to operate an agency.

89. "Manager" means the individual who has the responsibility to operate according to the requirements in this Chapter:

a. A Level 4 transitional agency,

b. A shelter for victims of domestic violence,

c. A rural substance abuse transitional agency, or

d. An adult therapeutic foster home.

90. "Marriage and family therapist" means:

a. Before July 1, 2004, an individual who is certified as a marriage and family therapist or associate marriage and family therapist according to A.R.S. Title 32, Chapter 33, Article 7;

b. On or after July 1, 2004, an individual who is licensed as a marriage and family therapist or associate marriage and family therapist according to A.R.S. Title 32, Chapter 33;

c. Until October 3, 2003, an individual who is a clinical member of the American Association of Marriage and Family Therapy; or

d. Until July 1, 2004, an individual who is licensed or certified to provide marriage and family therapy by a government entity in another state if the individual:

i. Has documentation of submission of an application for certification as a marriage and family therapist or associate marriage and family therapist according to A.R.S. Title 32, Chapter 33, Article 7; and

ii. Is certified as a marriage and family therapist or associate marriage and family therapist according to A.R.S. Title 32, Chapter 33, Article 7 within two years after submitting the application and before July 1, 2004.

91. "Mechanical restraint" means any device, article, or garment attached or adjacent to a client's body that the client cannot easily remove and that restricts the client's freedom of movement or normal access to the client's body but does not include a device, article, or garment:

a. Used for surgical or orthopedic purposes, or

b. Necessary to allow a client to heal from a medical condition or to participate in a treatment program for a medical condition.

92. "Medical emergency" means a situation that requires immediate medical intervention to prevent death, hospitalization, or serious physical harm.

93. "Medical practitioner" means a:

a. Physician,

b. Physician assistant, or

c. Nurse practitioner.

94. "Medical services" means the services pertaining to medical care that are performed at the direction of a physician on behalf of patients by physicians, dentists, nurses and other professional and technical personnel.

95. "Medication" means a prescription medication as defined in A.R.S. § 32-1901 or nonprescription drug, as defined in A.R.S. § 32-1901.

96. "Medication administration" means the provision or application of a medication to the body of a client by a medical practitioner or nurse or as otherwise provided by law.

97. "Medication adjustment" means a change made by a medical practitioner in the medication used to treat a client's behavioral health issue.

98. "Medication monitoring" means the determination, made by a medical practitioner or registered nurse, of whether a client's medication is achieving the desired effect.

99. "Medication organizer" means a container divided according to date or time increments and designated to hold medication.

100. "Medication services" means one or more of the following:

a. Medication administration,

b. Medication monitoring, or

c. Medication adjustment.

101. "Mental disorder" has the same meaning as in:

a. A.R.S. § 36-501; or

b. For an individual receiving treatment as a sexually violent person according to A.R.S. Title 36, Chapter 37, A.R.S. § 36-3701.

102. "Mental health care power of attorney" means a written designation of an agent to make mental health care decisions that meets the requirements of A.R.S. § 36-3281.

103. "Misdemeanor domestic violence offender treatment program" means a behavioral health service provided to an individual convicted of a misdemeanor domestic violence offense and ordered by a court to complete domestic violence offender treatment according to A.R.S. § 13-3601.01.

104. "Neglect" means a pattern of conduct resulting in deprivation of food, water, medication, treatment, medical services, shelter, cooling, heating, or ancillary services necessary to maintain minimum physical or behavioral health.

105. "NFPA" means National Fire Protection Association.

106. "Nurse" means an individual licensed as a registered nurse or a practical nurse according to A.R.S. Title 32, Chapter 15.

107. "Nurse practitioner" means an individual certified as a registered nurse practitioner according to A.R.S. Title 32, Chapter 15.

108. "Nursing assessment" means the collection of data on an individual's medical history and current physical health status and the analysis of that data performed by a registered nurse.

109. "OBHL" means the Department's Office of Behavioral Health Licensure.

110. "On-call" means the immediate availability of an individual in person, by telephone, or other electronic means.

111. "Opioid treatment" means dispensing a medication, medication administration, or other treatment that includes an opioid agonist treatment medication or other narcotic treatment medication approved by the Federal Government for the treatment of opiate addition, to alleviate or eliminate an individual's dependence upon an opioid drug.

112. "Order" means an instruction to provide a behavioral health service or a medical service to a client.

113. "Orientation" means familiarizing an individual with a new setting or situation.

114. "Outing" means a planned activity sponsored by an agency that:

a. Occurs off the premises,

b. Is not part of the agency's regular program or daily routine, and

c. Lasts for more than four hours or occurs in a location where emergency medical services cannot be anticipated to respond within 12 minutes.

115. "Outpatient clinic" means an agency that provides treatment to a client for less than 24 consecutive hours and is not licensed as an agency subclass in R9-20-102(A)(2) through (11).

116. "Owner" means a person who appoints, elects, or otherwise designates a health care institution's governing authority.

117. "Partial care" means a day program that provides counseling or medication services at an outpatient clinic.

118. "Person" has the same meaning as in A.R.S. § 1-215 and includes governmental agencies.

119. "Personal funds account" means client monies that are held and managed by a licensee according to the requirements in R9-20-403(C) and (D).

120. "Personal restraint" means the application of physical force without the use of any device, for the purpose of restricting the free movement of a client's body, but:

a. For a Level 1 RTC or a Level 1 sub acute agency, does not include:

i. Holding a client for no longer than five minutes, without undue force, in order to calm or comfort the client, or

ii. Holding a client's hand to safely escort the client from one area to another; and

b. For a correctional facility, does not include physically holding a client by a security officer for purposes not related to a client's behavioral health issue.

121. "Personality disorder" means an enduring, pervasive, and lifelong pattern of behavior that deviates from the expectations of an individual's culture; leads to an individual's functional impairment and distress; and has been diagnosed by a behavioral health professional.

122. "Pharmacist" means an individual licensed according to A.R.S. Title 32, Chapter 18.

123. "Pharmacological abuse" means administration of medication:

a. For purposes of discipline, convenience, retaliation, or coercion; and

b. That is not required to treat a client's medical or behavioral health issue or for restraint.

124. "Physical examination" means the collection of data on an individual's medical history and current physical health and the analysis of the data by a medical practitioner.

125. "Physician" means an individual licensed according to A.R.S. Title 32, Chapter 13 or 17.

126. "Physician assistant" means an individual licensed according to A.R.S. Title 32, Chapter 25.

127. "Premises" means a licensed facility and the facility's contiguous grounds or a branch office where behavioral health services are provided.

128. "Prepetition screening" has the same meaning as in A.R.S. Title 36, Chapter 5.

129. "Presenting issue" means one or more behavioral health issues that are the reason for an individual's seeking or needing behavioral health services.

130. "PRN" means pro re nata or given as needed.

131. "Professionally recognized treatment" means a behavioral health service that is:

a. Supported by research results published in a nationally recognized journal, such as the Journal of the American Psychiatric Association, the Journal of the American Medical Association, or the Journal of Psychiatric Rehabilitation; or

b. A generally accepted practice as determined by a Department approved psychiatrist or psychologist.

132. "Progress note" means documentation of:

a. A behavioral health service or medical service provided to a client and the client's response that is observed,

b. A client's significant change in condition, or

c. Staff member observations of client behavior.

133. "Psychiatrist" has the same meaning as in A.R.S. § 36-501.

134. "Psychologist" means an individual licensed according to A.R.S. Title 32, Chapter 19.1.

135. "Referral" means assistance or direction provided to an individual to enable the individual to obtain information, behavioral health services, medical services, or ancillary services.

136. "Regional behavioral health authority" means an organization under contract with the Department to coordinate the delivery of mental health services in a geographically specific service area of the state for eligible persons.

137. "Registered nurse" means an individual licensed as a graduate nurse, professional nurse, or registered nurse according to A.R.S. Title 32, Chapter 15.

138. "Representative payee" means an individual or agency authorized by the Social Security Administration to receive and manage the money a client receives from the Social Security Administration.

139. "Research" means the systematic study of a field of knowledge.

140. "Residential agency" means a:

a. Level 2 behavioral health residential agency, or

b. Level 3 behavioral health residential agency.

141. "Respite" means short term behavioral health services or general client supervision that provides rest or relief to a family member or other individual caring for the client and that is provided in:

a. A Level 1 sub-acute agency;

b. A Level 1 RTC;

c. A Level 2 behavioral health residential agency;

d. A Level 3 behavioral health residential agency;

e. An adult therapeutic foster home;

f. A domestic violence shelter; or

g. If provided by an outpatient clinic, a client's residence.

142. "Restraint" means personal restraint, mechanical restraint, or drug used as a restraint.

143. "Rural substance abuse transitional center" means an agency, located in a county with a population of fewer than 500,000 individuals according to the most recent U.S. decennial census, that provides behavioral health services to an individual who is intoxicated or has a substance abuse problem.

144. "Seclusion" means the involuntary confinement of a client in a room or an area from which the client cannot leave, but does not include the confinement of a client in a correctional facility.

145. "Secure facility" means the premises or portion of the premises that is locked or from which a client cannot leave without a key, special knowledge, or special effort.

146. "Security officer" has the same meaning as "security guard" in A.R.S. § 32-2601(23).

147. "Seriously mentally ill" means persons, who as a result of a mental disorder as defined in A.R.S. § 36-501 exhibit emotional or behavioral functioning which is so impaired as to interfere substantially with their capacity to remain in the community without supportive treatment or services of a long-term or indefinite duration. In these persons mental disability is severe and persistent, resulting in a long-term limitation of their functional capacities for primary activities of daily living such as interpersonal relationships, homemaking, self-care, employment and recreation.

148. "Shelter for victims of domestic violence" or "shelter" means a facility providing temporary housing or facilities to family or household members who are victims of domestic violence.

149. "Significant change in condition" means a deterioration or improvement in a client's physical or behavioral health that may require a modification in the client's treatment.

150. "Significant other" means an individual whose participation the client considers to be essential to the effective provision of behavioral health services to the client.

151. "Social worker" means:

a. Before July 1, 2004, an individual who is certified as a baccalaureate social worker, master social worker, or independent social worker, according to A.R.S. Title 32, Chapter 33, Article 5;

b. On or after July 1, 2004, an individual who is licensed as a baccalaureate social worker, master social worker, or independent social worker, according to A.R.S. Title 32, Chapter 33;

c. Until October 3, 2003, an individual who is certified by the National Association of Social Workers; or

d. Until July 1, 2004, an individual who is licensed or certified to practice social work by a government entity in another state if the individual:

i. Has documentation of submission of an application for certification as a baccalaureate social worker, master social worker, or independent social worker according to A.R.S. Title 32, Chapter 33, Article 5; and

ii. Is certified as a baccalaureate social worker, master social worker, or independent social worker according to A.R.S. Title 32, Chapter 33, Article 5 within two years after submitting the application and before July 1, 2004.

152. "Staff member" means an individual who is employed by or under contract with a licensee to provide behavioral health services to an agency client and who is a:

a. Behavioral health professional,

b. Behavioral health technician, or

c. Behavioral health paraprofessional.

153. "Subclass" means a type of behavioral health service agency listed in R9-20-102(A).

154. "Substance abuse" means the misuse of alcohol or another chemical or drug that:

a. Alters an individual's behavior or mental functioning;

b. May cause psychological or physiological dependence; and

c. Impairs, reduces, or destroys the individual's social or economic functioning.

155. "Substance abuse counselor" means:

a. Before July 1, 2004, an individual who is certified as a substance abuse counselor according to A.R.S. Title 32, Chapter 33, Article 8;

b. On or after July 1, 2004, an individual who is licensed as a substance abuse counselor according to A.R.S. Title 32, Chapter 33, Article 8; or

c. An individual who is certified by the Arizona Board of Certified Addiction Counselors.

156. "Therapeutic diet" means one of the following ordered for an individual by a medical practitioner:

a. Food, or

b. The manner in which food is to be prepared.

157. "Time out" means providing a client an opportunity to regain self-control in a designated area from which the client is not physically prevented from leaving.

158. "Transfer" means moving a client from one agency to another agency that assumes responsibility for the treatment of the client.

159. "Treatment" means:

a. A professionally recognized treatment that is provided to a client or the client's family to improve, eliminate, or manage the client's behavioral health issue; or

b. For court-ordered alcohol treatment, the same as in A.R.S. § 36-2021.

160. "Treatment goal" means the desired result or outcome of treatment.

161. "Treatment method" means the specific approach used to achieve a treatment goal.

162. "Treatment plan" means a description of the specific behavioral health services that an agency will provide to a client that is documented in the client record.

163. "Volunteer" means an individual who provides a behavioral health service or ancillary service at an agency without compensation.

164. "Working day" means Monday, Tuesday, Wednesday, Thursday, or Friday, excluding state and federal holidays.