Ala. Admin. Code r. 580-2-20-.04

Recipient Protection

This regulation establishes recipient rights and protection standards for all programs certified by the Alabama Department of Mental Health (ADMH), covering persons with serious emotional disturbance, serious mental illness, and/or substance use disorders. Operators must develop and implement written policies addressing informed consent, confidentiality, privacy, grievance procedures, abuse and neglect prevention, personal funds management, and rights notification at admission. Programs must inform recipients of their rights in their preferred language, post rights notices prominently, and document compliance throughout the service delivery process. Additional protections apply specifically to residential and inpatient settings, including dietary needs, medical/dental access, and privacy in living areas.

Ala. Admin. Code r. 580-2-20-.04 - Recipient Protection 

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Recipient definition - a person with serious emotional
 disturbance, serious mental illness and/or substance use disorder served in
 program programmatically certified by ADMH.

(1)
 There must be written policies and
 procedures that protect the recipient's welfare, the manner in which the
 recipient is informed of these protections, and the means by which these
 protections will be enforced. The legal guardian of a minor, except where the
 minor is above the age of fourteen (14) and chooses not to involve parents
 consistent with state law, will be given a copy of the recipient's rights and a
 copy of the grievance policies. Documentation must exist, unless waived by a
 minor at or above the age of fourteen (14) that demonstrates that family
 members of a minor receive a copy of the recipient's rights, written
 information and grievance policies. Any reference to "written" notification in
 these rules indicates that the recipient is entitled to receive information in
 their preferred language and manner understood by the recipient.

(2)
 Upon admission, and as soon as clinically
 appropriate, recipients are informed on an individual basis concerning services
 offered and fees for these services, with information presented in the
 recipient's preferred language and in terms appropriate to the recipient's
 condition and ability to understand. The program shall provide the
 recipient/lawful representative with written notification upon admission and
 when any changes or limitations in services or fees occur. Recipients who are
 primarily responsible for payment of charges for services are informed in
 writing of their eligibility for reimbursement by third party payers for
 service rendered and assisted as needed with application.

(3)
 The agency shall develop, maintain, and
 document implementation of written policies and procedures that: 
 
(a)
 Describe the mechanisms utilized for
 implementation and protection of recipient rights, which shall include at a
 minimum:
1.
 Informing the recipient of his/her
 rights at the time of admission in recipient's preferred language and in a
 manner understood by the recipient, and as needed throughout the service
 delivery process.

2.
 Providing the
 recipient with a copy of the rights, in a medium that the recipient
 understands, at admission and documenting this process in the recipient's
 record.

3.
 Prominently posting
 copies of the rights throughout the facility in which services are
 provided.

(4)

 The written policies and procedures shall, at a minimum, address the following
 rights:
(a)
 To privacy.

(b)
 To confidentiality.

(c)
 To be informed of the person(s) who has
 primary responsibility for the recipient's treatment and clinical
 care.

(d)
 To participate fully in
 all decisions related to treatment and clinical care provided by the
 agency.

(e)
 To be provided with
 appropriate information to facilitate informed decision making regarding
 treatment.

(f)
 To the provision of
 services in a manner that is responsive to and respectful of the recipient's
 strengths, needs, and abilities and preferences, including preference of
 language.

(g)
 To the development of
 an individualized unique service/treatment plan formulated in partnership with
 the program's staff, and to receive services based upon that plan.

(h)
 To the availability of an adequate number
 of competent, qualified, and experienced professional clinical staff to ensure
 appropriate implementation of the recipient's service/treatment plan.

(i)
 To the provision of care as according to
 accepted clinical practice standards within the least restrictive and most
 integrated setting appropriate.

(j)

 To be educated about the possible significant adverse effects of the
 recommended treatment, including any appropriate and available alternative
 treatments, services, and/or providers.

(k)
 To express preference regarding the
 selection of service provider(s). 

(l)
 To service delivery that is absent of
 abuse and neglect including but not limited to: 
 
1.
 Physical abuse.

2.
 Sexual abuse.

3.
 Harassment.

4.
 Physical punishment.

5.
 Psychological abuse, including
 humiliation.

6.
 Threats.

7.
 Exploitation.

8.
 Coercion.

9.
 Fiduciary abuse.

(m)
 To be protected from harm including any
 form of abuse, neglect, or mistreatment.

(n)
 To report without fear of retribution,
 any instances of perceived abuse, neglect, or exploitation.

(o)
 To provide input into the agency's
 service delivery processes through recipient satisfaction surveys and other
 avenues provided by the governing body.

(p)
 To access upon requests all information
 in the recipient's mental health, substance abuse, medical, and financial
 records consistent with applicable laws and regulations.

(q)
 To manage personal funds.

(r)
 To access funds when the provider is
 payee.

(s)
 To complaint and
 grievance procedures.

(t)
 To be
 informed of the financial aspects of treatment.

(u)
 To be informed of the need for parental
 or guardian consent for treatment, if applicable.

(v)
 To a written statement of services to be
 provided.

(w)
 To give informed
 consent prior to being involved in research or experimental projects.

(x)
 To have access to and privacy of mail,
 telephone communications, and visitors for recipients in residential or
 inpatient settings.

(y)
 To have
 access to courts and attorneys.

(z)

 To enforce rights through courts or appropriate administrative
 proceedings.

(aa)
 To be informed of
 commitment status, if any.

(bb)
 If
 committed, to be included in the community with appropriate and adequate
 supports on completion of or in conjunction with the terms of
 commitment.

(cc)
 To be accorded
 human respect and dignity on an individual basis in a consistently humane
 fashion.

(dd)
 To refuse services
 without reprisal except as permitted by law.

(ee)
 To be informed of the means for
 accessing advocates, an ombudsman, or rights protection services.

(ff)
 To be free from seclusion, restraint,
 drugs, or other interventions administered for purposes of punishment,
 discipline, or staff convenience.

(gg)
 To a well-balanced diet that meets
 his/her daily nutritional and special dietary needs if in inpatient or
 residential.

(hh)
 To assistance in
 accessing medical and dental care, including vision and hearing services if in
 residential or inpatient.

(ii)
 To
 access and utilization of appropriately prescribed medication.

(5)
 Each program affords every
 recipient the right to privacy relative to their treatment and care, unless
 contraindicated by clinical determination made by professional staff for
 therapeutic or security purposes. The agency shall ensure: 
 
(a)
 Emergency determinations limiting privacy
 shall be reviewed and documented frequently.

(b)
 Each program respects recipients' privacy
 during toileting, bathing, and personal hygiene activities.

(c)
 Each program allows recipients to
 converse privately with others and to have private access to telephone and
 visitors at reasonable hours.

(d)

 Searches of a recipient or his/her living area and personal possessions are
 only conducted when it is documented that the program director deems such to be
 necessary for the safety and security of the recipient, others, and/or the
 physical environment. The recipient and a witness must be present during a
 search unless there is documentation why the recipient could not be
 present.

(e)
 Each program has
 procedures established for conducting searches, which observe and adhere to the
 recipient's right to be accorded human respect and dignity on an individual
 basis in a consistently humane manner.

(f)
 In residential programs, written policies
 and procedures require that staff alert recipients prior to entering recipient
 living areas.

(g)
 Written and
 informed consent must be signed by the lawful representative of a recipient
 less than 14 years of age before photographs are taken and the photograph is to
 be returned to the lawful representative upon request when the recipient is
 discharged.

(6)

 Confidentiality and Privacy. The agency shall develop, maintain, and document
 implementation of written policies and procedures that govern confidentiality
 and privacy of recipient information that includes, at a minimum, the following
 specifications:
(a)
 Policies and procedures
 shall comply with all state and federal laws and regulations relative to
 confidentiality and privacy of recipient information, including but not limited
 to, Confidentiality of Alcohol and Drug Abuse Patient Records, 42 C.F.R. Part 
2

 and Part 8, and the Health Insurance Portability and Accountability Act of 1996
 (HIPAA), 
45 C.F.R.
 Pts. 160 & 164.

(b)
 Each program ensures that access to
 clinical records is restricted to individuals, entities, and instances
 permitted by applicable state and federal laws and regulations.

(c)
 No recipient's record(s) is released to
 other individuals or agencies without the written, informed consent of the
 recipient except for requests in accordance with state and federal laws and
 regulations (e.g. emergencies) and so documented.

(d)
 Each program is responsible for the
 safekeeping of each recipient's records and for securing it against loss,
 destruction, or use by unauthorized persons.

(7)
 Each program has established procedures
 regarding the content of a recipient's records and procedures for release or
 disclosure of parts thereof, in accordance with state and federal laws and
 regulations.
(a)
 Upon request by a
 recipient/lawful representative for access to the contents of his/her records,
 the program makes a clinical assessment to determine whether such access would
 or would not be detrimental to the recipient's health or present a threat of
 physical harm to a third party. Additional requests may be made at any
 time.

(b)
 Each program has
 established an appeals procedure regarding denial of the disclosure of the
 content of a recipient's records.

(8)
 Prior to or promptly upon admission, each
 program provides every recipient/lawful representative a concise written
 statement and verbal orientation, in their preferred language and terms
 appropriate for the recipient to understand, of rights and responsibilities and
 complaint procedures along with procedures to be followed to initiate, review,
 and resolve allegations of rights violations. 
 
(a)
 Each program obtains from the recipient a
 written verification of receipt of statement of rights and grievance procedure
 information.

(b)
 At a minimum, the
 complaint/grievance procedures shall include: 
 
1.
 The name and telephone number of a
 designated local contact within the program. The designated person shall be
 able to inform recipients of the means of filing grievances and of accessing
 advocates, ombudsmen, or right protection services within or outside the
 program.

2.
 Rights information is
 posted in commonly used public areas of outpatient and residential facilities
 where recipients receive services.

3.
 Such notices shall include the 800 numbers
 of the DMH Advocacy Program, Federal Protection and Advocacy System, and local
 Department of Human Resources.

4.

 Programs assure recipient access to advocates and the grievance/complaint
 process occurs without reprisal.

(9)
 Recipients shall manage their personal
 funds unless there is a payee, guardian, or similar appointee who manages the
 account for them.
(a)
 Program admissions shall
 not be contingent upon payee status.

(b)
 Any limitations placed by the provider on
 a recipient's right to manage his or her personal funds shall be time limited
 and can only be made:
1.
 After a specific
 assessment of the recipient's ability to manage funds,

2.
 After the recipient has been fully
 informed of the limitation, and

3.

 In consideration of the recipient's individual treatment plan as it relates to
 personal finances.

(c)

 The provider must establish a written, Board approved policy addressing: 
 
1.
 The procedures for recipients to gain
 access to their personal funds when the provider is the representative payee or
 otherwise the custodian of the recipients' personal funds.

2.
 Any limitations on the manner and
 frequency in which funds can be accessed.

3.
 Any limitations on the amount of funds
 that can be kept in the recipient's personal possession in a residential
 program.

4.
 Requirements for the
 provider on the management, at least quarterly accounting of all expenditures,
 and reporting of recipient personal funds when the provider is the
 representative payee or custodian of personal funds.

5.
 Requirements for obtaining the consent of
 the recipient or lawful representative for the provider to manage recipient's
 personal funds when the provider is not the representative payee.

6.
 Any expenditure must be exclusively for
 the recipient's use or benefit.

(d)
 Funds in excess of what is needed to
 maintain the recipient's personal fund account will be placed in an interest
 bearing account accrued to the recipient's account.

(10)
 Recipients are informed of the need for
 parental or guardian consent for treatment, if appropriate.

(11)
 Each program will provide any
 recipient/lawful_ representative who is asked to participate in a research or
 experimental project full information regarding procedures to be followed
 before consent is sought. The information presented shall follow the General
 Requirements for Informed Consent as cited in the Code of Federal Regulations
 45 CFR
 
46.116
, Department of Health and Human
 Services, National Institute of Health, Office for Protection from Research
 Risks: "Protection of Human Subjects".
(a)

 Each program obtains the written, informed consent of the recipient/lawful
 representative for participation in research or experimental
 procedures.

(b)
 The
 recipient/lawful representative may withdraw or withhold consent at any
 time.

(c)
 The recipient's/lawful
 representative's withdrawal of consent to participate in an experimental or
 research project will not be used in a coercive or retaliatory manner against
 the recipient.

(12)

 Without regard to competency or legal restrictions all recipients shall receive
 treatment and care in an environment which is safe, humane, and free from
 physical, verbal, or sexual abuse, neglect, exploitation, or mistreatment. 
 
(a)
 Each program actively investigates and
 maintains investigation documentation for any suspected abuse and/or neglect of
 recipients.

(b)
 Acts or alleged
 acts which are applicable under state and local laws are reported for
 investigation and/or disciplinary action.

(c)
 Each program provides each staff upon
 employment or promptly thereafter a written policy statement regarding abuse
 and neglect. The statement is prominently displayed and available in the
 program or facility.

(d)
 Each day
 and residential program employs sufficient numbers of qualified staff in
 accordance with approved program descriptions to protect recipients from abuse
 and neglect.

(e)
 Each program will
 inform the lawful representative of a recipient less than fourteen (14) years
 of age of all special incidents verbally and in writing as documented in the
 recipients file with the time and number called and the letter is sent the next
 business day after the incident.

(13)
 Unless contraindicated for
 individualized therapeutic or security reasons, each program has in place
 procedures affording recipients privacy in receiving visitors, receiving and
 sending communications by sealed mail, direct contact and telephone
 communications with persons both inside and outside the facility or program. 
 
(a)
 Every recipient is allowed visitation and
 opportunity for private conversation with members of his/her family, friends,
 and significant others.

(b)

 Recipients who are deaf or hard of hearing shall have ready access to adaptive
 telecommunication devices in order to make and receive telephone
 calls.

(c)
 Recipients are allowed
 to send and receive mail without hindrance.

(d)
 Recipients are provided adequate
 opportunities for interaction with members of the opposite sex. Specific
 interactions may be prohibited by the rules of the program and/or state and
 local laws.

(e)
 No restrictions are
 imposed by the program which would prohibit the recipient from communicating
 with advocacy officials, the court which ordered confinement, or the
 recipient's legal counsel, family or significant others, or personal physician,
 unless legally restricted.

(14)
 Attorneys and/or court representatives
 are allowed to visit privately and communicate with recipients at reasonable
 times.
(a)
 Every recipient is free to access
 courts, attorneys, and administrative procedures or to participate in those
 activities generally requiring legal representation, without fear or reprisal,
 interference, or coercion unless otherwise restricted by a court
 order.

(15)
 Promptly
 upon admission, each program or facility provides each legally committed
 recipient a concise written statement describing his/her commitment status, the
 requirements of the commitment, and the length of the commitment. 
 
(a)
 Information regarding recipient rights
 complaint and appeal procedures relative to legal commitment is made available
 to recipients in their preferred language and in terms appropriate for them to
 understand.

(16)

 Recipients legally committed to mental health services do not lose any rights
 to be included in the community with appropriate and adequate supports on
 completion of or in conjunction with the terms of commitment except as provided
 in the commitment order.
(a)
 Prior to
 termination of the commitment order, the program develops, with the active
 participation of the recipient, a transition plan which includes referral to
 community support services necessary to ensure the recipient's successful
 transition.

(17)

 Recipients are, without fear of reprisal, able to refuse treatment, except when
 refusals are not permitted under applicable law. Such refusal of treatment
 shall be documented in the recipient's record.

(18)
 Without fear of restraint, coercion,
 interference, discrimination, reprisal, or threat of discharge, recipients and
 others acting on their behalf are free to access available protection and
 advocacy services.

(19)
 Recipients
 are advised whenever special equipment, such as two-way mirrors or cameras, is
 used. A written, informed consent must be signed by the recipient, when used in
 non-emergency situations. Exceptional circumstance may exist when ADMH ODS
 provides services to recipients who are language dysfluent and incapable of
 giving informed consent.

(20)
 Each
 recipient's personal liberty must be respected with services provided in the
 least restrictive environment necessary. Liberty and/or rights must not be
 abridged without notification to recipient and agency compliance with due
 process.

(21)
 Recipients of mental
 health and substance abuse_ services have the same general rights as other
 citizens of Alabama. A provider of such services shall assure that such rights
 are not abridged by the provider's policies, procedure, or practices. These
 rights include but are not limited to the following rights: 
 
(a)
 To exercise rights as a citizen of the
 United States and the State of Alabama.

(b)
 To be served through general services
 available to all citizens.

(c)
 To
 choose to live, work, be educated, and recreate with persons who do not have
 disabilities.

(d)
 To be presumed
 competent until a court of competent jurisdiction, abiding by statutory and
 constitutional provisions, determines otherwise.

(e)
 To vote and otherwise participate in the
 political process.

(f)
 To free
 exercise of religion.

(g)
 To own
 and possess real and personal property. Nothing in this section shall affect
 existing laws pertaining to conveyance of personal property.

(h)
 To make contracts.

(i)
 To obtain a driver's license on the same
 basis as other citizens.

(j)
 To
 social interaction with members of either sex.

(k)
 To marry and divorce.

(l)
 To be paid the value of work
 performed.

(m)
 To exercise rights
 without reprisal.

(22)

 Each program provides recipients in residential programs with safe and humane
 physical and psychological environment(s) in accordance with applicable federal
 and state laws and DMH standards of certification and licensure. Each program
 provides safety precautions to promote the individual welfare of all
 recipients. The environment shall at a minimum provide: 
 
(a)
 Comfortable living and sleeping
 areas.

(b)
 Clean and private
 bathroom facilities.

(c)
 Attractive
 and adequately furnished visiting and living rooms.

(d)
 Clean and comfortable dining
 facilities.

(e)
 Facilities and
 equipment for laundering services.

(f)
 Safe and sturdy furnishings in good
 repair.

(g)
 Adequate provisions for
 smoking and/or non-smoking preference.

(h)
 Adequate and decorative room
 decor.

(i)
 Space and materials for
 leisure time and recreational activities.

(j)
 Each program ensures regular housekeeping
 and maintenance to assure safe and clean conditions throughout the facility or
 program.

(k)
 Unless contraindicated
 for therapeutic or security purposes, recipients are allowed regular access to
 the outdoors.

(23)
 The
 recipient's personal health and hygiene needs are recognized and addressed in a
 safe and humane manner.

(24)
 In
 addition to treatment for mental or substance use disorders, every recipient is
 provided prompt assistance in accessing medical and dental treatment. 
 
(a)
 Recipients are either provided or
 referred to other health and/or dental services as deemed necessary by
 qualified staff.

(b)
 No program
 prohibits a recipient from accessing dental or medical services of his/her
 choice. Such should not be construed to be an obligation for the program to
 provide/pay for such services.

Notes

Ala. Admin. Code
 r. 
580-2-20-.04

Adopted by
 
Alabama
 Administrative Monthly Volume XXXVII, Issue No. 01, October 31,
 2018
, eff. 
11/30/2018
.

Author:
 Division of Mental Health and Substance
 Abuse Services, DMH

Statutory Authority:

Code of Ala.
 1975
, §
 
22-50-11
.

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