Sec.17a-453a-2. Definitions

As used in sections 17a-453a-1 to 17a-453a-19, inclusive, of the Regulations of Connecticut State Agencies:

(1) "Acute care services" means short-term inpatient treatment for a psychiatric disability, substance use disorder or both and includes the following covered behavioral health services: acute psychiatric hospitalization, medically managed inpatient detoxification and medically monitored residential detoxification;

(2) "ASAM PPC-2R" means the American Society of Addictions Medicine Patient Placement Criteria, Second Revision;

(3) "Authorized representative" means a person designated by an individual or a person authorized by law to act on behalf of an individual;

(4) "Behavioral health services" means services designed for the treatment of persons with psychiatric disabilities, substance use disorders or both;

(5) "CARF" means the Commission on Accreditation of Rehabilitation Facilities;

(6) "Certified alcohol and drug counselor" means a person that meets and maintains all applicable licensing and certification requirements of federal and state statutes or regulations;

(7) "CFR" means the Code of Federal Regulations;

(8) "Clinical contact" means communication with direct observation of an individual in order to establish a therapeutic relationship and assist with the amelioration of identified problems;

(9) "Clinical risk" means the potential for injury or harm to self, others or property;

(10) "Commissioner" means the commissioner of the Department of Mental Health and Addiction Services (DMHAS);

(11) "Contracted provider" means a provider that is credentialed and has a contract with DMHAS to provide a covered behavioral health service under the general assistance behavioral health program as established pursuant to section 17a-453a of the Connecticut General Statutes;

(12) "Co-occurring disorder" means a concurrent psychiatric disability and substance use disorder;

(13) "Critical incident" means any event that has serious effects on an individual or others;

(14) "Designated agent" means an organization under contract with DMHAS to provide utilization management, process providers' claims for payment or provide other support services necessary for the operation of the general assistance behavioral health program established pursuant to section 17a-453a of the Connecticut General Statutes;

(15) "Discharge plan" means the written summary of an individual's behavioral health services needs, developed in order to arrange for appropriate care after discharge or upon transfer from one level of care to another;

(16) "DMHAS" or "department" means the state of Connecticut Department of Mental Health and Addiction Services;

(17) "DPH" means the state of Connecticut Department of Public Health;

(18) "DSS" means the state of Connecticut Department of Social Services;

(19) "DSM-IV" means the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition;

(20) "EMS-ID" means the unique identifier assigned to each individual applying for or receiving general assistance under Department of Social Services' (DSS) programs;

(21) "Eligible recipient" means an individual eligible for medical services under the state-administered general assistance program, pursuant to section 17b-192 of the Connecticut General Statutes, and in need of behavioral health services, as determined by DMHAS;

(22) "Emergency medical services" means services delivered to individuals suffering from medical emergencies, including psychiatric or substance use disorder emergencies. Emergency medical services include the detection and reporting of medical emergencies; initial care, transportation and care for individuals en route to health care facilities; medical treatment for the acutely ill and severely injured within emergency departments and referrals to continued care;

(23) "Facility" means the physical structure, building or portions thereof in which mental health or substance use treatment services or both are delivered;

(24) "GABHP" means the general assistance behavioral health program established pursuant to section 17a-453a of the Connecticut General Statutes;

(25) "General hospital" means a facility that meets and maintains all applicable licensing and certification requirements of federal and state statutes or regulations;

(26) "Individualized treatment" means treatment designed to meet a particular individual's needs, guided by a recovery plan that is directly related to a specific assessment of the individual;

(27) "Joint Commission" means the entity formerly known as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO);

(28) "Level of care" means a discrete set of behavioral health services as specified in the ASAM PPC-2R or other DMHAS-authorized level-of-care placement criteria;

(29) "Licensed behavioral health professional" means a person that meets and maintains all applicable licensing and certification requirements of federal and state statutes or regulations and who has experience in the treatment of psychiatric disabilities, substance use disorders or both.

(30) "Medical coverage" means a plan or program that pays for medically necessary behavioral health services;

(31) "Medical necessity" or "medically necessary" means appropriate and necessary for the symptoms, diagnosis or treatment of a psychiatric disability or substance use disorder or both, as specified in DSM-IV or its successor, ASAM PPC-2R or its successor or other DMHAS authorized level-of-care placement criteria;

(32) "Panel or profile test" means certain multiple laboratory tests performed on a single specimen;

(33) "Prior authorization" means the process of obtaining prior approval from the designated agent to deliver a covered behavioral health service;

(34) "Private freestanding mental health day treatment facility" means a facility that meets and maintains all applicable licensing and certification requirements of federal and state statutes or regulations;

(35) "Private freestanding psychiatric hospital" means a facility that meets and maintains all applicable licensing and certification requirements of federal and state statutes or regulations;

(36) "Provider" means a person or entity that delivers behavioral health services;

(37) "Psychiatrist" means an individual that meets and maintains all applicable licensing and certification requirements of federal and state statutes or regulations;

(38) "Psychologist" means an individual that meets and maintains all applicable licensing and certification requirements of federal and state statutes or regulations;

(39) "Recovery" means a process of restoring or developing a positive and meaningful sense of identity apart from one's psychiatric disability or substance use disorder and then rebuilding one's life within the limitations imposed by that disability or disorder;

(40) "Recovery plan" means a written plan that directly relates to an individual's biopsychosocial assessment and that is developed with the involvement of the individual or his or her authorized representative as specified in section 17a-453a-9 of the Regulations of Connecticut State Agencies. A recovery plan also may be referred to as a treatment plan;

(41) "Rehabilitation" means the restoration of an optimum state of health by medical, psychological and social means for the specific purpose of reducing the use of substances or mitigating the effects of substance use disorders;

(42) "Relapse" means a recurrence of psychoactive substance use by an individual who has previously achieved and maintained abstinence for a significant period of time beyond withdrawal;

(43) "SAMHSA" means the Substance Abuse and Mental Health Services Administration of the U.S. Department of Health and Human Services;

(44) "State-operated facility" means a hospital or other facility that meets and maintains all applicable licensing and certification requirements of federal and state statutes or regulations, that delivers treatment for individuals with psychiatric disabilities or substance use disorders or both and that is operated in whole or in part by the state of Connecticut; and

(45) "Substance use disorders services" means services delivered for the care and treatment of individuals with substance use disorders that include medical, psychiatric and biopsychosocial assessments; individual, group and family counseling; peer counseling; vocational counseling and education groups.

(Adopted effective December 7, 2009)