20 CAR pt. 418 | 20 CAR Part 418 — Partial Hospitalization Certification

Chapter X

Subchapter A

Subpart 1

20 CAR § 418-101 Purpose {#sec-20-car-418-101 omnilex-key=us-ar-regs-official--title-20-part-418--20 CAR § 418-101}

20 CAR § 418-101. Purpose.

(a) This part sets forth the standards and criteria used in the certification of partial hospitalization providers by the Department of Human Services, Division of Behavioral Health Services.

(b) The rules regarding the certification processes including, but not necessarily limited to, applications, requirements for, levels of, and administrative sanctions are found in this part.

20 CAR § 418-102 Applicability {#sec-20-car-418-102 omnilex-key=us-ar-regs-official--title-20-part-418--20 CAR § 418-102}

20 CAR § 418-102. Applicability.

The standards and criteria for services as subsequently set forth in this part are applicable to partial hospitalization providers as stated in each section.

20 CAR § 418-103 Definitions {#sec-20-car-418-103 omnilex-key=us-ar-regs-official--title-20-part-418--20 CAR § 418-103}

20 CAR § 418-103. Definitions.

The following words or terms, when used in this part, shall have the defined meaning unless the context clearly indicates otherwise:

(1) "Abuse" means the causing or permitting of harm or threatened harm to the health, safety, or welfare of a resident by a staff responsible for the client's health, safety, or welfare, including but not limited to:

(A) Nonaccidental physical injury or mental anguish;

(B) Sexual abuse;

(D) Use of mechanical restraints without proper authority;

(E) Intentional use of excessive or unauthorized force aimed at hurting or injuring the resident; or

(F) Deprivation of food, clothing, shelter, or health care by a staff responsible for providing these services to a resident;

(2)(A) “Adverse license action” means any action by a licensing authority that is related to client care, any act or omission warranting exclusion under Participant Exclusion, 25 CAR pt. 30, or that imposes any restriction on the licensee’s practice privileges.

(B) The action is deemed to exist when the licensing entity imposes the adverse action except as provided in Arkansas Code § 25-15-211(c);

(3) “Certification” means a written designation, issued by the Department of Human Services, declaring that the provider has demonstrated compliance as declared within and defined by this part;

(4) “Client” means any person for whom a partial hospitalization program furnishes, or has agreed or undertaken to furnish, services;

(5) "Clinical privileging" means an organized method for treatment facilities to authorize an individual permission to provide specific care and treatment services to clients within well-defined limits, based on the evaluation of the individual's:

(A) License;

(B) Education;

(D) Experience;

(E) Competence;

(F) Judgment; and

(G) Other credentials;

(6) "Co-occurring disorder" means any combination of mental health and substance use disorder symptoms or diagnoses in a client;

(7) "Co-occurring disorder capability" means the organized capacity within any type of program to routinely screen, identify, assess, and provide properly matched interventions to individuals with co-occurring disorders;

(8) “Compliance” means conformance with applicable state and federal laws, rules, and regulations including without limitation:

(A) Title XIX of the Social Security Act and Title XXI of the Social Security Act, and implementing regulations;

(B) Other federal laws and regulations governing the delivery of health care funded in whole or in part by federal funds, for example, 42 U.S.C. § 1320c-5;

(C) All state laws and rules applicable to Medicaid generally and to partial hospitalization program services specifically;

(D) Title VI of the Civil Rights Act of 1964, as amended, and implementing regulations;

(E) The Americans with Disabilities Act of 1990, as amended, and implementing regulations; and

(F) The Health Insurance Portability and Accountability Act of 1996 (HIPAA), as amended, and implementing regulations;

(9)(A) "Critical incident" means an occurrence or set of events inconsistent with the routine operation of the facility or the routine care of a client.

(B) “Critical incidents” specifically include but are not necessarily limited to the following:

(i) Adverse drug events;

(ii) Self-destructive behavior;

(iii) Deaths and injuries to clients, staff, and visitors;

(iv) Medication errors;

(v) Clients that are absent without leave (AWOL);

(vi) Neglect or abuse of a client;

(vii) Fire;

(viii) Unauthorized disclosure of information;

(ix) Damage to or theft of property belonging to a client or the facility;

(x) Other unexpected occurrences; or

(xi) Events potentially subject to litigation.

(10) “Deficiency” means an item or area of noncompliance;

(11) “DHS” means the Department of Human Services;

(12) "Initial assessment" means examination of current and recent behaviors and symptoms of an individual who appears to be mentally ill or substance dependent;

(13) "Intervention plan" means a description of services to be provided in response to the presenting crisis situation that incorporates the identified problem or problems, strengths, abilities, needs, and preferences of the individual served;

(14) “Linkage services" means the communication and coordination with other service providers that assure timely appropriate referrals between the partial hospitalization program and other providers;

(15)(A) “Mental health professional” or “MHP” means a person who possesses an Arkansas license to provide clinical behavioral health care.

(B) The license must be in good standing and not subject to any adverse license action;

(16) "Minor" means any person under eighteen (18) years of age;

(17)(A) "Performance improvement" or "PI" means an approach to the continuous study and improvement of the processes of providing healthcare services to meet the needs of clients and others.

(B) Synonyms and near synonyms include:

(i) “Continuous performance improvement”;

(ii) “Continuous improvement”;

(iii) “Organization-wide performance improvement”; and

(iv) “Total quality management”;

(18)(A) "Persons with special needs" means any persons with a condition which is considered a disability or impairment under the Americans with Disabilities Act of 1990 including, but not limited to:

(i) The deaf/hearing impaired;

(ii) The visually impaired;

(iii) The physically disabled;

(iv) The developmentally disabled;

(v) Persons with disabling illness; and

(vi) Persons with mental illness and/or substance abuse disorders.

(B) See "Americans with Disabilities Handbook", published by the United States Equal Employment Opportunity Commission and United States Department of Justice;

(19)(A) “Professionally recognized standard of care” means that degree of skill and learning commonly applied under all the circumstances in the community by the average prudent reputable member of the profession.

(B) Conformity with Substance Abuse and Mental Health Services Administration evidence-based practice models is evidence of compliance with professionally recognized standards of care;

(20) "Progress notes" means:

(A) A chronological description of services provided to a client;

(B) The client's progress or lack of; and

(21) “Provider” means an entity that is:

(A) Certified by the Department of Human Services as a partial hospitalization program; and

(B) Enrolled by the Division of Medical Services as a behavioral health agency;

(22) "Psychosocial evaluations" are in-person interviews conducted by professionally trained personnel designed to elicit historical and current information regarding the behavior and experiences of an individual, and are designed to provide sufficient information for problem formulation and intervention.;

(23) “Qualified behavioral health provider” means a person who:

(A) Does not possess an Arkansas license to provide clinical behavioral health care;

(B) Works under the direct supervision of a mental health professional;

(C) Has successfully completed prescribed and documented courses of initial and annual training sufficient to perform all tasks assigned by a mental health professional; and

(D) Acknowledges in writing that all qualified behavioral health provider services are controlled by client care plans and provided under the direct supervision of a mental health professional;

(24)(A) "Restraint" refers to manual, mechanical, and chemical methods that are intended to restrict the movement or normal functioning of a portion of the individual's body.

(B) For clients, mechanical restraints shall not be used;

(25)(A)(i) "Sentinel event" is a type of critical incident that is an unexpected occurrence involving the death or serious physical or psychological injury to a client, or risk thereof.

(ii) Serious injury specifically includes loss of limb or function.

(iii) The phrase "or risk thereof" includes a variation in approved processes which could carry a significant chance of a serious adverse outcome to a client.

(iv) These events signal the need for immediate investigation and response.

(B) “Sentinel events” include, but are not limited to:

(i) Suicide;

(ii) Homicide;

(iii) Criminal activity;

(iv) Assault and other forms of violence, including domestic violence or sexual assault; and

(v) Adverse drug events resulting in serious injury or death; and

(26) "Trauma informed" means the recognition and responsiveness to the presence of the effects of past and current traumatic experiences in the lives of all clients.

History

Codification Notes: Title XIX of the Social Security Act is codified at 42 U.S.C. § 1396 et seq.Title XXI of the Social Security Act is codified at 42 U.S.C. § 1397aa et seq.Title VI of the Civil Rights Act of 1964 is codified at 42 U.S.C. § 2000d et seq.The Americans with Disabilities Act of 1990 is codified at 42 U.S.C. § 12101 et seq.The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was enacted as Pub. L. No. 104-191. Authorities: Arkansas Code § 20-76-201; Arkansas Code § 20-77-107

20 CAR § 418-104 Meaning of verbs in rules {#sec-20-car-418-104 omnilex-key=us-ar-regs-official--title-20-part-418--20 CAR § 418-104}

20 CAR § 418-104. Meaning of verbs in rules.

The attention of the facility is drawn to the distinction between the use of the words ”shall”, “should”, and "may" in this part:

(1) "Shall" is the term used to indicate a mandatory statement, the only acceptable method under the present standards;

(2) “Should" is the term used to reflect the most preferable procedure, yet allowing for the use of effective alternatives; and

(3) "May" is the term used to reflect an acceptable method that is recognized but not necessarily preferred.

Subpart 2

20 CAR § 418-201 Service definition {#sec-20-car-418-201 omnilex-key=us-ar-regs-official--title-20-part-418--20 CAR § 418-201}

20 CAR § 418-201. Service definition.

(a)(1) Partial hospitalization is an intensive nonresidential, therapeutic treatment program.

(2) It can be used as an alternative to and/or a step-down service from inpatient residential treatment or to stabilize a deteriorating condition and avert hospitalization.

(3) The program provides clinical treatment services in a stable environment on a level equal to an inpatient program, but on a less than twenty-four-hour basis.

(4) The environment at this level of treatment is highly structured and should maintain a staff-to-patient ratio of one-to-five (1:5) to ensure necessary therapeutic services and professional monitoring, control, and protection.

(5) This service shall include at a minimum:

(A) Intake;

(B) Individual therapy;

(D) Psychoeducation.

(6) Partial hospitalization shall be at a minimum five (5) hours per day, of which ninety (90) minutes must be a documented service provided by a mental health professional.

(7) If a beneficiary receives other services during the week but also receives partial hospitalization, the beneficiary must receive, at a minimum, twenty (20) documented hours of services on no less than four (4) days in that week.

(b) The allowable staff, as referenced in the Outpatient Behavioral Health Services Medicaid Manual, included in the staff-to-patient ratio of one-to-five (1:5) are:

(1) Independently licensed clinicians;

(2) Nonindependently licensed clinicians;

(3) Registered nurses;

(4) Advanced practice nurses; and

(5) Physicians.

20 CAR § 418-202 Partial hospitalization provider certification {#sec-20-car-418-202 omnilex-key=us-ar-regs-official--title-20-part-418--20 CAR § 418-202}

20 CAR § 418-202. Partial hospitalization provider certification.

(a)(1) A partial hospitalization provider shall be certified by the Department of Human Services as a behavioral health agency.

(2) A partial hospitalization site shall be certified as a site of a behavioral health agency.

(b)(1) Partial hospitalization provider facilities shall be inspected a minimum of once per year, but are subject to visit by the department’s designee at other times to ensure continuing conformance of the operations of the facility with this part.

(2) The department may request the facility to provide information concerning programs and fiscal operations at the department’s discretion.

(c) Partial hospitalization providers will not be reimbursed for services provided without certification as a partial hospitalization provider by the department.

(d)(1) The goal of partial hospitalization is to increase the level of patient functioning.

(2) The service may be provided to clients with chronic or acute mental disorders who require active treatment.

(e)(1) Partial hospitalization providers shall have their programs nationally accredited.

(2) A provisional certification for a partial hospitalization program will be issued by the Division of Behavioral Health Services for up to twelve (12) months in order for a partial hospitalization program to have their program become nationally accredited.

(3) If after the twelve-month provisional certification period the partial hospitalization program is not nationally accredited, then a department partial hospitalization program certification will not be granted.

(4) In all instances, the partial hospitalization provider shall comply with all applicable program national accreditation requirements in order to remain certified by the department.

20 CAR § 418-203 Organizational structure {#sec-20-car-418-203 omnilex-key=us-ar-regs-official--title-20-part-418--20 CAR § 418-203}

20 CAR § 418-203. Organizational structure.

(a) The partial hospitalization unit shall be as a separate, identifiable organizational unit with its own director or supervisor and staffing pattern.

(b)(1) When the unit is a portion of a larger organizational structure, the director or supervisor of the unit shall be identified and his or her responsibilities clearly defined.

(2) The organizational structure of the unit shall be described in an organizational chart.

(c) A written description of all services provided by the unit shall be on file and available to the Department of Human Services.

(d) The department shall be notified of any major change in the organizational structure or services.

20 CAR § 418-204 Treatment planning and records {#sec-20-car-418-204 omnilex-key=us-ar-regs-official--title-20-part-418--20 CAR § 418-204}

20 CAR § 418-204. Treatment planning and records.

(a)(1) An individualized treatment plan shall be formulated for patients in partial hospitalization programs by the patient’s treatment team.

(2)(A) A treatment team shall consist of:

(i) A treatment team leader;

(ii) A psychiatrist when the treatment team leader is not a psychiatrist; and

(iii) Other appropriate staff.

(B) The treatment team leader shall be a mental health professional.

(3) Treatment plans shall be reviewed with parents or guardians of persons in children and youth partial hospitalization programs, if appropriate.

(b) The treatment plan shall include the following:

(1) Be formulated, to the extent possible, with the cooperation and consent of the patient or a person acting on his or her behalf;

(2) Be based upon diagnostic evaluation which includes examination of the medical, psychological, social, cultural, behavioral, familial, educational, vocational, and developmental aspects of the patient’s situation;

(3) Set forth treatment objectives and prescribe an integrated program of therapies, activities, experiences, and appropriate education designed to meet these objectives;

(4) Be maintained and updated with signed daily notes, and be kept in the patient’s medical record or a form developed by the facility; and

(5) Be developed within the first five (5) days of service and reviewed by the treatment team a minimum of once every twenty (20) days of service to the individual patient and modified as appropriate.

20 CAR § 418-205 Linkage services to higher or lower levels of care or longer term placement {#sec-20-car-418-205 omnilex-key=us-ar-regs-official--title-20-part-418--20 CAR § 418-205}

20 CAR § 418-205. Linkage services to higher or lower levels of care or longer term placement.

(a) Persons needing behavioral health services shall be treated with the least restrictive clinically appropriate methods.

(b)(1) The partial hospitalization program requires a close relationship with an acute psychiatric inpatient service.

(2) A written statement as to the availability of these services to patients:

(A) Is required; and

(B) Shall be maintained on file at the facility.

(c)(1) The partial hospitalization program shall also ensure linkages with other appropriate treatment and rehabilitative services including:

(A) Emergency services;

(B) Outpatient services; and

(2) A written statement documenting such linkages shall be maintained on file at the facility.

20 CAR § 418-206 Treatment policies and procedures {#sec-20-car-418-206 omnilex-key=us-ar-regs-official--title-20-part-418--20 CAR § 418-206}

20 CAR § 418-206. Treatment policies and procedures.

(a) Each facility shall have a written plan describing the policies and procedures of the partial hospitalization program.

(b)(1) The plan shall provide for:

(A) The services to be provided and the scope of such services;

(B) Intake policy and procedures;

(D) Policies providing for continuity care for patients.

(2) There shall be a planned regular, ongoing program for staff development.

Subpart 3

20 CAR § 418-301 Medical recordkeeping system {#sec-20-car-418-301 omnilex-key=us-ar-regs-official--title-20-part-418--20 CAR § 418-301}

20 CAR § 418-301. Medical recordkeeping system.

(a) Each partial hospitalization program shall maintain an organized medical recordkeeping system to collect and document information appropriate to the treatment processes.

(b) This system shall be organized, easily retrievable, usable medical records stored under confidential conditions, and with planned retention and disposition.

20 CAR § 418-302 Basic requirements {#sec-20-car-418-302 omnilex-key=us-ar-regs-official--title-20-part-418--20 CAR § 418-302}

20 CAR § 418-302. Basic requirements.

The partial hospitalization program’s policies and procedures shall:

(1) Define the content of the client’s medical record;

(2) Define storage, retention, and destruction requirements for client medical records;

(3) Require client medical records be confidentially maintained in locked equipment under secure measures;

(4) Require legible entries in client medical records signed with first name or initial, last name, credentials, and dated by the person making the entry;

(5) Require the client's name be typed or written on each sheet of paper or page in the client record;

(6) Require a signed consent for treatment before the client is admitted; and

(7) Require a signed consent for follow-up before any contact after discharge is made.

20 CAR § 418-303 Record access for clinical staff {#sec-20-car-418-303 omnilex-key=us-ar-regs-official--title-20-part-418--20 CAR § 418-303}

20 CAR § 418-303. Record access for clinical staff.

(a) The partial hospitalization program shall ensure client records are readily accessible to the partial hospitalization staff directly caring for the client.

(b) Such access shall be limited to the minimum necessary to carry out the staff member’s job functions or the purpose for the use of the records.

20 CAR § 418-304 Progress notes {#sec-20-car-418-304 omnilex-key=us-ar-regs-official--title-20-part-418--20 CAR § 418-304}

20 CAR § 418-304. Progress notes.

(a) The partial hospitalization program shall have a policy and procedure mandating the chronological documentation of progress notes for clients admitted to the partial hospitalization program.

(b) Progress notes shall minimally address the following:

(1) Person or persons to whom services were rendered;

(2) Activities and services provided and as they relate to the goals and objectives of the treatment plan, including ongoing reference to the treatment plan;

(3) Documentation of the progress or lack of progress, as defined in the treatment plan;

(4) Documentation of the treatment plan's implementation, including client activities and services;

(5) The client's current status;

(6) Documentation of:

(A) The client's response to services;

(B) Changes in behavior and mood; and

(7) Plans for continuing therapy or for discharge, whichever is appropriate; and

(8) Progress notes shall document progress daily.

20 CAR § 418-305 Medication record {#sec-20-car-418-305 omnilex-key=us-ar-regs-official--title-20-part-418--20 CAR § 418-305}

20 CAR § 418-305. Medication record.

(a) The partial hospitalization program shall maintain a medication record on all clients who receive medications or prescriptions in order to provide a concise and accurate record of the medications the client is receiving or has been prescribed for the client.

(b) The client medical record shall contain a medication record with information on all medications ordered or prescribed by physician staff which shall include, but not be limited to:

(1) The record of medication administered, dispensed, or prescribed shall include all of the following:

(A) Name of medication;

(B) Dosage;

(D) Route of administration; and

(E) Staff member who administered or dispensed each dose, or prescribing physician; and

(2) A record of pertinent information regarding adverse reactions to drugs, drug allergies, or sensitivities shall be:

(A) Updated when required by virtue of new information; and

(B) Kept in a highly visible location in or on the record.

20 CAR § 418-306 Aftercare and discharge planning {#sec-20-car-418-306 omnilex-key=us-ar-regs-official--title-20-part-418--20 CAR § 418-306}

20 CAR § 418-306. Aftercare and discharge planning.

(a)(1) Aftercare and discharge planning is to be initiated for the client at the earliest possible point in the partial hospitalization service delivery process.

(2) Discharge planning must be matched to the client’s needs and address the presenting problem and any identified co-occurring disorders or issues.

(b) The program will have designated staff with responsibility to initiate discharge planning.

(c) Referral and linkage procedures shall be in place so staff can adequately advocate on behalf of the person served as early as possible during the stabilization treatment process to transition to lesser restrictive or alternative treatment settings, as indicated.

Subpart 4

20 CAR § 418-401 Department investigations {#sec-20-car-418-401 omnilex-key=us-ar-regs-official--title-20-part-418--20 CAR § 418-401}

20 CAR § 418-401. Department investigations.

The Department of Human Services in any investigation or program monitoring regarding client rights shall have access to:

(1) Clients;

(2) Partial hospitalization program records; and

(3) Partial hospitalization program staff.

Subpart 5

20 CAR § 418-501 Organizational description {#sec-20-car-418-501 omnilex-key=us-ar-regs-official--title-20-part-418--20 CAR § 418-501}

20 CAR § 418-501. Organizational description.

(a) The partial hospitalization program shall have a written organizational description which is reviewed annually by both the partial hospitalization program, behavioral health agency, and the Department of Human Services, which minimally includes:

(1) The overall target population, specifically including those individuals with co-occurring disorders, for whom services will be provided;

(2) The overall mission statement; and

(3) The annual facility goals and objectives, including the goal of continued progress for the facility in providing person-centered, culturally competent, trauma-informed, and co-occurring capable services.

(b) The partial hospitalization program’s governing body shall:

(1) Approve the mission statement and annual goals and objectives; and

(2) Document their approval.

(c) The partial hospitalization program shall make the organizational description, mission statement, and annual goals and objectives available to staff.

(d) The partial hospitalization program shall make the organizational description, mission statement, and annual goals and objectives available to the general public upon request.

(e) Each partial hospitalization program shall have a written plan for professional services, which shall have in writing the following:

(1) Services description and philosophy;

(2) The identification of the professional staff organization to provide these services;

(3) Written admission and exclusionary criteria to identify the type of clients for whom the services are primarily intended;

(4) Written goals and objectives; and

(5) Delineation of processes to ensure accessible, integrated, and co-occurring-capable services and a plan for how each program component will address the needs of individuals with co-occurring disorders.

(f)(1) There shall be a written statement of the procedures/plans for attaining the organization's goals and objectives.

(2) These procedures/plans should:

(A) Define specific tasks, including actions regarding the organization’s co-occurring capability;

(B) Set target dates; and

20 CAR § 418-502 Information analysis and planning {#sec-20-car-418-502 omnilex-key=us-ar-regs-official--title-20-part-418--20 CAR § 418-502}

20 CAR § 418-502. Information analysis and planning.

(a) The partial hospitalization program shall have a defined plan for conducting an organizational needs assessment that specifies the methods and data to be collected, which shall include but not be limited to information from:

(1) Clients;

(2) Governing authority;

(3) Staff;

(4) Stakeholders;

(5) Outcomes management processes; and

(6) Quality record review.

(b) The partial hospitalization program shall have a defined system to collect data and information on a quarterly basis to manage the organization.

(d) The partial hospitalization program shall prepare an end-of-year management report, which shall include but not be limited to:

(1) An analysis of the needs assessment process; and

(2) Performance improvement program findings.

(e) The management report shall be communicated and made available to, among others:

(1) The governing authority;

(2) Partial hospitalization program staff; and

(3) The Department of Human Services, if and when requested.

Subpart 6

20 CAR § 418-601 Performance improvement program {#sec-20-car-418-601 omnilex-key=us-ar-regs-official--title-20-part-418--20 CAR § 418-601}

20 CAR § 418-601. Performance improvement program.

(a) The partial hospitalization program shall have an ongoing performance improvement program designed to objectively and systematically monitor, evaluate, and improve the quality of client care.

(b) The performance improvement program shall also address the fiscal management of the organization.

(c)(1) There shall be an annual written plan for performance improvement activities.

(2) The plan shall include, but not be limited to:

(A) Outcomes management processes specific to each program component minimally measuring:

(i) Efficiency;

(ii) Effectiveness; and

(iii) Client satisfaction;

(B) A quarterly record review to minimally assess:

(i) Quality of services delivered;

(ii) Appropriateness of services;

(iii) Patterns of service utilization;

(iv) Clients, relevant to:

(a) Their orientation to the partial hospitalization program and services being provided; and

(b) Their active involvement in making informed choices regarding the services they receive;

(v) The client assessment information thoroughness, timeliness, and completeness;

(vi) Treatment goals and objectives are based on:

(a) Assessment findings; and

(b) Client input;

(vii) Services provided were related to the goals and objectives;

(viii) Services are documented as prescribed by policy; and

(ix) The treatment plan is reviewed and updated as prescribed by policy;

(D) Fiscal management and planning, which shall include:

(i) An annual budget that is approved by the governing authority and reviewed at least annually;

(ii) The organization's capacity to generate needed revenue to produce desired client and other outcomes; and

(iii) Monitoring client records to ensure documented dates of services provided coincide with billed service encounters; and

(E) Review of critical incident reports and client grievances or complaints.

(d) The partial hospitalization program shall:

(1) Monitor the implementation of the performance improvement plan on an ongoing basis; and

(2) Make adjustments as needed.

(e) Performance improvement findings shall be communicated and made available to, among others:

(1) The governing authority;

(2) Partial hospitalization program staff; and

(3) The Department of Human Services, if and when requested.

20 CAR § 418-602 Incident reporting {#sec-20-car-418-602 omnilex-key=us-ar-regs-official--title-20-part-418--20 CAR § 418-602}

20 CAR § 418-602. Incident reporting.

(a) The partial hospitalization program shall have written policies and procedures requiring documentation and reporting of critical incidents.

(b) The documentation for critical incidents shall contain, minimally:

(1) The facility name and name and signature of the person or persons reporting the incident;

(2) The name of client or clients, staff person or persons, or others involved in the incident;

(3) The time, place, and date the incident occurred;

(4) The time and date the incident was reported and name of the person within the facility to whom it was reported;

(5) A description of the incident;

(6)(A) The severity of each injury, if applicable.

(B) Severity shall be indicated as follows:

(i) No offsite medical care required or first-aid care administered onsite;

(ii) Medical care by a physician or nurse or follow-up attention required; or

(iii) Hospitalization or immediate offsite medical attention was required; and

(7) The resolution or action taken, date action taken, and signature of the partial hospitalization program director.

(c) The partial hospitalization program shall report those critical incidents to the Department of Human Services that include critical incidents requiring medical care by a physician or nurse or follow-up attention and incidents requiring hospitalization or immediate offsite medical attention shall be delivered via fax or mail to DHS Provider Certification within twenty-four (24) hours of the incident being documented.

(d) The partial hospitalization program shall document and monitor internally, with a quality assurance and improvement process that will be made available for review and/or audit by an appropriate agency, the following:

(1) Critical incidents requiring medical care by a physician or nurse or follow-up attention; and

(2) Incidents requiring hospitalization or immediate offsite medical attention.

Subpart 7

20 CAR § 418-701 Personnel policies and procedures {#sec-20-car-418-701 omnilex-key=us-ar-regs-official--title-20-part-418--20 CAR § 418-701}

20 CAR § 418-701. Personnel policies and procedures.

(a) The partial hospitalization program shall have written personnel policies and procedures approved by the governing authority.

(b) All employees shall have access to personnel policies and procedures, as well as other rules and regulations governing the conditions of their employment.

(1) Develop, adopt, and maintain policies and procedures to promote the objectives of the program; and

(2) Provide for qualified personnel during all hours of operation to:

(A) Support the functions of the center; and

(B) Provide quality care.

20 CAR § 418-702 Job descriptions {#sec-20-car-418-702 omnilex-key=us-ar-regs-official--title-20-part-418--20 CAR § 418-702}

20 CAR § 418-702. Job descriptions.

(a) The partial hospitalization program shall have written job descriptions for all positions setting forth minimum qualifications and duties of each position.

(b) All job descriptions shall include an expectation of core competencies in relation to individuals with co-occurring disorders.

Subpart 8

20 CAR § 418-801 Staff qualifications {#sec-20-car-418-801 omnilex-key=us-ar-regs-official--title-20-part-418--20 CAR § 418-801}

20 CAR § 418-801. Staff qualifications.

(a) The partial hospitalization program shall document the qualifications and training of staff providing crisis stabilization services, which shall be in compliance with the partial hospitalization program’s clinical privileging process.

(b) Failure to comply with this section will result in the initiation of procedures to deny, suspend, and/or revoke certification.

20 CAR § 418-802 Staff development {#sec-20-car-418-802 omnilex-key=us-ar-regs-official--title-20-part-418--20 CAR § 418-802}

20 CAR § 418-802. Staff development.

(a) The partial hospitalization program shall have a written plan for the professional growth and development of all administrative, professional clinical and support staff.

(b) This plan shall include but not be limited to:

(1) Orientation procedures;

(2) In-service training and education programs;

(3) Availability of professional reference materials; and

(4) Mechanisms for ensuring outside continuing educational opportunities for staff members.

findings and recommendations shall be addressed by and documented in the staff development and clinical privileging processes.

(d) Staff competency development shall:

(1) Be aligned with the organization’s goals related to co-occurring capability; and

(2) Incorporate a training plan, training activities, and supervision designed to improve co-occurring core competencies of all staff.

(e) Staff education and in-service training programs shall be evaluated by the partial hospitalization program at least annually.

20 CAR § 418-803 In-service training {#sec-20-car-418-803 omnilex-key=us-ar-regs-official--title-20-part-418--20 CAR § 418-803}

20 CAR § 418-803. In-service training.

(a) Trainings are required annually for all employees who provide clinical services within the partial hospitalization program on the following topics:

(1) Fire and safety;

(2) Infection control and universal precautions;

(3) Client's rights and the constraints of the Mental Health Client's Bill of Rights;

(4) Confidentiality;

(5) The Adult and Long-Term Care Facility Resident Maltreatment Act, Arkansas Code § 12-12-1701 et seq.;

(6) Facility policy and procedures;

(7) Cultural competence;

(8) Co-occurring disorder competency and treatment principles; and

(9) Trauma-informed, age-specific, and developmental-specific trainings.

(b) All staff providing clinical services shall have a current certification in:

(1) Basic first aid; and

(2) Cardiopulmonary resuscitation.

(c)(1) All clinical staff shall have training in nonphysical intervention techniques and philosophies addressing appropriate nonviolent interventions for potentially physical interpersonal conflicts, staff attitudes which promote dignity and enhanced self-esteem, keys to effective communication skills, verbal and nonverbal interaction, and nonviolent intervention within thirty (30) days of being hired with annual updates thereafter.

(2) This training shall occur prior to direct patient contact.

(d)(1) The partial hospitalization executive director shall designate which positions and employees, including temporary employees, will be required to successfully complete physical intervention training.

(2) The employee shall successfully complete this training within thirty (30) days of being hired, with annual updates thereafter.

(3) This training shall occur prior to direct patient contact.

Subpart 9

20 CAR § 418-901 Standards {#sec-20-car-418-901 omnilex-key=us-ar-regs-official--title-20-part-418--20 CAR § 418-901}

20 CAR § 418-901. Standards.

(a)(1) Partial hospitalization programs shall apply these standards to all sites operated.

(2) The primary concern of the partial hospitalization program should always be the safety and well-being of the clients and staff.

(3) Partial hospitalization programs shall be physically located in the State of Arkansas.

(4) Partial hospitalization programs shall provide a safe and sanitary environment.

(b)(1) A partial hospitalization program is defined by its staff and organizational structure rather than by a specific building or facility.

(2) It may operate at more than one (1) site if the respective sites:

(A) Meet all physical facility standards; and

(B) Operate as a portion of a total partial hospitalization program.

(3) The Department of Human Services will issue a single certificate of compliance to the parent organization (behavioral health agency), which will list all operational sites.

20 CAR § 418-902 Facility environment generally {#sec-20-car-418-902 omnilex-key=us-ar-regs-official--title-20-part-418--20 CAR § 418-902}

20 CAR § 418-902. Facility environment generally.

(a)(1) Adequate space, equipment, and supplies shall be provided in order that the partial hospitalization services can be provided effectively and efficiently.

(2) Functional surroundings shall be readily accessible to the patient and community served.

(b) All space and equipment shall:

(1) Be well-maintained; and

(2) Meet applicable federal, state, and local requirements for safety, fire, and health.

(1) Chairs;

(2) Desks;

(3) Tables; and

(4) Other necessary equipment.

(d) There shall be an adequate number of suitably equipped conference rooms to provide for staff conferences and therapy.

(e) There shall be adequate provisions for the privacy of the patient in interview rooms.

(f) The facility shall be appropriate to the age and developmental needs of the persons served.

(g) The partial hospitalization program shall obtain an annual fire and safety inspection from the State Fire Marshal or local authorities which documents approval for continued occupancy.

(h) Partial hospitalization program staff shall know the exact location, contents, and use of:

(1) First-aid supply kits; and

(2)(A) Firefighting equipment and fire detection systems.

(B) All firefighting equipment shall be annually maintained in appropriately designated areas within the facility.

(i) The partial hospitalization program shall have a written hazardous communication program and staff shall be knowledgeable of chemicals in the workplace, location of material safety data sheets, personal protective equipment, and toxic or flammable substances shall be stored in approved locked storage cabinets.

(j) The partial hospitalization program’s telephone number or numbers and actual hours of operation shall be posted at all public entrances.

(k) Signs must be posted at all public entrances informing staff, clients, and visitors as to the following requirements:

(1) No alcohol or illicit drugs are allowed in the partial hospitalization program facility;

(2) No firearms or other dangerous weapons are allowed in the partial hospitalization program facility with the exception of law enforcement while in the performance of their duties; and

(3) The use of tobacco is not allowed in the partial hospitalization program facility.

(l) A copy of compliance with Title VI of the Civil Rights Act of 1964 and Title VII of the Civil Rights Act of 1964 shall be prominently displayed within the partial hospitalization program facility.

(m)(1) Plumbing in partial hospitalization program facilities shall be in working condition to avoid any health threat.

(2) All toilets, sinks, and showers shall be clean and in working order.

(n) A secure locked storage shall be provided for client valuables when requested.

(o) Separate storage areas are provided and designated for:

(1) Food, kitchen, and eating utensils;

(2) Clean linens;

(3) Soiled linens and soiled cleaning equipment; and

(4) Cleaning supplies and equipment.

(p)(1) When handling soiled linen or other potentially infectious material, universal precautions are to be followed and addressed in the partial hospitalization program policies and procedures.

(2) Hazardous and regulated waste shall be disposed of in accordance with federal requirements.

(q) Poisons, toxic materials, and other potentially dangerous items shall be stored in a secured location.

History

Codification Notes: Title VI of the Civil Rights Act of 1964 is codified at 42 U.S.C. § 2000d et seq.Title VII of the Civil Rights Act of 1964 is codified at 42 U.S.C. § 2000e et seq. Authorities: Arkansas Code § 20-76-201; Arkansas Code § 20-77-107

20 CAR § 418-903 Medication clinic — Medication monitoring {#sec-20-car-418-903 omnilex-key=us-ar-regs-official--title-20-part-418--20 CAR § 418-903}

20 CAR § 418-903. Medication clinic — Medication monitoring.

(a) Medication administration, storage, and control and client reactions shall be continuously monitored.

(b)(1) Partial hospitalization programs shall ensure proper storage and control of medications, immediate response if incorrect or overdoses occur, and have appropriate emergency supplies available if needed.

(2) Written procedures for medication administration shall be:

(A) Available and accessible in all medication storage areas; and

(B) Available to all staff authorized to administer medications.

(3)(A) All medications shall be kept in locked, non-client-accessible areas.

(B) Factors which shall be considered in medication storage are:

(i) Light;

(ii) Moisture;

(iii) Sanitation;

(iv) Temperature;

(v) Ventilation; and

(vi) The segregation and safe storage of poisons, external medications, and internal medications.

(4) Telephone numbers of the state poison centers shall be immediately available in all locations where medications are:

(A) Prescribed;

(B) Administered; or

20 CAR § 418-904 Medication — Error rates {#sec-20-car-418-904 omnilex-key=us-ar-regs-official--title-20-part-418--20 CAR § 418-904}

20 CAR § 418-904. Medication — Error rates.

The partial hospitalization program shall have an ongoing performance improvement program that specifically, objectively, and systematically monitors medication administration or dispensing or medication orders and prescriptions to evaluate and improve the quality of client care.

20 CAR § 418-905 Food and nutrition {#sec-20-car-418-905 omnilex-key=us-ar-regs-official--title-20-part-418--20 CAR § 418-905}

20 CAR § 418-905. Food and nutrition.

(a) If the partial hospitalization program prepares meals onsite, the partial hospitalization program shall have a current food establishment health inspection as required by the Department of Health.

(b) When meals are provided by a food service, a written contract shall be maintained and shall require the food service to have a current food establishment health inspection as required by the department.

(c) Partial hospitalization programs shall provide at least three (3) meals daily to any client receiving services for up to twenty-three (23) hours, with no more than fourteen (14) hours between any two (2) meals.

(d) All food shall be stored, prepared, and served in a safe, healthy manner.

(e) Perishable items shall not be used once they exceed their sell-by date.

20 CAR Part 418 — Partial Hospitalization Certification