Division of Behavioral Health Services
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BHS Definitions List (revised 10/01/14)
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Pre-Admission Screening and Resident Review.
Parent-Delivered Support or Service
Emotional and informational support provided by a parent or caregiver who has similar personal life expertise and has navigated two child serving systems.
Any person undergoing examination, evaluation or behavioral health treatment.
All communications related to payment for a patient's health care that contain individually identifiable information.
Sheriffs of counties, constables, marshals and/or policemen of cities and towns.
An individual who is, or has been, a recipient of behavioral health services and has an experience of recovery to share.
Peer-delivered services reflect a continuum of programs and supports provided by individuals who identify themselves as having behavioral health challenges and are receiving or have received behavioral health care. Peer services can include programs that are peer-operated (planned, delivered and administered by people with lived experience), peer partnerships (shared governance between peer and non-peer organizations or staff) and peer employees - the unique discipline of providing peer services as a member of the target population.
Social and emotional support, generally coupled with specific, skill-based training, coaching or assistance, that is provided to bring about a targeted social or personal change at the symptom, individual, family or community level. Targets for peer support services can include a variety of individualized and personal goals, including living preferences, employment or educational goals and development of social networks and interests.
An in-depth review specifically intended to investigate the clinical soundness of treatment provided for a member by a clinician (e.g. medical doctor, nurse practitioner, physician assistant), typically conducted through a committee structure inclusive of same-specialty peers. The peer review process is confidential and is not disclosed as public record or produced in response to a subpoena or other legal order unless otherwise required by law.
Peer Reviewed Literature
Scientific studies critically assessed by scholars in the author's field or specialty and deemed eligible for publication. The review process is used to ensure studies are sound and findings are valid.
Peer-Operated Services that are:
- Independent - Owned, administratively controlled, and managed by peers
- Autonomous - All decisions are made by the program
- Accountable - Responsibility for decisions rests with the program
- Peer - controlled - Governance board is at least 51% peers
Peer Support Services
The provision of assistance to more effectively utilize the service delivery system (e.g., assistance in developing plans of care, identifying needs, accessing supports, partnering with professionals, overcoming service barriers) or understanding and coping with the stressors of the person's disability (e.g., support groups), coaching, role modeling and mentoring.
Self-help/peer services are intended for enrolled persons and/or their families who require greater structure and intensity of services than those available through community-based recovery fellowship groups and who are not yet ready for independent access to community-based recovery groups (e.g., AA, NA, Dual Recovery). These services may be provided to a person, group or family.
Peer Support Specialist / Recovery Support Specialist
A peer who has completed training and passed a competency test through an ADHS/DBHS Approved Peer Support Employment Training Program, and meets the requirements to function as a behavioral health paraprofessional, behavioral health technician, or behavioral health professional, as defined in A.A.C. R9-20-101 and A.A.C. R9-20-204.
Peer Worker refers to an individual who is, or has been, a recipient of behavioral services and who currently provides behavioral health services to individuals enrolled in the public behavioral health system. The peer worker may be either an employee or volunteer/unpaid. Services that may be provided by a peer worker vary depending on the peer worker's education and experience. For example, a peer worker who is also behavioral health professional can provide all of the treatment and support services that the agency is able to provide under the agency's OBHL license or the agency's ADHS/DBHS Community Services Agencies Title XIX certification. Peer Workers may have job titles such as Peer Support Specialists, Recovery Guides, Recovery Specialists, etc.
Pending Admission List
A list of individuals who have been appointed for admission by the Chief Medical Officer, but not yet admitted to the Arizona State Hospital.
Community-based housing available to low-income individuals with disabilities and provides long-term housing and supportive services for not more than: 8 such persons in a single structure or contiguous structures; 16 such persons, but only if not more than 20 percent of the units in a structure are designated for such persons; or more than 16 persons if the applicant demonstrates that local market conditions dictate the development of a large project and such development will achieve the neighborhood integration objectives of the program within the context of the affected community.
Persistently or Acutely Disabled (PAD)
Means a severe mental disorder that meets all of the following criteria:
- If not treated has a substantial probability of causing the person to suffer or continue to suffer severe and abnormal mental, emotional, or physical harm that significantly impairs judgment, reason, behavior, or capacity to recognize reality.
- Substantially impairs the person's capacity to make an informed decision regarding treatment and this impairment causes the person to be incapable of understanding and expressing an understanding of the advantages and disadvantages of accepting treatment and understanding and expressing an understanding of the alternatives to the particular treatment offered after the advantages, disadvantages, and alternatives are explained to that person.
- Has a reasonable prospect of being treatable by outpatient, inpatient, or combined inpatient and outpatient treatment.
Person Centered Planning
Person-centered planning is a process-oriented approach to empowering people with disability labels. It focuses on the people and their needs by putting them in charge of defining the direction for their lives, not on the systems that may or may not be available to serve them. This ultimately leads to greater inclusion as valued members of both community and society.
The application of physical force without the use of any device, for the purpose of restricting the free movement of a behavioral health recipient's body, but for a behavioral health agency licensed as an OBHL Level I RTC or a Level I subacute facility, does not include:
- Holding a person for no longer than five minutes, without undue force, in order to calm or comfort the person; or
- Holding a person's hand to escort the person from one area to another.
Personal Restraint- Level I Psychiatric Acute Hospital Programs
The application of physical force without the use of any device, for the purpose of restricting the free movement of a behavioral health recipient's body. Personal restraint does not include the temporary touching or holding of the hand, wrist, arm, shoulder or back for the purpose of inducing a resident to walk to a safe location. ((42 CFR 482.13(1)(ii))
Personal Restraint- Residential Treatment Centers Providing Services to Persons under the Age of 21
The application of physical force without the use of any device, for the purpose of restricting the free movement of a behavioral health recipient's body. Personal restraint does not include briefly holding without undue force a resident in order to calm or comfort him or her, or holding a resident's hand to safely escort a resident from one area to another. (42 CFR 483.352)
Personal Restraint, Sub-Acute Agency
The application of physical force without the use of any device, for the purpose of restricting the free movement of a behavioral health recipient's body, but:
- For a Level 1 RTC or a Level 1 sub acute agency, does not include:
- Holding a behavioral health recipient for no longer than five minutes, without undue force, in order to calm or comfort the behavioral health recipient, or
- Holding a behavioral health recipient's hand to safely escort the behavioral health recipient from one area to another; and
- For a correctional facility, does not include physically holding a person by a security officer for purposes not related to a behavioral health recipient's behavioral health issue.
(A.A.C. R9 20-101)
The impairment or physical condition that includes any skin bruising, pressure sores, bleeding, failure to thrive, malnutrition, dehydration, burns, fracture of any bone, subdural hematoma, soft tissue swelling, injury to any internal organ or any physical condition that imperils health or welfare.
The health care provided for a period of up to 60 days post-delivery. Family planning services are included, if provided by a physician or practitioner, as addressed in AHCCCS AMPM Policy 420.
Post Stabilization Services
Medically necessary services, related to an emergency medical condition, provided after the person's condition is sufficiently stabilized in order to maintain, improve or resolve the person's condition so that the person could alternatively be safely discharged or transferred to another location.
Certified nurse practitioners in midwifery, physician's assistants and other nurse practitioners. Physician's assistants and nurse practitioners are defined in A.R.S. Title 32, Chapters 25 and 15 respectively.
Preconception Counseling Services
As part of a well woman visit, these services are provided when medically necessary. This counseling focuses on the early detection and management of risk factors before pregnancy, and includes efforts to influence behaviors that can affect a fetus (even before conception is confirmed), as well as regular health care. The purpose of preconception counseling is to ensure that a woman is healthy prior to pregnancy. Preconception counseling does not include genetic testing.
The artificially induced expulsion of an embryo or fetus. As used in legal context, the term usually refers to induced abortion.
The review of each application requesting court-ordered evaluation, including an investigation of facts alleged in such application, an interview with each applicant and an interview, if possible, with the proposed patient. The purpose of the interview with the proposed patient is to assess the problem, explain the application and, when indicated, attempt to persuade the proposed patient to receive, on a voluntary basis, evaluation or other services.
Preliminary Protective Hearing (PPH)
A Hearing held within 5-7 days of when a dependency petition is filed. At the PPH, the court will make orders about the child's placement, visitation and tasks and services to be provided.
Preponderance of Evidence
A standard of proof that it is more likely than not that an alleged event occurred.
For the purposes of this section, a prescriber is a behavioral heath medical practitioner licensed to prescribe medications and includes:
- A physician;
- A physician assistant; or
- A nurse practitioner.
Prescription Drug Plan (PDP)
Prescription drug coverage that is offered under a policy, contract, or plan that has been approved as specified in 42 CFR 423.272 and that is offered by a Prescription Drug Plan (PDP) sponsor that has a contract with CMS that meets the contract requirements under 42 CFR 423.505. This includes fallback prescription drug plans.
The creation of conditions, opportunities, and experiences that encourage and develop healthy, self-sufficient children and that occur before the onset of problems (Arizona Revised Statutes). Prevention is an active process that creates and rewards conditions that lead to healthy behaviors and life styles (Center for Substance Abuse Prevention, (CSAP)).
Any activity provided in accordance with ADHS/DBHS Framework for Prevention in Behavioral Health.
Primary Care Physician
An individual who meets the requirements of A.R.S. § 36-2901, and who is responsible for the management of the member's health care. A PCP may be a physician defined as a person licensed as an allopathic or osteopathic physician according to A.R.S. Title 32, Chapter 13 or Chapter 17, or a practitioner defined as a physician assistant licensed under A.R.S. Title 32, Chapter 25, or a nurse practitioner licensed under A.R.S. Title 32, Chapter 15. The PCP must be an individual, not a group or association of persons, such as a clinic.
Primary Source Verification
Verification is a direct contact with the sources of credentials. For example, this may include residency programs, licensing agencies, and specialty boards to guarantee that statements about training, experience and other qualifications are legitimate, unchallenged and appropriate.
The process by which ADHS/DBHS, a RBHA or subcontracted provider authorizes, in advance, the delivery of covered services contingent upon the medical necessity of the services.
Prior Period Coverage
AHCCCS provides prior period coverage for the period of time prior to the Title XIX member's enrollment during which the member is eligible for covered services. The time frame is from the effective date of eligibility (or 10/1 if the effective date of eligibility is prior to 10/1) to the day the member is enrolled with an acute health plan. ADHS receives notification from the Administration of the member's enrollment. ADHS is responsible for payment of all claims for medically necessary behavioral health services, provided to members during prior period coverage.
The process by which a health organization reviews training, clinical competency and the scope of practice of its health providers.
"Provider practices that are inconsistent with sound fiscal, business or medical practices, and result in an unnecessary cost to the Medicaid program, or in reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards for health care. It also includes recipient practices that result in unnecessary cost to the Medicaid program." (42 CFR §455.2).
Elements of Program Abuse:
- Inconsistency (pattern of not following known laws, rules, regulations, contracts or industry practices/procedures).
- Costs (unnecessary loss to a government program).
- Not necessary/does not meet standards (general disregard for professional or industry standards and practices).
The Community Service Agency staff person who is directly responsible for the program, direct service staff or contractor and services provided by the CSA.
Protected Health Information
The Privacy Rule protects all "individually identifiable health information" held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper or oral. (45 C.F.R. § 160.103)
An attribute, situation, condition, or environmental context that develops resiliency in individuals and prevents the likelihood of Alcohol Tobacco and Other Drug (ATOD) use.
A person or entity that contracts with a T/RBHA to provide covered services directly to members.
A formal written disagreement with a decision made by a T/RBHA or ADHS/DBHS.
Provider Preventable Conditions
42 CFR Section 447.26 prohibits payment for services related to Provider-Preventable Conditions. Provider-Preventable Condition means a condition that meets the definition of a Health Care-Acquired Condition (HCAC) or an Other Provider-Preventable Condition (OPPC). These terms are defined as follows:
- Health Care-Acquired Condition (HCAC) - means a Hospital Acquired Condition (HAC) under the Medicare program, with the exception of Deep Vein Thrombosis/Pulmonary Embolism following total knee or hip replacement for pediatric and obstetric patients, which occurs in any inpatient hospital setting and which is not present on admission. Refer to Chapter 900, Policy 960 for the list of HCACs.
- Other Provider-Preventable Condition (OPPC) - means a condition occurring in the inpatient and outpatient health care setting which AHCCCS has limited to the following:
- a. Surgery on the wrong member,
- b. Wrong surgery on a member and
- c. Wrong site surgery
A member's health status may be compromised by hospital conditions and/or medical personnel in ways that are sometimes diagnosed as a "complication". If it is determined that the complication resulted from an HCAC or OPPC, any additional hospital days or other additional charges resulting from the HCAC or OPPC will not be reimbursed.
If it is determined that the HCAC or OPPC was a result of mistake or error by a hospital or medical professional, the Contractor must conduct a quality of care investigation and report the occurrence and results of the investigation to the AHCCCS Clinical Quality Management Unit.
Temporary/Provisional Credentialing is used when it is in the best interest of members that providers be available to provide care prior to completion of the entire credentialing process. The T/RBHA has 14 calendar days from receipt of a complete application to render a decision regarding temporary or provisional credentialing.
A person without medical training who exercises those qualities of attention, knowledge, intelligence and judgment which society requires of its members for the protection of their own interest and the interests of others.
Public Housing Authority (PHA)
HUD funded unit of local government that provides independent housing for low-income individuals and families. Program includes Section 8 Housing Choice Vouchers and low rent units.
Psychiatric Acute Hospital
A hospital that provides inpatient services licensed per 9 A.A.C. 20 and includes a general hospital with a psychiatric unit and a specialty psychiatric hospital (including the Arizona State Hospital).