OAR Chapter 309 — Oregon Health Authority, Health Systems Division: Behavioral Health Services

Division 1 PROCEDURAL RULES

Or. Admin. R. 309-001-0000 Model Rules of Procedure

The Oregon Health Authority (Authority), Health Systems Division (Division), Addiction Services, chapter 309, shall comply with Authority rules in chapter 943 regarding Model Rules of Procedure, Notices of Rulemaking, adoption of Temporary Rules, and Delegation of Rulemaking Authority.

History

Statutory/Other Authority: ORS 413.042
Statutes/Other Implemented: ORS 413.042
BHS 7-2018, adopt filed 03/21/2018, effective 04/11/2018

Division 8 CERTIFICATION OF BEHAVIORAL HEALTH TREATMENT SERVICES

Or. Admin. R. 309-008-0100 Purpose and Scope

(1) These rules establish procedures for the application, initial certification, certification renewal, review, and other actions on a certificate including revocation, denial, suspension, and placement of conditions for the behavioral health treatment services for the types listed in section (2) of this rule.

(2) These rules apply to providers seeking certification to provide behavioral health treatment services under the following service delivery rules:

(a) OAR 309-014-0000 to 0040 (Community Mental Health Programs);

(b) OAR 309-019-0100 to 0220 (Outpatient Behavioral Health Services);

(c) OAR 309-022-0100 to 0190 (Intensive Treatment Services for Children and Adolescents), but not including Integrated or IPSR (Child and Adolescent Integrated Psychiatric and Substance Use Disorders Residential Treatment Program) licenses;

(d) OAR 309-022-0195 to 0230 (Children's Emergency Safety Intervention Specialist);

(e) OAR 309-033-0200 to 0970 (Involuntary Commitment Proceedings);

(f) OAR 309-039-0500 to 0580 (Standards for the Approval of Providers of Non-Inpatient Mental Health Treatment Services);

(g) OAR 415-020-0000 to 0090 (Standards for Outpatient Opioid Treatment Programs); and

(h) OAR 415-057-0020 to 0150 (Standards for Department of Corrections-Based Alcohol and Other Drugs Treatment Programs).

(3) These rules do not establish procedures for other health care services types or licenses not listed in section (2) of this rule and specifically do not establish procedures for:

(a) Licensing a residential facility under ORS 443.410 or 443.725;

(b) Licensing or certifying an individual behavioral health care practitioner otherwise licensed to render behavioral health care services in accordance with applicable statutes by the applicable licensing board;

(c) Licensing or certifying a behavioral health treatment services provider comprised exclusively of health care practitioners or behavioral health care practitioners otherwise licensed to provide behavioral health care services in accordance with applicable statutes by the applicable licensing board; or

(d) Licensing Integrated or IPSR (Child and Adolescent Integrated Psychiatric and Substance Use Disorders Residential Treatment) programs.

(4) These rules apply to applications, initial certifications, renewals of certification, reviews, and other actions that were pending or initiated on or after July 1, 2016.

History

Statutory/Other Authority: ORS 179.040, ORS 413.042, ORS 413.032-413.033, ORS 426.072, ORS 426.236, ORS 426.500, ORS 430.021, ORS 430.256, ORS 430.357, ORS 430.560, ORS 430.640, ORS 430.870 & ORS 743A.168
Statutes/Other Implemented: ORS 413.520, ORS 426.060, ORS 426.140, ORS 430.010, ORS 430.254, ORS 430.335, ORS 430.590, ORS 430.620 & ORS 430.637
BHS 23-2018, amend filed 12/26/2018, effective 01/09/2019
BHS 15-2018, temporary amend filed 07/17/2018, effective 08/01/2018 through 01/27/2019
BHS 8-2018, amend filed 03/22/2018, effective 04/01/2018
MHS 17-2017, amend filed 12/28/2017, effective 01/01/2018
MHS 15-2017, temporary amend filed 12/01/2017, effective 12/01/2017 through 05/29/2018
MHS 16-2016, f. 11-28-16, cert. ef. 11-30-16
MHS 12-2016(Temp), f. & cert. ef. 7-29-16 thru 12-27-16
MHS 6-2016(Temp), f. 6-28-16, cert. ef. 7-1-16 thru 12-27-16

Or. Admin. R. 309-008-0200 Definitions

(1) “ASAM Criteria” means the most current publication of the American Society of Addiction Medicine criteria; Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions, which is a clinical guide used in matching individuals to appropriate levels of care, and incorporated by reference in these rules.

(2) “Applicant” means any provider with an existing certificate listed in OAR 309-008-0100(2) to provide behavioral health treatment services or any person, organizational provider, tribal organization, or Community Mental Health Program seeking initial certification listed in OAR 309-008-0100(2) by submitting an application to provide behavioral health treatment services.

(3) “Behavioral Health” means mental health, mental illness, addictive health, and addiction and gambling disorders.

(4) “Behavioral Health Treatment Services” means mental health treatment, substance use disorder treatment, and problem gambling treatment services.

(5) “Certificate” means the document issued by the Division that identifies and declares provider certification. A letter accompanying issuance of the certificate shall detail the scope and approved service delivery locations of the certificate.

(6) “Certification Review” means an assessment of a provider or applicant by the Division or by another state agency or contractor on behalf of the Division for the purpose of assessing compliance with these rules with applicable service delivery rules and other applicable regulations.

(7) “Community Mental Health Program” (CMHP) means the organization of various services for individuals with a mental health diagnosis or addictive disorders operated by or contractually affiliated with a local mental health authority and operated in a specific geographic area of the state under an agreement with the Division pursuant to OAR 309-014-0000.

(8) “Condition" means a provision attached to a new or existing certificate that limits or restricts the scope of the certificate or imposes additional requirements on the applicant or provider.

(9) “Coordinated Care Organization” (CCO) means an entity that has been contracted by the Authority to provide coordinated and integrated health services.

(10) “Director” means the Director of the Oregon Health Authority or designee.

(11) “Division” means the Health Systems Division of the Oregon Health Authority or designee.

(12) “Division Staff” means those staff employed by the Division to conduct certification activities under these rules or a contracted entity delegated the authority by the Division to conduct certification activities under these rules.

(13) “Individual” means the person requesting or receiving behavioral health treatment services from a provider certified by the Division.

(14) “Individual Services Records” means documentation, written or electronic, regarding an individual including information relating to entry, assessment, orientation, services and supports planning, services and supports provided, and transfer.

(15) “Initial Certification” means a certificate issued to a new provider.

(16) “Non-Inpatient Provider” means a provider not contractually affiliated with the Division, a CMHP, or other Division contractor, providing behavioral health treatment services under group health insurance coverage that seeks or maintains Division approval under ORS 743A.168.

(17) “Oregon Health Authority” (Authority) means the agency established in ORS Chapter 413 that administers the funds for Titles XIX and XXI of the Social Security Act. It is the single state agency for the administration of the medical assistance program under ORS chapter 414. For purposes of these rules, divisions of the Oregon Health Authority include the Public Health Division and the Health Systems Division.

(18) “Plan of Correction” (POC) means a written plan and attached supporting documentation created by the provider when required by the Division to address findings of noncompliance with these rules or applicable service delivery rules.

(19) “Provider” means an individual, organizational provider as defined in ORS 430.637(1)(b), tribal organization, or CMHP that holds a current certificate listed in OAR 309-008-0100(2) to provide behavioral health treatment services pursuant to these and applicable service delivery rules.

(20) “Program Staff” includes employees of the provider, individuals who provide services by contract with the provider, program administrators, directors, or others who manage the provision of services, and the provider itself when the provider is an individual or group of individuals.

(21) “Program Director” means an individual with appropriate professional qualifications and experience as regulated by the applicable service delivery rules listed on the certificate who is designated to manage the operation of a program.

(22) “Public Funds” means financial support, in part or in full, provided directly or indirectly by a local, state, or federal government.

(23) "Regulatory Standard" means a rule, condition, or requirement describing the following information for products, systems, or practices:

(a) Classification of components;

(b) Specification of materials, performance, or operations; or

(24) “Service Delivery Rules” means the OARs describing the specific regulatory standards for each of the types of behavioral health treatment services the Division certifies.

(25) “Service Delivery Location” means the office, facility, location, or other physical premises where the applicant or provider intends to provide or currently provides behavioral health treatment services.

(26) "Services" means those activities and treatments intended to assist the individual's transition to recovery from a substance use disorder, gambling disorder, or mental health condition, and to promote resiliency and rehabilitative and functional individual and family outcomes.

(27) "Substantial Compliance" means a level of adherence to applicable administrative rules, statutes, and other applicable regulations that even if one or more requirements is not met in the determination of the Division does not:

(a) Constitute a danger to the health, welfare, or safety of any individual or to the public;

(b) Constitute a willful, negligent, or ongoing violation of the rights of any individuals as set forth in administrative rules; or

(c) Constitute impairment to the accomplishment of the Division’s purposes in approving or supporting the applicant or provider.

(28) "Substantial Failure to Comply" means a level of adherence to applicable administrative rules, statutes, contractual requirements, and other applicable regulations that in the determination of the Division:

(a) Constitutes a danger to the health, welfare, or safety of any individual or to the public;

(b) Constitutes a willful, negligent, or ongoing violation of the rights of individuals as set forth in applicable administrative rules; or

(c) Constitutes impairment to the accomplishment of the Division’s purposes in approving or supporting the applicant or provider.

(29) "Treatment" means the planned, medically appropriate, individualized program of medical, psychological, and rehabilitative procedures, and experiences and activities designed to remediate symptoms of a DSM diagnosis.

History

Statutory/Other Authority: ORS 179.040, 179.505, ORS 413.042, 413.032-413.033, 426.072, 426.175, 426.236, 426.500, 430.010, 430.021, 430.256, 430.357, 430.560, 430.640, 430.870, ORS 743A.168 & 743.556
Statutes/Other Implemented: ORS 413.520, 426.060, 426.140, 430.010, 430.254, 430.335, 430.590, 430.620 & 430.637
BHS 11-2018, amend filed 05/10/2018, effective 05/10/2018
MHS 15-2017, temporary amend filed 12/01/2017, effective 12/01/2017 through 05/29/2018
MHS 16-2016, f. 11-28-16, cert. ef. 11-30-16
MHS 6-2016(Temp), f. 6-28-16, cert. ef. 7-1-16 thru 12-27-16

Or. Admin. R. 309-008-0250 Required Certifications for Behavioral Health Treatment Services

(1) A current certificate is required for each provider offering behavioral health treatment services by contract with the Division, by contract with a public body, or by receipt of other public funds except as provided in subsection (4) of this rule. A provider is considered to contract with a public body or receive public funds where:

(a) The provider operates under an intergovernmental agreement, a direct contract with the Division, or a direct contract with one or more CCOs;

(b) The provider receives funds administered by the Division or one or more CCOs;

(c) The provider is a community hospital, regional acute care psychiatric facility, or nonhospital facility providing care, custody, and treatment for a committed person in custody, or a person on diversion pursuant to ORS 426.070 & 426.140; and

(d) The provider is a CMHP operating under 309-014-0000.

(2) A current certificate is required for each provider offering behavioral health treatment services by contract with the Division, by contract with a public body, or by receipt of other public funds.

(3) An applicant or provider not described in subsection (1) or (2) of this rule offering behavioral health treatment services regulated by the service delivery rules listed in 309-008-0100(2), and reimbursable under group health coverage as set forth in ORS 743A.168, may seek certification pursuant to these rules in order to establish reimbursement eligibility.

(4) A certificate under these rules is not required for the following types of providers regardless of whether public funds are received:

(a) An individual behavioral health care practitioner otherwise licensed to render behavioral health care services in accordance with applicable statutes by the applicable licensing board; or

(b) A behavioral health treatment services provider comprised exclusively of health care practitioners or behavioral health care practitioners otherwise licensed to render behavioral health care services in accordance with applicable statutes by the applicable licensing board; independent of payer or funding source.

(5) Certificates are not a substitute for a required license, such as those required in ORS 443.410 and 443.725 for residential facilities.

History

Statutory/Other Authority: ORS 161.390, 161.392, 179.040, 179.505, 413.042, 413.032-413.033, 426.072, 426.140, 426.175, 426.236, 426.500, 430.010, 430.021, 430.256, 430.357, 430.560, 430.640, 430.870 & 743A.168
Statutes/Other Implemented: 413.520, 426.060, 426.140, 430.010, 430.254, 430.335, 430.590, 430.620, 430.637, 743.556, 813.021 & 813.260
MHS 16-2016, f. 11-28-16, cert. ef. 11-30-16
MHS 12-2016(Temp), f. & cert. ef. 7-29-16 thru 12-27-16
MHS 6-2016(Temp), f. 6-28-16, cert. ef. 7-1-16 thru 12-27-16

Or. Admin. R. 309-008-0300 Terms of Certification

(1) Each applicant and provider shall:

(a) Permit Division staff to inspect the service delivery location where the applicant or provider intends to provide or currently provides behavioral health treatment services:

(A) During regular business hours and at any other reasonable hour verify information contained in the application or ensure compliance with all applicable statutes, administrative rules, other applicable regulations, or contractual obligations; and

(B) Allow immediate entry and inspection, extending to any premises the Division has reason to believe a provider provides behavioral health treatment services.

(b) Permit Division staff to inspect, audit, assess, and collect data or copies from all records maintained by the applicant or provider in relation to the certificate including but not be limited to:

(A) Financial records;

(B) Individual service records;

(C) Records related to the supply, storage, disbursement, and administration of prescribed and over-the-counter medications;

(D) Records of utilization and quality assurance reviews conducted by the applicant, provider, or other accredited entity;

(E) Employee records including but not limited to:

(i) Academic degrees;

(ii) Professional licenses;

(iii) Supervision notes, disciplinary actions, and logs;

(iv) Criminal background checks;

(v) All documentation required by applicable service delivery rules, statute, other applicable regulations, and administrative rules;

(vi) Additional documentation deemed necessary by the Division to determine compliance with this or any other applicable administrative rules, statutes, or other applicable regulations.

(c) Assure the provider is certified to provide only those services that are specified in the scope of services and conditions listed on the certificate;

(d) Post the certificate or a legible copy and any accompanying letter noting approved service delivery locations or applicable conditions in a public space of each approved service delivery location to be available for inspection at all times;

(e) Ascertain the certificate does not create an express or implied contract in the absence of a fully executed written contract; and

(f) Ensure that the certificate is not transferable to any other individual, provider, or service delivery location without Division approval.

(2) The Division may not discriminate in its review procedures or services on the basis of race, color, national origin, age, or disability. The Division may issue certificates to specialized programs to assure maximum benefit for special populations, in which case the Division may identify that special population in the certificates and impose applicable program criteria under the applicable service delivery rules.

(3) A certificate is void immediately:

(a) Upon voluntary closure by a provider;

(b) Upon change in the provider’s majority or controlling ownership; or

(c) Upon the listed expiration date of the certificate if the provider fails to timely submit a complete application for certification renewal pursuant to these rules.

(4) Discontinuation of services:

(a) A provider discontinuing services voluntarily must:

(A) Notify the Division at least 60 days prior to the date of voluntary closure and provide a written plan to comply with record retention standards set out in OAR 309-014-0035(4) and 42 CFR Part 2, “Federal Confidentiality Regulations” as applicable;

(B) Make reasonable and timely efforts to obtain alternative treatment placement or other services for individuals currently being served; and

(C) Make reasonable and timely efforts to contact individuals on waitlists and refer them to other treatment services; and

(b) A provider discontinuing services must provide individuals with a minimum 30-day written notice regarding discontinuation of services. In circumstances where undue delay might jeopardize the health, safety, or welfare of individuals or the public, including where the Division has revoked or immediately suspended the certificate pursuant to OAR 309-008-1100, the provider must notify individuals regarding the discontinuation of services as soon as possible.

History

Statutory/Other Authority: ORS 179.040, 179.505, ORS 413.042, 413.032-413.033, 426.072, 426.175, 426.236, 426.500, 430.010, 430.021, 430.256, 430.357, 430.560, 430.640, 430.870, ORS 743A.168 & 743.556
Statutes/Other Implemented: ORS 413.520, 426.060, 426.140, 430.010, 430.254, 430.335, 430.590, 430.620 & 430.637
BHS 11-2018, amend filed 05/10/2018, effective 05/10/2018
MHS 15-2017, temporary amend filed 12/01/2017, effective 12/01/2017 through 05/29/2018
MHS 16-2016, f. 11-28-16, cert. ef. 11-30-16
MHS 6-2016(Temp), f. 6-28-16, cert. ef. 7-1-16 thru 12-27-16

Or. Admin. R. 309-008-0400 The Application Process

(1) An applicant seeking initial certification or certification renewal and an existing provider seeking to expand its certified scope of services, relocate an existing service delivery location, or open new service delivery location must submit a completed application to the Division.

(2) The Division shall furnish an application with instructions and provide appropriate technical assistance to facilitate completion of the application upon:

(a) Request from an applicant seeking initial certification;

(b) Request from an existing provider seeking certification renewal congruent with timelines established by these rules;

(d) Request from an existing provider seeking to change the scope of services approved on the current certificate.

(3) An applicant with multiple service delivery locations must submit documentation with the application sufficient for the Division to evaluate each service delivery location. A separate application for each service delivery location is not required.

(4) The application must be legible and completed on the forms furnished by the Division in the manner specified by the Division. Each application must include:

(a) A detailed plan outlining the implementation of the proposed services congruent with these rules, applicable service delivery rules, other applicable regulations, and OAR and ORS noted herein;

(b) Written attestation by the applicant that all applicable rules of the Division for provision of the proposed services shall be met and maintained in substantial compliance with applicable service delivery rules;

(c) Other documentation required by applicable OAR, ORS, other applicable regulations, local regulations, contract or by judgment of the Division to assess applicant’s compliance; and

(d) Complete and current copies of the following documents:

(A) A description of the applicant’s service delivery locations describing the type and scope of behavioral health treatment services provided or proposed by the applicant at each service delivery location;

(B) Applicant’s policies regarding credentialing practices of individual practitioners;

(D) Applicant’s policies and procedures regarding seclusion and restraint practices; and

(E) Applicant’s Code of Conduct.

(e) Identification of financial interest of any individual including stockholders who have an incident of ownership in the applicant representing an interest of five percent or more. For purposes of these rules, an individual with a five percent or more incident of ownership is presumed to have an effect on the operation of the provider, unless the individual establishes that the individual has no involvement in the operation of the provider;

(f) Background information on all licenses, certifications, and letters of approval held or previously held by the applicant or by any owner disclosed under subsection (e) of this rule to provide care or treatment or engage in a profession or trade. The list shall include every license, certification, and letter of approval regardless of whether it was issued by the Authority or another regulatory body:

(A) The type of license or certification;

(B) The name of the issuing regulatory body;

(D) The start and end date of the period of license or certification;

(E) A list of the dates of any suspensions, revocations, conditions, penalties, denials, nonrenewal, or other adverse actions initiated or taken on a license or certificate, including documentation of the final resolution of those actions;

(F) Disclosure of whether any of the licenses or certificates had expired or were relinquished while a suspension, revocation, condition, penalty, denial, nonrenewal, or other adverse action was pending or proposed; and

(G) Copies of all current licenses or certificates.

(g) Disclosure of any substantiated findings of abuse, neglect, or mistreatment by the applicant, owner, or program staff.

(5) Where applicable, the Division shall maintain copies of the documents listed in section (4)(d) of this rule within the Division’s CCO document bank.

(6) Timeframe for application submission:

(a) An applicant seeking initial certification under these rules must submit a completed application at least six months in advance of the applicant’s desired date of certification;

(b) An applicant seeking to renew its certificate must:

(A) Request an application from the Division; and

(B) Submit a complete application at least six months prior to the expiration of the existing certificate.

History

Statutory/Other Authority: ORS 179.040, 179.505, ORS 413.042, 413.032-413.033, 426.072, 426.175, 426.236, 426.500, 430.010, 430.021, 430.256, 430.357, 430.560, 430.640, 430.870, ORS 743A.168 & 743.556
Statutes/Other Implemented: ORS 413.520, 426.060, 426.140, 430.010, 430.254, 430.335, 430.590, 430.620 & 430.637
BHS 11-2018, amend filed 05/10/2018, effective 05/10/2018
MHS 15-2017, temporary amend filed 12/01/2017, effective 12/01/2017 through 05/29/2018
MHS 16-2016, f. 11-28-16, cert. ef. 11-30-16
MHS 6-2016(Temp), f. 6-28-16, cert. ef. 7-1-16 thru 12-27-16

Or. Admin. R. 309-008-0500 Response to Application

(1) Within 60 days upon receipt of application materials, the Division shall conduct a comprehensive audit of the application materials to determine compliance with these rules:

(a) If the application is found to be complete and the materials demonstrate compliance with applicable administrative rules, the Division may contact the applicant to schedule a certification review;

(b) If the application is not complete or does not demonstrate compliance, the Division shall provide written notice of the incomplete or noncompliant application describing any necessary amendment to the application. The applicant must submit an amended application to the Division within 14 calendar days of receipt of the Division’s notice.

(2) The Division shall issue a written notice of intent to deny completed applications in accordance with ORS 183.

(3) An application for certification may be denied when:

(a) The applicant’s proposed behavioral health treatment services are not subject to the service delivery rules listed in OAR 309-008-0100(2) and, therefore, are not subject to certification under these rules;

(b) The applicant fails to demonstrate the ability to sustain substantial compliance with applicable statutes, administrative rules, or other applicable regulations;

(d) The applicant submits an application within 180 days of a prior application denial or certificate revocation under these rules by the Division.

(4) The Division may issue a notice of intent to deny a completed application when:

(a) The applicant has previously had any certification or license suspended or revoked by the Division, the Authority, the Department of Human Services, or any other similar state agency outside of Oregon;

(b) The applicant employs or contracts with any program staff for whom there is substantiated evidence of abuse, neglect, or mistreatment;

(d) The applicant submits false or inaccurate information to the Division.

(5) An applicant may withdraw an initial or renewal application at any time prior to the Division acting on the application unless the Division has determined that the applicant submitted false or misleading information in which case the Division may refuse to accept the withdrawal and may issue a notice of proposed denial in accordance with this rule.

History

Statutory/Other Authority: ORS 179.040, 179.505, ORS 413.042, 413.032-413.033, 426.072, 426.175, 426.236, 426.500, 430.010, 430.021, 430.256, 430.357, 430.560, 430.640, 430.870, ORS 743A.168 & 743.556
Statutes/Other Implemented: ORS 413.520, 426.060, 426.140, 430.010, 430.254, 430.335, 430.590, 430.620 & 430.637
BHS 11-2018, amend filed 05/10/2018, effective 05/10/2018
MHS 15-2017, temporary amend filed 12/01/2017, effective 12/01/2017 through 05/29/2018
MHS 16-2016, f. 11-28-16, cert. ef. 11-30-16
MHS 6-2016(Temp), f. 6-28-16, cert. ef. 7-1-16 thru 12-27-16

Or. Admin. R. 309-008-0600 Appealing Denial of Application for Certification

(1) When the Division has denied an application, the Division shall notify the applicant within 30 days of the denial determination in writing and provide the applicant the opportunity to request a hearing under ORS Chapter 183.411 to 500. Any request for a contested case hearing must be submitted in writing to the Division by the applicant according to the deadline set out in the notice of denial.

(2) When the Division has issued a notice of intent to deny an application under these rules in addition to or in lieu of a hearing under ORS Chapter 183, an applicant may request in writing an informal conference with the Division as set forth in OAR 309-008-1200.

History

Statutory/Other Authority: ORS 179.040, 179.505, ORS 413.042, 413.032-413.033, 426.072, 426.175, 426.236, 426.500, 430.010, 430.021, 430.256, 430.357, 430.560, 430.640, 430.870, ORS 743A.168 & 743.556
Statutes/Other Implemented: ORS 413.520, 426.060, 426.140, 430.010, 430.254, 430.335, 430.590, 430.620 & 430.637
BHS 11-2018, amend filed 05/10/2018, effective 05/10/2018
MHS 15-2017, temporary amend filed 12/01/2017, effective 12/01/2017 through 05/29/2018
MHS 16-2016, f. 11-28-16, cert. ef. 11-30-16
MHS 6-2016(Temp), f. 6-28-16, cert. ef. 7-1-16 thru 12-27-16

Or. Admin. R. 309-008-0700 Types of Reviews

(1) The Division may conduct the following types of certification reviews:

(a) After receipt of a complete application, the Division shall complete a comprehensive audit of the required application documentation and the service delivery locations. The Division may not issue an initial certification without a completed Initial Certification Review;

(b) After receipt of a complete application, the Division shall complete a comprehensive audit of the required application documentation and the service delivery locations. For continued certification, Certification Renewal Reviews must occur prior to the expiration of the existing certificate and at least once every three years;

(c) The Division may conduct Discretionary Certification Reviews with reasonable notice to ensure compliance with applicable statute, administrative rules, other applicable regulations, and contractual obligations. Discretionary Certification Reviews may be conducted by the Division with or without notice for the following reasons:

(A) The Division has reasonable concern the provider may act to alter records or make them unavailable for inspections;

(B) The Division received a complaint or information that suggests or alleges conditions or practices that could threaten the health, safety, rights, or welfare of individuals; or

(C) The Division has reason to believe a certification review is necessary to ensure a provider is in substantial compliance with these rules, service delivery rules, other applicable administrative rules, contractual obligations, or with conditions placed upon the certificate.

(2) If the Division is not permitted access to records or service delivery locations for the purpose of conducting a certification review, the Division may take action on the certificate up to and including the application of conditions, suspension, or revocation.

(3) A provider or applicant must permit state or local fire inspectors and state or local health inspectors to enter and inspect the service delivery locations as required by administrative rule, state fire code, or local regulations.

(4) At the sole discretion of the Division, the Division may complete a certification review partially or fully via a desk review process. A desk review process is when the Division conducts a certification review based on the provider or applicant’s submission of required documentation and telephonic interviews when the Division does not physically visit the service delivery locations:

(a) The Division shall furnish a list of documentation necessary to complete the desk review to the applicant or provider;

(b) The applicant or provider must submit all requested documents to the Division in compliance with state and federal privacy and data transmission regulations;

(c) The Division may elect to schedule telephone interviews deemed necessary to fulfill the objectives of a certification review; and

(d) Upon completion of the desk review, the Division shall securely dispose of documentation containing protected health information submitted by the applicant or provider.

History

Statutory/Other Authority: ORS 179.040, 179.505, ORS 413.042, 413.032-413.033, 426.072, 426.175, 426.236, 426.500, 430.010, 430.021, 430.256, 430.357, 430.560, 430.640, 430.870, ORS 743A.168 & 743.556
Statutes/Other Implemented: ORS 413.520, 426.060, 426.140, 430.010, 430.254, 430.335, 430.590, 430.620 & 430.637
BHS 11-2018, amend filed 05/10/2018, effective 05/10/2018
MHS 15-2017, temporary amend filed 12/01/2017, effective 12/01/2017 through 05/29/2018
MHS 16-2016, f. 11-28-16, cert. ef. 11-30-16
MHS 6-2016(Temp), f. 6-28-16, cert. ef. 7-1-16 thru 12-27-16

Or. Admin. R. 309-008-0800 Conduct of Certification Reviews

(1) The Division shall employ review procedures deemed adequate to determine applicant or provider compliance with applicable administrative rules, statutes, other applicable regulations, and as necessary, contractual obligations. These procedures may include but are not limited to:

(a) Entry and inspection of any service delivery location;

(b) Document review; and

(c) Interviews with or a request for completion of a questionnaire by individuals knowledgeable about the provider or applicant. Individuals interviewed may include program staff, managers, governing or advisory board members, allied agencies, individuals, their family members, and significant others.

(2) Program staff must cooperate with the Division during a certification review.

(3) Within 30 days following the completion of each discretionary review, the Division may at its discretion issue a report and require a Plan of Correction (POC) congruent with section (4) of this rule.

(4) Within 30 days following the completion of each initial or renewal certification review, the Division shall issue a report that includes:

(a) A statement of any deficiency including a description of the review findings related to non-compliance with applicable administrative rules, statutes, other applicable regulations, and any required corrective actions where applicable;

(b) Pursuant to a certification review when the Division determines a provider or applicant is not operating in substantial compliance with all applicable statutes, administrative rules, and other regulations, and the POC process is appropriate, the Division may require the provider or applicant to submit a POC. The Division shall provide written notice of the requirement to submit a POC, and the provider or applicant shall prepare and submit a POC according to the following terms:

(A) The provider or applicant shall submit the POC to the Division within 30 days of receiving the statement of deficiency. The Division may issue up to a 90-day extension to the existing certification to allow the provider or applicant to complete the POC process;

(B) The POC shall address each finding of non-compliance and shall include:

(i) The planned action already taken or to be taken to correct each finding of non-compliance;

(ii) The anticipated or requested timeframe for the completion of each corrective action not yet complete at the time of POC submission to the Division;

(iii) A description of and plan for quality assurance activities intended to ensure ongoing compliance; and

(iv) The name of the individual responsible for ensuring the implementation of each corrective action within the POC.

(c) If the Division finds that clarification or supplementation to the POC is required prior to approval, the Division shall contact the provider or applicant to provide notice of requested clarification or supplementation, and the provider or applicant shall submit an amended POC within 14 calendars days of notification;

(d) The provider shall submit a sufficient POC approved by the Division prior to receiving a certificate. Upon the Division’s approval of the POC, the Division shall issue the appropriate certification;

(e) The Division may deny, revoke, not renew, or place conditions on an applicant or provider’s certification if the provider fails to submit an adequate POC within the timeframes established in this rule.

History

Statutory/Other Authority: ORS 179.040, 179.505, ORS 413.042, 413.032-413.033, 426.072, 426.236, 426.500, 430.010, 430.021, 430.256, 430.357, 430.560, 430.640, 430.870 & 743A.168
Statutes/Other Implemented: 413.520, 426.060, 426.140, 430.010, 430.254, 430.335, 430.590, 430.620 & 430.637
BHS 11-2018, amend filed 05/10/2018, effective 05/10/2018
MHS 15-2017, temporary amend filed 12/01/2017, effective 12/01/2017 through 05/29/2018
MHS 4-2017, f. 5-23-17, cert. ef. 6-1-17
MHS 30-2016(Temp), f. 12-30-16, cert. ef. 1-1-17 thru 6-29-17
MHS 16-2016, f. 11-28-16, cert. ef. 11-30-16
MHS 6-2016(Temp), f. 6-28-16, cert. ef. 7-1-16 thru 12-27-16

Or. Admin. R. 309-008-0900 Issuing Certificates

(1) The Division shall issue an approved applicant a certificate to provide behavioral health treatment services. Every certificate shall:

(a) Be signed by the Director;

(b) Apply to all approved service delivery locations listed in the accompanying letter;

(d) List the effective and expiration dates of the certificate;

(e) List any conditions applied to the certificate;

(f) List any variances approved by the Division; and

(g) Be accompanied by a letter from the Division noting:

(A) All service delivery locations approved under the certificate; and

(B) Approved alternative practices related to variances listed on the certificate.

(2) After conduct of the certification review, the Division shall issue initial certificates to new applicants that demonstrate substantial compliance with applicable administrative rules and statutes:

(a) For up to one calendar year from the date of initial certification; and

(b) Initial certifications may be issued with conditions pursuant to this rule.

(3) After conduct of the certification review and the plan of correction process where applicable, the Division shall renew the certificate of an applicant with a current certification that demonstrates substantial compliance with applicable administrative rules or statutes:

(a) For up to three calendar years from the date of renewal; and

(b) Renewal certifications may be issued with conditions pursuant to these rules.

History

Statutory/Other Authority: ORS 161.390, 161.392, 179.040, 179.505, 413.042, 413.032-413.033, 426.072, 426.236, 426.500, 430.010, 430.021, 430.256, 430.357, 430.560, 430.640, 430.870 & 743A.168
Statutes/Other Implemented: ORS 413.520, 426.060, 426.140, 430.010, 430.254, 430.335, 430.590, 430.620, 430.637, 813.021 & 813.260
MHS 4-2017, f. 5-23-17, cert. ef. 6-1-17
MHS 30-2016(Temp), f. 12-30-16, cert. ef. 1-1-17 thru 6-29-17
MHS 16-2016, f. 11-28-16, cert. ef. 11-30-16
MHS 6-2016(Temp), f. 6-28-16, cert. ef. 7-1-16 thru 12-27-16

Or. Admin. R. 309-008-0905 Conditions

(1) The Division may elect at any time and at its discretion to place conditions on a certificate upon a finding that:

(a) The applicant or provider employs or contracts with any program staff for whom there is substantiated evidence of abuse, neglect, or mistreatment;

(b) The applicant or provider employs or contracts with any program staff that fails to meet relevant minimum qualifications described in these rules, service delivery rules, or other applicable law;

(d) The applicant or provider operates such that there is a threat to the health, welfare, or safety of an individual or the public;

(e) The applicant or provider has substantially failed to comply with these rules, service delivery rules, or other applicable law;

(f) The applicant or provider fails to fully implement a POC or adequately maintain a corrective action;

(g) The Division has issued the applicant or provider through two or more consecutive certification reviews substantially similar findings of non-compliance with these rules, service delivery rules, or other applicable administrative rules, statutes, or regulations;

(h) There is a need for increased regulatory oversight of the applicant or provider; or

(i) The applicant or provider fails to comply with any reporting requirements relating to funding certification.

(2) The Division shall consider the sum of the circumstances including but not limited to the following criteria when deciding whether to impose conditions as opposed to denying, suspending, refusing to renew, or revoking a certificate:

(a) The expressed willingness and demonstrated ability of the applicant or provider to gain and maintain compliance with all applicable administrative rules and law;

(b) Submission of a POC prescribing reasonable, sustained, and timely resolution to areas of non-compliance;

(c) The relative availability of alternative providers to address any service needs that would be unmet if the applicant or provider is not issued a certificate with conditions as an alternative to revocation or refusal to award a certificate; or

(d) The applicant or provider’s historical compliance with Division rules, previous conditions placed on certificates, and previous POC’s.

(3) Conditions to the certificate may include:

(a) Requiring corrective actions with associated timeframes for completion necessary for the applicant or provider to correct areas of non-compliance or concerns identified by the Division;

(b) Limiting the total number of individuals enrolled in services or on a waitlist for services;

(d) Limiting the scope and type of services that the applicant or provider may provide;

(e) Other conditions deemed necessary by the Division to ensure the health and safety of individuals and the public; and

(f) Other conditions deemed necessary by the Division for the purpose of ensuring regulatory compliance with this or other applicable administrative rules and law.

(4) The Division may issue a notice of intent to impose conditions as described in section (15) of this rule or may impose conditions on a certificate with notice or without notice as described in sections (4) to (8). In imposing conditions with notice or without notice, a provider or an applicant may request an informal conference:

(a) The Division may issue the conditions with notice by issuing a Notice of Impending Imposition of Certificate Condition (Notice) at least 48 hours prior to issuing an Order Imposing Certificate Condition (Order) to a provider or an applicant. After the Order is issued, the Division shall revise the certificate to indicate the conditions that have been ordered;

(b) The Division may impose the conditions without notice only if the Division determines that there is an imminent threat to individuals such that the Division determines it is not safe or practical to give an applicant or a provider advance notice. The Division may impose the conditions without notice by issuing an Order to a provider or an applicant. After the Order is issued, the Division shall revise the certificate to indicate the conditions that have been ordered.

(5) The Notice may be provided in writing or orally. When the Notice is provided in writing, it shall be sent by certified or registered mail or delivered in person to the applicant or provider. If the Notice is provided orally, it may be provided by telephone or in person to the applicant, provider, or person represented as being in charge of the program. When the Notice is delivered orally, the Division shall subsequently provide written notice to the applicant or provider by registered or certified mail. The Notice shall:

(a) Generally describe the acts or omissions of the applicant or provider and the circumstances that led to the finding that the imposition of a certificate condition is warranted;

(b) Generally describe why the acts or omissions and the circumstances create a situation for which the imposition of a condition is warranted;

(d) Identify a person within the Division whom the applicant or provider may contact and who is authorized to enter the Order or to make recommendations regarding issuance of the Order;

(e) Specify the date and time the Order is scheduled to take effect; and

(f) Offer that the applicant or provider may request an informal conference prior to the issuance of the Order Imposing Certificate Condition, or if the provider has already requested an informal conference, specify the date and time that an informal conference shall be held.

(6) If an informal conference is requested regarding conditions, the conference shall be held at a location designated by the Division. If determined to be appropriate by the Division, the conference may be held by telephone. Following the informal conference, the Division may modify the conditions. The timing of the informal conference is described as follows:

(a) If a Notice is issued, the applicant or provider may request an informal conference to object to the Division’s proposed action before the condition is scheduled to take effect. The request for an informal conference shall be made prior to the date the conditions are intended to be effective. If timely requested, the informal conference shall be held within seven days of the request. The Order Imposing Condition may be issued at any time after the informal conference;

(b) If an Order Imposing Condition is issued without a prior Notice, the applicant or provider may within 48 hours of the issuance of the Order request an informal conference. If timely requested, the informal conference shall be held within two business days of receipt of the request. Following the informal conference, the Division at its discretion may modify the conditions.

(7) When an Order is issued, the Division must serve the Order either personally or by registered or certified mail. The Order must include the following statements:

(a) The authority and jurisdiction under which the condition is being issued;

(b) A reference to the particular sections of the statute and administrative rules involved;

(d) A short and plain statement of the nature of the matters asserted or charged;

(e) The specific terms of the certificate condition;

(f) Right to request a contested case hearing under ORS Chapter 183.411 to 500;

(g) A statement that if a request for hearing is not received by the Division within 21 days of the date of the Order, the applicant or provider shall have waived the right to a hearing under ORS Chapter 183.411 to 500;

(h) Findings of specific acts or omissions of the applicant or provider that are grounds for the condition and the reasons the acts or omissions create a situation for which the imposition of a certificate condition is warranted; and,

(i) A statement that the Division may combine the hearing on the Order with any other proceeding affecting the certificate. The procedures for the combined proceeding must be those applicable to the other proceedings affecting the certificate.

(8) Hearing:

(a) If the Division serves an Order Imposing Condition, the applicant or provider is entitled to a contested case hearing.;

(b) The Division must receive the request for a hearing within 21 days of the date of Order. If a request for hearing is not received by the Division within 21 days of the date of the Order, the applicant or provider shall have waived the right to a hearing;

(c) The applicant or provider may request a contested case hearing regarding the imposition of the conditions in addition to or in lieu of an informal conference. Requesting a contested case hearing may not delay the effective date of the conditions.

(9) When a restriction of enrollment or intake is in effect pursuant to an Order, the Division in its sole discretion may authorize the provider to admit or serve new individuals for whom the Division determines that alternate placement or provider is not feasible.

(10) Conditions may be imposed for the duration of the certificate or limited to some other shorter period of time. If the condition corresponds to the certificate period, the reasons for the condition shall be considered at the time of renewal to determine if the conditions are still appropriate. The effective date and expiration date of the condition shall be indicated on the certificate.

(11) When the applicant or provider determines that the circumstances leading to imposition of the condition no longer exist and that effective systems are in place to ensure that similar deficiencies do not recur, the applicant or provider may make written request to the Division for re-inspection.

(12) Re-inspection:

(a) If the Division finds that the situation for which the condition was imposed has been corrected and finds that systems are in place to ensure that similar deficiencies do not recur, the condition shall be withdrawn, and the Division must revise the certificate accordingly. Following re-inspection, the Division shall notify the facility by telephone of the decision to withdraw the condition. Telephone notification shall be followed by written notification;

(b) If the Division determines after a re-inspection that the situation for which the condition was imposed continues to exist or that there are not sufficient systems in place to prevent similar deficiencies, the certificate condition may not be withdrawn, and the Division is not obligated to re-inspect again for at least 45 days. A decision not to withdraw the Order shall be given to the applicant or provider in writing, and the applicant or provider shall be informed of the right to a contested case hearing. Nothing in this rule is intended to limit the Division’s authority to conduct a certification review at any time.

(13) The Division may deny and refuse to renew or revoke the certificate when the provider or applicant fails to comply timely with the condition.

(14) When the Division orders a condition be placed on a certificate With Notice or Without Notice under the provisions of this rule, the applicant or provider is entitled to request a contested case hearing.

(15) In addition to or instead of imposing conditions With Notice or Without Notice as described in sections (4) to (8) and (14), the Division may issue a notice of intent to impose a condition with the opportunity for a contested case hearing prior to imposing the condition. Notices of intent to impose a condition shall be issued consistent with sections (1)-(3) and (9)-(13).

History

Statutory/Other Authority: ORS 179.040, 179.505, ORS 413.042, 413.032-413.033, 426.072, 426.236, 426.500, 430.010, 430.021, 430.256, 430.357, 430.560, 430.640, 430.870 & 743A.168
Statutes/Other Implemented: ORS 413.520, 426.060, 426.140, 430.010, 430.254, 430.335, 430.590, 430.620 & 430.637
BHS 11-2018, amend filed 05/10/2018, effective 05/10/2018
MHS 15-2017, temporary amend filed 12/01/2017, effective 12/01/2017 through 05/29/2018
MHS 4-2017, f. 5-23-17, cert. ef. 6-1-17
MHS 30-2016(Temp), f. 12-30-16, cert. ef. 1-1-17 thru 6-29-17

Or. Admin. R. 309-008-1000 Modification to Certification

(1) A provider with a current certificate seeking to open new service delivery locations, relocate current service delivery locations, or provide additional types of treatment services under different service delivery rules must submit a written request for Division approval prior to any such changes:

(a) The Division must receive the written request for such changes at least 60 days prior to the desired effective date for any such changes;

(b) The Division shall make reasonable efforts to make final determination for approval or disapproval of changes to the certificate within 45 days of receiving the written request.

(2) A provider with a current certificate seeking to designate a new program director must submit a written request for Division approval prior to making such a designation:

(a) The provider must include copies of relevant qualifications with its written request when designating a new program director;

(b) The Division shall make every reasonable effort to review documents and make a final determination regarding whether the proposed program director meets applicable service delivery rule requirements and qualifications within 30 days of receipt of the provider’s written request. The Division shall provide written notice of its determination;

(A) The provider must make every reasonable effort to expediently designate a new program director and must submit a request for the designation to the Division within 15 calendar days of the new designation and include copies of relevant qualifications of the new program director; and

(B) The Division shall make every reasonable effort to expediently review the provider’s request for the designation and make a final determination whether the proposed program director meets applicable service delivery rule requirements. The Division shall provide written notice of its determination.

History

Statutory/Other Authority: ORS 179.040, 179.505, ORS 413.042, 413.032-413.033, 426.072, 426.175, 426.236, 426.500, 430.010, 430.021, 430.256, 430.357, 430.560, 430.640, 430.870, ORS 743A.168 & 743.556
Statutes/Other Implemented: 413.520, 426.060, 426.140, 430.010, 430.254, 430.335, 430.590, 430.620 & 430.637
BHS 11-2018, amend filed 05/10/2018, effective 05/10/2018
MHS 15-2017, temporary amend filed 12/01/2017, effective 12/01/2017 through 05/29/2018
MHS 16-2016, f. 11-28-16, cert. ef. 11-30-16
MHS 6-2016(Temp), f. 6-28-16, cert. ef. 7-1-16 thru 12-27-16

Or. Admin. R. 309-008-1100 Nonrenewal, Suspension, and Revocation of Certification

(1) Immediate suspension of a certificate may occur if there is a serious danger to the public health and safety during a period of time the Division sets forth specific reasons for its finding. The provider may request a contested case hearing to contest the immediate suspension order. Requests for a hearing must be received by the Division within 90 days from the date the immediate suspension order was served on the provider personally or was mailed by certified or registered mail. If the provider requests a hearing, the hearing shall be held as soon as practicable:

(a) The Division finds there is substantial failure to comply with applicable statutes, administrative rules, service delivery rules, or other applicable regulations;

(b) There is a threat to health or safety of individuals.

(2) The Division may revoke or refuse to renew a certificate of one or more service delivery locations listed on the certificate when the Division determines that there is substantiated evidence of abuse, neglect, or mistreatment or determines that a provider:

(a) Demonstrates substantial failure to comply with these administrative rules or with applicable state or federal law;

(b) There is a threat to the health or safety of individuals;

(d) Has a direct contract with the Division, and the Division terminates its agreement or contract with the provider;

(e) Fails to comply with the requirements of one or more conditions on the certificate;

(f) Fails to submit and or implement a POC sufficient to come into substantial compliance with these and other applicable rules or regulations;

(g) Submits falsified or incorrect information to the Division;

(h) Refuses to allow access to information for the purpose of verifying compliance with applicable statutes, administrative rules, or other applicable regulations within a specified date or fails to submit such information following the date specified for such a submission in the written notification;

(i) Fails to maintain sufficient staffing or fails to comply with staff qualification requirements;

(j) The provider fails to demonstrate the ability to meet and sustain compliance with all applicable statutes, rules, and regulations.

(3) When the Division determines the need to revoke or deny renewal of a certificate issued under these rules, a notice of intent to take action on the certificate shall be issued to the provider.

History

Statutory/Other Authority: ORS 430.870, ORS 743A.168, ORS 179.040, 179.505, ORS 413.042, 413.032-413.033, 426.072, 426.236, 426.500, 430.010, 430.021, 430.256, 430.357, 430.560 & 430.640
Statutes/Other Implemented: ORS 413.520, 426.060, 426.140, 430.010, 430.254, 430.335, 430.590, 430.620 & 430.637
BHS 11-2018, amend filed 05/10/2018, effective 05/10/2018
MHS 15-2017, temporary amend filed 12/01/2017, effective 12/01/2017 through 05/29/2018
MHS 4-2017, f. 5-23-17, cert. ef. 6-1-17
MHS 30-2016(Temp), f. 12-30-16, cert. ef. 1-1-17 thru 6-29-17
MHS 16-2016, f. 11-28-16, cert. ef. 11-30-16
MHS 6-2016(Temp), f. 6-28-16, cert. ef. 7-1-16 thru 12-27-16

Or. Admin. R. 309-008-1200 Informal Conference

(1) When the Division issues an Order of Suspension, a notice of intent to revoke, notice of intent to deny an application or notice of refusal to renew the certificate to an applicant or provider pursuant to these rules, the Division shall offer the applicant or provider an opportunity for an informal conference. The applicant or provider shall make its request for an informal conference in writing within 14 calendar days of the issuance of the notice of intent and within 14 calendar days of an Order of Suspension. Upon receipt of a timely written request, the Division shall select a location and time for such a conference.

(2) Following the conference, the Division may:

(a) Withdraw or amend the notice of intent or suspension order; or

(b) Choose not to withdraw the notice of intent or suspension order.

(3) The Division shall provide written notice of its decision under section (2) of this rule within 14 calendar days of the informal conference.

(4) Informal conferences regarding conditions are not described in this rule and instead are described in OAR 309-008-0905.

History

Statutory/Other Authority: ORS 179.040, 179.505, ORS 413.042, 413.032-413.033, 426.072, 426.236, 426.500, 430.010, 430.021, 430.256, 430.357, 430.560, 430.640, 430.870 & ORS 743A.168
Statutes/Other Implemented: ORS 413.520, 426.060, 426.140, 430.010, 430.254, 430.335, 430.590, 430.620 & 430.637
BHS 11-2018, amend filed 05/10/2018, effective 05/10/2018
MHS 15-2017, temporary amend filed 12/01/2017, effective 12/01/2017 through 05/29/2018
MHS 4-2017, f. 5-23-17, cert. ef. 6-1-17
MHS 30-2016(Temp), f. 12-30-16, cert. ef. 1-1-17 thru 6-29-17
MHS 16-2016, f. 11-28-16, cert. ef. 11-30-16
MHS 6-2016(Temp), f. 6-28-16, cert. ef. 7-1-16 thru 12-27-16

Or. Admin. R. 309-008-1300 Hearings

(1) An applicant or provider who issued a notice of intent to revoke, impose conditions, or refuse to renew its certificate under these rules shall be entitled to request a hearing in accordance with ORS Chapter 183.

(2) When the Division orders the imposition of a condition or orders immediate suspension of a certificate under the provisions of this rule, the provider shall be entitled to request a hearing in accordance with ORS Chapter 183.

History

Statutory/Other Authority: ORS 179.040, 179.505, ORS 413.042, 413.032-413.033, 426.072, 426.236, 426.500, 430.010, 430.021, 430.256, 430.357, 430.560, 430.640, 430.870 & 743A.168
Statutes/Other Implemented: ORS 413.520, 426.060, 426.140, 430.010, 430.254, 430.335, 430.590, 430.620 & 430.637
BHS 11-2018, amend filed 05/10/2018, effective 05/10/2018
MHS 15-2017, temporary amend filed 12/01/2017, effective 12/01/2017 through 05/29/2018
MHS 4-2017, f. 5-23-17, cert. ef. 6-1-17
MHS 30-2016(Temp), f. 12-30-16, cert. ef. 1-1-17 thru 6-29-17
MHS 16-2016, f. 11-28-16, cert. ef. 11-30-16
MHS 6-2016(Temp), f. 6-28-16, cert. ef. 7-1-16 thru 12-27-16

Or. Admin. R. 309-008-1400 Information to CCOs and Other Health Plans

(1) Upon completion of the site review process and the issuance of a certificate, the Division will make copies of the following information available to Coordinated Care Organizations and other health plans for the purpose of credentialing a provider:

(a) A current program description that reflects the type and scope of behavioral health treatment services provided by the provider;

(b) Provider policies and procedures regarding the provider’s credentialing practices of individual clinicians;

(d) An attestation from the Division verifying that the provider has passed a screening and meets the minimum requirements to be a Medicaid provider, where applicable;

(e) Reports detailing the findings of the Division’s certification review of the provider;

(f) The provider’s Medicaid Vendor Identification Number issued by the Division, where applicable;

(g) Copies of the provider’s policies and procedures regarding seclusion and restraint practices; and

(h) Copies of the provider’s Code of Conduct.

History

Statutory/Other Authority: ORS 161.390, 161.392, 179.040, 179.505, 413.042, 413.032-413.033, 426.072, 426.175, 426.236, 426.500, 430.010, 430.021, 430.256, 430.357, 430.560, 430.640, 430.870, 743A.168 & 743.556.
Statutes/Other Implemented: 413.520, 426.060, 426.140, 430.010, 430.254, 430.335, 430.590, 430.620, 430.637, 813.021 & 813.260.
MHS 16-2016, f. 11-28-16, cert. ef. 11-30-16
MHS 6-2016(Temp), f. 6-28-16, cert. ef. 7-1-16 thru 12-27-16

Or. Admin. R. 309-008-1500 Complaints

(1) Any individual may file a complaint with the Division concerning a provider holding a certificate under these rules. The Division may require the complainant to exhaust grievance procedures available through the provider and, if applicable, the Medicaid payer, prior to initiating an investigation.

(2) The Division shall only investigate a complaint concerning a provider falling within the Division’s scope and regulatory authority:

(a) The Division shall investigate and respond to a complaint pursuant to Division policies and procedures;

(b) The Division shall refer the complainant to the appropriate entity if the complaint pertains to a provider falling outside the Division’s scope or regulatory authority or otherwise regulated by another state or local entity.

(3) Consequences of a substantiated complaint related to the health, safety or welfare of an individual or the public may result in the suspension, revocation, denial or nonrenewal of an applicant or provider’s application or certificate.

History

Statutory/Other Authority: ORS 179.040, 179.505, ORS 413.042, 413.032-413.033, 426.072, 426.175, 426.236, 426.500, 430.010, 430.021, 430.256, 430.357, 430.560, 430.640, 430.870, ORS 743A.168 & 743.556
Statutes/Other Implemented: ORS 413.520, 426.060, 426.140, 430.010, 430.254, 430.335, 430.590, 430.620 & 430.637
BHS 11-2018, amend filed 05/10/2018, effective 05/10/2018
MHS 15-2017, temporary amend filed 12/01/2017, effective 12/01/2017 through 05/29/2018
MHS 16-2016, f. 11-28-16, cert. ef. 11-30-16
MHS 6-2016(Temp), f. 6-28-16, cert. ef. 7-1-16 thru 12-27-16

Or. Admin. R. 309-008-1600 Variance

(1) An applicant or provider may request a variance to these rules, applicable service delivery rules, or other applicable regulations.

(2) The applicant or provider must submit the variance request directly to the Division along with the application documents submitted to the Division. The variance request must include:

(a) A description and applicable details of the variance requested, including the applicable section of the rule for which the variance is sought;

(b) The rationale and necessity for the requested variance;

(d) The proposed duration of the variance, including a plan and timetable for compliance with the rule exempted or adjusted by the variance.

(3) The Director, whose decision is final, shall approve or deny the variance request and include an expiration date for the variance not to exceed the length of the provider’s current certificate.

(4) A variance granted by the Division becomes part of the certificate. Continuance of the variance will not be automatic and will be reconsidered at the expiration of the variance or when the certification is being considered for renewal, whichever comes first.

(5) Requesting renewal of a variance in advance of current variance expiration is the responsibility of each provider.

(6) Failure by the provider to implement approved alternative practices or otherwise demonstrate noncompliance with an approved variance may result in the Division withdrawing approval for a variance.

(7) Failure by the provider to implement approved alternative practices or otherwise demonstrate noncompliance with an approved variance such that the health or safety of individuals is jeopardized to the degree that cessation of services by the provider is considered necessary to prevent harm to the individual may result in the Division taking action on the certificate pursuant to OAR 309-008-1100.

History

Statutory/Other Authority: ORS 179.040, 179.505, ORS 413.042, 413.032-413.033, 426.072, 426.175, 426.236, 426.500, 430.010, 430.021, 430.256, 430.357, 430.560, 430.640, 430.870, ORS 743A.168 & 743.556
Statutes/Other Implemented: ORS 413.520, 426.060, 426.140, 430.010, 430.254, 430.335, 430.590, 430.620 & 430.637
BHS 11-2018, amend filed 05/10/2018, effective 05/10/2018
MHS 15-2017, temporary amend filed 12/01/2017, effective 12/01/2017 through 05/29/2018
MHS 16-2016, f. 11-28-16, cert. ef. 11-30-16
MHS 6-2016(Temp), f. 6-28-16, cert. ef. 7-1-16 thru 12-27-16

Division 9 CERTIFIED COMMUNITY BEHAVIORAL HEALTH CLINIC (CCBHC) PROGRAM

Or. Admin. R. 309-009-0000 Purpose and Scope

(1) These rules establish the Certified Community Behavioral Health Clinics (CCBHC) and define the criteria and process that the Authority must use to recognize, verify status, and certify provider organizations as CCBHCs. These rules specify the standards for the CCBHC application and certification process.

(2) In addition to meeting all state and federal criteria outlined in Chapter 309 Division 009 and the “Oregon Certified Community Behavioral Health Clinic (CCBHC) Program Requirements Manual - Version 1”, only organizations certified under OAR 309-008-0100 to 309-008-1600 (Standards for Certification of Behavioral Health Treatment Services) for the following certifications may become certified:

(a) Outpatient mental health (Chapter 309 Division 019),

(b) ASAM 0.5 (OAR 309-019-0181),

(d) ASAM 2.1 (OAR 309-019-0183;

(e) If directly providing mobile crisis services, Mobile Crisis Intervention Services and Crisis Stabilization Services (Chapter 309 Division 072).

(3) The “Oregon Certified Community Behavioral Health Clinic (CCBHC) Program Requirements Manual- Version 1” should be used as the primary source outlining CCBHC requirements and duties. Should there be a perceived conflict between rules and manual, CCBHCs and applicants should defer to “Oregon Certified Community Behavioral Health Clinic (CCBHC) Program Requirements Manual - Version 1”.

[ED. NOTE: To view attachments referenced in rule text, click here to view rule.]

History

Statutory/Other Authority: ORS 413.042 & HB 4002 (2024)
Statutes/Other Implemented: ORS 413.042
BHS 22-2025, amend filed 09/30/2025, effective 10/01/2025
OHP 10-2018, renumbered from 409-062-0000, filed 08/01/2018, effective 08/01/2018
OHP 14-2016, f. & cert. ef. 9-26-16
OHP 7-2016(Temp), f. & cert. ef. 4-22-16 thru 10-18-16

Or. Admin. R. 309-009-0010 Definitions

The following definitions apply to Oregon Administrative Rules (OAR) 309-009-0000 to 309-009-0060:

(1) “Access facility” means an outpatient setting owned and operated by a CCBHC and subject to approval by the Authority that provides low barrier services that facilitate engagement and access to care within the scope of CCBHC. Access facilities offer unscheduled, voluntary services.

(3) “Authority” means the Oregon Health Authority.

(4) “Certification” means the process which the Authority uses to determine if an applicant has met the criteria in OAR chapter 309 division 009 and in the document titled “Oregon Certified Community Behavioral Health Clinic (CCBHC) Program Requirements Manual - Version 1” found on the Oregon CCBHC website.”

(5) “Certified Community Behavioral Health Clinic” means an organizational provider that the Authority has affirmed substantially meets the federal and Oregon CCBHC standards as outlined in “Oregon Certified Community Behavioral Health Clinic (CCBHC) Program Requirements Manual- Version 1” and these rules, OAR chapter 309 division 009.

(6) “Designated Collaborating Organization (DCO)” means an entity that is not under the direct supervision of the CCBHC but is engaged in formal Memorandum of Understanding (MOU) to deliver one or more of the required services.

(7) “Full application” means the formal application provided by the Authority to verify provider organizations meet all of the requirements to be a CCHBC.

(8) “Organizational provider” means an organization that provides mental health treatment or chemical dependency treatment and is not a coordinated care organization.

(9) Oregon CCBHC website” means http://www.oregon.gov/oha/HPA/CSI-BHP/Pages/Community-BH-Clinics.aspx.

(10) “Preliminary application” means a limited review of prerequisites to meet CCBHC certification requirements intended to determine if an organizational provider is ready to apply for CCBHC certification.

(11) “Qualified Satellite facility” means a facility that was established by the CCBHC, operates under the governance and financial control of that CCBHC, and provides the following services: crisis services, except mobile crisis; screening, diagnosis, and risk assessment; service planning; and outpatient mental health and substance use services.

(12) “Service area” means the county in which applicant’s or CCBHC’s main organizational provider site is located.

(13) “Site Improvement Plan (SIP)” means a written plan using the provided template on the CCBHC website addressing deficiencies to CCBHC requirements.

(14) “Verification” means the process that the Authority shall conduct to ensure that an organizational provider has submitted accurate information to the Authority for purposes of CCBHC certification.

History

Statutory/Other Authority: ORS 413.042 & HB 4002 (2024)
Statutes/Other Implemented: ORS 413.042
BHS 22-2025, amend filed 09/30/2025, effective 10/01/2025
OHP 10-2018, renumbered from 409-062-0010, filed 08/01/2018, effective 08/01/2018
OHP 14-2016, f. & cert. ef. 9-26-16
OHP 7-2016(Temp), f. & cert. ef. 4-22-16 thru 10-18-16

Or. Admin. R. 309-009-0020 Program Certified Community Behavioral Health Clinic (CCBHC) Administration

(1) Oregon Health Authority (Authority) must develop and implement a uniform application and process for certifying CCBHCs throughout the state of Oregon.

(2) The Authority must recognize provider organizations as certified CCBHCs upon meeting criteria set forth in Oregon Administrative Rules (OAR) 309-009-0040.

(3) The Authority must administer CCBHC program requirements, including:

(a) Data collection and analysis;

(b) Verification that a provider organization meets the defined CCBHC criteria outlined in OAR 309-009-0040, including requirements outlined in “Oregon Certified Community Behavioral Health Clinic (CCBHC) Program Requirements Manual- Version 1”; and

History

Statutory/Other Authority: ORS 413.042 & HB 4002 (2024)
Statutes/Other Implemented: ORS 413.042
BHS 22-2025, amend filed 09/30/2025, effective 10/01/2025
OHP 10-2018, renumbered from 409-062-0020, filed 08/01/2018, effective 08/01/2018
OHP 14-2016, f. & cert. ef. 9-26-16
OHP 7-2016(Temp), f. & cert. ef. 4-22-16 thru 10-18-16

Or. Admin. R. 309-009-0030 Application and Certification Process

(1) An applicant seeking initial certification, certification renewal, or changes to existing certification must submit a completed Oregon Health Authority (Authority) designated application to the Authority.

(a) Applicants seeking initial certification must attend orientation prior to submitting application.

(b) Applicants seeking certification renewal or changes to existing certification must submit application 90 days prior to the desired effective date and must receive approval via certification prior to the change being implemented. Changes to certification include:

(A) Changing the scope of services provided at any certified CCBHC facility location, including access facilities and qualified satellite facilities;

(B) Changes to Designated Collaborating Organizations (DCO);

(D) Adding or removing a facility location from the current CCBHC certification, including satellite facilities and/or access facilities.

(2) A qualified satellite facility is a facility owned and operated by a CCBHC that does not provide all required CCBHC services but at minimum:

(a) Provides the following CCBHC services:

(A) Crisis services, except mobile crisis;

(B) Screening, diagnosis, and risk assessment;

(D) Outpatient mental health and substance use services;

(b) Ensures individuals receiving services at satellite facilities have access to all CCBHC services not provided at the facility.

(c) The satellite facility location is within the service area of the CCBHC and appropriately certified and/or licensed for the services provided there.

(3) A CCBHC access facility is an outpatient setting owned and operated by a CCBHC and subject to approval by the Authority that provides low barrier services that facilitate engagement and access to care within the scope of CCBHC. Access facilities offer unscheduled, voluntary services and are differentiated from CCBHC satellite facilities which must provide a set of required services. Access facilities must:

(a) Ensure individuals receiving services at the access facility have access to all CCBHC services not provided at the facility; and

(b) Be within the service area of the CCBHC and be appropriately certified and/or licensed for the services provided there.

(4) An applicant with multiple facility locations under the same management must have each facility approved for CCBHC certification. Each facility location is independently considered for CCBHC certification. An applicant must submit documentation with the application sufficient for the Authority to evaluate each facility location. A separate application for each facility location is not required as long as the provider structure, including but not limited to policies and procedures, governs all locations.

(5) For initial certification, applicants must complete the following:

(a) Verification and attendance at a Certified Community Behavioral Health Clinic (CCBHC) orientation hosted by the Authority;

(b) Complete and submit the preliminary application provided by the Authority:

(A) If not already certified in one of the following certifications, the applicant must first submit an application following chapter 309 division 008 rules. CCBHC certification is contingent on approval of the following certifications:

(i) Outpatient mental health (chapter 309 division 019)

(ii) ASAM 0.5 (OAR 309-019-0181)

(iii) ASAM 1 (OAR 309-019-0182)

(iv) ASAM 2.1 (OAR 309-019-0183)

(v) If directly providing mobile crisis services, Mobile Crisis Intervention Services and Crisis Stabilization Services (chapter 309 division 072)

(B) Community needs assessment plan

(i) Draft or finalized Memorandum of Understanding (MOU) with each DCO; and

(ii) Documentation of each DCO’s applicable certifications and Medicaid provider enrollments authorizing the DCO to provide the services outlined in the MOU

(D) Applicants who are not Community Mental Health Programs (CMHP) must submit:

(i) Documentation of outreach to CMHP within service area notifying the CMHP of intent to apply for CCBHC; or

(ii) Draft or finalized written agreement meeting requirements outlined in the “CMHP-CCBHC Written Agreement Guidance” found on the CCBHC website between applicant and CMHP.

(6) The Authority shall review the preliminary application within 30 days of its submission to determine whether it is accurate, complete, and meets the certified requirements.

(a) If the application is found not complete and/or does not demonstrate compliance, the Authority shall provide written notice of the incomplete or noncompliant application describing any necessary amendments to the application. The applicant must submit an amended application to the Authority within 14 calendar days of receipt of the Authority’s notice

(b) If the Authority determines the applicant has met the requirements of these rules, the Authority shall inform the applicant in writing that the preliminary application has been approved as a potential CCBHC, send a full application form to be completed and submitted by the applicant, and send information regarding site visit planning.

(7) Initial applicants and applicants applying for recertification must complete a full application form provided by the Authority:

(a) Complete full application form for all required certifications outlined in OAR 309-009-0000(2)

(A) Applicants that are not a community mental health program (CMHP) must submit a finalized written agreement between the applicant and CMHP, meeting the requirements outlined in the “CMHP-CCBHC Written Agreement Guidance,” found on the CCBHC website.

(i) If the non-CMHP and CMHP are unable to reach a mutual agreement on the coordination of services, either entity is permitted to request a meeting with the Authority;

(ii) For recertification, agreement need only be submitted if changes are made to the agreement since last submission

(B) Community needs assessment and staffing plan

(b) Complete a site visit

(8) The Authority may deny CCBHC certification if an applicant does not meet the requirements of these rules, including the requirements outlined in “Oregon Certified Community Behavioral Health Clinic (CCBHC) Program Requirements Manual- Version 1”. A practice may request that the Authority reconsider the denial of CCBHC certification

(9) An applicant may request that the Authority reconsider the denial of CCBHC certification:

(a) A request for reconsideration must be submitted in writing to the Authority within 30 days of the date of the denial or approval letter and must include a detailed explanation of why the practice believes the Authority’s decision is in error along with any supporting documentation.

(b) The Authority shall inform the practice in writing whether it has reconsidered its decision.

History

Statutory/Other Authority: ORS 413.042 & HB 4002 (2024)
Statutes/Other Implemented: ORS 413.042
BHS 22-2025, amend filed 09/30/2025, effective 10/01/2025
OHP 10-2018, renumbered from 409-062-0030, filed 08/01/2018, effective 08/01/2018
OHP 14-2016, f. & cert. ef. 9-26-16
OHP 7-2016(Temp), f. & cert. ef. 4-22-16 thru 10-18-16

Or. Admin. R. 309-009-0040 Certification Criteria

An applicant seeking Certified Community Behavioral Health Clinic (CCBHC) certification must meet the following criteria:

(1) CCBHCs must conform to at least one of the following criteria for organizational authority:

(a) Is a non-profit organization exempt from tax under Section 501(c)(3) of the United States Internal Revenue Code

(b) Is part of a local government behavioral health authority. An applicant is considered part of a local government behavioral health authority when a locality, county, region, or state maintains authority to oversee behavioral health services at the local level and utilizes the clinic to provide those services;

(c) Is operated under the authority of the Indian Health Service, an Indian tribe, or tribal organization pursuant to a contract, grant, cooperative agreement, or compact with the Indian Health Service pursuant to the Indian Self-Determination Act (25 U.S.C. 450 et seq.); or

(d) Is an urban Indian organization pursuant to a grant or contract with the Indian Health Services, under Title V of the Indian Health Care Improvement Act (25 U.S.C 1601 et seq.)

(2) Meet designation requirements for “Ready to Certify” or “Mostly ready to certify, with assistance” as defined in OAR 309-009-0050,

(3) Meet state criteria stated in the document titled “Oregon CCBHC Program Requirements Manual - Version 1” located on the CCBHC website;

(4) Hold certifications as outlined in Oregon Administrative Rules (OAR) 309-009-0000(2);

(5) Provide directly or through designated collaborating organization, all required services:

(a) 24-hour crisis behavioral health services, including mobile crisis outreach;

(b) Screening, assessment, and diagnosis;

(d) Outpatient mental health and substance use disorder services;

(e) Primary care screening and monitoring;

(f) Targeted case management;

(g) Psychiatric rehabilitation services;

(h) Peer and family support services; and

(i) Intensive, community-based mental health care for members of the armed forces and veterans;

(6) Agree to site visit and follow up activities with the CCBHC site review team.

(7) Applicants that are not a community mental health program (CMHP) must submit a finalized written agreement between the applicant and CMHP, meeting the requirements outlined in the “CMHP-CCBHC Written Agreement Guidance,” found on the CCBHC website. If the non-CMHP and CMHP are unable to reach a mutual agreement on the coordination of services, either entity is permitted to request a meeting with the Authority.

History

Statutory/Other Authority: ORS 413.042 & HB 4002 (2024)
Statutes/Other Implemented: ORS 413.042
BHS 22-2025, amend filed 09/30/2025, effective 10/01/2025
OHP 10-2018, renumbered from 409-062-0040, filed 08/01/2018, effective 08/01/2018
OHP 14-2016, f. & cert. ef. 9-26-16
OHP 7-2016(Temp), f. & cert. ef. 4-22-16 thru 10-18-16

Or. Admin. R. 309-009-0050 Level of Readiness

(1) The Authority must review CCBHC criteria using a level of readiness tool to specify a level of readiness designation as follows:

(a) Ready to certify: Demonstrates substantial conformance to the criteria, current operation has capacity to be maintained and/or improved, demonstrates ongoing quality improvement. May require a Site Improvement Plan (SIP) for only a few criteria.

(b) Mostly ready to certify, with assistance: Demonstrates conformance to many of the standards, has significant areas for improvement but evidence of the organization's capability to improve and commitment to progress. Requires a SIP for multiple criteria to achieve compliance.

(2) Not ready to certify: Does not demonstrate sufficient conformance.

History

Statutory/Other Authority: ORS 413.042 & HB 4002 (2024)
Statutes/Other Implemented: ORS 413.042
BHS 22-2025, amend filed 09/30/2025, effective 10/01/2025
OHP 10-2018, renumbered from 409-062-0050, filed 08/01/2018, effective 08/01/2018
OHP 14-2016, f. & cert. ef. 9-26-16
OHP 7-2016(Temp), f. & cert. ef. 4-22-16 thru 10-18-16

Or. Admin. R. 309-009-0055 Types of Certifications

Based on level of readiness designation, Certified Community Behavioral Health Clinics (CCBHC) will receive the following certification types:

(1) Full certification is given when CCBHC receives level of readiness designation of “ready to certify”. Full certification is effective for 3 years.

(a) Prior to certification, the CCBHC will have 30 calendar days to submit a Site Improvement Plan (SIP) to address areas of deficiency. The SIP must include a plan to achieve compliance which must not to exceed a duration of 3 years.

(A) When access or care to persons served is a serious issue, the CCBHC site may be given a much shorter period to initiate SIPs, and this condition may be established, in writing, as part of the Authority findings

(B) If the Authority identifies an issue that places a person served in imminent risk to health or safety, the Authority may require immediate response based on risk.

(b) The Authority will review the SIP, seek clarifying or additional information from the CCBHC site as needed, and issue a response within 30 calendar days of receipt.

(c) The Authority will take steps to monitor the CCBHC site’s implementation of the SIP as part of performance monitoring, including but not limited to annual check-ins over a 3-year period.

(2) Provisional certification is given when the CCBHC receives a level of readiness designation of “mostly meets, needs support”. Provisional certification is effective for 1 year.

(B) If the Authority identifies an issue that places a person served in imminent risk to health or safety, the Authority may require immediate response based on risk.

(b) The Authority will review the SIP, seek clarifying or additional information from the CCBHC site as needed, and issue a response within 30 calendar days of receipt.

(c) The Authority will take steps to monitor the CCBHC site’s implementation of the SIP as part of performance monitoring, including but not limited to conducting quarterly check-ins over 12 months.

(d) Following 12 months, if the CCBHC site still fails to meet requirements for full certification, provisional certification will continue for an additional six (6) months of monitoring with quarterly check-ins required;

(e) If deficiencies are resolved, and full certification criteria has been met by the CCBHC at the conclusion of the SIP process, the CCBHC is given full certification.

(3) CCBHCs with full certification must submit a recertification application to the Authority in conjunction with their Chapter 309 Division 008 certifications.

(4) The Authority will use the level of readiness tool to review each application and verify CCBHC certification.

History

Statutory/Other Authority: ORS 413.042 & HB 4002 (2024)
Statutes/Other Implemented: ORS 413.042
BHS 22-2025, adopt filed 09/30/2025, effective 10/01/2025

Or. Admin. R. 309-009-0060 Variances

(1) The Authority may grant a variance to a CCBHC applicant or provider if:

(a) There is a lack of resources to meet the criteria required in these rules; or

(b) Implementation of the proposed alternative services, methods, concepts or procedures would result of in improved outcomes for the individual.

(2) CCBHC applicants must submit the variance request directly to the Authority using the approved “Application for Continued Variance” form.

(3) The authority must approve or deny the request for a variance and must notify the provider in writing of the decision to approve or deny the requested variance.

(4) Granting a variance for one request does not set a precedent that must be followed by the Authority when evaluating subsequent requests for variance. Variances are only approved for a specified duration of time as established in the variance approval.

History

Statutory/Other Authority: ORS 413.042 & HB 4002 (2024)
Statutes/Other Implemented: ORS 413.042
BHS 22-2025, amend filed 09/30/2025, effective 10/01/2025
OHP 10-2018, renumbered from 409-062-0060, filed 08/01/2018, effective 08/01/2018
OHP 14-2016, f. & cert. ef. 9-26-16
OHP 7-2016(Temp), f. & cert. ef. 4-22-16 thru 10-18-16

Division 11 ADMINISTRATIVE PRACTICES

Or. Admin. R. 309-011-0024 Purpose and Scope

The purpose of these rules is to implement ORS 430.073, related to the Oregon Health Authority’s Oregon Consumer Advisory Council (OCAC). The scope of these rules is limited strictly to the OCAC, and will clarify OCAC’s purpose, scope, membership, roles, and responsibilities, and those of the Oregon Health Authority.

History

Statutory/Other Authority: ORS 413.042 & 430.073
Statutes/Other Implemented: ORS 430.073
BHS 16-2024, amend filed 06/27/2024, effective 07/01/2024
MHS 25-2016, f. & cert. ef. 12-27-16
MHS 17-2012, f. & cert. ef. 12-28-12

Or. Admin. R. 309-011-0026 Definitions

(1) “Administrative Support” means the tasks provided by the Oregon Health Authority, which are detailed in OAR 309-011-0230(b) below.

(2) “Advise” means to recommend, suggest, or inform.

(3) “OCAC” means the Consumer Advisory Council authorized by ORS 430.073 and comprised of consumers appointed by the Director.

(4) “Consumer” means a person who is receiving, or has received services for a mental health condition, substance use disorder, or problem gambling disorder; or identifies as having lived experience with a mental health condition, substance use disorder, process addictions or problem gambling disorder; or is currently or formerly the parent or caregiver of a similarly qualifying youth (up to age 25).

(5) “Director” means the Director of the Oregon Health Authority.

(6) Director’s Designee means the OHA staff member with delegated authority from the Director as liaison to the OCAC.

(7) “Majority Vote” means a decision agreed upon by the majority of appointed council members.

(8) “Oregon Health Authority Representative” means the individual(s) identified by Oregon Health Authority to provide administrative support to the OCAC.

(9) “Present” in relation to meetings means being physically present, or connected to the meeting process via conference call, tele-conference, audio, or video connection.

(10) “Public Meeting” means those meetings open to the public and governed by ORS 192.610 through 192.690.

History

Statutory/Other Authority: ORS 413.042 & 430.073
Statutes/Other Implemented: ORS 430.073
BHS 16-2024, amend filed 06/27/2024, effective 07/01/2024
MHS 25-2016, f. & cert. ef. 12-27-16
MHS 17-2012, f. & cert. ef. 12-28-12

Or. Admin. R. 309-011-0028 CAC Roles

(1) The role of OCAC is to provide the Oregon Health Authority feedback and recommendations from the independent, consumer and community voices of People with Lived and Living Experience, through recommendations on the provision of Behavioral Health services under the scope of the Oregon Health Authority.

(2) OCAC shall work cooperatively with the Director’s Designee or other designated OHA representatives to provide feedback and recommendations on the provision of Behavioral Health services.

(3) OCAC shall adhere to public meeting laws.

(4) OCAC may develop a vision statement and goals, in alignment with ORS 430.073.

(5) Once per year, OCAC shall, in consultation with the OHA Representative, develop and adopt a work plan for the ensuing twelve months.

(6) OCAC may establish committees to investigate specific areas of interest related to Behavioral Health services.

(7) OCAC shall not establish OHA policies, rules, internal directives, or procedures.

History

Statutory/Other Authority: ORS 413.042 & 430.073
Statutes/Other Implemented: ORS 430.073
BHS 16-2024, amend filed 06/27/2024, effective 07/01/2024
MHS 25-2016, f. & cert. ef. 12-27-16
MHS 17-2012, f. & cert. ef. 12-28-12

Or. Admin. R. 309-011-0031 CAC Responsibilities

(1) OCAC shall have a full council meeting at least once every two months.

(2) A meeting may continue without a quorum participating, but authorities granted to OCAC may not be exercised without a quorum.

(3) Recommendations to Oregon Health Authority shall be provided in writing when OCAC has a recommendation accepted by a majority of the council.

(4) Recommendations to the Oregon Health Authority shall be signed and dated by the chairs or vice-chairs.

(5) OCAC in collaboration with the OHA Representative may determine the procedures related to conducting OCAC business.

(6) OCAC shall provide guidance and mentorship to new members.

(7) OCAC shall adhere to the Oregon Health Authority’s equity statement.

(8) OCAC shall adhere to the Oregon Health Authority’s workplace policies and codes of conduct.

History

Statutory/Other Authority: ORS 413.042 & 430.073
Statutes/Other Implemented: ORS 430.073
BHS 16-2024, amend filed 06/27/2024, effective 07/01/2024
MHS 25-2016, f. & cert. ef. 12-27-16
MHS 17-2012, f. & cert. ef. 12-28-12

Or. Admin. R. 309-011-0032 Memberships: Selection and Terms

(1) Members shall be appointed by the OHA Director or their designee after considering OCAC recommendations and shall be appointed for a three-year term following a written acceptance of the offer.

(2) OCAC shall consist of between 15 and 25 consumers or People with Lived and Living Experience, and selection shall strive to represent:

(a) Members with Lived and Living experience of representing the family voice.

(b) Youth in transition (ages 16 to 25)

(d) A variety of cultures and ethnicities;

(e) Diverse gender identity;

(f) A balance of geographic areas within the state, and

(g) Members with lived and living experience of a variety of behavioral health experiences.

(3) Members may be reappointed for one additional three-year term. An OCAC member may submit an application for review, and OHA may appoint.

(4) No person shall be excluded from serving as a member of OCAC due to affiliation with any organization or institution, or based on race, ethnic origin, religious affiliation, gender, age, disability, or sexual orientation.

(5) Only the Director or their designee may remove a person from OCAC.

(6) Members of OCAC are entitled to compensation and travel expenses as permitted under ORS 292.495 and 430.073(7).

History

Statutory/Other Authority: ORS 413.042 & 430.073
Statutes/Other Implemented: ORS 430.073
BHS 16-2024, amend filed 06/27/2024, effective 07/01/2024
MHS 25-2016, f. & cert. ef. 12-27-16
MHS 17-2012, f. & cert. ef. 12-28-12

Or. Admin. R. 309-011-0034 Chair and Vice-Chair: Election and Duties

(1) The OCAC shall elect, by a majority vote, one of its members as chair and one as vice-chair, to serve for a two year term each, with the possibility of re-election for one additional consecutive term. The role of chair or vice-chair may be shared by two members, acting as co-chairs or co vice-chairs.

(2) The chair shall have the powers and duties necessary for the performance of the office. These duties shall include, but not be limited to the following:

(a) Facilitation of OCAC meetings;

(b) Ensuring that the content of OCAC meetings remains within the boundaries of its scope, purpose and authorities;

(d) Calling special meetings

(e) Signing documents from OCAC as may be required by these rules;

(f) Making membership recommendations, in collaboration with OCAC, the OHA representative, and a 7 person committee of independent consumers and people with lived and living experience in behavioral health services., as defined in ORS 430.073; and

(g) With approval from the OHA Representative, the Chair may represent OCAC by responding to requests for information or participation pertaining to OCAC.

(3) The vice-chair or co-vice-chairs shall be responsible for the chair’s or co-chair’s duties in their absence.

(4) Early termination or resignation of a chair or vice-chair’s position shall be filled by a majority vote, to serve a two-year term.

History

Statutory/Other Authority: ORS 413.042 & 430.073
Statutes/Other Implemented: ORS 430.073
BHS 16-2024, amend filed 06/27/2024, effective 07/01/2024
MHS 25-2016, f. & cert. ef. 12-27-16
MHS 17-2012, f. & cert. ef. 12-28-12

Or. Admin. R. 309-011-0036 OHA Responsibilities

(1) OHA may provide the following to OCAC members:

(2) OHA’s mission, vision, goals, roles and scope of business.

(3) Lobbying restriction information;

(4) Conflict of interest information;

(5) Public meeting law information;

(6) These administrative rules; and

(7) Other administrative rules, OHA policies and procedures, internal management directives, and state and federal laws related to topics OCAC is considering as part of a recommendation to the Director’s Designee.

History

Statutory/Other Authority: ORS 413.042 & 430.073
Statutes/Other Implemented: ORS 430.073
BHS 16-2024, amend filed 06/27/2024, effective 07/01/2024
MHS 25-2016, f. & cert. ef. 12-27-16
MHS 17-2012, f. & cert. ef. 12-28-12

Or. Admin. R. 309-011-0040 Purpose and Statutory Authority

(1) Purpose. These rules describe the organization and responsibilities of the Mental Health Advisory Board.

(2) Statutory Authority. These rules are authorized by ORS 413.042 and carry out the provisions of ORS 430.050.

History

Statutory/Other Authority: ORS 413.042
Statutes/Other Implemented: ORS 430.050
MHD 3-1990, f. 4-26-90, cert. ef. 4-30-90
MHD 6-1982, f. & ef. 3-23-82

Or. Admin. R. 309-011-0045 Definitions

As used in these rules:

(1) “Administrator” means the Assistant Director of the Addictions and Mental Health Division, Oregon Health Authority.

(2) “Consumer” means a person receiving or eligible to receive services under rules of the Division.

(3) “Division” means the Addictions and Mental Health Division of the Oregon Health Authority.

(4) “Mental Health Advisory Board” means a board appointed by the Administrator and approved by the Governor to study the problems of persons with mental illness or developmental disabilities, assist in planning, and make recommendations to the Administrator for the development of policies and procedures with respect to the state mental health services, and developmental disabilities services programs.

(5) “Disabled Person” means any person who:

(a) Has a physical or mental impairment which substantially limits one or more major life activities;

(b) Has a record of such an impairment; or

History

Statutory/Other Authority: ORS 413.042 & 430.050
Statutes/Other Implemented: 430.050
MHD 4-1995, f. 5-31-95, cert. ef. 6-1-95
MHD 3-1990, f. 4-26-90, cert. ef. 4-30-90
MHD 6-1982, f. & ef. 3-23-82

Or. Admin. R. 309-011-0050 Organization

(1) The Mental Health Advisory Board shall be composed of at least 15 but not more than 20 lay and professionally trained individuals.

(2) The Administrator, with the approval of the Governor, shall appoint the board members.

(3) Board members shall provide a balanced representation of program areas and populations served, and shall reflect the diverse ethnic, age and disability characteristics of consumers of services provided in Division programs.

(4) At least two members of the Board shall be disabled persons, one of whom is a consumer of mental health services and one of whom is a consumer of developmental disability services. Two additional members of the Board shall be consumers or family members of consumers.

(5) Members of the board shall serve for terms of four years expiring on the last day of odd numbered years.

(6) Members are entitled to compensation and expenses as provided in ORS 292.495.

(7) The Administrator may remove any member of the board for misconduct, incapacity or neglect of duty. Any member who is absent from three consecutive meetings of the Board may be removed, at the Administrator’s discretion.

(8) The Administrator may make provision for technical and clerical assistance to the Mental Health Advisory Board and for the expense of such assistance.

(9) The board shall meet at least twice each year.

History

Statutory/Other Authority: ORS 413.042 & 430.050
Statutes/Other Implemented: 430.050
MHD 4-1995, f. 5-31-95, cert. ef. 6-1-95
MHD 3-1990, f. 4-26-90, cert. ef. 4-30-90
MHD 6-1982, f. & ef. 3-23-82

Or. Admin. R. 309-011-0055 Responsibilities

(1) The board shall assist the Division in planning and preparation of administrative rules for the assumption of responsibility for psychiatric care in state and community hospitals by community mental health programs, in accordance with ORS 430.630.

(2) The board shall study the problems of mental health services, and developmental disabilities services and make recommendations for the development of policies and procedures with respect to these programs.

(3) The board shall review state laws and legislative concepts relative to state mental health services and developmental disabilities services programs.

(4) The board shall review and consider funding of state mental health services, and developmental disabilities services programs and make recommendations.

(5) The board shall advise the Administrator on the relationship of mental health and developmental disability programs to other state, local and private services and make recommendations for collaborative or joint program developments.

(6) The board shall serve as a consulting body to the Administrator.

(7) The board shall encourage public understanding and acceptance of state mental health services, and developmental disabilities services programs.

History

Statutory/Other Authority: ORS 413.042 & 430.050
Statutes/Other Implemented: 430.050 & 430.630
MHD 3-1990, f. 4-26-90, cert. ef. 4-30-90
MHD 6-1982, f. & ef. 3-23-82

Or. Admin. R. 309-011-0105 Purpose

(1) The purpose of OAR 309-011-0105 to 309-011-0115 is to establish the standards by which the Health Systems Division approves payments to licensed residential programs funded by the Division for adults diagnosed with mental health disorders.

(2) OAR 309-011-0105 to 309-011-0115 facilitate a system of residential services and supports driven by individual needs promoting recovery and wellness.

History

Statutory/Other Authority: ORS 430.210, 413.042 & 443.450
Statutes/Other Implemented: ORS 443.400 - 443.460 & 443.991
BHS 3-2019, minor correction filed 03/06/2019, effective 03/06/2019
BHS 2-2019, amend filed 02/08/2019, effective 02/08/2019
BHS 20-2018, temporary amend filed 08/13/2018, effective 08/13/2018 through 02/08/2019
MHS 9-2010, f. 6-30-10, cert. ef. 7-1-10

Or. Admin. R. 309-011-0110 Definitions

(1) "Adult" means an individual 18 years of age or older, or an emancipated minor, conditioned upon the following:

(a) An individual with Medicaid eligibility who is in need of services specific to children, adolescents, or young adults in transition must be considered a child until age 21.

(b) Adults who are between the ages of 18 and 21 who are considered children must have all rights afforded to Adults as specified in these rules.

(2) “Community Mental Health Program (CMHP)” means an entity that is responsible for planning and delivery of services for individuals with substance use disorders or a mental health diagnosis, operated in a specific geographic area of the state under an Intergovernmental Agreement or direct contract with the Division as defined in OAR 309-019-0105.

(3) "Division" means the Health Systems Division of the Oregon Health Authority or designee.

(4) “Occupied” means a specific individual is actively residing in a designated program living space and is receiving services as defined in OAR 410-172-0730.

(5) “Occupancy Rate” means the calculated minimum rate of occupancy in a residential program’s operating budget that reflects the percentage of occupancy needed to meet expenses.

(6) “Operating Budget” means a Division approved budget utilizing Division prescribed forms for setting rates in Residential Programs.

(7) “Population Designation” means any term used to describe an individual in terms of their legal status or other category to include but not limited to those who are civilly committed, admitted voluntarily, or under the jurisdiction of the Psychiatric Security Review Board (PSRB).

(8) “Provider” means the program administrator, individual, or organizational entity licensed by the Division that operates the program and provides services to individuals.

(9) “Residential Program” means all licensed Secure Residential Treatment Facilities, Residential Treatment Facilities, and Residential Treatment Homes funded by the Health Systems Division or its designee to provide services for Adults diagnosed with a mental health disorder.

(10) "Service Plan" means a comprehensive plan for services and supports provided to or coordinated for an individual and their family that is reflective of the comprehensive plan and the intended outcomes of service.

(11) “Services and Supports” means those services defined as habilitation services and psychosocial rehabilitation services under OAR 410-172-0700(1) (2) and 410-172-0710(1)(2).

(12) "Supervision" means a program staff’s observation and monitoring of an individual or oversight of a program staff by the program administrator applicable to the context.

(13) “Vacancy Rate” means the vacancy percentage calculated in a Residential Program’s operating budget that reflects the vacant days available per month without impact on funding.

(14) “Wellness” means an approach to healthcare that emphasizes good physical and mental health, preventing illness, and prolonging life.

History

Statutory/Other Authority: ORS 413.042 & 443.450
Statutes/Other Implemented: ORS 430.210, 443.400 - 443.460 & 443.991
BHS 4-2019, minor correction filed 03/06/2019, effective 03/06/2019
BHS 2-2019, amend filed 02/08/2019, effective 02/08/2019
BHS 20-2018, temporary amend filed 08/13/2018, effective 08/13/2018 through 02/08/2019
MHS 9-2010, f. 6-30-10, cert. ef. 7-1-10

Or. Admin. R. 309-011-0115 Provider Compensation

(1) Residential Program providers shall be compensated for services as defined in OAR 410-172-0710 to 410-172-0730.

(2) Individuals absent from a residential program on activities under the supervision of the program staff shall be considered as occupying their designated living space.

(3) The Division may make a Reserved Service Capacity Payment (RSCP) due to:

(a) An individual’s admission to an acute care hospital,

(b) An individual’s admission to a respite facility to avoid re-hospitalization or revocation of a conditional release order,

(d) An individual awaiting a court proceeding, a PSRB hearing, or for conditional release.

(e) Facilitating a planned transfer from a hospital, another residential setting, jail; or

(f) Temporary displacement due to unforeseen circumstances.

(4) In order to receive such funding, the provider must:

(a) Notify the Division within 48 hours by submitting an (RSCP) Request form via email to: car.amh@state.or.us. Upon receipt of the form, the Division shall review and respond by email within two business days of receiving the request, or as soon as possible thereafter.

(b) Receive final approval from the Division prior to receiving such payment. RSCP approvals are subject to correction or denial upon secondary review by the Division, if the approval is inconsistent with this rule or Division policy.

(c) For payment request, submit a contract amendment request (CAR) and the approved RSCP request form with the Client Status portion completed at the end of each approval period, as noted on the Division’s initial RSCP request response; and

(d) Use policies, procedures, and forms prescribed by the Division for the notification and request for payment.

(5) All Residential Program living spaces funded by the Division shall be available to any consumer approved by the Division without regard to their population designation or County of Responsibility.

History

Statutory/Other Authority: ORS 413.042 & 443.450
Statutes/Other Implemented: ORS 430.210, 443.400 - 443.460 & 443.991
BHS 5-2019, minor correction filed 03/07/2019, effective 03/07/2019
BHS 2-2019, amend filed 02/08/2019, effective 02/08/2019
BHS 20-2018, temporary amend filed 08/13/2018, effective 08/13/2018 through 02/08/2019
MHS 9-2010, f. 6-30-10, cert. ef. 7-1-10

Or. Admin. R. 309-011-0120 Purpose

These rules prescribe standards to be implemented by the Addictions and Mental Health (AMH) Division in order to establish the Self-Determination Policy as used in ORS 430.071.

History

Statutory/Other Authority: ORS 413.042 & 430.078
Statutes/Other Implemented: ORS 430.078
MHS 17-2012, f. & cert. ef. 12-28-12
MHS 10-2010, f. & cert. ef. 7-22-10

Or. Admin. R. 309-011-0125 Definitions

As used in these rules:

(1) "Director" means the Director of the Addictions and Mental Health (AMH) Division of the Oregon Health Authority (Authority), or his or her designee.

(2) "Consumer” means a person who has received or is receiving mental health or addiction services.

(3) "Consumer Advisory Council" means the council appointed by the Assistant Director to advise the Division on the provision of mental health services.

(4) "Division" means the Addictions and Mental Health (AMH) Division of the Oregon Health Authority.

(5) “Olmstead v. L.C.” means the 1999 Supreme Court decision under which states are required to place persons with disabilities in community settings rather than in institutions when the State’s treatment professionals have determined that community placement is appropriate, the transfer from institutional care to a less restrictive setting is not opposed by the affected individual and the placement can be reasonably accommodated, taking into account the resources of the State and needs of others with disabilities.

(6) As used in ORS 430.075, these terms have the following meanings:

(a) "Task force" means a group or committee, usually composed of experts or specialists, formed for analyzing, investigating, or solving a specific problem or objective;

(b) "Commission" means a group of individuals that meet on a regular basis, and that are officially authorized to perform certain duties or functions;

(c) "Advisory group" means a collection of individuals who bring unique knowledge and skills, and who are appointed to support a particular service or function, or to investigate, report on, or act upon a particular matter; and

(d) "Committee" means a body of persons that are officially delegated or assigned to consider, investigate, act on, or report on a particular service or function.

History

Statutory/Other Authority: ORS 413.042 & 430.078
Statutes/Other Implemented: ORS 430.078
MHS 17-2012, f. & cert. ef. 12-28-12
MHS 10-2010, f. & cert. ef. 7-22-10

Or. Admin. R. 309-011-0130 Policy

The Addictions and Mental Health (AMH) Division shall adopt a policy that supports and promotes self-determination for persons receiving mental health services. The policy shall be designed to remove barriers that:

(1) Segregate persons with disabilities from full participation in the community in the most integrated setting in accordance with the United States Supreme Court decision in Olmstead v. L.C., 527 U.S. 581 (1999); and

(2) Prevent persons with disabilities from enjoying a meaningful life, the benefits of community involvement and citizen rights guaranteed by law.

History

Statutory/Other Authority: ORS 413.042 & 430.078
Statutes/Other Implemented: ORS 430.078
MHS 17-2012, f. & cert. ef. 12-28-12
MHS 10-2010, f. & cert. ef. 7-22-10

Division 12 ADMINISTRATIVE PRACTICE AND PROCEDURE

Or. Admin. R. 309-012-0025 Procedures for Appeals of Reimbursement Orders

(1) Purpose. This rule prescribes procedures for appeals of Reimbursement Orders issued by the Division.

(2) Statutory Authority and Procedure. This rule is authorized by ORS 179.640, 413.042 & 179.040 and carries out the provisions of ORS 179.610 to 179.770.

(3) Definitions. As used in this rule:

(a) “Administrator” means the Administrator of the Addictions and Mental Health Division;

(b) “Authorized Representative” means those parties named in ORS 305.240, or those parties who are determined to have the authority to represent the person;

(d) “Hearing” means the hearing authorized by ORS 179.640 for the purpose of review of Reimbursement Orders and modified Reimbursement Orders issued pursuant to ORS 179.640;

(e) “Hearings Officer” means any person designated by the Administrator to hold hearings on matters coming before the Division. Staff of the Reimbursement Section of the Division may not be designated as hearings officers;

(f) “Informal Conference” means a proceeding held before the appeal hearing to allow the person to obtain a review of the action or proposed action without the necessity of a formal hearing;

(g) “Person” means:

(A) A patient who is receiving or has received treatment or care at a state institution for the mentally ill;

(B) A current or former resident at a state institution for the mentally retarded;

(D) Any other individual or entity having a financial interest in contesting a Reimbursement Order.

(h) “Reimbursement Order” means the order issued to determine the person’s ability to pay pursuant to ORS 179.640;

(i) “Service” means deposit of a Reimbursement Order by U.S. mail, state mail, or deposit with a state institution for hand delivery;

(j) “State Institution” means Dammasch State Hospital in Wilsonville, Oregon State Hospital in Salem, Fairview Training Center in Salem, and Eastern Oregon Hospital and Training Center in Pendleton.

(4) Authorization for Hearing: A hearing before the Administrator or a Hearings Officer shall be granted to a person who appeals to the Administrator in the following instances:

(a) A person may appeal the Division’s determination or redetermination of the person’s ability to pay the state’s charges for institutional care and maintenance. The appeal must be submitted within 60 days of the service of the Reimbursement Order;

(b) The Division, on or about the time of the person’s discharge, shall determine whether or not any of the funds previously paid by the person or on his or her behalf to the State of Oregon to cover his or her cost of care should be reimbursed to the person to satisfy his or her financial needs upon release, or whether any of the previous Reimbursement Orders for the current hospitalization should be modified. This redetermination may be appealed within 60 days of service.

(5) Request for Hearing:

(a) No particular format for a request for a hearing is required, but, to be considered, each request must be in writing and must specify:

(A) The name and address of the person requesting the hearing;

(B) The action being appealed, including:

(i) The year or years involved;

(ii) A reference to any Division correspondence on the subject known to the person;

(iii) Why the action being appealed is claimed to be incorrect;

(iv) The specific relief requested.

(b) The request for a hearing must be signed by the person or his or her authorized representative;

(c) All requests for hearings shall be filed by mailing or delivering the appeal to the Reimbursement Section, Addictions and Mental Health Division, 500 Summer St. NE, E-86, Salem, OR 97301;

(d) If the request for a hearing is considered insufficient in content by the Division, the Division may require the request to be reasonably supplemented with additional information before any further action is taken on the appeal;

(e) Prior to the time of an appeal hearing, if there is no objection by the person, the Hearings Officer may refer the matter in controversy for an informal conference for settlement or simplification of issues.

(6) Authorization for Informal Conference:

(a) A person who has requested an appeal hearing pursuant to section (5) of this rule may request that he or she have an informal conference with a representative from the Reimbursement Section before the formal appeal hearing. Any request for an informal conference may be granted at the discretion of the Division;

(b) Such conferences are informal. A person may represent himself or herself or may choose someone to act as his or her representative. The purpose of the conference is to allow a person to obtain a review of the action or proposed action (without the necessity of a formal appeal hearing), if he or she believes that an action made or proposed by the Division is incorrect;

(c) Payment of the proposed charge for institutional care and maintenance will not jeopardize a conference request or decision.

(7) Request for Informal Conference:

(a) A conference request may be filed either with a hearing request required in section (5) of this rule or subsequent to the hearing request but at least 14 days before the date of a scheduled hearing;

(b) The conference request shall be in writing and must specify:

(A) The name and address of the person requesting the conference;

(B) The reason for the request, including:

(i) In what respect the action or proposed action of the Division is erroneous;

(ii) Reference to any prior Division correspondence on the subject.

(c) If a hearing has been requested, the material submitted as part of the request for a hearing may be used at the informal conference;

(d) The conference request should be addressed to the Reimbursement Section, Addictions and Mental Health Division, 500 Summer St. NE, E-86, Salem, OR 97301.

(8) Conduct of Informal Conference. A conference shall be held at a place designated by the Division. To the extent practical, the conference will be held at a location convenient to the person. The conference shall begin with a statement from the Division. The person requesting the conference shall then state his or her position, the facts as he or she knows them, and his or her questions of persons present to clarify the issues.

(9) Disposition of Informal Conference:

(a) After the conference, the Reimbursement Section will issue a proposed order disposing of the appeal for approval by the Administrator. The written order, approved by the Administrator, will be sent to the person within 14 days of the conference, unless during the conference the Division action is conceded by the person to be correct;

(b) The person’s request for a hearing will be stayed pending the outcome of the conference, at which time the request for a hearing will either be withdrawn by the person should he or she no longer desire to proceed, or the hearing will be rescheduled;

(d) The person may request within 30 days that the decision made at an informal conference be reconsidered by the Administrator. The person should set forth the specific ground or grounds for requesting the reconsideration.

(10) Subpoenas and Depositions:

(a) The Division shall issue subpoenas to any party to a hearing upon request. Witnesses appearing pursuant to subpena, other than parties or employees of the Division, shall receive fees and mileage as prescribed by law for witnesses in a civil action;

(b) Depositions may be taken on petition of any party to a hearing.

(11) Conduct of Appeal Hearing:

(a) To the extent practical, the Division, in designating the location of the hearing, shall designate a place convenient for the person;

(b) The hearing shall be conducted by and shall be under the control of the Hearings Officer;

(d) A verbatim record shall be made of all testimony and rulings. Parties who wish a transcription of the proceedings should make arrangements with the Division. If the Division determines the record is no longer needed, the Division may destroy the record after 180 days following the issuance of a final order, unless within the 180-day period arrangements are made by the person for further retention by the Division;

(e) The hearing shall begin with a statement of the facts and issues involved. The statement shall be given by a person requested to do so by the Hearings Officer;

(f) The Hearings Officer may set reasonable time limits for oral presentation and may exclude or limit testimony that is cumulative, repetitious or immaterial.

(12) Evidentiary Rules:

(a) All evidence of a type commonly relied upon by reasonably prudent persons in conduct of their serious affairs shall be admissible;

(b) The Hearings Officer shall receive all physical and documentary evidence presented by parties where practicable. All offered evidence is subject to the Hearings Officer’s power to exclude or limit cumulative, repetitious or immaterial matter;

(c) Evidence objected to may be received by the Hearings Officer, and rulings on its admissibility or exclusion may be made at the time a final order is issued;

(d) At the time of the hearing, the person will be notified that any exhibit introduced as evidence at the hearing will be destroyed after 180 days following the issuance of a final order, unless within the 180-day period, written request is made by the person presenting the exhibit for the return of the exhibit;

(e) The burden of presenting evidence to support a fact or position in a hearing rests on the proponent of the fact or position.

(13) Disposition of Appeal:

(a) After a hearing has been held, the Hearings Officer shall issue a proposed order, including findings of fact and conclusions of law. If the proposed order is adverse to the person, it shall be served upon the person and an opportunity afforded to the person to file exceptions and present written argument to the Administrator before a final order is issued. A person has a ten-day period in which to file exceptions and/or written argument to a proposed order;

(b) Final orders on a hearing shall be in writing and shall include:

(A) Rulings on admissibility of offered evidence;

(B) Findings of fact — Those matters which are either agreed as fact or which, when disputed, are determined by the Administrator, on substantial evidence, to be a fact over contentions to the contrary;

(C) Conclusions of law — Applications of the controlling law to the facts found and the legal results arising there from;

(D) The action taken by the Division as a result of the findings of fact and conclusions of law; and

(E) Notice of the person’s right to judicial review of the order.

(c) Parties to a hearing and their attorneys shall be mailed a copy of the final order and accompanying findings and conclusions.

(14) Administrative Review of Final Order:

(a) A person may file a petition for administrative review of the final order with the Division within 30 days after the order is served. The petition shall set forth the specific ground or grounds for requesting the review. The petition may be supported by a written argument. Examples of sufficient grounds are:

(A) The Division action is not supported by the written findings, or the written findings are inaccurate; or

(B) Pertinent information was available at the time of the original hearing which, through no fault of the party, was not considered; or

(D) The matters raised on appeal may have an effect on the original decision.

(b) The Division may grant a rehearing petition if sufficient reason therefore is made to appear. The rehearing may be limited by the Division to specific matters. If a rehearing is held, an amended order shall be entered;

(d) If the administrative review has been requested, the Division order is not final until the administrative review is granted or denied.

(15) Time Extensions. Where any provision of this rule specifies a particular time period in which a person must act, for good cause shown, the Hearings Officer may, in his or her discretion, allow a reasonable extension of time if so doing is not inconsistent with ORS 179.640 to 179.650.

(16) Appeal. An appeal from the final order of the Division may be taken as provided by law. Caution: Either ORS 179.650 or 183.482 may be applicable. See League of Women Voters v. Lane County Boundary Commission, 32 Or. App. 53, 573P.2d 1255, rev. denied, 283 Or. 503 (1978).

History

Statutory/Other Authority: ORS 179.770, 413.042 & 430.021
Statutes/Other Implemented: 179.610 – 179.770
MHD 1-1980, f. & ef. 1-14-80
MHD 6-1979(Temp), f. & ef. 9-20-79

Or. Admin. R. 309-012-0030 Purpose and Statutory Authority

(1) Purpose. Individuals admitted to the Division institutions are liable for the full cost of their care, but are required to pay only what they are able to pay. This rule establishes guidelines for determining a person’s ability to pay for the cost of care in a state institution.

(2) Statutory Authority. This rule is made necessary by ORS 179.610, authorized by ORS 413.042 and carries out the provisions of ORS 179.610 to 179.770.

History

Statutory/Other Authority: ORS 179.770 & 413.042
Statutes/Other Implemented: ORS 179.610 – 179.770
MHD 9-1991, f. 12-13-91, cert. ef. 12-16-91
MHD 14-1980, f. & ef. 6-24-80
MHD 5-1980(Temp), f. & ef. 4-18-80

Or. Admin. R. 309-012-0031 Definitions

As used in these rules:

(1) “Ability to Pay” means the ability of a person in a state institution to pay past, current, or ongoing cost of care, as determined by the Division in accordance with these rules.

(2) “Assets” means, excluding income, the total value of an individual’s equity in real and personal property of whatever kind or nature. Assets include, but are not limited to the individual’s stocks, bonds, cash, accounts receivable, moneys due, or any other interests, whether they are self-managed, or held by the individual’s authorized representative, or by any other individual or entity on behalf of the individual. “Assets” held in trust are subject to laws generally applicable to trusts.

(3) “Authorized Representative” means an individual or entity appointed under authority of ORS 125, as guardian or conservator of a person, who has the ability to control the person’s finances, and any other individual or entity holding funds or receiving benefits or income on behalf of any person.

(4) “Benefits from Health Insurance” means payments from insurance programs with the limited purpose of paying for the cost of care provided to an individual by a hospital or other health care provider. Benefits of this type include, but are not limited to payments from:

(a) Private and group health insurance policies;

(b) The Medicare and Medicaid programs;

(5) “Charges” means the amount the Division has determined that the person is required to pay toward the cost of care based on his or her ability to pay.

(6) “Cost of Care” means the person’s full liability for care as determined by the Division using the rates established in accordance with ORS 179.701.

(7) “Dependents” means individuals whom a person has a legal duty to support. “Dependents” may include non-emancipated children and spouse of a person, as well as any other individual for whom a person would be allowed a personal exemption under federal or Oregon personal income tax laws.

(8) “Division” means the Addictions and Mental Health Division of the Oregon Health Authority.

(9) “Fair Market Value” means the cash price a capable and diligent individual could obtain in a reasonable amount of time for an asset after negotiating with those accustomed to buying such property.

(10) “Funds for Personal Support Following Release” means the cash that a person will need following his/her release from a state institution to live in the community in a reasonable manner for a period of time, not normally to exceed six months.

(11) “Income” means all funds received by an individual, or for an individual by his or her authorized representative, from any source, whether earned or unearned, after making applicable deductions for state and federal taxes. “Income” includes benefits from both income protection insurance which replaces the person’s earned income when he or she is unable to work, and governmental retirement or disability insurance, such as Social Security, Veterans, and Railroad Retirement benefits.

(12) “Legal Obligations” means any financial duty imposed by law. “Legal obligations” include, but are not limited to, loan or mortgage contracts for which an individual is responsible, as well as liabilities arising out of other contracts or legal duties to pay money. “Legal obligations” include administratively or judicially ordered child and/or spousal support.

(13) “Moral Obligations” means any payments that an individual feels a moral duty to pay, but for which the individual does not have a legal duty to pay.

(14) “Person” means:

(a) A current or former patient at a state institution for the mentally and emotionally disturbed;

(b) A current or former resident at a state institution for the developmentally disabled.

(15) “Person’s Representative” means:

(a) Any individual who is the person’s authorized representative as defined in section (3) of this rule; and/or

(b) Any other individual who has the person’s written authority to represent the person.

(16) “Personal Expense Allowance” means the cash allowed for the reasonable miscellaneous expenses the person has while he or she is in the state institution, including but not limited to expenses for personal grooming and hygiene items; books, newspapers, or other publications; snacks or refreshments not provided by the state institution; and minor entertainment or excursions.

(17) “Primary Personal Automobile” means the automobile, if the person has more than one, which the person would choose to keep if required to sell all but one. If the person has only one, it is the primary personal automobile.

(18) “Primary Personal Residence” means the home the person owns, or is purchasing, and in which the person lived prior to entering the state institution, and/or in which the person will live after leaving the state institution.

(19) “Special Authorized Expense Allowance” means the cash needed for the reasonable personal expenses of the person which cannot be met by the personal expense allowance, and which the Division determines are necessary.

(20) “State Institution” means Dammasch State Hospital in Wilsonville; Eastern Oregon Psychiatric Center in Pendleton; Eastern Oregon Training Center in Pendleton; Fairview Training Center in Salem; and Oregon State Hospital in Salem.

(21) “Support for Dependents” means the cash necessary to meet the reasonable needs of the dependents, less the amounts the dependents receive from any other sources. Support for dependents excludes administratively or judicially ordered child and/or spousal support.

History

Statutory/Other Authority: ORS 179.770 & 413.042
Statutes/Other Implemented: ORS 179.610 – 179.770
MHD 9-1991, f. 12-13-91, cert. ef. 12-16-91
MHD 14-1980, f. & ef. 6-24-80
MHD 5-1980(Temp), f. & ef. 4-18-80

Or. Admin. R. 309-012-0032 Requirements for Obtaining Financial Information

(1) Information Obtained from the Person and/or the Person’s Representative. The Division shall require the person and/or the person’s representative to submit financial information on forms provided by the Division. Financial information required by the Division shall include, but shall not be limited to the following:

(a) A description of the person’s assets, and their values;

(b) A description of the person’s liabilities, the dates they were incurred, the total amounts owing, and a schedule of actual or planned payment dates and amounts;

(d) The sources of available benefits from health insurance;

(e) A description and the amounts of the person’s expenses;

(f) The names and ages of any dependents, and the sources and amounts of income and assets, other than those of the person, which are available for their support; and

(g) The income, assets, and liabilities of the person’s spouse or other individual who shares the person’s expenses;

(h) Other information the person and/or the person’s representative considers important to the determination of the person’s ability to pay.

(2) Information Obtained from Other Sources. In addition, the Division may obtain financial information regarding the person from other sources the Division considers to be reliable. These sources may include, but are not limited to, the Social Security and Veterans Administrations, Oregon Department of Revenue, and other Oregon Health Authority agencies.

History

Statutory/Other Authority: ORS 179.770 & 413.042
Statutes/Other Implemented: ORS 179.610 – 179.770
MHD 9-1991, f. 12-13-91, cert. ef. 12-16-91
MHD 14-1980, f. & ef. 6-24-80
MHD 5-1980(Temp), f. & ef. 4-18-80

Or. Admin. R. 309-012-0033 Procedures for Determining Ability-to-Pay for Cost of Care

(1) Ability-to-Pay Orders — Based on the financial information received or obtained, the Division will determine the person’s ability to pay. If the person, and/or the person’s authorized representative fails to provide sufficient information to show the person cannot pay the full cost of care, the Division may determine the person has the ability to pay the full cost of care. The determination of the person’s ability to pay shall be set forth in an Ability-to-Pay Order. The four types of Ability-to-Pay orders are Determination of Charges, Modification to Charges, Return of Funds for Personal Support Following Release, and Waiver of Charges. Each Order shall be given one of these titles to identify the type of determination it sets forth, and it shall be based on the factors and criteria described in the following sections.

(2) Limit on Charges — The amount determined by the Division to be the person’s charges shall not exceed the full cost of care for the dates of service covered by the Ability-to-Pay Order, less payments and/or credits from any other sources the Division has received, or reasonably anticipates receiving.

(3) Determination of Charges — An Ability-to-Pay Order which sets forth a determination of the person’s charges for the care received which is made either while the person is in the state institution, or after the person’s release from the state institution. A Determination of Charges may be issued any time during the person’s stay in the state institution. A Determination of Charges will be issued after the person’s release if none was issued during the person’s stay, or if the person’s financial circumstances change to enable the person to pay cost of care which exceeds amounts charged by previous Ability-to-Pay Orders. When issuing a Determination of Charges, the Division will consider the following factors:

(a) Factors relating to the person’s eligibility for and coverage by benefits from health insurance;

(b) Factors relating to the person’s assets:

(A) Except as otherwise provided in this section, charges will be assessed using the person’s equity in all assets whether the asset is controlled by the person, or by the person’s authorized representative. The Division will determine the person’s equity in each asset by deducting from the fair market value of the asset any bona fide encumbrance against the asset;

(B) Charges will be assessed using the person’s equity in a primary personal residence only if:

(i) Information is provided by the treatment staff at the state institution stating the person cannot reasonably be expected to return to the residence to live at any time following discharge from the institution; and

(ii) None of the following individuals is residing in the residence:

(I) The person’s spouse;

(II) The person’s child or children under age 21, or blind or disabled;

(III) The person’s sibling or siblings who own an interest in the residence, and who lived in the residence for at least one year immediately prior to the person’s admission to the state institution;

(IV) The person’s parents or emancipated children who are unable to work to maintain themselves as declared in ORS 109.010.

(D) The value of an asset which has great sentimental value to the person (such as a family heirloom or gift from a loved one) may be disregarded if selling the asset would cause the person great emotional distress. The Division shall confer with the person’s treatment staff to decide whether or not to make this disregard;

(E) When assets are used as the basis for ongoing charges, the Division will estimate the length of time the assets are expected to last. During the final 60 days of that time period, the Division will review the person’s financial circumstances in preparation for modifying the person’s charges.

(A) Charges will be assessed using the total amount of all income received either by the person, or for the person by the person’s authorized representative;

(B) Income received at intervals other than monthly may be prorated for use in a calculation of a monthly charge to the person.

(d) Factors relating to the person’s legal and moral obligations:

(A) For legal obligations other than administratively or judicially ordered child and/or spousal support, the person must have demonstrated an intent to pay the obligation, either by showing a history or regular payments toward the full amount owing, or by providing a plan showing dates and amounts of payments to be made in the future;

(B) The Division shall seek the advice of treatment staff as to whether or not, in the interest of the person’s rehabilitation, welfare, and/or treatment, the person’s need to satisfy declared moral obligations should be given priority over the person’s obligation to pay the cost of care;

(C) Any deduction allowed by the Division for legal or moral obligations must be used to satisfy the current obligation. It may not be accumulated by, or on behalf of the person, or used for purposes other than that for which it was approved.

(e) Factors relating to the person’s obligation to provide financial support for dependents:

(A) Before approving a deduction for financial support for a dependent, the Division shall determine how much money is required to reasonably support the dependent. From that amount, the Division shall subtract any funds available from sources other than the person, such as the dependent’s own income and assets, or any form of governmental aid such as public assistance payable to, or on behalf of the dependent;

(B) Any deduction allowed by the Division for the financial support of dependents must be used to provide current support. It may not be accumulated by, or on behalf of the person, and it may not be used for other purposes.

(f) Factors relating to the person’s personal and special authorized expenses while in the state institution:

(A) The personal expense allowance while the person is in the state institution shall be established by the Division to reflect the Supplemental Security Income Program’s payment limit for institutionalized individuals (The allowance was $30 per month as of July 1, 1988.);

(B) Special authorized expense allowances while the person is in the state institution shall be approved based on the following criteria:

(i) The state institution treatment staff’s advice that satisfying the need will not interfere in any way with the successful treatment or general welfare of the person, and it may enhance the person’s ability to meet the goals of the treatment plan; and

(ii) There are no other resources available to meet the need.

(g) Factors related to the person’s need for funds for personal support following release from the state institution when the Division is issuing any Ability-to-Pay Order after release or when release is scheduled within 30 days:

(A) As necessary, funds for personal support following release will be allowed to pay for the following items:

(i) Rental costs including the monthly rent payment, as well as one time deposits or fees, or mortgage payments related to the purchase of a residence;

(ii) Food for the person and dependents;

(iii) Utilities such as heating fuel, water, electricity, garbage service, basic telephone service, and basic television cable service;

(iv) Transportation and related insurance coverage;

(v) Routine household maintenance and insurance coverage;

(vi) Health and dental care and related insurance coverage for the person and dependents;

(vii) Clothing and entertainment for the person and dependents; and

(viii) Other personal expenses which the person shows to be reasonable and necessary, including payments toward moral obligations and legal obligations (other than mortgage contracts), as described in subsection (d) of this section.

(B) The funds allowed for personal support following release shall be based on what a reasonable and prudent individual would spend for the items given the resources available to the individual;

(C) The amount approved for support of the dependents shall take into consideration all other resources available to meet the dependent’s needs.

(h) Factors relating to the time period during which the Division may assess charges, and the time period during which the person is required to pay assessed charges:

(A) Ability-to-Pay Orders issued after release which establish an ongoing monthly charge based on the person’s ability to pay after release shall not add new charges beyond the 36th month following the month in which the person was released from the state institution;

(B) The person is required to pay beyond the 36 month period, any assessed charges not paid prior to release or during the 36 month period after release.

(4) Modification to Charges — An Ability-to-Pay Order which sets forth a modification to the person’s charges established by a prior Ability-to-Pay Order. A Modification to Charges will be made to reflect either a change in the person’s financial circumstances which affects the person’s ability-to-pay ongoing monthly charges, or the Division’s receipt of benefits from health insurance that were not recognized in a prior Ability-to-Pay Order, which cause established charges to exceed the maximum cost of care chargeable to the person in accordance with section (2) of this rule. When issuing a Modification to Charges, the Division will consider the same factors used for a Determination of Charges as described in section (3) of this rule.

(5) Return of Funds for Personal Support Following Release — An Ability-to-Pay Order which sets forth a determination by the Division regarding the return of funds paid toward the person’s charges to provide the person with adequate funds for personal support following his or her release from the state institution. When issuing a Return of Funds for Personal Support Following Release, the Division will use the following criteria:

(a) A Return of Funds for Personal Support Following Release is subject to the following conditions:

(A) The person or the person’s representative has made payments toward the cost of care provided by the state institution.

NOTE: Returned funds for personal support following release cannot exceed the total amount paid from the person’s own income and assets. Benefits from health insurance are not included in the amounts paid.

If charges are due, but the person or the person’s representative has made no payment, funds for personal support following release will be considered under the provisions for Waiver of Charges;

(B) The person will be discharged from the state institution within the next 30 days, or he/she was discharged from the state institution within the last 60 days;

(C) The person has financial obligations following release from the state institution as described in subsection (3)(g) of this rule which cannot be immediately satisfied with other available resources.

(b) Funds for personal support following release will be provided for a limited amount of time, not normally to exceed six months, during which time the person will be expected to become otherwise supported through employment, public assistance, or other available programs;

(c) Funds for personal support following release for a period of time exceeding six months will be considered only if the Division receives information which shows the person’s circumstances require such consideration.

(6) Waiver of Charges — An Ability-to-Pay Order which sets forth a determination by the Division regarding waiver of collection of part or all of the person’s unpaid charges based upon the best interest of the person or the Division:

(a) A waiver of charges should be granted when the Division, after considering information regarding extraordinary circumstances pertaining either to the person’s financial situation, or the person’s physical, psychological, or sociological well-being, determines:

(A) Charges assessed by prior Ability-to-Pay Orders are unpaid, and a subsequent change in the person’s circumstances shows that collection of all or part of the unpaid charges would be detrimental to the best interests of the person or of the Division;

(B) Charges assessed by prior Ability-to-Pay Orders are unpaid, and the Division either receives a written statement from the person’s treating physician, or accepts, on a case-by-case basis, a non-physician mental health professional’s written statement, which indicates the person’s physical, psychological, and/or sociological condition is interfering with the person’s ability to satisfy the outstanding obligation, and further efforts by the Division to collect the unpaid charges would be harmful to the person; or

(C) Charges have not been assessed by a prior Ability-to-Pay Order extraordinary circumstances as described in paragraph (A) and/or (B) of this subsection are present, and based on those circumstances the charges should not be assessed.

(b) In accordance with ORS 179.640(4), charges may be assessed or reassessed at a later time by a new Determination of Charges Ability-to-Pay Order if the basis for waiver under this section ceases to exist.

History

Statutory/Other Authority: ORS 179.770 & 413.042
Statutes/Other Implemented: ORS 179.610 – 179.770
MHD 9-1991, f. 12-13-91, cert. ef. 12-16-91
MHD 14-1980, f. & ef. 6-24-80
MHD 5-1980(Temp), f. & ef. 4-18-80

Or. Admin. R. 309-012-0034 Delivery of Ability-to-Pay Orders and Factors Relating to Appeals

(1) Delivery to the Person — The original Ability-to-Pay Order shall be delivered to the person, unless the person has an authorized representative.

(2) Delivery to the Authorized Representative — If the person has an authorized representative, the original Ability-to-Pay Order shall be delivered to the authorized representative, and a copy shall be delivered to the person. Any Ability-to-Pay Order delivered to an authorized representative shall include an explanation of the Division’s right to demand payment of the charges assessed by the Order, and the consequences to the authorized representative of failing to comply, as provided by ORS 179.653.

(3) Appeal Rights — The Ability-to-Pay Order shall include an explanation of the person’s right to appeal the determination set forth by the Order.

(4) Successor Authorized Representative — If the person’s authorized representative does not pay or appeal the charges assessed by an Ability-to-Pay Order, and he or she is subsequently replaced by a new authorized representative, the successor authorized representative shall be provided with the opportunity to either pay the assessed charges, or to appeal the determination set forth by the Order. The Division will take the following actions when notified there is a successor authorized representative:

(a) Deliver copies of all Ability-to-Pay Orders not fully paid to the successor authorized representative with a letter which describes the delivery of the Order(s) to the previous authorized representative(s), and any actions taken by the previous representative(s) with regard to the Order(s);

(b) Include with the Order copies, an explanation of the successor authorized representative’s right to appeal the determination(s) set forth by the Ability-to-Pay Order(s).

(5) Resolving Appeals — If the person or the person’s authorized representative appeals a determination set forth by an Ability-to-Pay Order, the Division will attempt to resolve the appeal by issuing a new Ability-to-Pay Order which takes into consideration the information on which the appeal is based. If the appeal cannot be resolved by issuing a new Order, it will be addressed through the contested case appeal process.

History

Statutory/Other Authority: ORS 179.770 & 413.042
Statutes/Other Implemented: ORS 179.610 – 179.770
MHD 9-1991, f. 12-13-91, cert. ef. 12-16-91

Or. Admin. R. 309-012-0035 Enforcement of Recoupment Liens

(1) Purpose. This rule establishes procedures for implementing recoupment liens used in carrying out Reimbursement Orders issued by the Division.

(2) Statutory Authority and Procedure. This rule is authorized by ORS 179.770 and carries out the provisions of ORS 179.653 and 179.655.

(3) Definitions. As used in this rule:

(a) “Cost of Care” means the cost determined by the Division in accordance with ORS 179.701;

(b) “Division” means the Addictions and Mental Health Division of the Oregon Health Authority;

(A) A patient who is receiving or has received treatment or care at a state institution for the mentally ill;

(B) A current or former resident at a state institution for the mentally retarded.

(d) “Person’s Representative” means a conservator, guardian of the person, or estate of the person in a state institution, or an individual who has been appointed by a court in this or another state or by Federal Court to serve as the legal representative of a person in a state institution, and also includes an individual whom a person in a state institution has designated to receive the notice of information involved in the particular transaction;

(e) “Recoupment Lien” means a charge or security or encumbrance upon real or personal property that can be used to satisfy the amount due for the person’s cost of care;

(f) “Reimbursement Order” means the order issued to determine the person’s ability to pay pursuant to ORS 179.640(1) and (2);

(g) “State Institution” means Dammasch State Hospital in Wilsonville, Oregon State Hospital in Salem, Fairview Training Center in Salem, and Eastern Oregon Hospital and Training Center in Pendleton;

(h) “Warrant” means the document issued by the Division directed to the sheriff of any county of the state commanding the sheriff to levy upon and sell the real and personal property which is subject to satisfaction of the recoupment lien.

(4) Enforcement of Lien by Issuance of Warrant. The Division shall enforce its recoupment lien created by ORS 179.653 by issuance of a warrant in the manner stated in 179.655. Any warrant issued by the Division pursuant to 179.655 shall clearly provide that the sheriff or other person executing the warrant shall not levy upon and sell any real or personal property that would be exempt under Oregon law from execution pursuant to a judgment. However, the Division shall not issue a warrant pursuant to 179.655 where:

(a) The amount due to the Division for the cost of care of a person in a state institution is not at least 30 days overdue;

(b) Provision has been made to secure the payment by bond or deposit or otherwise in conformance with section (5) of this rule;

(c) The person has exercised the right to appeal the Reimbursement Order pursuant to OAR 309-012-0025(6) and that appeal is still pending;

(d) Sixty-one days have not passed since the issuance of the Reimbursement Order;

(e) The person or the person’s representative has not been given at least ten days’ prior written notice that the Division intends to issue such a warrant.

(5) Methods of Securing Satisfaction of Reimbursement Order:

(a) The issuance of a warrant to the sheriff to enforce collection of delinquent money due the Division for the cost of care for a person in a state institution will be stayed either by paying the amount due and accrued interest after it becomes due or by securing payment of that amount by bond or deposit or otherwise;

(b) The bond given by the person must be for an amount not less than the amount due, plus interest for a reasonable period determined by the Division:

(A) The bond must be executed by:

(i) A surety company which is registered with, and under the supervision of, the Insurance Commissioner of the State of Oregon; or

(ii) By two or more individual sureties, each of whom shall be a resident and homeowner or holder of an interest in land within the state and each of whom shall be worth sums specified in the under-taking, exclusive of property exempt from execution and over and above all valid debts and liability.

(B) The Division may allow more than two sureties to justify several amounts less than that expressed in the undertaking, if the whole justification is equivalent to that of two sufficient undertakings.

(c) Any one of the following items, or combination of items acceptable to the Division, equal to the amount due, plus accrued interest thereon, may be deposited with the Division:

(A) A deposit of money;

(B) A certified check or checks on any state or national bank within the State of Oregon payable to the Division;

(D) Any other security satisfactory to the Division.

(d) The Division may require additional security whenever, in its opinion, the value of the security pledged is no longer sufficient to adequately secure the payment of the amount due, plus accrued interest thereon.

(6) Release of Tax Lien and Clouds on Title. Any request made to the Division for the release of a warrant, where such warrant is not in fact a lien on title to the real property in question but merely a cloud on the title to such real estate, shall be accompanied by a statement. This statement shall show the facts affecting the title to the real property in question that render the Division’s warrant a cloud on the title to such real property and the reasons the warrant does not actually constitute a lien thereon:

(a) This type of request for release of a warrant should be accompanied by a current title report;

(b) The Division may require other documentary proof showing the present condition of the title to the property in question.

History

Statutory/Other Authority: ORS 179.770 & 413.042
Statutes/Other Implemented: ORS 179.610 – 179.770
MHD 15-1980, f. & ef. 6-24-80
MHD 8-1980(Temp), f. & ef. 4-18-80

Or. Admin. R. 309-012-0070 Policy

(1) Requests for copies of medical records must be made in writing with proper consent and must be specific to assure that only the essential portions of the medical record are copied and released.

(2) A patient or resident shall not be denied access to the medical record because of inability to pay. The patient may review his or her record in the Medical Record Department at no charge.

(3) A copy of the most recent release summary shall be furnished free of charge to authorized persons or agencies providing follow-up care.

(4) A copy of required portions of medical records may be provided without charge to the following agencies and individuals. When a substantial part or all of a medical record is requested, the Division may charge for copies in accordance with OAR chapter 943-003:

(a) Community mental health programs;

(b) Courts;

(d) Individuals or agencies providing follow-up care for the patient;

(e) Insurance carriers paying for patient's or resident's care; and

(f) Physicians.

(5) All other requests for public records shall be charged in accordance with OAR 943-003.

History

Statutory/Other Authority: ORS 179.770, 413.042 & 431.120
Statutes/Other Implemented: ORS 179.610 – 179.770
MHS 4-2007, f. & cert. ef. 5-25-07
MHD 10-1983, f. & ef. 6-8-83
MHD 2-1983(Temp), f. & ef. 2-18-83

Or. Admin. R. 309-012-0100 Purpose and Statutory Authority

(1) Purpose. These rules establish the amount of earned income the Division excludes when calculating ability-to-pay for cost of care at a mental health institution. The purpose of this earned income exclusion is to reduce the disincentive to work for patients and residents.

(2) Statutory Authority. These rules are authorized by ORS 413.042 and carry out the provisions of ORS 179.770.

History

Statutory/Other Authority: ORS 179.770 & 413.042
Statutes/Other Implemented: ORS 179.610 – 179.770
MHD 11-1985, f. & ef. 6-19-85

Or. Admin. R. 309-012-0105 Definitions

As used in these rules:

(1) “Earned Income” means money received by a patient or resident in a mental health institution in return for services rendered, while receiving care or treatment at the institution.

(2) “Mental Health Institution” means Dammasch State Hospital in Wilsonville, Oregon State Hospital in Salem, Fairview Training Center in Salem, and Eastern Oregon Psychiatric Center and Eastern Oregon Training Center in Pendleton.

History

Statutory/Other Authority: ORS 179.770 & 413.042
Statutes/Other Implemented: ORS 179.610 – 179.770
MHD 11-1985, f. & ef. 6-19-85

Or. Admin. R. 309-012-0110 Earned Income in Calculation of Ability-to-Pay

The Division includes earned income as income in the calculation of ability-to-pay, as described in OAR 309-012-0030.

History

Statutory/Other Authority: ORS 179.770 & 413.042
Statutes/Other Implemented: ORS 179.610 – 179.770
MHD 11-1985, f. & ef. 6-19-85

Or. Admin. R. 309-012-0115 Earned Income Exclusion

The Division allows a patient or resident to retain a portion of any income earned while in a mental health institution. The amount of earned income to be excluded in the calculation of ability-to-pay is determined by subtracting $65 from earned income. An additional $25 will be subtracted from the total income (both earned and unearned) as an allowance for personal need.

History

Statutory/Other Authority: ORS 179.770 & 413.042
Statutes/Other Implemented: ORS 179.610 – 179.770
MHD 11-1985, f. & ef. 6-19-85

Or. Admin. R. 309-012-0235 Termination of Relative Foster Care Funding

(1) This rule is adopted in coordination with the Oregon Health Authority’s (Authority) work with counties to transition participating individuals from relative adult foster care to Medicaid-funded services or other available programs.

(2) Effective December 31, 2017, the Authority shall no longer fund relative adult foster care directly or through Service Element 34A of its contracts with community mental health programs.

(3) Relative adult foster care does not include the services provided in licensed adult foster homes pursuant to OAR chapter 309, division 040.

History

Statutory/Other Authority: ORS 413.042 & ORS 430.640
Statutes/Other Implemented: ORS 413.042 & ORS 430.610-430.651
MHS 16-2017, adopt filed 12/26/2017, effective 12/31/2017
MHS 14-2017, temporary adopt filed 11/21/2017, effective 11/21/2017 through 05/19/2018

Division 13 ACCOUNTING AND BUSINESS PRACTICES

Or. Admin. R. 309-013-0030 Management of Trust Accounts and Patient Funds in State Institutions

(1) Purpose. This rule establishes standards and procedures to be observed by Superintendents and their employees in the management of trust accounts and patient funds in state institutions, as well as make applications on behalf of patients for Social Security or Veterans Administration benefits or be appointed representative payee for a patient’s Social Security or Veterans Administration benefit payments.

(2) Statutory Authority and Procedure. This rule is authorized by ORS and carries out the provisions of ORS 179.510 to 179.530.

(3) Definitions. As used in this rule:

(a) “Agency trust account” means an account established in the name of a patient by the Superintendent of a state institution under ORS 179.510 to retain funds deposited with the Superintendent by or for the named patient;

(b) “Division” means the Addictions and Mental Health Division of the Oregon Health Authority;

(c) “Patient’s Designee” means a person designated by the patient in a state institution in writing to receive duplicate copies of documents sent to the patient relating to the patient’s funds;

(d) “Representative or Indirect Payee Trust Account” means a trust account established in the name of a patient by the Superintendent of a state institution or other staff representative or indirect payee to retain the patient’s Social Security or Veterans benefits paid to the representative payee;

(e) “State Institution” means Dammasch State Hospital in Wilsonville, Oregon State Hospital in Salem, Fairview Training Center in Salem, and Eastern Oregon Hospital and Training Center in Pendleton;

(f) “Superintendent” means the executive head of the state institution as listed in subsection (3)(e) of this rule;

(g) “Treatment Team” means the group whose membership consists of professional and direct care staff.

(4) Admission to State Institution. Upon admission or readmission to a state institution, the patient, a guardian or conservator, and the patient’s designee, if any, shall be provided with written notices containing the following information:

(a) The patient’s obligation under state law to reimburse the state for the actual cost of the patient’s care and maintenance, according to the patient’s ability to pay, whichever is less;

(b) The patient’s option to place money in either an agency trust account or other suitable depository outside the state institution. The agency trust account withdrawal and deposit procedures and the Superintendent’s powers with respect to such accounts shall be explained therein;

(c) In the event the patient requests the state institution to forward funds outside the state institution to other than a bank or secure financial institution and, in the clinical judgment of the Superintendent, the patient is not able to understand the implications of the patient’s request, the Superintendent shall provide notice that the patient’s funds have been placed in an agency trust account; and a proceeding to have a conservator appointed will be commenced within ten days from the date of the notice;

(d) Copies of all relevant state laws and rules regarding handling of patient funds and institutional reimbursement shall be made available to the patient, a guardian or conservator, and the patient’s designee on request;

(e) The patient, a guardian, or a conservator may designate another responsible person to be representative or indirect payee for benefits and/or to receive duplicate copies of all further documents detailing procedures, agency trust account transactions, applications by the Superintendent for patient benefits, or documents otherwise related to the institutional reimbursement process as it affects the patient. A form for designating one other person to receive such documents shall be provided upon request.

(5) Agency Trust Account Transactions. A monthly statement indicating the deposits and withdrawals during the prior month of the agency trust account shall be delivered to the patient, a guardian or conservator, and the patient’s designee, if any.

(6) Representative or Indirect Payee Trust Account Transactions. A monthly statement indicating the deposits and withdrawals during the prior month of the representative or indirect payee trust account shall be delivered to the patient, a guardian or conservator, and the patient’s designee, if any.

(7) Determination of Patient’s Capability to Manage Funds:

(a)(A) If an investigation indicates the patient is incapable of managing his or her funds, the relevant Social Security Administration or Veterans Administration form and recommendation shall be forwarded to the Superintendent’s office. Upon receiving the form, the Superintendent or the Superintendent’s designee shall cause notice of the proposed application to be sent as indicated in section (8) of this rule;

(B) Inquiries may be made of attending doctors and other reliable persons who deal with the patient frequently.

(b) When, after investigation, in the opinion of the Superintendent, a patient is or has become incompetent and/or incapable of making an informed consent or incapable of managing funds, and there is no person legally responsible for the patient (such as a guardian or conservator), the Superintendent may:

(A) Apply to have a representative or indirect payee appointed under section (8) of this rule; and/or

(B) Commence proceedings to establish a guardianship or conservatorship.

(8) Application for Benefits or Notification of Incapacity to Manage Funds:

(a) When, after investigation pursuant to section (7) of this rule, the Superintendent determines that such a step would be in the best interests of the patient, the Superintendent or the Superintendent’s designee may apply for Social Security or Veterans benefits on behalf of a patient. Before each application, the patient, a guardian or conservator, and the patient’s designee, if any, shall be mailed notice of the proposed application. Notice shall include the following:

(A) A statement of the intention to apply for such benefits;

(B) A copy of the proposed application, indicating the reason for the application and the evidence relied upon in determining that an application is warranted;

(C) If the applicant seeks to be selected as representative or indirect payee, a statement that this will mean that the representative of the federal agency concerned will determine whether it is in the best interests of the patient that a payee be appointed;

(D) A statement that the patient, a guardian or conservator, or the patient’s designee, if any, may submit to the Superintendent a written statement including written evidence why the application should not be made. This statement and evidence must be submitted not more than 12 days from the date of the notice; and

(E) A statement that any such written statement submitted on behalf of the patient and received within the time specified shall be considered by the Superintendent or other official in the decision to submit the proposed application.

(b) After such notice has been given, and either:

(A) Twelve days have elapsed without response from the patient, a guardian or conservator, or the patient’s designee, if any; or

(B) The statement or written evidence submitted pursuant to paragraph (8)(a)(D) of this rule has been received, the Superintendent or the Superintendent’s designee shall consider all the evidence submitted and decide whether an application would be in the patient’s best interest. If it is decided that the application should be made, the patient, a guardian or conservator, and the patient’s designee, if any, shall receive copies of the application and any supporting materials thereof.

(c) The response of the Social Security Administration or Veterans Administration to the application shall likewise be forwarded, along with information concerning the rights of patients and other interested persons regarding Social Security or Veterans Administration benefits, to the patient, a guardian or conservator, and the patient’s designee, if any.

(9) Deposit of Social Security Administration and Veterans Administration Checks:

(a) Checks for which the patient is the payee must be deposited directly into the patient’s agency trust account if the patient has elected to have such an account. In the event the patient has elected a suitable depository outside the state institution, arrangements for forwarding the patient’s funds to that depository are the responsibility of the patient, a guardian or conservator, or the patient’s designee, if any. Notification of receipt of the check and the deposit thereof in the agency trust account shall be made in the next monthly statement to the patient, a guardian or conservator, and the patient’s designee, if any. When such Social Security or Veterans funds are deposited in the agency trust account, the funds shall be clearly designated as Social Security Administration or Veterans Administration benefit money;

(b) Social Security or Veterans funds in the agency trust account may be taken to pay the patient’s bill for care and maintenance at the state institution only when the patient (if not judicially or factually incompetent) or the patient’s guardian or conservator has executed a written consent for that particular transaction. “Blanket” or continuing consents will not be honored insofar as they affect Social Security or Veterans benefits;

(c) Checks payable to the Superintendent or the Superintendent’s designee as indirect or representative payee may be deposited directly into the patient’s representative or indirect payee trust account. Notification of receipt of the check and the deposit thereof in the representative or indirect payee trust account shall be made in the next quarterly statement to the patient, a guardian or conservator, and the patient’s designee, if any.

(10) Discharge from State Institution. At or before discharge from a state institution, each patient, a guardian or conservator, and the patient’s designee, if any, shall be provided with a statement containing the following information:

(a) The patient’s continuing obligation under state law to reimburse the state for the actual cost of the patient’s care and maintenance, according to the patient’s ability to pay;

(b) The patient may contest payments made to the State of Oregon for charges for institutional care and maintenance during the period of recent hospitalization;

(c) Copies of the relevant state laws and administrative rules regarding the patient’s post-discharge right to contest payments made to the State of Oregon for charges for institutional care and maintenance will be made available to the patient or other interested party on request;

(d) Copies of monthly statements of transactions concerning the activity in the patient’s agency trust account and quarterly statement of representative or indirect payee trust account may be made available to the patient, legal representative, or other designated person not otherwise prohibited from seeing them upon request.

(11) Incapacity to Perform:

(a) The patient’s treatment team at the state institution may certify in writing that a patient’s mental illness or mental retardation has rendered the patient incapable of even minimal understanding of any of the notices provided for in this rule. Notwithstanding any other provision of this rule, should such certification occur, the Division or state institution is not required to provide the patient with the various forms of notice otherwise required by this rule;

(b) Certification that a patient’s mental illness or mental retardation renders the patient incapable of understanding the notice provided by this rule shall be reviewed and redetermined annually by the Superintendent as part of the patient’s annual plan of care.

History

Statutory/Other Authority: ORS 179.040 & 413.042
Statutes/Other Implemented: ORS 179.510 – 179.530
MHD 16-1980, f. & ef. 6-24-80
MHD 9-1980(Temp), f. & ef. 4-18-80
MHD 42(Temp), f. & ef. 9-9-76

Or. Admin. R. 309-013-0035 Purpose and Statutory Authority

(1) Purpose. The Pay for Patient and Resident Workers Program was established to support the goals or the patient’s or resident’s treatment/training plan. These rules establish standards and procedures for administering the agency payroll system for patient and resident workers in state institutions.

(2) Statutory Authority. These rules are authorized by ORS 413.042, and carry out the provisions of ORS 179.440, 426.385 and 427.031.

History

Statutory/Other Authority: ORS 179.040 & 413.042
Statutes/Other Implemented: ORS 426.385 & 179.440
MHD 2-1985, f. & ef. 2-7-85
MHD 2-1981, f. & ef. 6-25-81

Or. Admin. R. 309-013-0040 Definitions

As used in these rules:

(1) “Appointment Notice” means the form used at the institution to enter a patient or resident worker into the agency payroll system.

(2) “Division” means the Addictions and Mental Health Division of the Oregon Health Authority.

(3) “Patient Worker” means a person in a state institution for the mentally or emotionally disturbed who performs work for pay that is of therapeutic benefit to the patient.

(4) “Resident Worker” means a person in a state institution for the mentally retarded and other developmentally disabled who performs work for pay that is of training benefit to the resident.

(5) “State Institution” means all Oregon State Hospital campuses.

History

Statutory/Other Authority: ORS 179.040 & 413.042
Statutes/Other Implemented: ORS 426.385 & 179.440
BHS 2-2021, amend filed 01/15/2021, effective 01/15/2021
BHS 7-2020, temporary amend filed 04/21/2020, effective 04/21/2020 through 10/17/2020
MHD 2-1985, f. & ef. 2-7-85
MHD 2-1981, f. & ef. 6-25-81

Or. Admin. R. 309-013-0045 Wage Standards

(1) State institutions shall ensure a fair and equitable system to calculate reasonable compensation for work performed by patient and resident workers.

(a) The compensation rate shall reflect the community pay rates for similar jobs;

(b) Be calculated using labor market information through Oregon Employment Department; and

(2) Patients and residents will be allowed, upon request, to review their record used to calculate their reasonable wage.

History

Statutory/Other Authority: ORS 179.040 & 413.042
Statutes/Other Implemented: ORS 426.385 & 179.440
BHS 2-2021, amend filed 01/15/2021, effective 01/15/2021
BHS 7-2020, temporary amend filed 04/21/2020, effective 04/21/2020 through 10/17/2020
MHD 2-1985, f. & ef. 2-7-85
MHD 2-1981, f. & ef. 6-25-81

Or. Admin. R. 309-013-0055 Hiring Procedure

(1) Prior to employment, all patient and resident workers must be informed verbally, and in writing, of their rights with respect to their working relationship with the state institution. Those rights are as follows:

(a) To receive reasonable compensation for all work performed, other than personal housekeeping chores;

(b) To receive overtime compensation for work performed in excess of an eight hours per day or 40 hours per week;

(d) To review their productivity rating if less than 100 percent.

(2) The institution must complete an appointment notice for each patient and resident worker.

(3) Each patient worker and resident worker must complete a Form W-4.

(4) Each patient and resident worker without a Social Security number must apply for and receive one prior to employment.

(5) Each patient and resident worker who receives Social Security benefits (SSI or SSD), or is eligible for Title XIX, must be informed that an earnings record will be sent to those offices for possible payment adjustment.

(6) Each patient and resident worker under 18 years of age must have a work permit prior to employment.

(7) If applicable, the patient or resident worker must sign, in the presence of a witness, the Notice to Patient/Resident Worker form, (MHD-ADM-0169), prior to beginning work. No billing for cost of care based on agency earnings will predate the delivery of this notice.

History

Statutory/Other Authority: ORS 179.040 & 413.042
Statutes/Other Implemented: ORS 426.385 & 179.440
MHD 2-1985, f. & ef. 2-7-85
MHD 2-1981, f. & ef. 6-25-81

Or. Admin. R. 309-013-0060 Payroll Procedure

(1) Each state institution will use a gross payroll system for processing the agency payroll for patient and resident workers. Biennial budgets for agency payroll will be based on expected gross payroll expenses.

(2) The work supervisor will keep a record of each patient or resident worker’s work times and/or specific tasks completed.

(3) Each institution shall adopt written procedures, approved by the Division Administrator, to prepare, distribute, and account for agency payroll payments.

(4) Payroll records will be maintained in accordance with the appropriate record retention requirements of the Secretary of State’s Archives Division.

History

Statutory/Other Authority: ORS 179.040 & 413.042
Statutes/Other Implemented: ORS 426.385 & 179.440
MHD 2-1985, f. & ef. 2-7-85
MHD 2-1981, f. & ef. 6-25-81

Or. Admin. R. 309-013-0075 Purpose and Statutory Authority

(1) Purpose. These rules prescribe procedures for handling cases of fraud and embezzlement involving Division employees working in the central office or state institutions, persons working under personal service contracts with the Division, and service providers and subcontractors of service providers contracting with the Division.

(2) Statutory Authority. These rules are authorized by ORS 179.040 and 413.042, and carry out the provisions of 430.021(2).

History

Statutory/Other Authority: ORS 179.040 & 413.042
Statutes/Other Implemented: ORS 430.021
MHD 18-1982, f. & ef. 8-6-82

Or. Admin. R. 309-013-0080 Definitions

As used in these rules:

(1) “Central Office” means all organizational elements of the Addictions and Mental Health Division which are not a part of a state institution.

(2) “Division” means the Addictions and Mental Health Division of the Oregon Health Authority.

(3) “Embezzlement” means any action to willfully take or convert to one’s own use, money or property of another, which the wrongdoer acquired lawfully through some office or employment or position of trust.

(4) “Fraud” means any action by an individual to knowingly, willfully and with deceitful intend take or use for their own personal gain money or property which does not belong to them.

(5) “Service Provider” means a public or private community agency or organization that provides a particular mental health service (such as preschool services for the developmentally disabled, a detoxification center, or a day treatment program) approved by the Division. An agency organization may provide more than one service element, and more than one agency or organization in a county may provide the same service element.

(6) “State Institution” means Dammasch State Hospital in Wilsonville, Oregon State Hospital in Salem, Fairview Training Center in Salem, and Eastern Oregon Hospital and Training Center in Pendleton.

History

Statutory/Other Authority: ORS 179.040 & 413.042
Statutes/Other Implemented: ORS 430.021
MHD 18-1982, f. & ef. 8-6-82

Or. Admin. R. 309-013-0085 Reporting of Suspected Fraud and Embezzlement

(1) Upon discovery, all cases of suspected fraud and embezzlement related to the central office shall be referred, along with all related information, to the Administrator. The Administrator shall review the case, call upon appropriate sources to investigate, and notify appropriate authorities.

(2) In case of suspected fraud or embezzlement involving a state institution, the superintendent of the institution shall review the case, call upon appropriate sources to investigate, and notify appropriate authorities. All cases under review shall be reported to the Administrator.

(3) Each service provider contracting with the Division shall report in writing the details of all cases of suspected fraud and embezzlement involving its employees and/or the employees of its subcontractors to the Division’s Administrator not later than one working day after the date the alleged activity comes to their attention. The report shall describe the incident and action being taken to resolve the problem.

History

Statutory/Other Authority: ORS 179.040 & 413.042
Statutes/Other Implemented: ORS 430.021
MHD 18-1982, f. & ef. 8-6-82

Or. Admin. R. 309-013-0090 Investigation of Suspected Fraud and Embezzlement

(1) In cases of suspected fraud and embezzlement involving funds and resources of the Division:

(a) The Administrator shall begin the investigation immediately and may, in the course of investigation, call upon the services of appropriate law enforcement agencies, the Attorney General, the Division Audit Unit, and/or other who may be of assistance in developing the case;

(b) A service provider which has contracted with the Division is responsible for developing cases of suspected fraud and embezzlement involving its employees and/or the employees of its subcontractors, and is responsible for referral to the proper authorities. However, the Division may assume control of any case not handled to the Division’s satisfaction.

(2) In cases of suspected fraud and embezzlement which do not involve funds and resources of the Division:

(a) The aggrieved parties shall seek their own resolution, and the Division will not become involved in development of the case or prosecution, except it may intervene in cases involving resources of clients of service providers;

(b) The Division shall review the case to determine whether the lack of internal controls which allowed fraud or embezzlement to occur might also endanger Division resources. If that possibility exists, the service provider shall be required to adopt and follow procedures which the Division decides are needed to minimize chances for recurrence of the fraud or embezzlement. Failure of the service provider to adopt and follow such procedures shall constitute grounds for refusing to contract with the service provider in the future, and for terminating the existing contract.

History

Statutory/Other Authority: ORS 179.040 & 413.042
Statutes/Other Implemented: ORS 430.021
MHD 18-1982, f. & ef. 8-6-82

Or. Admin. R. 309-013-0095 Consequences of Failure to Adopt Procedures

Failure of a service provider to adopt and follow procedures which the Division decides are needed to minimize chances for fraud and embezzlement of Division resources shall constitute grounds for terminating any contract between the Division and that service provider. If the service provider is a subcontractor of a service provider contracting with the Division, then such failure on the part of the subcontractor shall constitute grounds for stipulation by the Division that no Division managed funds be used for payment to that subcontractor.

History

Statutory/Other Authority: ORS 179.040 & 413.042
Statutes/Other Implemented: ORS 430.021
MHD 18-1982, f. & ef. 8-6-82

Or. Admin. R. 309-013-0100 Disclosure Requirement

Disclosure must be made to the Division before a contract is entered into, or at the time it becomes known, of the name of any person who has ownership or control interest of five percent or more, or is an officer, director, agent, or managing employee, and has been convicted of a criminal offense related to the involvement of such person in any such program, including theft of patient funds. Failure to make this disclosure shall constitute grounds for terminating that contract.

History

Statutory/Other Authority: ORS 179.040 & 413.042
Statutes/Other Implemented: ORS 430.021
MHD 18-1982, f. & ef. 8-6-82

Or. Admin. R. 309-013-0105 Disciplinary Action

Fraud or embezzlement of Division resources and/or patient or resident funds committed by Division employees shall constitute grounds for disciplinary action. The type and extent of disciplinary action will be determined in accordance with the Division’s collective bargaining agreements and “Personnel Relations Law, Personnel Rules and Personnel Policies.” Notwithstanding any portion of these rules, existing agreements with unions representing the employee(s) involved, governing complaint investigation, shall be observed.

History

Statutory/Other Authority: ORS 179.040 & 413.042
Statutes/Other Implemented: ORS 430.021
MHD 18-1982, f. & ef. 8-6-82

Or. Admin. R. 309-013-0120 Purpose and Statutory Authority

(1) Purpose. These rules establish a Division procedure for audits of community mental health programs, mental health organizations and their subcontractors and vendors and any service provider agreeing to offer services through direct contract with the Division. These rules also establish basic record keeping standards for programs subject to audit under these rules, establish procedures for appealing audit findings, and set out a process to implement the findings of the final audit report.

(2) Statutory Authority. These rules are authorized by ORS 179.040, 413.042 & 430.640 and are promulgated to enable the Division to carry out its responsibilities under ORS 414.018 to 414.024 and 430.610 through 430.695.

History

Statutory/Other Authority: ORS 179.040, 413.042 & 430.640
Statutes/Other Implemented: ORS 414.018 & 430.610–430.695
MHD 15-1998, f. 8-12-98, cert. ef. 9-1-98, Renumbered from 309-013-0020
MHD 9-1978, f. & ef. 12-11-78

Or. Admin. R. 309-013-0130 Definitions

(1) “Audit” means the examination of documents, records, reports, systems of internal control, accounting and financial procedures, and other evidence for one or more of the following purposes:

(a) To ascertain whether the financial statements present fairly the financial position and the results of financial operations of the fund types and/or account groups in accordance with Generally Accepted Accounting Principles and federal and state rules and regulations;

(b) To determine compliance with applicable laws, rules, regulations and contract provisions;

(d) To review effectiveness in achieving program results.

(2) “Capital Construction” is an expenditure related to construction or remodeling of physical facilities with a projected cost of $250,000 or more.

(3) “Capital Improvement” is an expenditure related to construction or remodeling of physical facilities with a projected cost of more than $5,000 but less than $250,000.

(4) “Capital Outlay” are purchases of equipment and tangible personal property of a non-expendable nature which have a useful life of more than one year. The minimum dollar threshold for determining if a purchase is capital outlay can not exceed the amount set for state purchases of capital outlay. The current threshold for the State of Oregon is $5,000, however, a lessor amount may be used.

(5) “Community Mental Health Program (CMHP)” means the organization of all services for individuals with mental or emotional disturbances, developmental disabilities or chemical dependency, operated by, or contractually affiliated with, a local mental health authority, operated in a specific geographic area of the state under an intergovernmental agreement or direct contract with the Division.

(6) “Direct Contractor” means a person or organization which operates under a direct contract with the Division to provide services to persons with mental or emotional conditions and/or developmental disabilities.

(7) “Internal Auditor” means auditors within the Audit Unit of the Division.

(8) “Internal Control Structure” means the plan of organization including all of the methods and measures adopted within a business to safeguard its assets, check the accuracy and reliability of its accounting data, and promote operational efficiency and adherence to management’s policies.

(9) “Local Mental Health Authority (LMHA)” means the county court or board of county commissioners of one or more counties who choose to operate a CMHP; or, if the county declines to operate or contract for all or part of a CMHP, the board of directors of a public or private corporation which contracts with the Division to operate a CMHP for that county.

(10) “Addictions and Mental Health Division (Division)” means the Oregon Health Authority (Authority) Agency responsible for the administration of the State mental health and developmental disability services to persons who qualify for certain programs under federal and state laws, rules and regulations.

(11) “Mental Health Organization (MHO)” means a Prepaid Health Plan under contract with the Division to provide covered services under the Oregon Health Plan Medicaid Demonstration Project. MHOs can be Fully Capitated Health Plans (FCHPs), CMHPs or private MHOs or combinations thereof.

(12) “Non-allowable Expenditures” means expenditures made by a contractor or subcontractor of the Division which are not consistent with relevant federal and state laws, rules, regulations and contract provisions. To be allowable, expenditures must be necessary and reasonable for the proper and efficient performance of the contracted services. If only state funds are involved, expenditures will be evaluated based on state laws and rules, the contract provisions, and whether they are necessary and reasonable for the proper and efficient performance of the contracted services. When federal funds are involved, determination of allowable expenditures includes, but is not limited to, those rules and regulations itemized and referred to in applicable Office of Management and Budget circulars.

(13) “Office of Medical Assistance Programs (OMAP)” means the office of the Oregon Health Authority responsible for coordinating the Medical Assistance Program within the State of Oregon.

(14) “Reasonable Cost” means a cost that in nature or amount does not exceed that which would be incurred by a prudent person under the circumstance prevailing at the time the decision was made to incur the cost. Consideration shall be given to whether the cost is of a type generally recognized as ordinary and necessary for the operation of the organization; what restraints or requirements exist such as those imposed by factors of generally accepted sound business practices, federal and state laws and regulations, and terms and conditions of the contract; whether the individuals concerned acted with prudence in the circumstances, considering their responsibilities to the organization, their employer, their clients, the public and the governments; and whether significant deviations from the organization’s established practices unjustifiably increase costs.

(15) “Service Element” means a distinct service or combination of services as defined in Part III of the Intergovernmental Agreement for persons with mental or emotional conditions and or developmental disabilities provided in the community setting by a contract with the Division or through a subcontract with a local mental health authority.

(16) “Service Provider” means a public or private community agency or organization contracted by the Division that provides recognized mental health or developmental disability service(s) and is approved by the Division or other appropriate agency to provide these service(s). For the purpose of this rule, “provider” or “program” is synonymous with “service provider.”

History

Statutory/Other Authority: ORS 179.040, 413.042 & 430.640
Statutes/Other Implemented: ORS 414.018 & 430.610–430.695
MHD 15-1998, f. 8-12-98, cert. ef. 9-1-98, Renumbered from 309-013-0020
MHD 9-1978, f. & ef. 12-11-78

Or. Admin. R. 309-013-0140 Scope and Application of the Rule

Under these rules, the Division may audit any service provider that provides any part of the community mental health program including the community mental health program itself, Mental Health Organizations providing services under the Oregon Health Plan including subcontractors and vendors providing mental health services, or any direct contractor. The scope of the audit shall include only Division funds or related matching funds. However, Division may include other funds in its tests to the extent necessary to audit Division funds or matching funds. These rules shall be read and applied consistently with OAR 309-014-0000 (Community Mental Health Contractors) or the Division of Medical Assistance Programs general rules (OAR 410-120-0000 through 410-120-1980) when these are applicable.

History

Statutory/Other Authority: ORS 413.042 & 430.640
Statutes/Other Implemented: ORS 430.610–430.695
MHD 15-1998, f. 8-12-98, cert. ef. 9-1-98, Renumbered from 309-013-0020
MHD 9-1978, f. & ef. 12-11-78

Or. Admin. R. 309-013-0150 Revenue

(1) A service provider shall maintain a revenue account for each income source which results from the operation of the service or is used to support the service. For example, separate revenue accounts shall be established for each service element for which the provider receives payment from Division or the Division of Medical Assistance Programs, direct federal payments, donations, fees, interest earned, rentals collected from subleases and parking lots, sales of capital equipment, training grants or any other source of income.

(2) Only cash revenue may be used to match state funds unless the Division gives prior authorization in writing to use contributed services or property to match state funds.

History

Statutory/Other Authority: ORS 179.040, 413.042 & 430.640
Statutes/Other Implemented: ORS 414.018 & 430.610–430.695
MHD 15-1998, f. 8-12-98, cert. ef. 9-1-98, Renumbered from 309-013-0020
MHD 9-1978, f. & ef. 12-11-78

Or. Admin. R. 309-013-0160 Expenses

(1) A service provider subject to audit under these rules shall keep its accounting records consistent with Generally Accepted Accounting Principles. Accounting records shall be retained for three years from the date of the expiration of the Division’s agreement or from the finalization of an audit, whichever comes later. Allocation methods for expenses shall be documented. Relevant calculations representing allocations shall be shown. The allocation method shall reasonably distribute expenses which are shared by service providers or service elements. Charges assessed against a service provider by a related organization shall be justified by the related organization as to the method and reason for relevant cost allocation. The expense invoice shall list the location where services and supplies purchases are delivered for any item in excess of $1,000.

(2) Record requirements for Personal Services:

(a) Reports reflecting the distribution of labor of each employee must be maintained for all staff members, professional and nonprofessional, whose compensation is charged in whole or in part to Division funds. To support the allocation of indirect costs, such reports must also be maintained for other employees whose work involves two or more functions or activities if a distribution of their compensation between such functions or activities is needed in the determination of the organization’s indirect cost rate(s). Reports maintained to satisfy these requirements must meet the following standards:

(A) The reports must reflect an after-the-fact determination of the actual activity of each employee. Budget estimates (i.e., estimates determined before the services are performed) do not qualify as support for charges to Division funds;

(B) Each report must account for the total activity for which employees are compensated and which is required in fulfillment of their obligations to the organization;

(C) The reports must be signed by the individual employee, or by a responsible supervisory official having first-hand knowledge of the activities performed by the employee, to attest that the distribution of activity represents a reasonable distribution of the actual work performed by the employee during the periods covered by the reports;

(D) The reports must be prepared at least monthly and must coincide with one or more pay periods;

(E) Periodic time studies, in lieu of ongoing time reports, may be used to allocate salary and wage costs. However, the time studies used must meet the following criteria:

(i) A minimally acceptable time study must encompass at least one full week per month of the cost reporting period;

(ii) Each week selected must be a full work week (e.g., Monday to Friday, Monday to Saturday or Sunday to Saturday);

(iii) The weeks selected must be equally distributed among the months in the cost reporting period, e.g., for a 12 month period three of the 12 weeks in the study must be the first week beginning in the month, three weeks the second week beginning in the month, three weeks the third and three weeks the fourth;

(iv) No two consecutive months may use the same week for the study, (e.g., if the second week beginning in April is the study week for April, the weeks selected for March and May may not be the second week beginning in those months);

(v) The time study must be contemporaneous with the costs to be allocated. Thus, a time study conducted in the current cost reporting year may not be used to allocate the costs of prior or subsequent cost reporting years;

(vi) The time study must apply to a specific provider. Thus, chain organizations may not use a time study from one provider to allocate the costs of another provider or a time study of a sample group of providers to allocate the costs of all providers within the chain.

(b) Any person being compensated for services to a service provider who is not an employee of the organization shall have a written contract with the service provider. The contract shall set forth the specific services being purchased, the contract time period, the rate at which compensation will be paid and an hourly rate where applicable.

(3) Record Requirements for Capital Expenditures:

(a) Depreciation for capital outlay, capital improvements, and capital construction shall be documented in a depreciation schedule. The depreciation schedule at a minimum shall include a description of the asset, date of acquisition, cost basis, depreciation method, estimated useful life, annual depreciation expense and accumulated depreciation.

(b) Any capital expenditures purchased by a service provider using Division funds shall be listed on an inventory system showing location of item and reference to purchase invoice and payment receipt location. The inventory shall be checked annually and verification of the inventory list signed by the inventory control person. All capital items purchased with Division funds must be used in an Division approved program.

(4) Reasonable Procedures will be established to ensure the security of cash, blank checks, purchase orders, check protector machines, and signature stamps.

(5) A service provider must expend funds consistent with an intergovernmental agreement or direct contract, these rules, the required program or licensing rule, and federal and state requirements. For service elements contracted with a predetermined rate, Division funds not used in delivering the service of the required quantity and quality shall be classified as carryover. Carryover of Division administered funds shall be spent for Division services. These funds shall be kept in restricted accounts in the financial records. Funds spent on unallowed costs shall be considered noncompliance and shall be returned to Division.

(6) All travel expenses shall be supported by a system of authorized trip reports, receipts, and/or other documentation. Authorization is indicated by approval of the travel expenditure by the Director (or person with delegated authority) of the service provider.

History

Statutory/Other Authority: ORS 179.040, 413.042 & 430.640
Statutes/Other Implemented: ORS 414.018 & 430.610–430.695
MHD 15-1998, f. 8-12-98, cert. ef. 9-1-98, Renumbered from 309-013-0020
MHD 9-1978, f. & ef. 12-11-78

Or. Admin. R. 309-013-0170 Audit Process and Reports

(1) Any person, organization, or agency, including the Division, may request an audit of a community mental health program or any service provider offering a service thereunder or any direct contractor by submitting an audit request in writing to the Division Internal Audit Unit Coordinator. The request shall clearly identify the service provider to be audited, setting forth its name, location, program director, the period for which the audit is requested and the reason for the request.

(2) The Internal Audit Unit Coordinator shall review the request and arrange for scheduling if an audit is considered appropriate. The Internal Audit Unit Coordinator shall notify appropriate Assistant Administrators of the audit schedule.

(3) The Assistant Administrator of the Division for the Office of Finance has the discretion to notify the appropriate community mental health program director of the scheduled audit in advance. The Division retains the right to perform an audit without prior notice to the subject service provider.

(4) Upon completion of the audit, the Internal Audit Unit Coordinator shall prepare a report setting forth the findings, recommendations, and auditee responses where applicable. Audit work papers shall be available showing the details of the audit findings.

History

Statutory/Other Authority: ORS 179.040, 413.042 & 430.640
Statutes/Other Implemented: ORS 414.018 & 430.610–430.695
MHD 15-1998, f. 8-12-98, cert. ef. 9-1-98, Renumbered from 309-013-0020
MHD 9-1978, f. & ef. 12-11-78

Or. Admin. R. 309-013-0180 Disposition of Audit Findings

(1) To the extent an audit documents non-allowable expenditures in non-capitated programs, the Division shall recover such funds.

(2) To the extent an audit report evidences non-compliance with applicable program and/or licensing rules, the audit findings may be referred to the Administrator of the Division to assess civil penalties, where applicable, or for other corrective action deemed necessary by the program office.

(3) Notwithstanding any other provisions of these rules, to the extent an audit report reveals non-compliance with Generally Accepted Accounting Principles or these rules, the Division may require corrective action to bring the deficiencies into compliance with state and federal rules and regulations. Non-compliance which results in substantial misrepresentation of financial activities may result in termination of the license and/or contract upon consultation with Division program offices and/or the local mental health authority.

History

Statutory/Other Authority: ORS 179.040, 413.042 & 430.640
Statutes/Other Implemented: ORS 414.018 & 430.610–430.695
MHD 15-1998, f. 8-12-98, cert. ef. 9-1-98, Renumbered from 309-013-0020
MHD 9-1978, f. & ef. 12-11-78

Or. Admin. R. 309-013-0190 Provider Appeals

(1) A provider may appeal certain decisions affecting the provider by making a written request to the Division Assistant Administrator for the Office of Finance. The request must state whether the provider wants an administrative review, and/or a contested case hearing, as outlined in the OMAP General Rules OAR 410-120-1560, Provider Appeals, through 410-120-1840, Provider Hearings-Role of Hearings Officer. If the subject service provider decides to appeal the audit, it shall set forth in writing the reasons for its appeal within 30 days of receipt of the report.

(2) When the Division seeks to recover funds under these rules, the Division shall negotiate the terms and conditions of repayment with the audited service provider, after consultation with the community mental health program director or the MHO director (if applicable).

History

Statutory/Other Authority: ORS 179.040, 413.042 & 430.640
Statutes/Other Implemented: ORS 414.018 & 430.610–430.695
MHD 15-1998, f. 8-12-98, cert. ef. 9-1-98, Renumbered from 309-013-0020
MHD 9-1978, f. & ef. 12-11-78

Or. Admin. R. 309-013-0200 Basic Accounting Records

A service provider subject to audit under these rules shall maintain a chart of accounts that defines all items included in determining the cost for each service element. The chart of accounts shall list all revenues and expense accounts. The organization shall have bank deposit records and documentation to verify the source of revenue. Revenue and expense accounts, with related asset, liability, and equity accounts, shall account for all expenditures related to delivery of the service. All basic accounting records shall be retained for at least three years following the expiration of the contract or from the finalization of an audit including any appeal, whichever is later.

History

Statutory/Other Authority: ORS 179.040, 413.042 & 430.640
Statutes/Other Implemented: ORS 414.018 & 430.610–430.695
MHD 15-1998, f. 8-12-98, cert. ef. 9-1-98, Renumbered from 309-013-0020
MHD 9-1978, f. & ef. 12-11-78

Or. Admin. R. 309-013-0210 Internal Controls

Establishing and maintaining an internal control structure is the responsibility of the service provider. Effective internal controls are considered essential to achieving the proper conduct of business with full accountability for the resources made available. Internal controls shall be implemented and maintained to provide reasonable assurance that:

(1) The provider identifies, assembles, classifies, records, analyzes, and reports its transactions in conformity with Generally Accepted Accounting Principles or appropriate regulatory requirements for preparing financial statements and other required financial reports;

(2) Losses or misappropriations of assets due to errors or irregularities in processing transactions and handling the related assets are prevented or detected;

(3) Noncompliance with applicable federal and state laws and rules and regulations and terms of the contract is prevented or detected;

(4) State and federal funds are reasonably, prudently and economically spent; and

(5) All costs are appropriately allocated among programs, departments, and other benefiting units.

History

Statutory/Other Authority: ORS 179.040, 413.042 & 430.640
Statutes/Other Implemented: ORS 414.018 & 430.610–430.695
MHD 15-1998, f. 8-12-98, cert. ef. 9-1-98, Renumbered from 309-013-0020
MHD 9-1978, f. & ef. 12-11-78

Or. Admin. R. 309-013-0220 Independent Audit Reports

The Division may, in its discretion, accept an independent audit, in lieu of a Division audit, if it determines the workpapers and procedures of the independent auditor meet Government Auditing Standards (where applicable), Generally Accepted Auditing Standards and other audit standards which may be adopted by the Division.

History

Statutory/Other Authority: ORS 179.040, 413.042 & 430.640
Statutes/Other Implemented: ORS 414.018 & 430.610–430.695
MHD 15-1998, f. 8-12-98, cert. ef. 9-1-98, Renumbered from 309-013-0020
MHD 9-1978, f. & ef. 12-11-78

Division 14 COMMUNITY MENTAL HEALTH PROGRAMS

Or. Admin. R. 309-014-0000 Purpose and Statutory Authority

(1) Purpose. These rules prescribe general administrative standards for Division community mental health programs.

(2) Certificate Required: To receive a certificate for the provision of behavioral health treatment services a Community Mental Health Program must meet the criteria under OAR 309-008-0100 to 309-008-1600; in addition, the Opioid Treatment Program must:

(3) Renewal: The renewal of a Certificate shall be governed by OAR 309-008-0100 to 309-008-1600.

(4) Denial, Revocation, Nonrenewal, Suspension: The denial, revocation, nonrenewal, or suspension of a letter of approval or license for an opioid treatment program may be based on any of the grounds set forth in OAR 309-008-1100.

History

Statutory/Other Authority: ORS 413.042 & 430.640
Statutes/Other Implemented: ORS 430.610 – 430.695
MHS 23-2016, f. & cert. ef. 12-1-16
MHD 13-2000, f. 9-15-00, cert. ef. 9-16-00
MHD 14-1982, f. & cert. ef. 7-7-82, Sec. (3) thru (13) Renumbered to 309-014-0005 thru 309-014-0040
MHD 39, f. 5-20-76, cert. ef. 6-11-76

Or. Admin. R. 309-014-0005 Definitions

As used in these rules:

(1) “Certificate” means the document or documents issued by the Division, which identifies and declares certification of a provider pursuant to OAR 309-008-0100 to 309-008-1600. A letter accompanying issuance of the certificate will detail the scope and approved service delivery locations of the certificate.

(2) “Chief Officer” means the Chief Health Systems Officer of the Oregon Health Authority, or his or her designee.

(3) “CMHP” means "Community Mental Health Program": an entity that is responsible for planning and delivery of safety net services for persons with mental or emotional disturbances, drug abuse problems, and alcoholism and alcohol abuse in a specific geographic area of the state under a contract with the Division or a local mental health authority.

(4) "CMHP Program Area" means the organization of all services for persons with either mental or emotional disturbances, drug abuse problems, or alcoholism and alcohol abuse problems, operated by, a local mental health authority, operated in a specific geographic area of the state under a contract with the Division.

(5) "CMHP Director" means the director of a CMHP who operates or contracts for all services for persons with mental or emotional disturbances, drug abuse problems, and alcoholism and alcohol abuse problems under the omnibus contract with the Division.

(6) "Community Mental Health Advisory Committee" means the advisory committee to a local mental health authority.

(7) "Division" means the Health Systems Division of the Oregon Health Authority.

(8) "Individual" means a person receiving services under these rules. (9) "Local Mental Health Authority" means the county court or board of county commissioners of one or more counties who operate a community mental health program, or in the case of a Native American reservation, the tribal council, or if the county declines to operate or contract for all or part of a community mental health program, the board of directors of a public or private corporation.

(9) "Local Revenues" means all money, other than state or federal grant or contract funds, expended by a local mental health authority and any of its subcontractors for community mental health services and included in the approved community mental health contractor plan and budget. However, federal funds expended for alcoholism treatment and rehabilitation services provided under ORS 430.345 to 430.380 in accordance with ORS 430.359(3) by community mental health contractors shall be considered local revenues.

(10) "Omnibus Contract" means the Financial Assistance Grant Agreement or contract between the Health Systems Division and a local mental health authority for all services for persons with mental or emotional disturbances, drug abuse problems, and alcoholism and alcohol abuse problems, operated in a specific geographic area.

(11) "Quality Assurance" means a systematic procedure for assessing the effectiveness, efficiency, and appropriateness of services provided by the community mental health contractor.

(12) "Service Element" means a distinct service or group of services for person with mental or emotional disturbances, drug abuse problems, and alcoholism and alcohol abuse problems, operated in the community under a contract with the Health Systems Division, or under contract with a local mental health authority.

(13) "Service Provider" means an entity or person that delivers services funded wholly or in part by the Division under a contract with the Division.

(14) "State Institution" means Oregon State Hospital in Junction City and Salem.

History

Statutory/Other Authority: ORS 413.042
Statutes/Other Implemented: ORS 430.610 – 430.640
MHS 23-2016, f. & cert. ef. 12-1-16
MHD 13-2000, f. 9-15-00 cert. ef. 9-16-00
MHD 8-2000(Temp), f. 3-20-00, cert. ef. 3-21-00 thru 9-16-00
MHD 14-1982, f. & ef. 7-7-82, Renumbered from 309-014-0000(3)
MHD 39, f. 5-20-76, ef. 6-11-76

Or. Admin. R. 309-014-0010 Purpose of a Community Mental Health Program

The purpose of a CMHP is to provide a system of appropriate, accessible, coordinated, effective, efficient safety net services to meet the mental health needs of the citizens of the community.

History

Statutory/Other Authority: ORS 413.042 & 430.640
Statutes/Other Implemented: ORS 430.610 – 430.640
MHS 23-2016, f. & cert. ef. 12-1-16
MHD 13-2000, f. 9-15-00, cert. ef. 9-16-00
MHD 14-1982, f. & ef. 7-7-82, Renumbered from 309-014-0000(4)
MHD 39, f. 5-20-76, ef. 6-11-76

Or. Admin. R. 309-014-0015 Division Responsibility for Community Addictions and Mental Health

The Division shall assist the local mental health authority in establishing and operating community mental health services and shall integrate such services with other mental health system components in the state by:

(1) Assessing needs for community mental health services in the state.

(2) Identifying priorities among needs and preparing state plans for community mental health disability services.

(3) Conducting the Division's activities in the least costly and most efficient manner so that delivery of services to the mentally or emotionally disturbed, alcohol abuser, alcoholic, drug abuser and drug-dependent persons shall be effective, coordinated and integrated with other services within the Oregon Health Authority.

(4) Obtaining resources and contracting with local mental health authorities for the operation of community mental health safety net service.

(5) Subject to the availability of funds, providing public information, program consultation, technical assistance, and training concerning community mental health services.

History

Statutory/Other Authority: ORS 413.042 & 430.640
Statutes/Other Implemented: ORS 430.610 – 430.640
MHS 23-2016, f. & cert. ef. 12-1-16
MHD 13-2000, f. 9-15-00, cert. ef. 9-16-00
MHD 14-1982, f. & cert. ef. 7-7-82, Renumbered from 309-014-0000(4) & (7)
MHD 39, f. 5-20-76, cert. ef. 6-11-76

Or. Admin. R. 309-014-0020 Program Director Qualifications

(1) The CMHP Director shall be a full time employee of the local mental health authority or the public or private corporation operating the community mental health program;

(2) The CMHP Director shall meet the following requirements:

(a) Hold at least a master's degree in a behavioral, social, health science, special education, public administration, or human service administration; and

(b) Have a minimum of five years of experience in human services programs, two of which are in community mental health and two of which are program managerial experience in human services; and

(3) When the position of community mental health program director becomes vacant, an interim director shall be appointed to serve until a permanent director is appointed.

History

Statutory/Other Authority: ORS 413.042 & 430.640
Statutes/Other Implemented: ORS 430.610 – 430.640
MHS 23-2016, f. & cert. ef. 12-1-16
MHD 13-2000, f. 9-15-00, cert. ef. 9-16-00
MHD 8-2000(Temp), f. 3-20-00, cert. ef. 3-21-00 thru 9-16-00
MHD 14-1982, f. & cert. ef. 7-7-82, Renumbered from 309-014-0000(5), (6), (9), (10) & (12)
MHD 39, f. 5-20-76, cert. ef. 6-11-76

Or. Admin. R. 309-014-0021 Management Functions

(1) In addition to other duties as may be assigned in the area of developmental disability services, the CMHP shall, at a minimum, assure the following duties are performed:

(a) Develop plans as may be needed to provide a coordinated and efficient use of resources available to serve people with developmental disabilities;

(b) Develop positive and cooperative working relationships with families, advocates, service providers, the Division, and other state and local agencies with an interest in developmental disability services;

(c) Assure collection and timely reporting of information as may be needed to conduct business with the Division, including but not limited to information needed to license foster homes, to collect federal funds supporting services, and to investigate complaints related to services or suspected individual abuse; and

(2) Management Plan. The CMHP shall maintain a plan assigning responsibility for the management functions and duties described in this section. The community mental health program shall assure that the functions and duties are assigned to people who have the knowledge and experience necessary to perform them.

History

Statutory/Other Authority: ORS 413.042 & 430.640
Statutes/Other Implemented: ORS 430.610 – 430.640
MHS 23-2016, f. & cert. ef. 12-1-16

Or. Admin. R. 309-014-0022 Contracts

(1) In keeping with the principles of family support expressed in ORS 417.342, and notwithstanding 430.670(2) or 291.047(3), an entity operating a CMHP may purchase services for an individual from a service provider without first providing an opportunity for competition among other service providers if the service provider is selected by the individual, the individual’s family or the individual’s guardian, as long as the service provider has been approved by the Division to provide such service.

(2) Limit on contract requirements. When a CMHP contracts with a public agency or private corporation for delivery of developmental disability services, the CMHP shall include in the contract only terms that are substantially similar to model contract terms established by the Division. The CMHP may not add contractual requirements, including qualifications for contractor selection, which are nonessential to the service element(s) being provided under the contract. The CMHP shall specify in contracts with service providers that disputes, which arise from these limitations, shall be resolved according to procedures contained in these rules. For purposes of this section, the following definitions apply:

(a) "Model contract terms established by the Division" means all applicable material terms and conditions of the omnibus contract, as modified to appropriately reflect a contractual relationship between the service provider and the CMHP, and any other requirements approved by the Division as local options under procedures established in these rules.

(b) "Substantially similar to model contract terms" means that the terms developed by the CMHP and the model contract terms require the service provider to engage in approximately the same type activity and expend approximately the same resources to achieve compliance.

(c) "Nonessential to the service element(s) being provided" means requirements that are not substantially similar to model contract terms developed by the Division.

History

Statutory/Other Authority: ORS 413.042 & 430.640
Statutes/Other Implemented: ORS 430.610 – 430.640
MHS 23-2016, f. & cert. ef. 12-1-16

Or. Admin. R. 309-014-0023 The Appeal Process

(1) Notice of Appeal.

(a) If a service provider believes that the contract offered by the CMHP contains terms or conditions that are not substantially similar to those established by the Division in the model contract, the service provider may appeal imposition of the disputed terms or conditions by sending a written notice of appeal to the Division’s Chief Officer within 30 calendar days after the effective date of the contract requirement. The notice of appeal shall include:

(A) A copy of the contract and any pertinent contract amendments;

(B) Identification of the specific term(s) that are in dispute; and

(D) The service provider shall send a copy of its notice of appeal to the CMHP. Upon receipt of this notice, the CMHP shall suspend enforcement of compliance with any contract requirement under appeal by the contractor until the appeal process is concluded.

(2) The Chief Officer or designee, shall offer to meet with both to mediate a solution. If a solution cannot be mediated, the Chief Officer shall declare an impasse through written notification to all parties and immediately appoint a panel to consider arguments from both parties.

(3)(a) The Mediation Panel The panel shall include, at a minimum, a representative from the Division, a representative from another CMHP, and a representative from another service provider organization.

(b) The panel shall meet with the parties, consider their respective arguments, and send written recommendations to the Chief Officer of the Division within 45 business days after an impasse was declared. If an appeal requiring panel consideration has been received from more than one contractor, the Division may organize materials and discussion in any manner it deems necessary, including combining appeals from multiple contractors, to assist the panel in understanding the issues and operating efficiently.

(c) The Chief Officer shall notify all parties of his/her decision within 15 business days after receipt of the panel’s recommendations. The decision of the Administrator is final. The CMHP shall take immediate action to amend contracts as needed to comply with the Administrator’s decision.

(3)(a) Expedited Appeal Process. The CMHP or the contractor may request an expedited appeal process that provides a temporary resolution, if it can be shown that the time needed to follow procedures to reach a final resolution would cause imminent risk of serious harm to individuals or organizations.

(b) The request shall be made in writing to the Division’s Chief Officer. It shall describe the potential harm and level of risk that will be incurred by following the appeal process. The Division shall notify all parties of its decision to approve an expedited appeal process within two business days.

(c) If an expedited process is approved, the Chief Officer shall notify all parties of his/her decision concerning the dispute within three additional business days. The Chief Officer’s decision resulting from an expedited appeal process shall be binding, but temporary, pending completion of the appeal process. All parties shall act according to the Chief Officer’s temporary decision until notified of a final decision.

(4) Exception to Facility Requirements. The CMHP may add contract requirements that the CMHP considers necessary to ensure the siting and maintenance of residential facilities in which individual care is provided. These requirements shall be consistent with all applicable state and federal laws and regulations related to housing.

(5) Needs Assessment and Planning. The CMHP shall assess local needs for services to persons with mental or emotional disturbances, drug abuse problems, mental retardation or other developmental disabilities, and alcoholism and alcohol abuse problems. The CMHP shall plan for meeting those needs within the constraints of resources available. The local mental health authority shall review and approve the plan before it is submitted to the Division.

(6) Monitoring. The local mental health authority shall monitor all CMHP service elements to assure that:

(a) Service elements are provided as specified in the contract with the Division; and

(b) Service elements are in compliance with these rules and other applicable Division administrative rules.

History

Statutory/Other Authority: ORS 413.042 & 430.640
Statutes/Other Implemented: ORS 430.610 – 430.640
MHS 23-2016, f. & cert. ef. 12-1-16

Or. Admin. R. 309-014-0025 Management of Community Mental Health Program Areas

Each CMHP contractor providing a community mental health program area under a contract with the Division is required to meet the following standards for management:

(1) Organizations:

(a) Each CMHP area contractor shall have an up-to-date organization chart showing the line of authority and responsibility from the local mental health authority to the CMHP area director and to each of the components of the CMHP area contractor;

(b) For all components of the community mental health program area contractor operated by agencies other than the local mental health authority, there shall be a contract between the local mental health authority and the subcontract agency specifying the authorities and responsibilities of each party and conforming to the requirements of any Division rule pertaining to contracts.

(2) Needs Assessment and Planning: When the Division contracts for a CMHP program area, the contractor shall assess local needs for services to persons within that program area, and shall plan to effectively and efficiently meet those needs within the constraints of available resources. The local mental health authority shall review and approve the plan before it is submitted to the Division.

(3) Monitoring: The local mental health authority shall monitor all community mental health service elements within the program area to assure that:

(a) Service elements are provided as specified in the contract with the Division; and

(b) Service elements are in compliance with these rules and other applicable Division administrative rules.

History

Statutory/Other Authority: ORS 413.042 & 430.640
Statutes/Other Implemented: ORS 430.610 – 430.640
MHS 23-2016, f. & cert. ef. 12-1-16
MHD 13-2000, f. 9-15-00, cert. ef. 9-16-00
MHD 14-1982, f. & cert. ef. 7-7-82, Renumbered from 309-014-0000(5) & (6)
MHD 39, f. 5-20-76, cert. ef. 6-11-76

Or. Admin. R. 309-014-0030 Management of All Service Elements

All contractors providing community mental health service elements under a contract with the Division are required to meet the following standards for management:

(1) Fee Policy. For all community mental health service elements, except local administration and those provided by a public education district, the agency providing the service element shall:

(a) Determine the cost of each type of service element provided;

(b) Establish a schedule of fees for service elements based on the costs of the service elements, adjusted on the basis of the client's ability to pay;

(c) At the time the service elements is initiated, inform the client of the agency fee policy, the agency fee schedules, and the fee rate to be collected from the client in the event that third party payments do not cover the cost of the client's service elements;

(d) Billings for Title XIX funds shall in no case exceed the customary charges to private clients for any like item or service charged by the service element; and

(e) Charge fees for service elements as follows:

(A) Except where expressly prohibited by federal law or regulation, when third party payments do not cover the full fee for the service elements provided, charge the client or those legally responsible for the cost of the client's care, in an amount which is the lesser of:

(i) The balance of the fee charged to but not paid by the third party payor(s); or

(ii) A fee adjusted on the basis of the client's ability to pay.

(B) Charge any third party payor in the amount of the full fees for the service elements provided. Should the sum of any third party payments and client payments exceed the fee, a refund of the excess payment shall be given to the client.

(2) Quality Assurance. Each provider of community mental health and developmental disability service elements shall implement and maintain a quality assurance program.

(3) Internal Management. Each provider of CMHP service elements funded by the Division shall meet the following internal management standards:

(a) There shall be an up-to-date organization chart showing lines of authority and responsibility for the services within the agency;

(b) There shall be up-to-date, written position descriptions for all staff providing community mental health and developmental disability services;

(A) Recruitment and termination of employees;

(B) Compensation plan;

(D) Employee benefits; and

(E) Grievance procedures.

(d) Each employee providing CMHP services shall have the opportunity for in-service training with pay;

(e) There shall be up-to-date accounting records for each mental health service element accurately reflecting all revenue by source, all expenses by object of expense, and all assets, liabilities, and equities, consistent with generally accepted accounting principles and conforming to the requirements of OAR 309-013-0120 to 309-013-0220;

(f) There shall be written statements of policy and procedure as are necessary and useful to assure compliance with any administrative rule pertaining to fraud and embezzlement and abuse of patients, residents, and clients; and

(g) There shall be such other written statements of policy and procedure as are necessary and useful to enable the agency to accomplish its mental health service objectives and to meet the requirements of these rules and other applicable standards and rules.

History

Statutory/Other Authority: ORS 413.042 & 430.640
Statutes/Other Implemented: ORS 430.610 – 430.640
MHS 23-2016, f. & cert. ef. 12-1-16
MHD 13-2000, f. 9-15-00, cert. ef. 9-16-00
MHD 14-1982, f. & cert. ef. 7-7-82, Renumbered from 309-014-0000(5) & (6)
MHD 39, f. 5-20-76, cert. ef. 6-11-76

Or. Admin. R. 309-014-0035 Delivery of CMHP Service Elements

All community mental health contractors providing community mental health service elements under a contract with the Division are required to meet the following general standards for delivery of community mental health service elements:

(1) Eligibility for Service:

(a) In accordance with the Civil Rights Act of 1964, community mental health services shall not be denied any person on the basis of race, color, creed, sex, national origin or duration of residence. Community mental health contractors shall also comply with Section 504 of the Rehabilitation Act of 1973 as implemented by 45 CFR 84.4, which states in part, "No qualified person shall, on the basis of handicap, be excluded from participation in, be denied benefits of, or otherwise be subjected to discrimination under any program or activity which receives or benefits from federal financial assistance";

(b) No person shall be denied services or be discriminated against on the basis of age or diagnostic or disability category unless predetermined clinical or program criteria for service restrict the service to specific age or diagnostic groups or disability category;

(d) Any person eligible for community mental health services provided by one agency shall also be eligible for other CMHP services provided by any other agency, unless admission to the service is subject to diagnostic or disability category or age restrictions based on predetermined criteria.

(2) Continuity and Coordination:

(a) Each agency providing community mental health services shall make pertinent clinical and financial eligibility information concerning a client of the agency readily available to other community mental health service agencies responsible for the client's care, consistent with state statutes and federal laws and regulations concerning confidentiality;

(b) In the event that a person seeking or receiving services from one community mental health contractor requires services not provided by the contractor, the person shall be referred to an available appropriate agency which can provide the needed services;

(c) Planning and implementation of service for clients of the community mental contractor shall be coordinated between components of the community mental health and developmental disability contractor, and other human service agencies, and between components of the community mental health contractor and state institutions. Each CMHP or community mental health program area contractor shall maintain a written agreement with state institutions serving the county. The agreement shall include, but need not be limited to:

(A) The procedures to be followed to assure necessary communication between the state institution and the community mental health program or CMHP area contractor when a client is admitted to, and discharged from, the state institution and during the period of care, treatment or training;

(B) The type of client information which will be shared by the CMHP area contractor and the state institution, the manner in which the information will be transmitted and the times when such information will be provided;

(C) The names of the staff members from the state institution and the CMHP area contractor, who will have principal responsibility for liaison and implementation of the agreement; and

(D) Each agreement between the state institution and a CMHP, or program area contractor, shall be reviewed and renewed at least once a year.

History

Statutory/Other Authority: ORS 413.042 & 430.640
Statutes/Other Implemented: ORS 430.610 – 430.640
MHS 23-2016, f. & cert. ef. 12-1-16
MHD 13-2000, f. 9-15-00, cert. ef. 9-16-00
MHD 14-1982, f. & cert. ef. 7-7-82, Renumbered from 309-014-0000(8) & (11)
MHD 39, f. 5-20-76, cert. ef. 6-11-76

Or. Admin. R. 309-014-0036 Records

(1) Service Records. A record shall be maintained for each client who receives direct treatment training and/or care services. The record shall contain client identification, problem assessment, treatment, training and/or care plan, medical information when appropriate; and progress notes.

(2) Retention of Records. Records shall be retained in accordance with OAR 166-005-0000 through 166-040-0010 (State Archivist). Financial records, supporting documents, statistical records, and all other records (except client records) shall be retained for a minimum of three years after the close of the contract period, or until audited. Client records shall be kept for a minimum of seven years.

(3) Confidentiality of Client Records. Client records shall be kept confidential in accordance with ORS 179.505, 45 CFR 205.50 and 42 CFR Part 2, any Division administrative rule pertaining to client records, and the most current edition of the Division Handbook on Confidentiality.

(4) Client Rights. Each agency providing any community mental health service shall have written procedures to assure:

(a) Protection of client privacy and dignity;

(b) Confidentiality of records consistent with state statutes and federal statutes and regulations;

(c) Involvement of the client in planning the service through the provision of information, presented in general terms, which explains the following:

(A) The treatment to be undertaken;

(B) Alternative treatment methods available, if any; and

(d) Client's right to refuse service unless otherwise ordered by a court; and

(e) Client is provided with information, presented in general terms, concerning the agency fee policies.

History

Statutory/Other Authority: ORS 413.042 & 430.640
Statutes/Other Implemented: ORS 430.610 – 430.640
MHS 23-2016, f. & cert. ef. 12-1-16

Or. Admin. R. 309-014-0037 Dispute Resolution

(1) The CMHP shall adopt a dispute resolution policy that pertains to disputes that may arise from contracts with service providers that deliver services funded by the Division for the CMHP. Procedures implementing this policy shall be included in the contract with any such service provider.

(2) When a dispute exists between a county or a CMHP and a service provider regarding the terms of their contract or the interpretation of an administrative rule of the Division relating to Division programs under ORS Chapter 430, and local dispute resolution efforts have been unsuccessful, either party may request assistance from the Division in mediating the dispute.

(a) Procedure. The parties shall demonstrate a spirit of cooperation, mutual respect, and good faith in all aspects of the mediation process. Mediation shall be conducted as follows:

(A) Request. The party requesting mediation shall send a written request to the Division Chief Officer, the CMHP director, and the provider agency director, unless other persons are named as official contact persons in the specific rule or contract under dispute. The request shall describe the nature of the dispute and identify the specific rule or contract provisions that are central to the dispute.

(B) Arrangements. The Chief Officer or designee, shall arrange the first meeting of the parties at the earliest possible date. The agenda for the first meeting should include:

(i) Consideration of the need for services of an outside mediator. If such services are desired, agreement should be made on arrangements for obtaining these services.

(ii) Development of rules and procedures that will be followed by all parties during the mediation;

(iii) Agreement on a date by which mediation will be completed, unless extended by mutual agreement.

(i) Each party shall be responsible for the compensation and expenses of their own employees and representatives; and

(ii) Costs that benefit the group, such as services of a mediator, rental of meeting space, purchase of snack food and beverage, etc. shall be shared equally by all parties.

(b) Final Report. A written statement documenting the outcome of the mediation shall be prepared. This statement shall consist of a brief written statement signed by all parties or separate statements from each party declaring their position on the dispute at the conclusion of the mediation process. In the absence of written statements from other parties, the Division representative shall prepare the final report. The final report on each mediation shall be retained on file at the Division. The Division will, from time to time, or as requested by the legislature or others, prepare summary reports that describe the success of mediation in resolving disputes.

History

Statutory/Other Authority: ORS 413.042 & 430.640
Statutes/Other Implemented: ORS 430.610 – 430.640
MHS 23-2016, f. & cert. ef. 12-1-16
MHD 13-2000, f. 9-15-00, cert. ef. 9-16-00
MHD 8-2000(Temp), f. 3-20-00, cert. ef. 3-21-00 thru 9-16-00

Or. Admin. R. 309-014-0040 Variances

(1) Requirements and standards for requesting and granting variances or exceptions are found in OAR 309-008-1600.

(2) Division Review and Notification: The Division must approve or deny the request for a variance to these rules within the scope and authority The Division must be made in writing using the Division approved variance request form and following the variance request procedure compliant with OAR 309-008-1600.

(3) Granting a variance for one request does not set a precedent that must be followed by the Division when evaluating subsequent requests for variance.

(4) A variance granted by the Division shall be attached to, and become part, of the contract for that year.

History

Statutory/Other Authority: ORS 413.042 & 430.640
Statutes/Other Implemented: ORS 430.610 – 430.640
MHS 23-2016, f. & cert. ef. 12-1-16
MHD 13-2000, f. 9-15-00, cert. ef. 9-16-00
MHD 14-1982, f. & cert. ef. 7-7-82, Renumbered from 309-014-0000(13)
MHD 39, f. 5-20-76, cert. ef. 6-11-76

Or. Admin. R. 309-014-0300 Purpose and Scope

These rules relate to the implementation of Chapter 418, Oregon Laws 2011 sections 13 through 20. The scope is limited to the creation of the Central Health Council and the implementation of the Central Oregon Health Improvement Plan.

History

Statutory/Other Authority: ORS 413.042
Statutes/Other Implemented: 2011 OL Ch. 418 & Sec. 13-19
MHS 3-2012, f. & cert. ef. 2-23-12
MHS 6-2011(Temp), f. 8-26-11, cert. ef. 9-1-11 thru 2-28-12

Or. Admin. R. 309-014-0310 Definitions

(1) “Authority” means the Oregon Health Authority (OHA).

(2) “Central Oregon Health Council” (COHC) means a council which shall, as a minimum, conduct a regional health assessment and adopt a regional health improvement plan to serve as a strategic population health and health care system service plan for the region served by the council.

(3) “Commission” means the Commission on Children and Families.

(4) “Council” means the Central Oregon Health Council (COHC).

(5) “Plan” means the Regional Health Improvement Plan.

History

Statutory/Other Authority: ORS 413.042
Statutes/Other Implemented: 2011 OL Ch. 418 & Sec. 13-19
MHS 3-2012, f. & cert. ef. 2-23-12
MHS 6-2011(Temp), f. 8-26-11, cert. ef. 9-1-11 thru 2-28-12

Or. Admin. R. 309-014-0320 Regional Health Improvement Plan

(1) The Regional Health Improvement Plan (RHIP) submitted by the Central Oregon Health Council, defined in OAR 309-014-0300, must include, but need not be limited to the following:

(a) Federally required components;

(b) Health policy;

(d) Outcome and quality improvement;

(e) Integration of service delivery and

(f) Workforce development.

(2) Any additional requirements to the RHIP will be agreed upon in advance by the Council, the Authority and the Commission.

History

Statutory/Other Authority: ORS 413.042
Statutes/Other Implemented: 2011 OL Ch. 418 & Sec. 13-19
MHS 3-2012, f. & cert. ef. 2-23-12
MHS 6-2011(Temp), f. 8-26-11, cert. ef. 9-1-11 thru 2-28-12

Or. Admin. R. 309-014-0330 Central Oregon Health Council

(1) The council may not convene until the governing body of each county adopts a resolution signifying the body’s intention to do so.

(2) Subsequent to the formation of the council, a county that is adjacent to Crook, Deschutes or Jefferson County may join the council if:

(a) The governing body of the county seeking to join the council adopts a resolution signifying the body’s intention to include a portion of that county in the region served by the council;

(b) The portion of the county to be included in the region is part of a natural health care referral pattern with the other counties on the council; and

(3) The COHC shall consist of no more than 11 members, including:

(a) A formative council consisting of:

(A) One member each from the governing bodies of Crook, Deschutes and Jefferson Counties, appointed by each body;

(B) The chief executive officer, or a designee of the chief executive officer, of the health care system serving the region; and

(C) The chief executive officer, or a designee of the chief executive officer, of the Medicaid contractor serving the region; and

(b) At least three members appointed by the formative council established under paragraph (3)(a)(A) of this rule. Members appointed under this section shall be representatives of:

(A) Consumers of physical and behavioral health services;

(B) Health care professionals;

(D) The business community; or

(E) A member from the governing body of each county that joins the council defined in (3)(a)(A) of this rule.

(4) The term of office of the members of the council is four years.

(5) A majority of the members of the council constitutes a quorum for the transaction of business.

(6) The council shall elect a member of the council to serve as the chairperson.

(7) If there is a vacancy for any cause, the appointing authority shall make an appointment to the vacated position to become effective immediately.

(8) The council may enter into necessary contracts, apply for and receive grants, hold and dispose of property and take other actions necessary to carry out the activities, services and responsibilities assumed by the council.

(9) The council may adopt rules necessary for the operation of the council.

History

Statutory/Other Authority: ORS 413.042
Statutes/Other Implemented: 2011 OL Ch. 418 & Sec. 13-19
MHS 3-2012, f. & cert. ef. 2-23-12
MHS 6-2011(Temp), f. 8-26-11, cert. ef. 9-1-11 thru 2-28-12

Or. Admin. R. 309-014-0340 Central Oregon Health Improvement Plan (COHIP)

(1) The COHC shall develop a health improvement plan as detailed in OAR 309-017-0030.

(2) The COHIP will replace all prior plans required by the Authority in ORS 430.630, 430.640, 431.385 and 624.510 and plans required by the State Commission on Children and Families under ORS 417.705 through 417.801.

(3) The COHC will submit the plan no later than March 1, 2012 to the Authority.

(4) The Authority shall have 45 days from the date the plan is submitted to review the plan and return it to the Council either approved or with suggested modifications.

(a) If modifications are suggested the Council will have 45 days to respond to the suggestions and resubmit the plan.

(b) The Authority will have a final 30 days to review the plan.

(5) The plan is effective July 1, 2012.

(6) New plans must be submitted every four years if the sunset in the enabling legislation is removed by the Legislative Assembly.

History

Statutory/Other Authority: ORS 413.042
Statutes/Other Implemented: 2011 OL Ch. 418 & Sec. 13-19
MHS 3-2012, f. & cert. ef. 2-23-12
MHS 6-2011(Temp), f. 8-26-11, cert. ef. 9-1-11 thru 2-28-12

Division 15 MEDICAID PAYMENT FOR PSYCHIATRIC HOSPITAL INPATIENT SERVICES

Or. Admin. R. 309-015-0000 Purpose and Statutory Authority

(1) Purpose. These rules prescribe the eligibility criteria, methods, and standards for payments to psychiatric hospitals through the Division of Medical Assistance Programs, Oregon Health Authority. The rules apply to provision of psychiatric hospital inpatient services for persons eligible for medical assistance under the Basic Health Program (Section 1331 of the Affordable Care Act), which the Authority calls OHP Bridge – Basic Health Program, and Medicaid (Title XIX of the Social Security Act).

(2) Statutory Authority. These rules are authorized by ORS 413.042 and HB 4035 (2022) and carry out the provisions of ORS 414.025, 414.065, and 414.085 and Title XIX of the Social Security Act and 42 CFR 441, Subparts C and D and Section 1331 of the Affordable Care Act.

History

Statutory/Other Authority: ORS 413.042
Statutes/Other Implemented: ORS 414.025 & 414.065 & 414.241
BHS 12-2024, amend filed 05/29/2024, effective 06/01/2024
MHD 2-1994, f. & cert. ef. 2-24-94
MHD 12-1990, f. & cert. ef. 10-15-90
MHD 7-1987, f. & ef. 12-30-87
Reverted to MHD 21-1983, f. & ef. 12-5-83
MHD 12-1985(Temp), f. & ef. 7-1-85
MHD 21-1983, f. & ef. 12-5-83
MHD 17-1983(Temp), f. 9-30-83, ef. 10-1-83

Or. Admin. R. 309-015-0005 Definitions

(1) “Active Treatment” means implementation of a professionally developed and supervised plan of care that is in effect within 14 days of admission and designed to achieve the patient’s discharge at the earliest possible time. Custodial care is not active treatment.

(2) “Actual Costs” means all legitimate Medicaid expenditures. Since Oregon’s Addictions and Behavioral Health Division utilizes Medicare cost finding principles, actual costs must be the same as “Medicaid Allowable Costs” as defined in this rule.

(3) “Allowable Costs” means the costs applicable to the provision of psychiatric inpatient services as described in OAR 309-015-0050(3). They are derived using the Medicare cost finding principles located in the Medicare Provide Reimbursement Manual.

(4) “Annual Cost Report” means a financial report submitted to the Medicare/Medicaid Fiscal Intermediary by a hospital, on forms provided by the Fiscal Intermediary. This report details the actual revenues and expenses of the hospital during the latest fiscal period.

(5) “Base Year” means July 1, 1981 through June 30, 1982.

(6) “Basic Health Program” means Section 1331 of the Affordable Care Act, which the state calls “OHP Bridge – Basic Health Program.”

(7) “Disproportionate Share Adjusted Medicaid Rate” (DSR) means the weighted average Medicaid per diem rate (interim, year-end settlement or final settlement) for disproportionate share hospitals. This rate does not include the disproportionate share payment of uncompensated costs of participating hospital programs as provided in these rules.

(8) “Disproportionate Share Costs” means costs that are reimbursable under federal disproportionate share statutes and regulations. These costs are limited to costs of participating hospital programs which have not already been reimbursed by Medicare, Medicaid, insurance, or the patient’s own resources.

(9) “Disproportionate Share Hospital” means a psychiatric hospital which has a low-income utilization rate exceeding 25 percent as described in OAR 309-015-0035(5).

(10) “Disproportionate Share Payment” means the payment made quarterly to reimburse participating hospital programs for disproportionate share costs. This payment is subject to recalculation at the time of each year-end or final settlement payment.

(11) “Distinct Program” means a specialized inpatient psychiatric treatment program with unique admission standards approved by the Division. If a participating psychiatric hospital has a specialized program based upon patient age or medical condition, contains 50 or more beds, has a nursing staff specifically assigned to the program which has experience or training in working with the specialized population, and has record keeping systems adequate to separately account for expenditures and revenue to that program relative to the entire hospital, the Division may approve it as a distinct program.

(12) “Division” means the Addictions and Behavioral Health Division of the Oregon Health Authority.

(13) “Fiscal Intermediary” means:

(a) Blue Cross of Oregon for Medicare, Parts A and B; and

(b) Division for Medicaid services provided under the provisions of this rule;

(14) “Inpatient Psychiatric Services” means active treatment services provided under the direction of a licensed physician by a participating psychiatric hospital.

(15) “Interim Per Diem Rate” means the daily rate established with and paid to each provider for the agreement period during which reimbursable services are to be provided.

(16) “Low Income Utilization Rate” means the sum of the ratio of a hospital’s Medicaid revenues (plus governmental subsidies) to total revenue added to the ratio of a hospital’s proportion of charity care expenditures (less governmental subsidies) to total inpatient psychiatric services charges (as outlined in OAR 309-015-0035(5)).

(17) “Maximum Allowable Rate” means the statewide average per diem cost for services as derived in accordance with OAR 309-015-0020 and 309-015-0021.

(18) “Medicaid” means Title XIX of the Social Security Act.

(19) “Medicaid Allowable Costs” means that portion of total costs determined to be eligible for Medicaid reimbursement. Medicaid allowable costs are determined based on the amount of allowable cost for inpatient services by making the following calculations:

(a) For all providers, determine the reasonable cost of covered services furnished by multiplying the ratio of Medicaid patient days to total patient days by total allowable inpatient costs;

(b) For proprietary providers, determine the allowable return on equity capital invested and used for the provision of patient care by following the general rule outlined in 42 CFR 413.157(b);

(c) Adding the results of the calculations in subsections (a) and (b) of this section to establish the full Medicaid allowable cost.

(20) “Medicaid Intermediary” for the purpose of services provided under this rule, means the Assistant Administrator for Administrative Services, Addictions and Behavioral Health Division.

(21) “Medicaid Patient Days” means the accumulated total number of days, including therapeutic leave days, during which psychiatric inpatient services were provided to Medicaid eligible patients during a cost reporting period. The Fiscal Intermediary must determine the total number of Medicaid patient days on the basis of dates of service per patient by provider and fiscal period.

(22) “Medicaid Inpatient Utilization Rate” means the following fraction (expressed as a percentage) for a hospital:

(a) “Numerator”: The hospital’s number of inpatient days attributable to patients who (for such days) were eligible for Title XIX medical assistance under the state Medicaid plan and for whom the Division of Medical Assistance Programs made payment during the fiscal period;

(b) “Denominator”: The total number of the hospital’s inpatient days for the same period.

(23) “Medicare Market Basket Percentage Increase” means the annual allowable increase factor for a standard array of hospital services nationwide as published annually by the Health Care Financing Administration. The percentage is a component of the “Target Rate Percentage Increase” as defined in section (29) of this rule.

(24) “Non-Allowable Costs” means any costs excluded under the provisions of state and federal statutes, regulations, and administrative rules.

(25) “Participating Psychiatric Hospital” means those portions of a licensed psychiatric hospital certified to provide services to Medicaid patients.

(26) “Patient Eligibility” means persons eligible for medical assistance under Medicaid who meet the criteria for admission to psychiatric hospital inpatient services as defined in these rules and OAR 309-031-0200 through 309-031-0255.

(27) “Resident in the Hospital” means a patient who is in the facility at least 12 hours of each day, including the hours of sleep. The day of admission is exempt from this 12 hour rule; however, to be counted for residence purposes, the day of admission must extend through midnight (2,400 hours). The day of discharge is not counted.

(28) “Sanction” means:

(a) Termination of contract with the Division to provide psychiatric hospital services for Medicaid eligible patients;

(b) Suspension of contract with the Division to provide psychiatric hospital services for Medicaid eligible patients; or

(29) “Separate Cost Entity” means an entity of a hospital for which Medicare has approved the submission of a separate cost report.

(30) “Target Rate Percentage Increase” means the annual allowable increase factor applied to the previous year’s maximum allowable rate for psychiatric hospitals and hospital units excluded from the prospective payment system. This percentage includes the Medicare market basket percentage increase as a component and is published annually by the Health Care Financing Administration.

(31) “Therapeutic Leave Days” means a planned and medically authorized period of absence from the hospital not exceeding 72 hours in seven consecutive days.

(32) “Total Patient Days” means the accumulated total number of days, excluding non-Medicaid therapeutic leave days, during which psychiatric inpatient services were provided to patients during a cost reporting period. The fiscal intermediary must determine the total number of patient days on the basis of dates of service per patient by provider and fiscal period.

History

Statutory/Other Authority: ORS 413.042
Statutes/Other Implemented: ORS 414.025 & 414.065 & 414.241
BHS 12-2024, amend filed 05/29/2024, effective 06/01/2024
MHD 2-1994, f. & cert. ef. 2-24-94
MHD 12-1990, f. & cert. ef. 10-15-90
MHD 6-1989, f. & cert. ef. 11-17-89
MHD 7-1987, f. & ef. 12-30-87
MHD 21-1983, f. & ef. 12-5-83
MHD 17-1983(Temp), f. 9-30-83, ef. 10-1-83

Or. Admin. R. 309-015-0007 General Conditions of Eligibility and Treatment

In order for payment to be made by the Division, the following conditions must be met:

(1) Medicaid-eligible age. The patient must be eligible for Medicaid benefits, be aged 65 or over, aged 20 or under, or aged 21 and receiving services at the time of reaching age 21.

(2) Written plan of care. A professionally developed written plan of care for each patient will describe treatment objectives and prescribe an integrated program of appropriate therapy activities and experiences designed to improve the patient’s condition to the extent that inpatient care is no longer necessary.

(3) Unemancipated minor consultation. If the patient is under 18 years of age and not emancipated, the facility shall consult with the parent(s), legal guardian or others into whose care or custody the person will be released following discharge. The consultation shall be documented in the hospital records.

(4) Conformance with these rules. The Division has determined that admission and care of the patient who is eligible for Medicaid benefits is in accordance with these rules and regulations as evidenced by the hospital record.

(5) Service provider requirements. The service provider must meet all requirements for participation under OAR 309-015-0010.

History

Statutory/Other Authority: ORS 413.042
Statutes/Other Implemented: ORS 414.025 & 414.065
MHD 6-1989, f. & cert. ef. 11-17-89
MHD 7-1987, f. & ef. 12-30-87

Or. Admin. R. 309-015-0010 Conditions of Service Provider Participation

(1) Medicaid certification. A service provider must be certified by the responsible state or federal authority as meeting federal Medicaid certification requirements for psychiatric hospital inpatient services.

(2) Written agreement with the Division. A service provider must provide medically prescribed psychiatric hospital inpatient services to patients eligible for Medicaid benefits under terms of a written agreement with the Division. The agreement must assure that the psychiatric hospital and the services provided comply with all applicable state and federal requirements. No billing for Medicaid payment will be paid until a service provider has fully executed a written agreement with the Division.

(3) Legislative compliance. A service provider must be in compliance with:

(a) Title VI of the Civil Rights Act of 1964;

(b) Section 504 of the Rehabilitation Act of 1973;

(d) The Americans with Disabilities Act of 1990; and

(e) Any other applicable federal and state laws.

(4) Medicaid vendor number. A service provider must request a vendor number from the Division. No billing for Medicaid payment will be paid until a service provider has secured a Medicaid vendor number.

(5) Patient admission. A service provider must obtain approval for the admission of patients to the psychiatric hospital as required by Addictions and Mental Health Division’s OARs 309-031-0200 through 309-031-0255 (Admission and Discharge of Mentally Ill Persons).

(6) Clinical records. A service provider must maintain clinical records which are adequate to document the need for psychiatric hospital inpatient services, and the specific services provided, including mental health assessment, diagnosis, and treatment plans.

(7) Fiscal records. A service provider must maintain fiscal records in accordance with generally accepted accounting principles.

(8) Patient funds. A service provider must provide an accounting for any funds accepted from the patient for safekeeping. Such accounts will be available for inspection by personnel designated by the Division.

(9) Records review. A service provider must maintain the availability of financial and treatment records for review without notice by authorized personnel of the Medicaid Intermediary and of the United States Department of Health and Human Services during normal business hours at the location of its licensed psychiatric hospital.

(10) Reimbursement for services. A service provider must accept payment from the Division through the Division of Medical Assistance Programs as full and total reimbursement for the Medicaid services provided.

(11) Annual cost reports. A service provider must submit annually to the Division a Medicaid cost report accompanied by a copy of the provider’s Medicare cost report.

History

Statutory/Other Authority: ORS 413.042
Statutes/Other Implemented: ORS 414.025 & 414.065
MHD 12-1990, f. & cert. ef. 10-15-90
MHD 6-1989, f. & cert. ef. 11-17-89
MHD 7-1987, f. & ef. 12-30-87
MHD 21-1983, f. & ef. 12-5-83
MHD 17-1983(Temp), f. 9-30-83, ef. 10-1-83

Or. Admin. R. 309-015-0020 Establishing the Base Year and the Initial Maximum Allowable Rate

(1) Base year. In order to establish a base year rate, the Medicaid Intermediary used cost statements which overlapped the base period (July 1, 1981 through June 30, 1982) for all Oregon hospitals who were either:

(a) Licensed as psychiatric hospitals on the effective date of these rules (10-1-83) and in operation during the base period; or

(b) Were applicants for Joint Commission on Accreditation of Hospitals (JCAH) accreditation as a psychiatric hospital on the first effective date of these rules and had operated as a licensed hospital during the base period.

(2) Reporting period adjustments. If a psychiatric hospital’s cost report was for a period either longer or shorter than 12 months, the Medicaid allowable costs were reduced or increased, as appropriate, by multiplying the total allowable costs by the ratio that 12 months bore to the number of months in the hospital’s report period. This procedure resulted in a prorated 12-month cost projection for use in establishing the statewide average per diem rate for the base period.

(3) Inflation factor adjustments. If a psychiatric hospital had a fiscal period other than the base period, the hospital’s Medicaid allowable costs were adjusted by applying the relevant inflation factors from the Medicare market basket index so that the Medicaid costs corresponded to the base period. The inflation factors were applied to the interval between the mid-point of the hospital’s fiscal period and the mid-point of the base period. The number of Medicaid patient days in the hospital’s fiscal period were used as the number of days in the base period.

(4) Rate calculation. The total Medicaid allowable costs from all hospitals included in the base period divided by the total number of Medicaid patient days from all hospitals included in the base period yielded the statewide average per diem cost (maximum allowable rate) for the base period.

History

Statutory/Other Authority: ORS 413.042
Statutes/Other Implemented: ORS 414.025 & 414.065
MHD 6-1989, f. & cert. ef. 11-17-89
MHD 21-1983, f. & ef. 12-5-83
MHD 17-1983(Temp), f. 9-30-83, ef. 10-1-83

Or. Admin. R. 309-015-0021 Establishing the Maximum Allowable Rate for Years Following the Base Period

(1) Base rate usage. The statewide average per diem cost for the base period has been used as the fixed base for determining the maximum allowable reimbursement rate for all fiscal periods following the base period.

(2) Subsequent period rate calculations. The maximum allowable reimbursement rate for each new fiscal period affected by these rules is now calculated by inflating the maximum allowable reimbursement rate for the previous period by the annual Health Care Financing Administration target percentages for PPS — excluded hospitals (as published in the Federal Register). This percentage increase is applied from the mid-point of the previous period to the mid-point of the 12-month period for which the rate is being established.

(3) Hospitals with other fiscal periods. When a psychiatric hospital has a fiscal period other than that used by the State of Oregon, July 1 through June 30, the applicable maximum allowable rate for each month will be the same as the maximum allowable rate in effect that month for hospitals operating under the state fiscal period.

History

Statutory/Other Authority: ORS 413.042
Statutes/Other Implemented: ORS 414.025 & 414.065
MHD 12-1990, f. & cert. ef. 10-15-90
MHD 6-1989, f. & cert. ef. 11-17-89

Or. Admin. R. 309-015-0023 Interim Rate Setting

Rate establishment process. At least annually, the Medicaid intermediary will establish an interim Medicaid per diem rate for each participating psychiatric hospital, separate cost entity or distinct program within a hospital:

(1) A hospital may request an interim per diem rate or rates. If a review of the hospital’s prior year Medicaid cost report (adjusted for inflation, changes in patient populations and programs and other relevant factors) does not justify the requested rate(s), the Medicaid Intermediary may establish different interim rate(s):

(a) Actual expenditures for the most recent fiscal period available will be used to determine salary and wage and total expense distribution for each cost center included in the total expenditures. Any other directly relevant event, such as facility restructuring, will be considered as well;

(b) The Division will apply the proportions from subsection (a) of this section to total anticipated expenditures for the new period to determine salary and wage expense distribution for each cost center during the new period;

(c) The Division will establish and apply capital allowances and other adjustments to total anticipated expenditures for the new period from subsection (b) of this section;

(d) If the hospital has separate cost entities or distinct programs, the hospital will provide estimates to the Division of a weighted average interim rate. The average will be developed by multiplying each proposed interim rate by estimated Medicaid patient days for that rate, summing all of the products, and dividing that sum by the total annual estimated Medicaid patient days for the hospital;

(e) The interim or weighted average interim per diem rate may not exceed the maximum allowable rate unless the hospital meets the criteria for reimbursement above the maximum allowable rate as a disproportionate share hospital (see OAR 309-015-0035(5)). In that case, the interim or average interim Disproportionate Share adjusted Medicaid Rate (DSR) may include estimated costs up to 135 percent of the maximum allowable Medicaid rate except for hospitals meeting criteria set forth in the following paragraph;

(f) If a psychiatric hospital has a low-income rate of 60 percent and also receives 60 percent or more of its service revenue from any combination of the following:

(A) Public funds, excluding Medicare and Medicaid;

(B) Bad debts; or

(g) The hospital qualifies to receive disproportionate share payment at a rate based on 100 percent of the costs of uncompensated care during the facility’s previous fiscal year, subject to a disproportionate share allotment established for Oregon by the Health Care Financing Administration;

(h) The Division will base quarterly disproportionate share reimbursements on the estimated costs for each facility during the current fiscal year and will review and adjust the reimbursements, after conclusion of the fiscal period, to correspond with actual costs encountered during the period. Total reimbursement from disproportionate share and other sources will not exceed actual costs.

(2) If a hospital does not request an interim rate, the Medicaid Intermediary will establish an interim rate based on the hospital’s prior year cost report using the same factors listed in section (1) of this rule.

History

Statutory/Other Authority: ORS 413.042
Statutes/Other Implemented: ORS 414.025 & 414.065
MHD 2-1994, f. & cert. ef. 2-24-94
MHD 12-1990, f. & cert. ef. 10-15-90
MHD 6-1989, f. & cert. ef. 11-17-89
MHD 7-1987, f. & ef. 12-30-87, Renumbered from 309-015-0015
Reverted to MHD 21-1983, f. & ef. 12-5-83
MHD 12-1985(Temp), f. & ef. 7-1-85
MHD 21-1983, f. & ef. 12-5-83
MHD 17-1983(Temp), f. 9-30-83, ef. 10-1-83

Or. Admin. R. 309-015-0025 Retrospective Settlement Rate Setting (Year End and Final)

(1) Year-end settlement process. The year-end settlement process will be as follows:

(a) Upon receipt of an audited Medicaid cost report from the Supervisor of the Division Audit Section, the Revenue and Rates Manager of the Institutional Revenue Section will determine a retrospective year-end settlement rate for each participating hospital, separate cost entity or distinct program within a hospital on the basis of Division review of actual allowable Medicaid costs reported in the hospital’s cost statement for the previous year;

(b) The year-end settlement rate for a non-disproportionate share hospital will be calculated by using the following procedure:

(A) Divide the applicable Title XIX allowable costs for each participating hospital, separate cost entity, or distinct program by the applicable number of Title XIX patient days, including therapeutic leave days;

(B) If the hospital has more than one distinct program, divide the applicable Medicaid allowable costs by the applicable number of Medicaid patient days, including therapeutic leave days for each program. Then determine the weighted average Medicaid settlement rate for the entire hospital. This is accomplished by multiplying each proposed year-end settlement rate by Medicaid patient days for that rate, adding the products together, and dividing the resulting sum by total Medicaid patient days for the hospital;

(C) If the year-end Medicaid settlement rate or the average year-end Medicaid settlement rate from above is less than the maximum allowable Medicaid rate for psychiatric hospitals during the current fiscal year, use the lower rate;

(D) If the year-end Medicaid settlement rate or the average year-end settlement rate from above exceeds the maximum allowable rate established for psychiatric hospitals during the current fiscal year, use the maximum allowable rate as the retrospective year-end settlement rate for the hospital.

(c) The year-end settlement rate may exceed the maximum allowable rate if the Division determines the hospital meets the criteria listed in OAR 309-015-0035(5) as a disproportionate share hospital;

(d) In that case, the disproportionate share adjusted year-end settlement rate will be calculated as follows:

(A) Actual costs up to 135 percent of the maximum allowable rate; or

(B) Actual costs up to 100 percent of the cost of uncompensated care during the facility’s previous fiscal year, subject to a disproportionate share allotment established yearly by the Health Care Financing Administration, if the psychiatric hospital has a low-income rate of 60 percent and also receives 60 percent or more of its service revenue from any combination of the following:

(i) Public funds, excluding Medicare and Medicaid;

(ii) Bad debts; or

(iii) Free care.

(e) The year-end settlement will be determined by multiplying the settlement “rate” calculated above by the total number of Medicaid patient days, including therapeutic leave days or, for disproportionate share hospitals, multiplying the disproportionate share adjusted rate by the total number of Medicaid patient days, including therapeutic leave days. The result will be compared to the amount of reimbursement paid to the hospital during the fiscal period. If the result favors the hospital, the Division will pay the difference to the hospital. If the result favors the Division, the hospital will pay the difference to the Division. In either case, payments shall be made within 30 days approval of the year-end Medicaid cost report by the Medicaid Intermediary.

(2) Final settlement process. The final settlement process will be as follows:

(a) Upon receipt of the final Medicare Cost Report from the Medicare Intermediary, the hospital provider will prepare the final Medicaid cost report. The Medicaid report will reflect all relevant adjustments made to the Medicare cost report;

(b) Using the final Medicaid cost report developed in subsection (a) of this section, the Division will calculate the final settlement rate and settlement for each participating hospital, separate cost entity or distinct program within a hospital, following the steps outlined in subsections (1)(a) through (d) of this rule.

(3) Upon completion of each settlement, both year-end and final, the Division will review the disproportionate share costs and make any necessary adjustments to quarterly disproportionate share payments. The Division will review all factors relevant to the disproportionate share payments, including actual costs of services, amounts already paid and charges reimbursed from other sources during the time period included in the Medicaid cost settlement.

History

Statutory/Other Authority: ORS 413.042
Statutes/Other Implemented: ORS 414.025 & 414.065
MHD 2-1994, f. & cert. ef. 2-24-94
MHD 12-1990, f. & cert. ef. 10-15-90
MHD 6-1989, f. & cert. ef. 11-17-89
MHD 7-1987, f. & ef. 12-30-87
MHD 21-1983, f. & ef. 12-5-83
MHD 17-1983(Temp), f. 9-30-83, ef. 10-1-83

Or. Admin. R. 309-015-0030 Billing Requirements

(1) Bill submission time limits. Bills shall be submitted to the Division through the Division of Medical Assistance Programs, on forms designated by the Medicaid Intermediary, as soon as possible after the date service is rendered. Payment shall not be made for services which were provided more than 12 months prior to presentation of the claim unless the hospital shows that the delay was caused by factors outside its control.

(2) Billing charge limits. Billings to the Division shall in no case exceed the customary charges to private patients for any like item or service charged by the hospital.

(3) Customary charge criteria. In determining the customary charges to a private patient for use in billings or calculating interim or settlement rates, the following criteria will be applied:

(a) The private patient billing rate must be for items and services comparable to the items and services included in the rate for Medicaid services;

(b) When private patient rates are based on the number of beds in a room, the Medicaid intermediary considers the lowest room charge as the usual and customary charge for services;

(c) When ancillary charges are made to private patients in addition to a basic charge, the Medicaid Intermediary considers the usual and customary charge to be the lowest basic room charge plus the average ancillary charge for those items included in the Medicaid rate. The average ancillary charge is determined by dividing the ancillary costs by the number of patient days; or

(d) Where charges are based on the classification of the patient (i.e., Medicare, Medicaid and Private), the Medicaid Intermediary considers the usual and customary charge to be the rate for private patients exclusive of ancillary charges.

(4) Payment restrictions. Payment will be made only for those days a patient is actually in residence at the hospital in active treatment or when a patient is on therapeutic leave.

(5) Payment credit. Any payment received by the hospital prior to the submission of an invoice to the Division of Medical Assistance Programs shall be indicated as a credit on the invoice.

(6) Post-payment receipt of funds. Any payments to the provider from any source subsequent to payment by the Division of Medical Assistance Programs shall be reported to that Division on an adjustment form specified by the Division of Medical Assistance Programs, giving full particulars. Failure to report such payments will be considered concealment of material facts and is grounds for recovery and/or sanction (see OAR 309-015-0052).

History

Statutory/Other Authority: ORS 413.042
Statutes/Other Implemented: ORS 414.025 & 414.065
MHD 2-1994, f. & cert. ef. 2-24-94
MHD 12-1990, f. & cert. ef. 10-15-90
MHD 6-1989, f. & cert. ef. 11-17-89
MHD 7-1987, f. & ef. 12-30-87
MHD 21-1983, f. & ef. 12-5-83
MHD 17-1983(Temp), f. 9-30-83, ef. 10-1-83

Or. Admin. R. 309-015-0035 Payments

(1) Timing. Payments to providers will be made following the month of service, based on the invoice submitted by the provider to the Division of Medical Assistance Programs.

(2) Eligible services. Payments will be made for the provision of active psychiatric inpatient treatment services for persons eligible for such services under Medicaid.

(3) Non-eligible services. If review of a psychiatric hospital’s Medicaid patient records by a Professional Standards Review Organization reveals that a patient received an inappropriate level of care, (i.e., less than active treatment), payment will not be allowed under these rules. Any payments to the provider for patients receiving an inappropriate level of care shall be recovered by the Division. Such payments shall be reported to the Division of Medical Assistance Programs on an adjustment form specified by the Division of Medical Assistance Programs. Failure to report such payments will be considered concealment of material facts and is grounds for sanction (see OAR 309-015-0052).

(4) Payment to non-disproportionate share hospitals. The Division shall not pay more in total for psychiatric hospital inpatient services for hospitals which do not serve a disproportionate number of low-income patients with special needs than would be paid under the Medicare principles of reimbursement.

(5) Payment to disproportionate share hospitals. A participating psychiatric hospital may be reimbursed for allowable costs in excess of the maximum rate if it meets the following criteria as described in Section 1923(b)(3) of the Social Security Act: The hospital serves disproportionate numbers of low-income persons; i.e., has a low income utilization rate which exceeds 25 percent using the following formula:

(a) The total Medicaid in-patient revenues paid to the hospital, plus the amount of the cash subsidies received as payment for inpatient services directly from state and local governments in a cost reporting period, divided by the total amount of revenues of the hospital for in-patient psychiatric services (including the amount of such cash subsidies) in the same cost reporting period. The percentage derived in paragraph (a) of this subsection shall be added to the following percentage;

(b) The total amount of the hospital’s charges for in-patient psychiatric services attributable to charity care (care provided to individuals who have no source of payment, third-party or personal resources) in a cost reporting period, less the portion of any cash subsidies for in-patient services received directly from state and local governments described in paragraph (A) of this subsection in the period attributable to in-patient hospital services, divided by the total amount of the hospital’s charges for in-patient psychiatric services in the hospital in the same period. The total in-patient charges attributed to charity care shall not include contractual allowances and discounts (other than for indigent patients not eligible for Medical Assistance under an approved Medicaid State Plan);

(c) The sum of percentages derived in paragraphs (a) and (b) of this subsection shall exceed 25 percent in order to qualify as a disproportionate share hospital; and

(d) The hospital is efficiently and economically operated and is in compliance with treatment and program standards for psychiatric inpatient services as required by the state and federal statutes and regulations.

History

Statutory/Other Authority: ORS 413.042
Statutes/Other Implemented: ORS 414.025 & 414.065
MHD 2-1994, f. & cert. ef. 2-24-94
MHD 12-1990, f. & cert. ef. 10-15-90
MHD 6-1989, f. & cert. ef. 11-17-89
MHD 7-1987, f. & ef. 12-30-87
MHD 21-1983, f. & ef. 12-5-83
MHD 17-1983(Temp), f. 9-30-83, ef. 10-1-83

Or. Admin. R. 309-015-0040 Accounting and Record Keeping

(1) Records retention. The provider shall maintain, for a period of not less than three years following the date of submission of the annual Medicaid cost report to the Medicaid Intermediary, financial and statistical records of the period covered by such statement which are accurate and in sufficient detail to substantiate the cost data reported. If there are audit issues, the records shall be maintained for three years after the final audit settlement. The records shall be maintained in a condition that can be audited for compliance with generally accepted accounting principles and provisions of these rules. Failure to maintain records in such condition shall result in disallowance of costs.

(2) Documentation of allowable costs. Expenses reported as allowable costs must be adequately documented in the financial records of the provider or they shall be disallowed.

History

Statutory/Other Authority: ORS 413.042
Statutes/Other Implemented: ORS 414.025 & 414.065
MHD 6-1989, f. & cert. ef. 11-17-89
MHD 7-1987, f. & ef. 12-30-87
MHD 21-1983, f. & ef. 12-5-83
MHD 17-1983(Temp), f. 9-30-83, ef. 10-1-83

Or. Admin. R. 309-015-0045 Filing of Annual Medicaid Cost Report

(1) Timing of report. The provider shall file annually with the Medicaid Intermediary, an annual Medicaid cost report covering actual costs based on the latest fiscal period of operation of the facility. If the provider has separate cost entities or distinct programs, an annual Medicaid cost report shall be filed for each entity. A Medicaid cost report will be filed for less than an annual period only when necessitated by facilities terminating their agreement with the Division, or by a change in ownership, or by a change in fiscal period. The provider is to use the same fiscal period for the Medicaid cost report as that used for the Medicare cost report and the federal tax return. The Medicaid cost report is due within 90 days of the end of the normal fiscal period, change of ownership, or withdrawal from the program except when Medicare grants an extension of the Medicare cost report (upon which the Medicaid cost report relies). In that case, the due date for the Medicaid cost report may be extended by the Medicaid Intermediary for the same number of days as the due date for the Medicare cost report.

(2) Contents of report. The annual Medicaid cost report is a uniform cost report containing an itemized list of allowable costs to be used by all providers. It shall report the hospital’s actual financial data and be completed in accordance with instructions provided by the Medicaid intermediary.

(3) Application of Medicare principles of reimbursement. Providers filing annual Medicaid cost reports with the Medicaid Intermediary shall apply Medicare principles of reimbursement.

(4) Signature. Each required annual Medicaid cost report shall be signed by the individual who normally signs the provider’s federal income tax return or other reports. If the report is prepared by someone other than an employee of the provider, the individual preparing the report shall also sign and indicate his or her status with the provider.

(5) Improperly completed reports. The Medicaid Intermediary shall return improperly completed or incomplete annual Medicaid cost reports to the provider for proper completion. All providers shall return corrected or completed reports to the Division within 30 days or become subject to the same penalty as for failure to submit the cost statement.

(6) Reduction of interim per diem rate — Late reports. If the original submission of the Medicaid cost report is not made within the required 90-day time period or extended period (see section (1) of this rule), the interim per diem rate then in effect will be reduced to 80 percent of the hospital’s current interim per diem rate or the rate established from the last audited or desk reviewed cost statement, whichever is lower. This rate will remain in effect until submission of the Medicaid cost report.

(7) Late-billed services. If a hospital bills for services provided during a fiscal period for which the hospital has submitted an annual Medicaid cost report, the days which are late-billed may be included in the hospital’s next fiscal period.

(8) False reports. If a provider knowingly, or with reason to know, files a report containing false information, such action constitutes cause for termination of its agreement with the Division. Providers filing false reports may be referred for prosecution under applicable statutes (see OAR 309-015-0052).

(9) Maintenance of report. The Medicaid Intermediary shall maintain each required annual Medicaid cost report submitted by a provider for three years following the date of submission. In the event there are audit questions, the cost statement shall be maintained for three years after the final audit settlement.

History

Statutory/Other Authority: ORS 413.042
Statutes/Other Implemented: ORS 414.025 & 414.065
MHD 6-1989, f. & cert. ef. 11-17-89
MHD 7-1987, f. & ef. 12-30-87
MHD 21-1983, f. & ef. 12-5-83
MHD 17-1983(Temp), f. 9-30-83, ef. 10-1-83

Or. Admin. R. 309-015-0050 Auditing

(1) Desk review of annual Medicaid cost report. The Medicaid intermediary will analyze by desk review each annual Medicaid cost report after it has been properly completed and filed.

(2) Scope of desk review. The scope of the desk review will verify, to the extent possible:

(a) That the provider has properly included its allowable costs on the annual Medicaid cost report on the basis of generally accepted accounting principles and the provisions of these rules;

(b) That the provider has properly applied the cost finding method specified by the Medicaid Intermediary to its allowable costs determined in subsection (a) of this section; and

(c) Whether or not the analysis indicates that further auditing of the provider’s financial and statistical records is needed.

(3) Allowable costs. The costs considered allowable may include part or all of the following (worksheet form numbers are correct as of the effective date of this rule):

(a) The costs stated as final values on Worksheet B, HCFA-2552, Cost Allocation for General Services Costs;

(b) Physician costs as determined by completing Worksheet A-8-2, HCFA-2552;

(4) Ownership changes. Payments to providers shall not be increased, solely as a result of a change of ownership, in excess of the increase which would result from applying Section 1861(v)(1)(O) of the Social Security Act as applied to owners of record on or after July 18, 1984.

(5) Field audit. All filed annual Medicaid cost reports are subject to a field audit.

(6) Scope of field audit. The scope of the field audit will, at a minimum, be sufficiently comprehensive to verify that in all material respects:

(a) Generally accepted accounting principles and the provisions of these rules have been adhered to;

(b) Reported data is in agreement with supporting records; and

History

Statutory/Other Authority: ORS 413.042
Statutes/Other Implemented: ORS 414.025 & 414.065
MHD 2-1994, f. & cert. ef. 2-24-94
MHD 6-1989, f. & cert. ef. 11-17-89
MHD 7-1987, f. & ef. 12-30-87
MHD 3-1985, f. & ef. 2-25-85
MHD 10-1984(Temp), f. & ef. 12-21-84
MHD 21-1983, f. & ef. 12-5-83
MHD 17-1983(Temp), f. 9-30-83, ef. 10-1-83

Or. Admin. R. 309-015-0052 Provider Sanctions

(1) Basis for sanctioning. The Division will follow the Division of Medical Assistance Program rules OAR 410-120-0000 through 410-120-1980 and Section 1902 of the Social Security Act for provider sanctions. The basis for sanctioning will include:

(a) Criminal convictions;

(b) Exclusion, by the Secretary of Health and Human Services, from participation in the Medicare program;

(c) Not meeting the federal regulatory requirements for services in an institution for mental diseases or a psychiatric hospital as set forth at 42 CFR 435.1009 and 42 CFR 441, Subparts C and D;

(d) Having deficiencies which immediately jeopardize, or may jeopardize, the health and safety of patients;

(e) Abuse and misutilization, as described in OAR 410-120-0000 through 410-120-1980;

(f) Termination:

(A) From another governmental health/medical program;

(B) For failure to repay identified overpayments; or

(2) Sanctions. The following sanctions may be imposed on a provider by the Division, based on grounds specified in this rule and may include:

(a) Termination from participation in Oregon’s Medical Assistance Program and possible initiation of appropriate civil or criminal proceedings;

(b) Suspension from participation in Oregon’s Medicaid Assistance Program;

(d) Required attendance at provider education sessions.

(3) Notice to providers. The Division will notify a deficient provider of action the Division plans to take at least 15 days prior to commencement of the action; the notification will include an explanation of the provider’s right to appeal the proposed action (see OAR 309-015-0055).

History

Statutory/Other Authority: ORS 413.042
Statutes/Other Implemented: ORS 414.025 & 414.065
MHD 2-1994, f. & cert. ef. 2-24-94
MHD 12-1990, f. & cert. ef. 10-15-90
MHD 6-1989, f. & cert. ef. 11-17-89

Or. Admin. R. 309-015-0055 Appeals

(1) Rate appeals. A letter will be sent notifying the provider of the interim per diem rate, the year-end settlement rate, or the final settlement rate. A provider shall notify the Division in writing within 15 days of receipt of the letter if the provider wishes to appeal the rate. Letters of appeal must be postmarked within the 15-day limit and addressed to the Assistant Administrator, Administrative Services (the Medicaid Intermediary).

(2) The Medicaid Intermediary will forward all rate appeals to the Manager of the Division’s Audit Section for initial consideration. If no resolution is forthcoming, the provider will be given an opportunity for administrative review or a contested case hearing as outlined in OAR 410-120-1400 through 410-120-1600, except that final orders shall be issued by the Administrator of the Division.

(3) Monetary recovery, sanctions, or other appeals. A provider may appeal the Division’s proposed action by letter within the same 15-day period as allowed for rate appeals above; address the letter to the Assistant Administrator, Administrative Services (the Medicaid Intermediary).

History

Statutory/Other Authority: ORS 413.042
Statutes/Other Implemented: ORS 414.025 & 414.065
MHD 2-1994, f. & cert. ef. 2-24-94
MHD 12-1990, f. & cert. ef. 10-15-90
MHD 6-1989, f. & cert. ef. 11-17-89
MHD 7-1987, f. & ef. 12-30-87
MHD 21-1983, f. & ef. 12-5-83
MHD 17-1983(Temp), f. 9-30-83, ef. 10-1-83

Or. Admin. R. 309-015-0060 Emergency Services in Non-Participating Hospitals

Reimbursable services. Emergency services provided in licensed psychiatric hospitals not participating in Medicaid will be reimbursed if the Division determines they meet federal requirements for Medicare reimbursement of emergency services as outlined in Subpart G, Part 424 of the Medicare regulations.

History

Statutory/Other Authority: ORS 413.042
Statutes/Other Implemented: ORS 414.025 & 414.065
MHD 2-1994, f. & cert. ef. 2-24-94
MHD 6-1989, f. & cert. ef. 11-17-89
MHD 7-1987, f. & ef. 12-30-87

Division 18 RESIDENTIAL SUBSTANCE USE DISORDERS AND PROBLEM GAMBLING TREATMENT AND RECOVERY SERVICES

Or. Admin. R. 309-018-0100 Purpose and Scope

(1) Purpose: These rules prescribe minimum standards for services and supports provided by addictions and mental health providers approved by the Health Systems Division of the Oregon Health Authority.

(2) Scope: In addition to applicable requirements in OAR 410-120-0000 through 410-120-1980 and 943-120-0000 through 943-120-1550, these rules specify standards for services and supports provided in:

(a) Residential Substance Use Disorders Treatment and Recovery Services; and

(b) Residential Problem Gambling Treatment and Recovery Services.

History

Statutory/Other Authority: ORS 161.390, 413.042, 430.256, 428.205 - 428.270, 430.640 & 443.450
Statutes/Other Implemented: ORS 109.675, 179.505, 413.520 - 413.522, 430.010, 430.205 - 430.210, 430.254 - 430.640, 430.850 - 430.955, 443.400 - 443.460, 443.991, 461.549, 743A.168, 813.010 - 813.055 & 813.200 - 813.270
MHS 17-2016, f. 11-28-16, cert. ef. 11-30-16
MHS 10-2016(Temp), f. 6-29-16, cert. ef. 7-1-16 thru 12-27-16
MHS 3-2014, f. & cert. ef. 2-3-14
MHS 10-2013(Temp), f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14

Or. Admin. R. 309-018-0105 Definitions

(1) “Abuse of an Adult” means the circumstances defined in ORS 430.735 and OAR Chapter 407, Division 45 for abuse of an adult with mental illness or who is receiving residential substance use disorder treatment or withdrawal management services.

(2) “Abuse of a Child” means the circumstances defined in ORS 419B.005 and ORS 418.257

(3) “Active Supervision” means a designated supervisor is physically present who provides direct or indirect observation of the program staff, to determine if the service or task is being completed properly and providing intervention and consultation as needed.

(4) “Activities of Daily Living or Instrumental Activities of Daily Living (IADL)” means those personal functional activities required by an individual for continued well-being, which are essential for health and safety. Activities include eating, dressing, and grooming, bathing and personal hygiene, mobility, elimination, and cognition.

(5) “Admission” means the act or process of enrollment into services as regulated by Chapter 309 Division 18 rules.

(6) “Adolescent” means an individual from 12 through 21 years of age or those individuals who are determined to be developmentally appropriate for such services.

(7) "Adult" means an individual 18 years of age or older or an emancipated minor. An individual with Medicaid eligibility, who is in need of services specific to children, adolescents, or young adults in transition, shall be considered a child until age 21 for the purposes of these rules. Adults who are between the ages of 18 and 21, who are considered children for purposes of these rules, shall have all rights afforded to adults as specified in these rules.

(8) "The ASAM Criteria " means the criteria in the Third edition of The American Society of Addiction Medicine (ASAM) for the assessment, level of care placement and treatment of addictive, substance-related, and co-occurring conditions. The ASAM Criteria is a clinical guide to developing patient-centered service plans and making objective decisions about admission, continuing care, and transfer or discharge for individuals. The ASAM Criteria is incorporated by reference in these rules.

(9) “ASAM Dimensional Admission Criteria” means the specifications described in the ASAM Criteria for determining that an individual is appropriately admitted to a program based on six ASAM assessment dimensions. The criteria, dimensions and number of dimensions indicated differs per level of care and is described within The ASAM Criteria, Third Edition.

(10) “ASAM Level of Care” means one of several discrete intensities of services and supports, as described within The ASAM Criteria, Third Edition, within a substance use disorders program that are delivered in a structured, programmatic fashion, by a Division certified outpatient or licensed residential provider.

(11) “ASAM Level of Care 3.1” Clinically Managed Low-Intensity Residential Substance Use Disorder Services means a licensed residential setting as described in The ASAM Criteria, Third Edition with 24-hour structure and support that offers at least 5 hours per week of low-intensity substance use treatment services. Services and supports are designed to facilitate the uptake of recovery skills, relapse prevention, and emotional coping skills. Services and the milieu support individuals in addressing reintegration into family, work, education and other pro-social activities and communities. Programs facilitate reintegration and transition to lower levels of care.

(12) “ASAM Level of Care 3.3” Clinically Managed Population-Specific High-Intensity Substance Use Disorder Residential Services means a licensed residential setting as described in The ASAM Criteria, Third Edition with a 24-hour, structured recovery environment and high-intensity substance use treatment services and supports that meet the functional limitations of the individuals. The functional limitations appropriate for placement in this level of care are primarily cognitive and can be either temporary or permanent. When nursing supervision adequate to the identified needs is available, individuals who also have medical conditions may be placed in this level of care.

(13) “ASAM Level of Care 3.5” Clinically Managed High-Intensity Substance Use Disorder Residential Services means a 24-hour supportive living environment with a habilitative focus with a reliance on the treatment community. Severe substance use and social or emotional limitation(s) are treated in this level of care, where an emphasis on targeted interventions reduces the risk of relapse, reinforces prosocial behaviors, assists with integration into a health community, and offers basic life skills training. Duration at this level of care is marked by the acquisition of coping and relapse prevention skills so that relapse is no longer imminently dangerous. Individuals admitted to this level of care meet the DSM-5-TR criteria for moderate or severe substance use disorder(s) and may have co-occurring mental health disorder(s) meeting DSM-5-TR criteria or experience difficulties with mood, behavior or cognition that are problematic but do not meet diagnostic criteria.

(14) “ASAM Level of Care 3.7” Medically Monitored Intensive Substance Use Disorder Inpatient Services, means a planned and structured program of 24-hour, professionally directed evaluation, observation, medical monitoring and substance use treatment. Individuals admitted to this level of care have subacute biomedical and emotional or cognitive conditions that are severe enough to need a residential setting but not need medically managed inpatient services. This level of care addresses the needs of individuals who have functional limitations in Dimensions 1, 2 and 3. Services are delivered by an interdisciplinary staff that are appropriately credentialed. See also, “Bio-medical Enhanced ASAM Level of Care 3.7” and “Co-Occurring Enhanced ASAM Level of Care 3.7”

(15) “ASAM Level of Care Determination” means documentation in the service record that justifies the change in a Level of Care placement, whether the placement is more intensive or less intensive, completed in a multidimensional format that captures what has changed for the individual and resulted in the change in placement. It is the result of an evaluation of the level of care rating for each dimension, the interactions of each dimension, and the individual’s preferred level of care. These are used together to inform the determination of overall level of care assessment and placement decisions, with a rationale for any discrepancy.

(16) “Assessment” means the process of obtaining sufficient information through a face-to-face interview to determine a diagnosis and to plan individualized services and supports. For residential substance use disorder treatment programs, the assessment is multidimensional and consistent with The ASAM Criteria third edition

(17) “Authority” means the Oregon Health Authority.

(18) “Baseline evaluation” means an identification of the current status that an individual expresses a desire to change in order to identify the starting point(s) for measuring progress by using pre-determined benchmarks, such as a Likert Scale. Progress can then be determined by using the same benchmarks to obtain additional ratings of the identified status, and using the additional ratings to make comparisons between the starting rating and subsequent ratings, from which a measure of change can be assessed.

(19) “Behavioral Health Clinician” means a practitioner of behavioral health services whose authorized scope of practice includes substance use and mental health diagnosis and treatment.

(20) “Behavioral Health Treatment” means treatment for mental health, substance use disorders, and problem gambling.

(21) “Bio-medical Enhanced ASAM Level of Care 3.1” means ASAM Level of Care 3.1 Clinically Managed Low-Intensity Residential Substance Use Disorder Services programs that also offers onsite or closely facilitates off-site the medical services needed to assess and treat co-occurring bio-medical conditions, and the intensity of on-site nursing care meets each individual’s identified needs.

(22) “Bio-medical Enhanced ASAM Level of Care 3.3” means, in addition to the definition of ASAM Level of Care 3.3 Clinically Managed Population-Specific High-Intensity Substance Use Disorder Residential Services, medical services are rendered by medical staff working within their scope and staffed in a manner that meets the identified needs.

(23) “Bio-medical Enhanced ASAM Level of Care 3.5” means, in addition to the definition of ASAM Level of Care 3.5 Clinically Managed High-Intensity Substance Use Disorder Residential Services these programs offer medical services that are rendered by medical staff working within their scope, and the medical services are staffed in a manner such that the medical oversight and treatment meet the identified needs.

(24) “Bio-medical Enhanced ASAM Level of Care 3.7” means in addition to the definition of ASAM Level of Care these programs offer medical services that are rendered by medical staff working within their scope, and the medical services are staffed in a manner such that the medical oversight and treatment meet the identified needs.

(25) “Brief Intervention” means an early intervention for individuals using substances, by utilizing tribal-based, evidence-based, or culturally based practice designed to engage and motivate individuals at risk of substance use disorder and related health problems to seek services and/or support. Brief interventions can also be used to encourage those with more serious dependence or disorders to accept more intensive treatment. Brief interventions are intended to address problematic or risky substance use that presents with or without a previous diagnosis.

(26) “Care Coordination” means a process-oriented activity to facilitate ongoing communication and collaboration to meet multiple needs. Care coordination includes facilitating communication between the person or family served, natural supports, community resources, and involved providers and agencies; organizing, facilitating, and participating in team meetings; and providing for continuity of care by creating linkages to and managing transitions between levels of care and transitions for young adults in transition to adult services.

(27) "Case Management" or “Targeted Case Management” means the services provided to assist individuals who reside in a community setting or are transitioning to a community setting in gaining access to desired medical, social, educational, entitlement, and other applicable services.

(28) “Certificate” means the document or documents issued by the Division, which identifies and declares certification of a provider pursuant to OAR 309-008-0100 to 309-008-1600. A letter accompanying issuance of the certificate shall detail the scope and approved service delivery locations of the certificate.

(29) "Child" means an individual under the age of 18. An individual with Medicaid eligibility, who is in need of services specific to children, adolescents, or young adults in transition, shall be considered a child until age 21 for purposes of these rules.

(30) "Clinical Supervision" means oversight by a qualified clinical supervisor of the rendering of physical health, substance use, problem gambling, and mental health services and supports, according to these rules, including ongoing evaluation and improvement of the effectiveness of those services and supports.

(31) "Clinical Supervisor" means program staff qualified to oversee and evaluate the rendering of physical health, substance use, problem gambling, or mental health services and supports.

(32) "Community Mental Health Program (CMHP)" means the organization of various services for individuals with a mental health diagnosis or addictive disorders operated by or contractually affiliated with a local mental health authority and operated in a specific geographic area of the state under an agreement with the Division an entity that is responsible for planning and delivery of safety net services for persons with mental or emotional disturbances, drug abuse problems, and alcoholism and alcohol abuse in a specific geographic area of the state under a contract with the Division or a local mental health authority and pursuant to OAR 309-014.

(33) "Cognition" refers to how the individual is able to use information, make decisions, and ensure their daily needs are met. There are four components to cognition: self-preservation, decision-making, ability to make one’s self understood, and unsafe behaviors.

(34) “Cognitive Ability” means a general mental capability involving reasoning, problem solving, planning, abstract thinking, complex idea comprehension and learning from experience.

(35) “Cognitive Impairment” means a behavioral health condition or disability which impacts the individual’s cognitive abilities to perform Activities of Daily Living (ADL) or Instrumental Activities of Daily Living (IADL), regardless of whether the individual may be physically capable of performing ADLs or IADLs. For example, a cognitive impairment could prevent an individual from knowing when or how to carry out the task.

(36) Collaborative Educational Agreement” means an individualized written arrangement between an accredited college or university and a Division-certified provider pertaining to a student’s internship or field placement experience.

(37) “Consistent with ASAM Criteria” means containing information that demonstrates use of and adherence to the description of components contained within The ASAM Criteria, Third Edition.

(38) “Co-Occurring Enhanced ASAM Level of Care 3.1” means ASAM Level of Care 3.1 Clinically Managed Low-Intensity Residential Substance Use Disorder Services programs that also offer onsite or closely facilitate off-site psychiatric services that meet the individual’s identified needs, including medication evaluation and laboratory services. Individuals admitted to this care have documented mental health disorder(s) that may or may not meet criteria for a DSM-5-TR diagnosis.

(39) “Co-Occurring Enhanced ASAM Level of Care 3.3” means in addition to the definition of ASAM Level of Care 3.3 Clinically Managed Population-Specific High-Intensity Substance Use Disorder Residential Services, psychiatric services are rendered by psychiatrists and other qualified behavioral health clinicians trained in the interactions between psychotropic medications and substance use.

(40) “Co-Occurring Enhanced ASAM Level of Care 3.5” means in addition to the definition of ASAM Level of Care 3.5 Clinically Managed High-Intensity Substance Use Disorder Residential Services, these programs offer onsite or closely facilitate off-site psychiatric, medication evaluation and laboratory services that meets the individual’s identified needs within 24 hours, as indicated by the severity and urgency of the condition. These programs are staffed by psychiatrists and other qualified behavioral health clinician trained in the interactions between psychotropic medications and substance use. Individuals admitted to this level of care meet the diagnostic criteria for a mental health disorder as well as a substance use disorder, as defined by the DSM-5-TR.

(41) “Co-Occurring Enhanced ASAM Level of Care 3.7” means in addition to the definition of ASAM Level of Care these programs offer onsite psychiatric and medication evaluation, and nursing observation and care that meets the individual’s identified needs, as indicated by the severity and urgency of the condition. These programs are staffed by psychiatrists and other qualified medical and behavioral health clinicians trained in the interactions between psychotropic medications and substance use. Individuals admitted to this level of care meet the diagnostic criteria for a mental health disorder as well as a substance use disorder, as defined by the DSM-5-TR.

(42) “Co-occurring Enhanced Substance Use Disorder Programs” means, consistent with The ASAM Criteria, Third Edition, a setting where integrated services address concurrently unstable mental health and substance use disorder conditions. There is a focus on the integration of mental health and substance use disorders throughout the staffing, services, and program content, as well as the use of Motivational Enhancement therapies throughout services.

(43) “Co-occurring Substance Use, Problem Gambling, and Mental Health Disorders (COD)” means the existence of a diagnosis for a substance use disorder, problem gambling disorder, and/or a mental health disorder.

(44) “Community Health Worker (CHW)” means personnel who meets qualification criteria adopted by the authority under ORS 414.665 and who is certified pursuant to the requirements in OAR 410-180-0310.

(45) "Court" means a criminal court, drug court, circuit court, juvenile court or last convicting or ruling court in this state with jurisdiction over the individual.

(46) "Criminal Records Check" means documenting the criminal background check results for all employees, contracted staff, interns and volunteers considered to be program staff that render medical or behavioral health services and supports or have access to protected health information such as service records or billing information.

(47) "Crisis" means either an actual or perceived urgent or emergent situation that occurs when an individual’s stability or functioning is disrupted and there is an immediate need to resolve the situation to prevent a serious deterioration in the individual’s mental or physical health or to prevent referral to a significantly higher level of care or death.

(48) “Crisis Plan” means an individualized document designed in collaboration with the individual served to help anticipate and prevent future crisis episodes and to direct interventions in the instance of a crisis.

(49) “Crisis Stabilization Services” means providing evaluation and treatment to individuals experiencing a crisis. Crisis Services may be provided prior to completion of an intake. These services are intended to stabilize the individual in crisis, prevent further deterioration and provide immediate treatment and intervention in a location best suited to meet the needs of the individual and in the least restrictive environment available.

(50) "Cultural Competence" means the process by which people and systems respond respectfully and effectively to people of all cultures, languages, classes, races, ethnic backgrounds, disabilities, religions, genders, sexual orientations, and other diversity factors in a manner that recognizes, affirms, and values the worth of individuals, families, and communities and protects and preserves the dignity of each.

(51) “Culturally Responsive” means services that are respectful of and relevant to the beliefs, practices, culture and linguistic needs of diverse populations and communities whose members identify as having particular cultural or linguistic affiliations. Cultural responsiveness describes the capacity to respond to the issues of diverse communities and requires knowledge and capacity at different levels of intervention: systemic, organizational, professional, and individual.

(52) “Culturally Specific Program” means a program that is designed to meet the unique service needs of a specific culture and that provides services to a majority of individuals representing that culture.

(53) "Diagnosis" means the principal mental health, substance use or problem gambling diagnosis listed in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5-TR). The diagnosis is determined through the assessment and any examinations, tests, or consultations suggested by the assessment and are the medically necessary reason for services.

(54) “Division” means the Health Systems Division of the Oregon Health Authority, or its designee.

(55) “Diagnostic and Statistical Manual of Mental Disorders, DSM-5-TRFifth Edition, (DSM-5-TR)” means the textbook used to diagnose and classify mental disorders that is published by the American Psychiatric Association.

(56) “Emergent” means the onset of symptoms requiring attention within 24 hours to prevent serious deterioration in mental or physical health or threat to safety.

(57) “Employment Support Services” means services approved by the division, determined to be necessary and provided to an individual to obtain and maintain employment in the community as they are transitioning from an inpatient or residential facility that provides substance use disorder treatment.

(58) “Entry” means the act or process of acceptance and enrollment into services regulated by this rule.

(59) “Episode of Care” means care that begins at treatment admission and ends at discharge.

(60) “Face-to-Face” means a personal interaction where both words can be heard and facial expressions can be seen in person or through telehealth services where there is a live streaming audio and video, if clinically appropriate.

(61) “Family” means the biological or legal parents, siblings, other relatives, foster parents, legal guardians, spouse, domestic partner, caregivers, and other primary relations to the individual whether by blood, adoption, legal, or social relationships. Family also means any natural, formal, or informal support persons identified as important by the individual.

(62) “Gender Identity” means an individual’s self-identification of gender without regard to legal or biological identification, including but not limited to an individual identifying themselves as male, female, transgender, and transsexual.

(63) “Gender Expression” means the external characteristics and behaviors that are socially defined as either masculine or feminine, such as dress, mannerisms, speech patterns, and social interactions.

(64) “Grievance” means a formal complaint submitted to a provider verbally or in writing by an individual or the individual’s chosen representative.

(65) “Guardian” means an individual appointed by a court of law to act as guardian of a minor or a legally incapacitated person.

(66) “Habilitation or Habilitative” means medically necessary for the maintenance, learning or improving skills and function for daily living. Services are designed to help an individual improve their level of independence and includes, but is not limited to, services provided in order to help an individual acquire, retain, or improve skills in Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL), community survival skills, communication, self-help, socialization, and adaptive skills necessary to reside successfully in an individual’s home or a community-based setting.

(67) "Health Insurance Portability and Accountability Act (HIPAA)” means the federal[MSM1] Health Insurance Portability and Accountability Act of 1996 and the regulations published in Title 45, parts 160 and 164, of the Code of Federal Regulations (CFR).

(68) “Health Systems Services and Supports” means all services and supports including but not limited to Outpatient Community Mental Health Services and Supports for Children and Adults, Intensive Treatment Services for Children, Outpatient and Residential Substance Use Disorders Treatment Services, and Outpatient and Residential Problem Gambling Treatment Services.

(69) “Housing Support Services” means services approved by the division, provided to an individual to obtain and reside in an independent community setting and are tailored to the goal of maintaining an individual’s personal health and welfare in a home and community-based setting as they are transitioning from an inpatient or residential facility that provides substance use disorder treatment.

(70) “Immediate Need Profile” means the portion of an assessment that includes the identification of the most severe and destabilizing or life-threatening conditions, in order to inform the determination of the level of risk, the level of care placement and need for immediate intervention(s).

(71) “Institutions of Mental Disease (IMD)” means a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, which includes substance use disorders (SUDs).

(72) “Incident” means any event involving an individual or the child of an individual receiving services occurring on the premises of the program or involving program staff or any individual, occurring on the premises of the program, or during a service plan activity and including, but not limited to death, injury, major illness or medical event, accident, act of physical aggression, medication error, suspected abuse or neglect, or any other type of unusual or critical event that presents a risk to the health and/ or safety of any person. Critical incidents are reported to the Division.

(73) “Incident Report” means a written description of any incident.

(74) “Individual” means any individual being considered for or receiving services and supports regulated by these rules.

(75) "Informed Consent for Services" means that the service options, risks and benefits have been explained to the individual and guardian, if applicable, in a manner that they comprehend, and the individual and guardian, if applicable, have consented to the services on, or prior to, the first date of service.

(76) “Intensive Case Management” means the management of an array of services and supports that assist the individual in meeting service plan objectives, includes an evaluation of needs and offers to meet those needs through skill building, outreach, advocation, and arranging support services through the provider or external community providers.

(77) “Interim Referral and Information Services” means services provided by a substance use disorders treatment provider to individuals on a waiting list and whose services are funded by the Substance Use Prevention Treatment Recovery (SUPTR) Block Grant to reduce the adverse health effects of substance use, promote the health of the individual, and reduce the risk of disease transmission.

(78) “Institution” means an establishment that furnishes (in single or multiple facilities) food, shelter, and some treatment or services to four or more persons unrelated to the proprietor.

(79) “Institutions of Mental Disease (IMD)” means a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in providing diagnosis, treatment, or care of individuals with mental diseases, which includes substance use disorders (SUDs).

(80) "Level of Care" means the type, frequency, and duration of medically necessary services provided from the most integrated setting to the most restrictive and intensive inpatient setting.

(81) “Level of Care Determination” means documentation in the service record that justifies the change in a Level of Care placement, whether the placement is more intensive or less intensive, completed in a 6-Dimensional format that captures what has changed for the individual and resulted in the change in placement. The Level of Care Determination shall include the assessed level of care, the placed level of care, the individual’s preferred level of care, and a rationale if there is a difference between the assessed and placed levels of care.

(82) "Licensed Health Care Professional" means a practitioner of the healing arts acting within the scope of their practice under State law who is licensed by a recognized governing board in Oregon.

(83) "Licensed Medical Practitioner (LMP)” means aperson who meets the following minimum qualifications as documented by the Local Mental Health Authority (LMHA) or designee:(a) Physician licensed to practice in the State of Oregon; or

(b) Nurse practitioner licensed to practice in the State of Oregon; or

(d) Whose training, experience, and competence demonstrates the ability to conduct a medical exam, a mental health assessment and provide medication management.

(84) “Local Mental Health Authority (LMHA)” means one of the following entities:

(a) The board of county commissioners of one or more counties that establishes or operates a CMHP;

(b) The tribal council in the case of a federally recognized tribe of Native Americans that elects to enter into an agreement to provide mental health services; or

(85) "Low-Barrier” means the absence of programmatic barriers to service delivery including practice induced stigma. Fundamental elements of Low Barrier services:

(a) Take a harm reduction approach, including the immediate goal of improving quality of life and protecting against loss of life;

(b) Offer treatment that meets the unique needs of each individual;

(c) Recognize unique recovery trajectories that are personal to each individual and are not dictated by treatment providers;

(d) Enable individuals to engage in treatment services, including medication for substance use disorders, without administrative delays or lengthy intake processes;

(e) Provide treatment without appointment requirements, prior missed appointments cannot be used to hinder access to treatment;

(f) Address transportation barriers;

(g) Facilitate access to treatment, services and supports including mental, physical, dental and other ancillary health care services and supports throughout the treatment episode of care;

(h) Eliminate or facilitate minimal travel between multiple service providers; and

(i) Involve service providers in outreach services and community engagement.

(86) “Low-intensity” means a term used by The ASAM Criteria, Third Edition, in the title for ASAM Level 1 services, which are described in The ASAM Criteria, Third Edition, as generally less than 9 treatment contact hours per week and delivered by non-physician addiction professionals to individuals who are able to control their use or maintain abstinence with minimal support while pursuing recovery goals.

(87) "Mandatory Reporter" means anyone required by law, as defined in ORS 419B.005 or 430.735, who is required to report suspected abuse or neglect of a child, elderly person, or other adult as required by law in ORS 430.765, or ORS 419B.010, or ORS 124.060.

(88) "Medicaid" means the federal grant-in-aid program to state governments to provide medical assistance to eligible persons under Title XIX of the Social Security Act.

(89) "Medical Director" means a physician licensed to practice medicine in the State of Oregon and who is designated by a substance use disorders treatment program to be responsible for the program's medical services, either as an employee or through a contract.

(90) “Medical Treatment Staff” means program staff who are properly trained, educated, and credentialed to deliver medical services and who, while working within their scope of practice, are directly responsible for the delivery or oversight of withdrawal management services. “

(91) "Medically Necessary” means health services and items that are required for an individual to address one or more of the following:

(a) The prevention, diagnosis, or treatment of an individual’s condition or disorder that results in behavioral health impairments; or

(b) The ability for a client or member to achieve age-appropriate growth and development; and

(92) "Medication" means any drug, chemical, compound, suspension, or preparation in suitable form for use as a curative or remedial substance either internally or externally by any patient.

(93) “Medication Administration Record” means the documentation of the administration of written or verbal orders for medication, laboratory, and other medical procedures issued by an LMP acting within the scope of his or her license.

(94) “Medication Assisted Treatment (MAT)” means the use of medication in combination with counseling and behavioral therapies for the treatment of substance use disorders.

(95) “Mental Health Intern” means mental health program staff who meet qualifications for QMHA and are currently enrolled in a graduate program approved by the Division-approved certification or licensing body but does not have the necessary graduate degree in psychology, social work, or related field of behavioral science, or have an equivalent degree as determined by the Division-approved certification or licensing body.

(96) “Milieu Staff” means the type of staff providing support to program staff and the individuals receiving services by monitoring the common areas, providing direction and redirection to individuals receiving services, assisting individuals in getting requests and needs met, taking actions to maintain the safety of the individuals, and informing Substance Use Disorders Treatment Staff of events as to assist in the holding a trauma-informed environment.

(97) “Motivational Enhancement Therapy” (MET) means a person-centered approach to therapy that focuses on improving an individual's motivation to change.

(98) “Non-Institutions of Mental Disease (non-IMD)” means a hospital, nursing facility, or other institution with less than 16 beds that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, which includes substance use disorders (SUDs).

(99) “Non-Medicaid Service Data” means data collected through the mandated state data system regarding services paid for by any source other than Medicaid and includes, but is not limited to:

(a) Diagnosis;

(b) Date of service;

(d) Procedure code;

(e) Modifier;

(f) Number of service units; and

(g) Billed charges.

(100) “Nursing Services” means services that are provided by a registered nurse (RN) or a licensed practical nurse (LPN), Advanced Practice Nurse including Clinical Nurse Specialist, or Certified Nurse Practitioner, licensed by the Oregon Board of Nursing within the scope of practice as defined in OAR chapter 851 division 045.

(101) “On-site” means staff are physically present within the licensed facility, on duty, readily accessible and available to assist individuals.

(102) “Oregon Health Authority (Authority) or (OHA)” means the Oregon Health Authority of the State of Oregon.

(103) "Outreach" means the delivery of behavioral health services, referral services, and case management services in non-traditional settings, including but not limited to the individual's residence, shelters, streets, jails, transitional housing sites, drop-in centers, single room occupancy hotels, child welfare settings, educational settings, or medical settings. It also refers to attempts made to engage or re-engage an individual in services by such means as letters or telephone calls.

(104) “Peer” means any person supporting an individual or the individual's family member who has similar life experience, either as a current or former recipient of substance use, problem gambling, or mental health services, or as a family member of an individual who is a current or former recipient of substance use, problem gambling, or mental health services.

(105) “Peer-Delivered Services” are community-based services and supports provided by peers, peer support specialists, and peer wellness specialists to individuals or family members with similar lived experience. These services are intended to support individuals and families to engage individuals in ongoing treatment and to live successfully in the community.

(106) “Peer-Delivered Services Supervisor" means qualified program staff, with at least one year of experience as a PSS or PWS in behavioral health services, who is responsible for evaluating and guiding PSS and PWS program staff in the delivery of peer-delivered services and supports.

(107) “Peer Support and Peer Wellness Specialist Supervision" means supervision by a qualified clinical supervisor and a qualified peer-delivered services supervisor as resources are available. The supports provided include guidance in the unique discipline of peer-delivered services and the roles of peer support specialists and peer wellness specialists.

(108) "Peer Support Specialist" means a qualified program staff providing peer-delivered services to an individual or family member with similar life experience under the supervision of a qualified clinical supervisor and a qualified peer-delivered services supervisor as resources are made available.

(109) “Peer Wellness Specialist” means a program staff who supports an individual in identifying behavioral health service and support needs through community outreach, assisting individuals with access to available services and resources, addressing barriers to services, and providing education and information about available resources and behavioral health issues in order to reduce stigma and discrimination toward consumers of behavioral health services and to provide direct services to assist individuals in creating and maintaining recovery, health, and wellness under the supervision of a qualified clinical supervisor and a qualified peer-delivered services supervisor as resources are made available.

(110) “Problem Gambling Approved Certification Consultant” means program staff who is a Certified Gambling Addiction Counselor, level II (CGACII) for a minimum of two years and has a minimum of ten hours of clinical supervision education. The purpose of the position is to provide consultation for CGAC candidates on 1) Fundamentals of Problem Gambling Treatment case conceptualization 2) the process and requirements of earning certification as a CGAC. This is a Mental Health and Addiction Certification Board of Oregon (MHACBO) distinction.

(111) “Problem Gambling Treatment Staff” means program staff certified or licensed by a Division recognized credentialing body to provide problem gambling treatment services that include assessment, development of a Service Plan, group and family counseling.

(112) "Program" means an organized system of services and supports delivered by a provider designed to address the treatment needs of individuals and families.

(113) "Program Administrator" or "Program Director" means program staff with appropriate professional qualifications and experience who is designated to manage the operation of a program.

(114) "Program Staff" means personnel who renders a clinical service or support. Program staff could include, for example, be an employee, contractor, intern, or volunteer who is rendering or assisting with rendering clinical services or supports.

(115) "Provider" means an organizational entity or qualified person that is certified or licensed by the Division for the direct delivery of substance use, problem gambling, or mental health services and supports.

(116) “Publicly Funded” means financial support, in part or in full, with revenue generated by a local, state, or federal government.

(117) Psychiatrist" means a physician licensed by the Oregon Medical Board and who has completed an approved residency training program in psychiatry.

(118) "Psychologist" means a person who is currently licensed to practice psychology by the Oregon Board of Psychology.

(119) "Qualified Mental Health Associate (QMHA)” means mental health program staff delivering services under the direct supervision of a QMHP who meets the minimum qualifications as authorized by the LMHA or designee and specified in OAR 309-019-0125.

(120) "Qualified Mental Health Professional (QMHP)" means mental health program staff LMP or any other program staff meeting the minimum qualifications as authorized by the LMHA or designee and specified in OAR 309-019-0125.

(121) "Quality Assessment and Performance Improvement" means the structured, internal monitoring and evaluation of services to improve processes, service delivery, and service outcomes.

(122) “Recovery” means a process of healing and transformation for an individual to achieve full human potential and personhood in leading a meaningful life as they define it in communities of their choice.

(123) “Recovery Environment” means the quality and extent of the services and supports, offered within and coordinated by a program, that influence treatment outcomes and connect the individual to external recovery supports.

(124) "Rehabilitative Behavioral Health Services” means medical or remedial services recommended by a licensed medical practitioner or other licensed practitioner to reduce impairment to an individual’s functioning associated with the symptoms of a mental disorder or substance use disorder and are intended to restore functioning to the highest degree possible.

(125) "Representative" means someone who acts on behalf of an individual at the individual’s request with respect to a grievance, including but not limited to a relative, friend, employee of the Division, attorney, or legal guardian.

(126) “Resilience” means the universal capacity that an individual uses to prevent, minimize, or overcome the effects of adversity. Resilience reflects a person’s strengths as protective factors and assets for positive development.

(127) “Residential Substance Use Disorders Treatment Program" means a publicly or privately operated program as defined in ORS 430.010 that provides assessment, treatment, rehabilitation, and twenty-four hour observation and monitoring for individuals with substance use dependence, consistent with Level 3 of The ASAM Criteria, Third Edition.

(128) “Residential Problem Gambling Treatment Program” means a publicly or privately operated program that is licensed in accordance with OAR 415-012-0000 through 415-012-0090 that provides assessment, treatment, rehabilitation, and twenty-four-hour observation and monitoring for individuals with gambling related problems.

(129) “Risk Assessment” means an evaluation of the level or severity of risk the individual is experiencing and how each interact, resulting in an overall risk assessment rating.

(130) “Safety Plan” means a best practice, research-based, individualized, and directive document developed through a collaborative process in which the provider assists the individual in listing strategies to use when self-harm, harm to others or suicide ideation is elevated or following suicidal or parasuicidal behavior.

(131) "Screening" means the process to determine whether the individual needs further assessment to identify circumstances requiring referrals or additional services and supports.

(132) "Seclusion" means the involuntary confinement of a resident alone in a room or an area from which the resident is physically prevented from leaving.

(133) “Service Delivery Rules” means the OAR describing specific regulatory standards for the possible array of services covered by certificates issued under OAR 309-008.

(134) “Service Note” means the written record of services and supports provided, including documentation of progress toward intended outcomes, consistent with the timelines stated in the service plan.

(135) "Service Plan" means a comprehensive plan for services and supports provided to or coordinated with an individual and his or her family, as applicable, that is reflective of the assessment and the intended outcomes of service.

(136) “Service Plan Review” means a documented, clinical review by a Substance Use Disorders Treatment Staff of the individual’s response to the services and supports provided thus far and includes a current ASAM Level of Care recommendation.

(137) “Service Record” means the documentation, written or electronic, regarding an individual and resulting from entry, assessment, orientation, services and supports planning, services and supports provided, and transfer.

(138) "Services" means those activities and treatments described in the Service Plan that are intended to assist the individual's transition to recovery from a substance use disorder, problem gambling disorder, or mental health condition and to promote resiliency and rehabilitative and functional individual and family outcomes.

(139) “Signature” means any written or electronic means of entering the name, date of authentication, and credentials of the person providing a specific service or the person authorizing services and supports. Signature also means any written or electronic means of entering the name and date of authentication of the individual receiving services, the guardian of the individual receiving services, or any authorized representative of the individual receiving services.

(140) "Skills Training” or “Skills Restoration" means providing information and training to individuals and families designed to assist with the development of skills in areas including but not limited to anger management, stress reduction, conflict resolution, self-esteem, parent-child interactions, personal relationships, drug and alcohol awareness, behavior support, symptom management, accessing community services, and daily living.

(141) “Specialty Program” means a licensed Residential Substance Use Disorder treatment program that focuses on providing treatment to specialized populations. Treatment programming and planning must be specialized to the population and individual being served.

(142) “Stabilization” means the application of medical and psychosocial services and supports in a manner that results in the reduction of symptomology and increase in skill level to support and redirect patients to the most appropriate and least restrictive setting. Services are directed at restoring patients’ ability to maintain safety while enhancing their recovery, so they can successfully reintegrate into identified community settings.

(143) “Status Data” means data collected through the mandated state data system and includes, but is not limited to:

(a) Initial admission, diagnostic, and demographics data;

(b) Updates and changes as needed through the individual’s enrollment in services; and

(144) “Student Intern” or “Intern” means a program staff who provides a paid or unpaid program service and does not qualify as a Mental Health Intern.

(145) "Substance Use, Prevention, Treatment and Recovery Block Grant” or “SUPTR Block Grant” or “SUPTR” means the federal block grants for prevention and treatment of substance abuse under Public Law 102-321 (31 U.S.C. 7301-7305) and the regulations published in Title 45 Part 96 of the Code of Federal Regulations.

(146) "Substance Use Disorders” (SUD) as defined in DSM-5-TR, means disorders related to the taking of a drug of abuse including alcohol, the side effects of a medication, or a toxin exposure. The disorders include substance use disorders and substance-induced disorders, which include substance intoxication and withdrawal, and substance-related disorders such as delirium, neuro-cognitive disorders, and substance-induced psychotic disorder.

(147) “Substance Use Disorders Treatment and Recovery Services” means outpatient, intensive outpatient, and residential services and supports for individuals with substance use disorders.

(148) “Substance Use Disorders Treatment Staff” means one type of program staff certified by a Division-approved certification body to render substance use disorders treatment services.

(149) “Supports” means activities, referrals, and supportive relationships designed to enhance the services delivered to individuals and families for the purpose of facilitating progress toward intended outcomes.

(150) “Transfer” means the process of assisting an individual to transition from the current services to the next identified setting or ASAM level of care.

(151) “Transitioning” means a 90-day period which begins when an individual is discharged from an inpatient or residential stay back to a community setting.

(152) “Trauma Informed Services” means services that reflect the consideration and evaluation of the role that trauma plays in the lives of people seeking mental health, substance use, or problem gambling services, including recognition of the traumatic effect of misdiagnosis and coercive treatment. Services are responsive to the vulnerabilities of trauma survivors and are delivered in a way that avoids inadvertent re-traumatization and facilitates individual direction of services.

(153) "Treatment" means the planned, medically necessary, individualized program of medical, psychological, and rehabilitative procedures, experiences and activities designed to remediate symptoms of a DSM-5-TR-TR diagnosis.

(154) “Unethical” means any conduct that is incongruent with the American Counseling Association’s (ACA) Code of Ethics. The fact that a given conduct is not specifically addressed by an ethical standard does not mean that it is necessarily either ethical or unethical. Lack of awareness or misunderstanding of an ethical standard is not itself a defense to a charge of unethical conduct.

(155) "Urinalysis Test" means a sensitive, rapid, and inexpensive immunoassay screen that identifies the presence of a specific drug or metabolite in a urine specimen to eliminate "true negative" specimens from further consideration.

(156) "Urgent" means the onset of symptoms requiring attention within 48 hours to prevent a serious deterioration in an individual's mental or physical health or threat to safety.

(157) "Variance" means an exception from a provision of these rules granted in writing by the Division pursuant to the process regulated by OAR 415-012-0090 upon written application from the provider. Approval and duration of a variance is determined on a case-by-case basis.

(158) "Volunteer" means a person who performs a service willingly and without pay.

(159) “Wellness” means an approach to healthcare that emphasizes good physical and mental health, preventing illness, and prolonging life.

History

Statutory/Other Authority: ORS 413.042, 430.256, 428.205 - 428.270, 430.640 & 443.450
Statutes/Other Implemented: ORS 109.675, 179.505, 413.520 - 413.522, 430.010, 430.205 - 430.210, 430.254 - 430.640, 430.850 - 430.955, 443.400 - 443.460, 443.991, 461.549, 743A.168, 414.025 & 14.665
BHS 10-2023, amend filed 04/07/2023, effective 04/07/2023
BHS 1-2022, amend filed 01/05/2022, effective 01/05/2022
MHS 4-2018, amend filed 02/27/2018, effective 03/01/2018
MHS 10-2017(Temp), f. 9-15-17, cert. ef. 9-15-17 thru 3-13-18
MHS 17-2016, f. 11-28-16, cert. ef. 11-30-16
MHS 10-2016(Temp), f. 6-29-16, cert. ef. 7-1-16 thru 12-27-16
MHS 3-2014, f. & cert. ef. 2-3-14
MHS 10-2013(Temp), f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14

Or. Admin. R. 309-018-0107 Certification Required

Entities providing or seeking to provide residential treatment services under these rules shall also hold or successfully obtain from the Division a certificate to provide behavioral health treatment services under OAR 309-008-0100 to 309-008-1600 if they intend to provide an outpatient service regulated by the Division’s service delivery rules.

History

Statutory/Other Authority: ORS 413.042, 428.205 - 428.270, 430.640 & 443.450
Statutes/Other Implemented: ORS 109.675, 161.390 - 161.400, 179.505, 430.010, 430.205 - 430.210, 430.240 - 430.640, 430.850 - 430.955, 443.400 - 443.460, 443.991, 461.549 & 743A.168
MHS 4-2018, amend filed 02/27/2018, effective 03/01/2018
MHS 10-2017(Temp), f. 9-15-17, cert. ef. 9-15-17 thru 3-13-18
MHS 17-2016, f. 11-28-16, cert. ef. 11-30-16
MHS 10-2016(Temp), f. 6-29-16, cert. ef. 7-1-16 thru 12-27-16

Or. Admin. R. 309-018-0108 Licensing Standards

(1) Residential Substance Use Disorders Treatment and Recovery Services Programs shall be licensed by the Division in accordance with OAR 415-012 in order to render residential substance use disorder treatment and recovery services. A License issued to a program shall be effective for a duration not to exceed two years from the date of issue and may be renewed, conditioned, denied, suspended, or revoked by the Division in the manner set forth in OAR 415-012. Licensed programs shall meet the standards set forth in these rules and all applicable statutes.

(2) Adolescent and adult programs shall be licensed separately.

(3) Effective January 1, 2022, the following designations shall be contained within the residential substance use disorder treatment and recovery services license, as applicable:

(a) For all residential substance use disorder treatment and recovery programs, the IMD status shall be determined by the Division to be either:

(A) IMD Residential; or

(B) NON-IMD Residential.

(b) Optional residential substance use disorder treatment Specialty Service(s) a residential substance use disorder treatment and recovery services provider may apply to be approved to render:

(A) Pregnant and/ or parenting with dependent children; and

(B) Culturally Specific.

(4) Currently licensed providers shall submit complete residential substance use disorder treatment and recovery services applications to render each selected ASAM Level(s) of Care and any optional Enhanced ASAM Service Designation(s) no later than October 1, 2023.

(5) Division approved ASAM level(s) of Care and optional Enhanced ASAM Service designation(s), if any, shall be added to the residential substance use disorder treatment and recovery services licenses starting January 1, 2024.

(6) Effective April 1, 2024, all residential substance use disorder treatment programs must have a valid license designating each the following ASAM Level(s) of Care and any optional Enhanced ASAM Service designation(s) that they are licensed by the Division to provide:

(a) At a minimum, the program shall demonstrate compliance with at least one of the following residential substance use disorder ASAM Level(s) of Care in order for the Division to approve licensure:

(A) Adult Clinically Managed Low-Intensity Residential Substance Use Disorder Services, ASAM Level of Care 3.1;

(B) Adolescent Clinically Managed Low-Intensity Residential Substance Use Disorder Services, ASAM Level of Care 3.1;

(C) Adult Clinically Managed Population-Specific High-Intensity Substance Use Disorder Residential Services, ASAM Level of Care 3.3;

(D) Adult Clinically Managed High-Intensity Substance Use Disorder Residential Services, ASAM Level of Care 3.5;

(E) Adolescent Clinically Managed Medium-Intensity Substance Use Disorder Residential Services, ASAM Level of Care 3.5;

(F) Adult Medically Monitored Intensive Substance Use Disorder Inpatient Services, ASAM Level of Care 3.7; or

(G) Adolescent Medically Monitored High-Intensity Substance Use Disorder Inpatient Services, ASAM Level of Care 3.7.

(b) ASAM Enhanced Service designation(s) are service types that the program may choose to apply to render to either adults or adolescents when it corresponds to an ASAM Level of Care that is licensed by the Division:

(A) Co-occurring Capable ASAM Level of Care 3.1;

(B) Co-Occurring Enhanced ASAM Level of Care 3.1;

(D) Co-Occurring Enhanced ASAM Level of Care 3.3;

(E) Biomedical Enhanced ASAM Level of Care 3.3;

(F) Co-Occurring Enhanced ASAM Level of Care 3.5;

(G) Biomedical Enhanced ASAM Level of Care 3.5;

(H) Co-Occurring Enhanced ASAM Level of Care 3.7; or

(I) Biomedical Enhanced ASAM Level of Care 3.7

(7) Each program must operate within the scope of the service types listed on their license. Unless otherwise limited by the Division, programs with valid licenses for any of the following ASAM Levels of Care may render Clinically Managed Low-Intensity Residential Substance Use Disorder Services, ASAM Level of Care 3.1:

(a) Adult Clinically Managed Population-Specific High-Intensity Substance Use Disorder Residential Services, ASAM Level of Care 3.3;

(b) Adolescent Clinically Managed Medium-Intensity Substance Use Disorder Residential Services, ASAM Level of care 3.5;

(d) Adolescent Medically Monitored High-Intensity Impatient Services, ASAM Level of Care 3.7;

(e) Adult Medically Monitored Intensive Substance Use Disorder Inpatient Services, ASAM Level of Care 3.7.

(8) Applicants providing or seeking to provide residential treatment services under these rules who also intend to provide an outpatient service regulated by the Division’s service delivery rules, shall also have and maintain a Division certificate to provide behavioral health treatment services under OAR 309-008-0100 to 309-008-1600.

(9) The License shall be posted in a common area, able to be viewed at all times.

(10) At least every two years the Division shall inspect the facility and conduct a review of the program.

History

Statutory/Other Authority: ORS 161.390, 413.042, 430.256 & 430.640
Statutes/Other Implemented: ORS 161.390-161.400, 428.205-428.270, 430.010, 430.205-430.210, 430.254-430.640, 430.850-430.955 & 743A.168
BHS 10-2023, adopt filed 04/07/2023, effective 04/07/2023

Or. Admin. R. 309-018-0110 Provider Policies

(1) All providers shall develop and implement written policies and procedures compliant with these rules.

(2) Policies shall be available to individuals, guardians, and family members upon request.

(3) Providers shall develop and implement written policies and procedures including but not limited to:

(a) Personnel qualifications, credentialing and training;

(b) Criminal Records Checks that address program and milieu staff, compliant with ORS 181.533 through 181.575 and OAR 943-007-0001 through 0501, where applicable;

(d) Alcohol, Drug and Gambling free workplace;

(e) Fee agreements;

(f) Confidentiality and compliance with , Federal Confidentiality Regulations (42 CFR, Part 2), and state confidentiality regulations as specified in ORS 179.505 and 192.518 through 192.530;

(g) Compliance with Title 2 of the Americans with Disabilities Act of 1990 (ADA);

(h) Per ORS 413.046; Grievances and appeals, including an example grievance form;

(i) Individual rights;

(j) Quality assessment and performance improvement;

(k) Crisis prevention and response;

(l) Incident and critical incident reporting;

(m) Family involvement;

(n) Trauma-informed service delivery, consistent with the Division’s Trauma Informed Services Policy;

(o) Provision of culturally and linguistically appropriate services;

(p) Medical protocols;

(q) Medication administration, storage, and disposal;

(r) Facility standards;

(s) General safety and emergency procedures to include an evacuation plan and emergency plan in case of fire, explosion, accident, death, or other emergencies. The evacuation and emergency procedures and plans shall be current and posted in a common area;

(t) Delivery of services and supports consistent with The ASAM Criteria, Third Edition for each licensed level of care;

(u) Code of conduct that includes professional boundaries and ethics; and

(v) Referral, Care Coordination and Transfer of Services.

(4) Additionally, providers shall establish written policies that:

(a) Prohibit psychological and physical discipline of an individual;

(b) Prohibit seclusion, personal restraint, mechanical restraint, and chemical restraint;

(d) Prohibit discipline of one individual receiving services by another; and

(e) Prohibit titration of medications prescribed for the treatment of opioid dependence as a condition of receiving or continuing to receive treatment.

(f) Opportunity for individuals over 18 years of age to declare advanced directive for their mental health treatment per ORS 127.700 to 127.736

(g) Opportunity for individuals over 18 years of age to register to vote by making voter registration cards available.

History

Statutory/Other Authority: ORS 413.042, 428.205 - 428.270, 430.640 & 443.450
Statutes/Other Implemented: ORS 109.675, 161.390 - 161.400, 179.505, 430.010, 430.205 - 430.210, 430.254 - 430.640, 430.850 - 430.955, 443.400 - 443.460, 443.991, 461.549 & 743A.168
BHS 25-2024, amend filed 10/25/2024, effective 10/27/2024
BHS 10-2023, amend filed 04/07/2023, effective 04/07/2023
MHS 4-2018, amend filed 02/27/2018, effective 03/01/2018
MHS 10-2017(Temp), f. 9-15-17, cert. ef. 9-15-17 thru 3-13-18
MHS 3-2014, f. & cert. ef. 2-3-14
MHS 10-2013(Temp), f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14

Or. Admin. R. 309-018-0115 Individual Rights

(1) In addition to all applicable statutory and constitutional rights, every individual receiving services has the right to:

(a) Choose from available services and supports, those that are consistent with the Service Plan, culturally competent, provided in the most integrated setting in the community and under conditions that are least restrictive to the individual’s liberty, that are least intrusive to the individual, and that provide for the greatest degree of independence;

(b) Be treated with dignity and respect;

(c) Participate in the development of a written Service Plan, receive services consistent with that plan, and participate in periodic review and reassessment of service and support needs, assist in the development of the plan, and receive a copy of the written Service Plan;

(d) Have all services explained, including expected outcomes and possible risks;

(e) Confidentiality, and the right to consent to disclosure in accordance with ORS 107.154, 179.505, 179.507, 192.515, 192.507, 42 CFR Part 2 and 45 CFR Part 205.50;

(f) Give informed consent in writing prior to the start of services, except in a medical emergency or as otherwise permitted by law. Minor children may give informed consent to services in the following circumstances:

(A) Under age 18 and lawfully married;

(B) Age 16 or older and legally emancipated by the court; or

(C) Age 14 or older for outpatient services only. For purposes of informed consent, outpatient service does not include service provided in residential programs or in day or partial hospitalization programs.

(g) Inspect their Service Record in accordance with ORS 179.505;

(h) Refuse participation in experimentation;

(i) Receive medication specific to the individual’s diagnosed clinical needs, including medications used to treat opioid dependence;

(j) Receive prior notice of transfer, unless the circumstances necessitating transfer pose a threat to health and safety;

(k) Be free from abuse or neglect and to report any incident of abuse or neglect without being subject to retaliation;

(L) Have religious freedom;

(m) Be free from seclusion and restraint;

(n) Be informed at the start of services, and periodically thereafter, of the rights guaranteed by this rule;

(o) Be informed of the policies and procedures, service agreements and fees applicable to the services provided, and to have a custodial parent, guardian, or representative assist with understanding any information presented;

(p) Have family and guardian involvement in service planning and delivery;

(q) Have an opportunity to make a declaration for mental health treatment, when legally an adult;

(r) File grievances, including appealing decisions resulting from the grievance;

(s) Exercise all rights set forth in ORS 109.610 through 109.697 if the individual is a child, as defined by these rules;

(t) Exercise all rights set forth in ORS 426.385 if the individual is committed to the Authority; and

(u) Exercise all rights described in this rule without any form of reprisal or punishment.

(2) In addition to the rights specified in section (1) of this rule, every individual receiving residential services has the right to:

(a) A safe, secure, and sanitary living environment;

(b) A humane service environment that affords reasonable protection from harm, reasonable privacy, and daily access to fresh air and the outdoors;

(c) Keep and use personal clothing and belongings and to have an adequate amount of private, secure storage space. Reasonable restriction of the time and place of use of certain classes of property may be implemented if necessary to prevent the individual or others from harm, provided that notice of this restriction is given to individuals and their families, if applicable, upon entry to the program, documented, and reviewed periodically;

(d) Express sexual orientation, gender identity, and gender presentation;

(e) Have access to and participate in social, religious, and community activities;

(f) Private and uncensored communications by mail, telephone, and visitation, subject to the following restrictions:

(A) This right may be restricted only if the provider documents in the individual’s record that there is a court order to the contrary or that in the absence of this restriction, significant physical or clinical harm will result to the individual or others. The nature of the harm shall be specified in reasonable detail, and any restriction of the right to communicate shall be no broader than necessary to prevent this harm; and

(B) The individual and his or her guardian, if applicable, shall be given specific written notice of each restriction of the individual’s right to private and uncensored communication. The provider shall ensure that correspondence can be conveniently received and mailed, that telephones are reasonably accessible and allow for confidential communication, and that space is available for visits. Reasonable times for the use of telephones and visits may be established in writing by the provider.

(g) Communicate privately with public or private rights protection programs or rights advocates, clergy, and legal or medical professionals;

(h) Have access to and receive available and applicable educational services in the most integrated setting in the community;

(i) Participate regularly in indoor and outdoor recreation;

(j) Not be required to perform labor;

(k) Have access to adequate food and shelter; and

(L) A reasonable accommodation if, due to a disability, the housing and services are not sufficiently accessible.

(3) The provider shall give to the individual and, if appropriate, the guardian, a document that describes the applicable individual’s rights as follows:

(a) Information given to the individual shall be in written form or, upon request, in an alternative format or language appropriate to the individual’s need;

(b) The rights and how to exercise them shall be explained to the individual, and if appropriate, to her or his guardian; and

History

Statutory/Other Authority: ORS 413.042, 430.256, 428.205 - 428.270, 430.640 & 443.450
Statutes/Other Implemented: ORS 109.675, 161.390 - 161.400, 179.505, 430.010, 430.205 - 430.210, 430.254 - 430.640, 430.850 - 430.955, 443.400 - 443.460, 443.991, 461.549 & 743A.168
MHS 4-2018, amend filed 02/27/2018, effective 03/01/2018
MHS 10-2017(Temp), f. 9-15-17, cert. ef. 9-15-17 thru 3-13-18
MHS 3-2014, f. & cert. ef. 2-3-14
MHS 10-2013(Temp), f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14

Or. Admin. R. 309-018-0125 Specific Staff Qualifications and Competencies

Provider must assure that staff in the following positions meet applicable qualifications, credentialing or licensing standards and competencies, including those set forth in these rules:

(1) Program staff providing treatment services or Peer-Delivered Services in substance use disorders or problem gambling treatment programs shall be trained in and familiar with strategies for the delivery of trauma informed and culturally responsive treatment services. All treatment services shall be provided in a trauma informed and culturally responsive manner.

(2) Medical Directors shall be licensed under ORS 677 or 685 and may perform health maintenance and restoration measures consistent with generally recognized and accepted principles of medicine, including but not limited to:

(a) Administering, dispensing, or writing prescriptions for medications;

(b) Recommending the use of specific and appropriate over-the-counter pharmaceuticals;

(d) Perform tasks required by OAR 309-019-0200.

(3) Clinical supervisors in all programs shall demonstrate competence in leadership, wellness, oversight and evaluation of services, staff development, service planning, case management and coordination, utilization of community resources, group, family and individual therapy or counseling, documentation, and rationale for services to promote intended outcomes and implementation of all provider policies.

(4) Clinical supervisors in substance use disorders treatment and recovery programs shall be certified or licensed by a health or allied provider agency as follows:

(a) For supervisors holding a certification or license in substance use counseling, qualifications for the certificate or license shall have included at least:

(A) 4000 hours of supervised experience in substance use counseling;

(B) 300 contact hours of education and training in substance use related subjects; and

(b) For supervisors holding a health or allied provider license, the license or registration shall have been issued by one of the following state bodies, and the supervisor shall possess documentation of at least 120 contact hours of academic or continuing professional education in the treatment of substance use disorders:

(A) Oregon Medical Board;

(B) Board of Psychologist Examiners;

(D) Board of Licensed Professional Counselors and Therapists; or

(E) Oregon State Board of Nursing.

(c) Additionally, clinical supervisors in substance use disorders programs shall have one of the following qualifications:

(A) Five years of paid full-time experience in the field of substance use disorders counseling; or

(B) A Bachelor's degree and four years of paid full-time experience in the social services field with a minimum of two years of direct substance use disorders counseling experience; or

(C) A Master's degree and three years of paid full-time experience in the social services field with a minimum of two years of direct substance use disorders counseling experience.

(5) Clinical supervisors in problem gambling treatment and recovery programs shall meet the requirements for clinical supervisors in either mental health or substance use disorders treatment and recovery programs and have completed twelve hours of gambling specific training within two years of designation as a problem gambling services supervisor.

(6) Clinical supervisors of mental health services shall meet Qualified Mental Health Professional (QMHP) requirements and have completed two years equivalent of post-graduate clinical experience in a mental health treatment setting.

(7) Peer Delivered Services Supervisors shall be a certified Peer Support Specialist (PSS) or Peer Wellness Specialist (PWS) with at least one year experience as a PSS or PWS in behavioral health treatment services.

(8) Substance use disorders treatment staff shall:

(a) Demonstrate competence in the use of The ASAM Criteria, Third Edition , in treatment of substance-use disorders including individual assessment to include identification of health and safety risks to self or others; individual, group, family and other counseling techniques; program policies and procedures for service delivery and documentation and identification; development of a safety plan; implementation and coordination of services identified to facilitate intended outcomes; and

(b) Receive clinical supervision that documents progress towards certification and recertification; or

(c) At the date of first hire to provide substance use disorder treatment, if the program staff is not certified to provide substance use disorder treatment, they shall register with the Division recognized credentialing body within 30 days of hire and obtain professional substance use disorder treatment certification within two years from the date of first hire unless they obtain a variance from the Division before that time has elapsed;

(d) For program staff holding certification in substance use disorder counseling, qualifications for the certificate shall have included at least:

(A) 1000 hours of supervised experience in substance use counseling;

(B) 150 contact hours of education and training in substance use related subjects; and

(C) Successful completion of a professional psychometric examination by a Division recognized credentialing body. A substantively equivalent portfolio evaluation by Division recognized credentialing body may be accepted in lieu of a professional psychometric examination using procedures approved by the Division.

(e) Substance use disorder treatment staff not holding certification from a Division recognized credentialing body in substance use disorder counseling shall have a license or registration from a Division recognized credentialing body and at least 60 contact hours of academic or continuing professional education in the treatment of substance use disorders. The license or registration shall have been issued by one of the following state bodies:

(A) Oregon Medical Board;

(B) Board of Psychologist Examiners;

(D) Board of Licensed Professional Counselors and Therapists; or

(E) Oregon State Board of Nursing.

(9) Problem gambling treatment staff shall:

(a) Demonstrate competence in treatment of problem gambling including individual assessment to include identification of health and safety risks to self or others; individual, group, family and other counseling techniques; program policies and procedures for service delivery and documentation, implementation and coordination of services identified to facilitate intended outcomes and cultural responsiveness;

(b) Receive clinical supervision that documents progress towards certification and recertification;

(c) At the date of first hire to provide problem gambling treatment, if the program staff is not certified to provide problem gambling treatment, they shall register with the Division recognized credentialing body within 30 days of hire and obtain professional problem gambling treatment certification within two years from the date of first hire unless they obtain a variance from the Division before that time has elapsed;

(d) For program staff holding certification in problem gambling counseling, qualifications for the certificate shall have included at least:

(A) 500 hours of supervised experience in problem gambling counseling;

(B) 30 contact hours of education and training in problem gambling related subjects; and

(C) 24 hours of face-to-face, telephone, email or other electronic communication, of certification consultation from a problem gambling approved certification consultant; and

(D) Successful completion of a professional psychometric examination by a Division recognized credentialing body or a substantively equivalent portfolio evaluation by a Division recognized credentialing body may be accepted in lieu of a professional psychometric examination using procedures approved by the Division.

(e) Program staff not holding certification in gambling addiction counseling by a Division recognized credentialing body shall have at least 30 contact hours of academic or continuing professional education in the treatment of gambling addiction. The license or registration shall have been issued by one of the following state bodies:

(A) Oregon Medical Board;

(B) Board of Psychologist Examiners;

(D) Board of Licensed Professional Counselors and Therapists; or

(E) Oregon State Board of Nursing.

(10) Rehabilitative Behavioral Health Service Providers, including medical treatment staff, shall demonstrate cultural responsiveness and meet the requirements and qualifications in OAR 410-172-0660.

(11) Behavioral health clinicians shall meet one of the following qualifications and maintain the corresponding credential in the State of Oregon:

(a) A licensed psychiatrist;

(b) A licensed psychologist;

(d) A licensed clinical social worker;

(e) A licensed professional counselor or licensed marriage and family therapist;

(f) A certified clinical social work associate;

(g) A Mental Health Intern or resident who is working under a board-approved supervisory contract in a clinical mental health field;

(h) A Qualified Mental Health Practitioner (QMHP); or

(i) Any other clinician whose authorized scope of practice includes mental health diagnosis and treatment.

(12) Qualified Mental Health Associates (QMHA) program staff shall:

(a) Demonstrate the following minimum competencies: cultural responsiveness, effective communication, care coordination, inter- and intra-agency collaboration, working alliances with individuals, assist in the gathering and compiling of information to be included in the assessment, screen for suicide and other risks, and implement timely interventions, teach skill development strategies, case management, and transition planning;

(b) Render services and supports within their scope to individuals engaged in a Division approved behavioral health services provider; and

(A) Bachelor's degree in psychology, social work, or behavioral science field;

(B) An equivalent degree as evidenced by providing transcripts indicating applicable coursework meeting the required competencies and approved by a Division certified behavioral health provider; or

(d) Receive clinical supervision that documents progress towards certification and recertification.

(13) Qualified Mental Health Professional (QMHP) program staff shall:

(a) Demonstrate the following minimum competencies: cultural responsiveness, effective communication, care coordination, inter- and intra-agency collaboration, working alliances with individuals, suicide and other risk assessments and interventions, creating and monitoring safety plans, completion of bio-psycho-social assessments and additional assessments, updating assessments when clinical circumstances change, generating a differential DSM-5-TR diagnosis, prioritizing health, wellness and recovery needs, writing measurable service objectives, creating, monitoring and revising service plans, delivery of mental health and recovery treatment services in individual, group and family formats within their scope, gathering and recording data that measures progress toward the service objectives and documenting services, supports and other information supportive of the service plan.

(b) Render services and supports within their scope to individuals engaged in a Division approved behavioral health services program;

(A) Bachelor’s degree in nursing and licensed by the State of Oregon. Nurses are accountable to abide by the Oregon Nurse Practice Act to determine if job descriptions are compliant with the competencies listed above;

(B) Bachelor’s degree in occupational therapy and licensed by the State of Oregon;

(D) An equivalent degree as evidenced by providing transcripts indicating applicable coursework meeting the required competencies and approved by a Division certified behavioral health provider; or

(E) Qualify as a Mental Health Intern, as described in these rules.

(d) Receive clinical supervision that documents progress towards certification and recertification.

(14) Mental Health Intern (MHI) program staff shall:

(a) Be currently enrolled in a graduate program for a master’s degree in psychology, social work, or related field of behavioral science;

(b) Have a collaborative educational agreement between the Division certified provider and the graduate program for the student;

(c) Demonstrate cultural responsiveness, effective communication and competence in care coordination, development of working alliances with individuals, inter- and intra-agency collaboration, and the rendering of services and supports within their scope and in accordance with the service plan, including transition planning; and

(d) Work within the scope of practice and competencies identified by collaborative educational agreement and the policies and procedures for the credentialing of clinical staff as established by the provider and the graduate program;

(15) Student Intern program staff shall:

(a) Be currently enrolled in an educational program for an undergraduate degree in a behavioral health field;

(b) Have a collaborative education agreement between the Division certified provider and the educational institute for the student;

(d) Work within the scope of practice and competencies identified by the collaborative educational agreement and the policies and procedures for the credentialing of clinical staff as established by the provider; and

(e) Receive, at a minimum, weekly individual supervision by a qualified clinical supervisor employed by the provider of services.

(f) Render services and supports under the direct supervision of a qualified supervisor employed by the provider of services, within the scope of practice and competencies identified by the collaborative educational agreement, and within the policies and procedures for the credentialing of program staff as established by the provider.

(16) Intern program staff shall:

(a) Be working towards obtaining a behavioral health credential;

(b) Demonstrate cultural responsiveness, effective communication and competence in care coordination, development of working alliances with individuals, inter-and intra-agency collaboration, and the rendering of services and supports within their scope and in accordance with the service plan, including transition planning;

(c) Work within the scope of practice and competencies identified by the applicable Division recognized credentialing body and the policies and procedures for the credentialing of clinical staff as established by the provider; and

(d) Render services and supports under the direct supervision of a qualified supervisor employed by the provider of services, within the scope of practice and competencies identified by the applicable Division recognized credentialing body, and within the policies and procedures for the credentialing of program staff as established by the provider.

(17) Community Health Workers working in substance use disorders treatment and recovery programs shall be certified as described in OAR 410-180-0310 and who:

(a) Has expertise or experience in behavioral health;

(b) Works in an urban or rural community, either for pay or as a volunteer in association with a local health care system;

(c) To the extent practicable, shares ethnicity, language, socioeconomic status and life experiences with the members of the community where the worker serves;

(d) Assists members of the community to improve their health and increases the capacity of the community to meet the health care needs of its residents and achieve wellness;

(e) Provides health education and information that is culturally appropriate to the individuals being served;

(f) Assists community members in receiving the care they need;

(g) CHW staff may:

(A) Give peer assistance and guidance on health including behavioral health behaviors; and

(B) Provide skills restoration services.

(18) Peer Support Specialists and Peer Wellness Specialists, including family and youth support and wellness specialists, shall meet the requirements in OAR 410-180-0300 to 0380 for certification and continuing education, and:

(a) A Peer Support Specialist and Peer Wellness Specialist shall be:

(A) Someone self-identified as currently or formerly receiving mental health, problem gambling or substance use services;

(B) Someone self-identified as in recovery from a substance use disorder;

(D) Someone who has experience parenting a child who:

(i) Is a current or former recipient of mental health or substance use treatment; or

(ii) Is facing or has faced difficulties in accessing education and health and wellness services due to a mental health or other behavioral health barrier.

(b) A Peer Support Specialist and Peer Wellness Specialist shall demonstrate:

(A) The ability to support others in their recovery or resiliency;

(B) Personal life experience and tools of self-directed recovery and resiliency; and

(19) “Youth support specialist” means an individual who meets qualification criteria adopted by the authority under ORS 414.665 and who, based on a similar life experience, provides supportive services to an individual who:

(a) Is not older than 30 years of age; and

(b) Is a current or former consumer of mental health or addiction treatment; or

(c) Is facing or has faced difficulties in accessing education, health and wellness services due to a mental health or behavioral health barrier.

(d) A “youth support specialist” may be a peer wellness specialist or a peer support specialist.

(20) Program staff include:

(a) Oregon Licensed Medical Professional (LMP) licensed by the Oregon Medical Board;

(b) Oregon Licensed Practical Nurse (LNP) licensed by the Oregon Board of Nursing;

(d) Advanced Practice Nurse including Clinical Nurse Specialist and Certified Nurse Practitioner licensed by the Oregon Board of Nursing;

(e) Psychologist licensed by the Oregon Board of Psychology;

(f) Professional Counselor (LPC) or Marriage and Family Therapist (LMFT) licensed by the Oregon Board of Licensed Professional Counselors and Therapists;

(g) Clinical Social Worker (CSW) licensed by the Oregon Board of Licensed Social Workers;

(h) Licensed Master Social Worker (LCSW) licensed by the Oregon Board of Licensed Social Workers as described in OAR 877-015-0105;

(i) Licensed Psychologist Associate granted independent status as described in OAR 858-010-0039;

(j) Licensed Occupational Therapist licensed by the Oregon Occupational Therapy Licensing Board;

(k) Board registered interns, including:

(A) Psychologist Associate Residents as described in OAR 858-010-0037;

(B) Licensed Psychologist Associate under continued supervision as described in OAR 858-010-0038;

(C) Licensed Professional Counselor Associate or Marriage and Family Therapist Associate registered with the Oregon Board of Licensed Professional Counselors and Therapists as described in OAR 833-050-0011;

(D) Certificate of Clinical Social Work Associate issued by the Oregon Board of Licensed Social Workers as described in OAR 877-020-0009;

(E) Registered Bachelor of Social Work issued by the Oregon Board of Licensed Social Workers as described in OAR 877-015-0105.

(l) Qualified Mental Health Professional (QMHP) as defined in OAR 309-019-0125(8);

(m) Qualified Mental Health Associate (QMHA) as defined in OAR 309-019-0125(7);

(n) Mental health intern as defined in OAR 309-019-0105;

(o) Problem Gambling treatment staff registered with the Mental Health and Addiction Certification Board of Oregon (MHACBO), which includes:

(A) Certified Gambling Addiction Counselor-Registered (CGAC-R);

(B) Certified Gambling Addiction Counselor-I (CGAC-I); or

(p) Substance Use Disorders (SUD) Treatment Staff, which includes:

(A) Certified Alcohol and Drug Counselor-Registered (CADC-R);

(B) Certified Alcohol and Drug Counselor-I (CADC-I);

(D) Certified Alcohol and Drug Counselor-III (CADC-III).

(q) Peer-Support Specialist (PSS) as defined in OAR 410-180-0305;

(r) Peer Wellness Specialist;

(s) Peer Delivered Services Supervisor;

(t) Tribal Traditional Health Worker; and

(u) Youth Support Specialist.

(21) Milieu staff are not required to have credentials. Milieu staff shall have or obtain training and education in de-escalation, mental health symptoms, substance use disorder symptoms, and suicide ideation identification to maintain a safe, supportive and effective treatment environment, and shall demonstrate effective:

(a) Knowledge of substance use disorders, including the ability to identify drugs and paraphernalia, post-acute withdrawal symptoms, triggers and relapse warning signs;

(b) Interpersonal boundaries, communication and coordination within the interdisciplinary team;

(c) Application of the program’s Code of Conduct, philosophy, guidelines, policies, procedures, standards and expectations;

(d) Safe, trauma informed and respectful interpersonal communications and behaviors; and

(e) Identification of symptoms, behaviors and circumstances that require notification of or consultation with a program or medical treatment staff.

History

Statutory/Other Authority: ORS 413.042, 430.640 & 443.450
Statutes/Other Implemented: ORS 430.010, 430.205 - 430.210, 430.254 - 430.640, 430.850 - 430.955, 443.400 - 443.460, 443.991, 461.549 & 743A.168
BHS 25-2024, amend filed 10/25/2024, effective 10/27/2024
BHS 10-2023, amend filed 04/07/2023, effective 04/07/2023
BHS 1-2022, amend filed 01/05/2022, effective 01/05/2022
BHS 20-2019, amend filed 12/24/2019, effective 01/01/2020
MHS 4-2018, amend filed 02/27/2018, effective 03/01/2018
MHS 10-2017(Temp), f. 9-15-17, cert. ef. 9-15-17 thru 3-13-18
MHS 3-2014, f. & cert. ef. 2-3-14
MHS 10-2013(Temp), f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14

Or. Admin. R. 309-018-0130 Documentation, Training, and Supervision

(1) Providers shall maintain personnel records for each program and milieu staff that contain all of the following documentation:

(a) The results of a criminal records check applicable to the current position or title, and:

(A) For personnel who render mental health services or have access to mental health protected health information such as service records or billing information, the program shall use The Oregon Criminal Records Check and those processes and procedures required by OAR 943-007-0001 through 0501; and

(B) For personnel who render only substance use disorder treatment services or have access to only substance use disorder protected health information such as service records or billing information, the program shall use national and state-wide criminal records check processes.

(b) A current job description that includes applicable competencies;

(c) Copies of relevant licensure or certification, diploma, or certified transcripts from an accredited college, indicating that the program staff meets applicable qualifications;

(d) Periodic performance appraisals;

(e) Program orientation documentation;

(f) Disciplinary documentation;

(g) Results of a Tuberculosis screening as per OAR 333-071-0057;

(h) Documentation of trainings required by this or other applicable rules; and

(i) Documentation of clinical and non-clinical supervision. Documentation shall include the date supervision took place, the amount of supervision time, and a brief description of relevant topics discussed.

(2) Program Orientation: Providers shall ensure that each program staff receive training applicable to the specific population for whom services are planned, delivered, or supervised. The provider shall document that the following orientation was completed for each program staff providing or supervising the provision of services or supports within 30 days of the hire date, unless otherwise specified. At a minimum, program orientation training for all program staff shall include but not be limited to:

(a) A review of crisis prevention and response procedures;

(b) A review of emergency evacuation procedures;

(c) A review of program policies and procedures and the procedures for each licensed ASAM Level of Care for each certified ASAM Level of Care for substance use disorder treatment program staff;

(d) A review of rights for individuals receiving services and supports;

(e) A review of mandatory abuse reporting procedures;

(f) A review of confidentiality policies and procedures;

(g) A review of Fraud, Waste and Abuse policies and procedures;

(h) A review of care coordination procedures;

(i) A review of and agreement to abide by the Code of Conduct; and

(j) Substance use disorders treatment staff and substance use disorders clinical supervisors shall complete a training on The ASAM Criteria, Third Edition within the first 3 months of employment or have it documented as completed within the most recent two years.

(3) Milieu Staff Program Orientation: Providers shall ensure that each Milieu staff receive training applicable to the specific population for whom services are planned, delivered, or supervised. The provider shall document that at a minimum, the following orientation training was completed for each staff or person providing or supporting the provision of services or supports within 30 days of the hire date. At a minimum, program orientation training for all program staff shall include but not be limited to:

(a) A review of crisis prevention and response procedures;

(b) A review of emergency evacuation procedures;

(c) A review of program policies and procedures, including medical protocols and the procedures for each licensed ASAM Level of Care;

(d) A review of rights for individuals receiving services and supports;

(e) A review of mandatory abuse reporting procedures;

(f) A review of confidentiality policies and procedures;

(g) A review of an agreement to abide by the Code of Conduct; and

(h) For Milieu Staff, the personnel record shall contain verification of the completion of the following trainings within the first 6 months of employment:

(A) De-escalation;

(B) Overview of substance use disorders;

(D) Suicide risk and prevention.

(4) Clinical supervision and non-clinical supervision: program staff including applicable volunteers and interns providing direct services and or supports, and milieu staff, shall receive documented clinical supervision or non-clinicial supervision, and oversight by a qualified clinical supervisor or manager, as applicable and as defined in these rules. Part time program staff shall receive supervision prorated to reflect the average number of hours worked. Half the total supervision hours required may be accomplished through group supervision. Individual face-to face contact may include real time, two-way audio or audio-visual conferencing, and:

(a) Clinical Supervision and non-clinical supervision shall be related to the development of the staff and the services, and the implementation and outcome of the services. Supervision shall be provided to assist staff to:

(b) Increase their skills within their scope of practice;

(d) Ensure understanding and application of the code of conduct and program policies and procedures; and

(e) Documentation shall include the date, amount of time per session and a brief description of the topics addressed and shall demonstrate the following minimum amounts of clinical supervision:

(A) Non-licensed program staff and volunteers meeting the definition of program staff shall receive at least two hours per month of clinical supervision. The two hours shall include one hour of individual face-to-face supervision;

(B) Program staff holding a license issued by a Division recognized credentialing body shall receive at least two hours of clinical supervision quarterly;

(C) Mental Health Interns, Interns and Student Interns shall receive one-hour of individual clinical supervision per week;

(D) When available, a qualified Peer Delivered Services Supervisor shall provide one of the two hours of required monthly supervision to program staff providing direct Peer Delivered Services. Remaining hours of supervision shall be provided by a qualified clinical supervisor; and

(E) Non-clinical, group supervision shall be provided to milieu staff by the managing staff or clinical supervisor at least one hour per month.

(f) Mental health interns, interns and student interns shall render services and supports under the active supervision of a qualified supervisor, as defined in these rules; and

(g) Individualized, non-clinical supervision shall be utilized as needed and documented.

History

Statutory/Other Authority: ORS 413.042, 430.640 & 443.450
Statutes/Other Implemented: ORS 430.010, 430.205 - 430.210, 430.254 - 430.640, 430.850 - 430.955, 443.400 - 443.460, 443.991, 461.549 & 743A.168
BHS 10-2023, amend filed 04/07/2023, effective 04/07/2023
MHS 4-2018, amend filed 02/27/2018, effective 03/01/2018
MHS 10-2017(Temp), f. 9-15-17, cert. ef. 9-15-17 thru 3-13-18
MHS 3-2014, f. & cert. ef. 2-3-14
MHS 10-2013(Temp), f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14

Or. Admin. R. 309-018-0135 Entry

(1) The provider must utilize and document an entry procedure that at a minimum will ensure the following:

(a) Individuals shall be considered for entry without regard to race, ethnicity, gender, gender identity, gender presentation, sexual orientation, religion, creed, national origin, age, except when program eligibility is restricted to children, adults or older adults, familial status, marital status, source of income, and disability;

(b) Individuals shall receive services a manner consistent and appropriate with their presenting life circumstances; and

(c) The provider may not deny entry to individuals based on the individual’s decision to continue their currently prescribed medication to treat opioid dependence while receiving residential substance use disorder services.

(2) Except as permitted by law in emergencies, informed consent for services must be obtained prior to services. Written, voluntary informed consent for services shall be obtained from the individual or guardian, if applicable, prior to the start of services. If such consent is not obtained, the reason and any further attempts to obtain informed consent shall be documented in the service record.

(3) Per CFR 440.230, the provider shall develop and maintain service records and other documentation that demonstrates amount, duration and scope of each specific services and supports provided for each individual.

(4) The provider shall submit the identified status and service data, including Non-Medicaid Service Data where required, in the mandated state data system according to the timelines required by the Division for each individual whose services are paid for in-full or in-part by public funds and for individuals enrolled in DUII services within 10 days of the start of services

(5) An authorization for the release of information shall be obtained and contained in the service record for the release of any confidential information concerning the individual being considered for or receiving services.

(6) Except as permitted by law in emergencies, prior to or at the start of treatment services, , the program must obtain written, voluntary informed consent for services from the individual or guardian, if applicable. The provider shall offer to the individual and guardian, if applicable, written program information. The written program information shall be in a language understood by the individual and must include disclosures and description of services to be provided, as well as other information regarding the program. The written program information shall include:

(a) A description of individual rights consistent with these rules; and

(b) Notice of privacy practices; and

(c) Disclosure of opportunity to declare Advanced Directive for Mental Health Treatment, including description on how to access this opportunity.

(7) Entry requirements for providers that receive the Substance Use, Prevention, Treatment and Recovery (SUPTR) Block Grant:

(a) Providers shall maintain waitlist documentation demonstrating that individuals are prioritized for entry in the following order:

(A) Individuals who are pregnant and using substances intravenously;

(B) Individuals who are pregnant;

(D) Individuals or families with dependent children.

(b) Entry of pregnant individuals shall occur no later than 48 hours from the date of first contact and entry of individuals using substances intravenously shall occur no later than 14 days after the date of first contact. If services are not available within the required timeframes, the provider shall document the reason and provide interim referral and informational services, as defined in these rules, within 48 hours; and

(c) Individuals using substances intravenously shall receive interim resource recommendations and information prior to entry to reduce the adverse health effects of substance use, promote the health of the individual, and reduce the risk of transmission of disease. At a minimum, interim resource recommendations and informational services shall include:

(A) An opportunity for the individual to engage in routine services through care coordination, peer services or other interactive supports.

(B) Educational material about blood borne pathogens including Hepatitis, HIV, STDs, and Tuberculosis (TB); the risks of needle and paraphernalia sharing; and the likelihood of transmission to sexual partners and infants;

(D) Resource recommendations for addressing Hepatitis, HIV, STD, and TB testing, vaccine, or care services if necessary; and

(E) For pregnant individuals, counseling and educational information addressing the likelihood of blood borne pathogen transmission as well as the effects of alcohol, tobacco, and other drug use on the fetus and referral for prenatal care.

History

Statutory/Other Authority: ORS 413.042, 428.205 - 428.270, 430.640 & 443.450
Statutes/Other Implemented: ORS 109.675, 161.390 - 161.400, 179.505, 430.010, 430.205 - 430.210, 430.254 - 430.640, 430.850 - 430.955, 443.400 - 443.460, 443.991, 461.549 & 743A.168
BHS 25-2024, amend filed 10/25/2024, effective 10/27/2024
BHS 10-2024, temporary amend filed 05/21/2024, effective 05/21/2024 through 10/27/2024
BHS 8-2024, temporary amend filed 04/30/2024, effective 05/01/2024 through 10/27/2024
BHS 10-2023, amend filed 04/07/2023, effective 04/07/2023
MHS 4-2018, amend filed 02/27/2018, effective 03/01/2018
MHS 10-2017(Temp), f. 9-15-17, cert. ef. 9-15-17 thru 3-13-18
MHS 3-2014, f. & cert. ef. 2-3-14
MHS 10-2013(Temp), f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14

Or. Admin. R. 309-018-0140 Assessment

(1) Prior to, or at the time of entry, an assessment must be initiated and by a qualified program staff.

(a) Assessments must record diagnostic information derived from any combination of clinical observation, self-report interview, or collateral information (such as assessments from other programs or previous treatment episodes).

(b) Providers may minimize the number and length of assessments through use of collateral information to inform the current assessment, such as previous assessments on file.

(c) Any changes to the ASAM Level of Care placement decision must be justified within an update to the multidimensional assessment on file;

(d) Providers must update assessments within the scope of their practice when there are changes in clinical circumstances;

(e) At a minimum, each of following must be documented during initial assessment interview(s):

(A) A medically necessary reason for services, including supporting information;

(B) Appropriateness for treatment by the program;

(D) Immediate risk(s);

(E) Identification of current physical and psychological trauma; and

(2) In addition, for individuals entering residential substance use disorder services, each assessment and update thereof must be a multidimensional assessment that is consistent with The ASAM Criteria, Third Edition, and include, at a minimum, the following components, each consistent with The ASAM Criteria, Third Edition :

(a) The Level of Care recommendation for each ASAM dimension based on current and available information;

(b) A consideration of the history of each substance use-related risk as well as the present substance use related risk concern(s);

(d) An overall determination of the severity of risk the individual currently is experiencing.

(3) Assessments and assessment updates are considered complete when the following information has also been added to assessment documentation as soon as possible, but within a timeline that prioritizes the individual’s immediate needs:

(a) Clinically relevant current and historical biological, psychological, social information;

(b) Documentation of the presence of a DSM-5-TR diagnosis that is the medically necessary reason for services, including identification of each DSM-5-TR criteria established per diagnosis, and the symptoms supporting each criteria;

(d) A determination of immediate need for follow-up actions, additional services and supports; and

(e) The identification of psychological and physical trauma and risk to the individual or to others.

(f) Current Substance use;

(g) Current Problem Gambling Behavior;

(h) Current Mental Health conditions, including currently prescribed psychiatric medications, as clinically relevant;

(i) Current Medical conditions, including currently prescribed treatments and medications, as clinically relevant;

(j) When indicated, documentation must contain recommendations for each identified need, indicating further assessment, planning, and intervention from an appropriate professional, either with the same provider or with a collaborative community provider.

(k) ASAM Level of Care determination per dimension, overall, and noting any applicable discrepancies.

(l) If the provider cannot document a medically necessary reason for services that includes a DSM-5-TR diagnosis at entry, the provider must at minimum, document a screening for suicide risk, immediate needs, safety risk and current impact of trauma on daily functioning. The provider can render the following routine services for up to 3 business days without a documented medically necessary reason for services, or at any appropriate time during a treatment episode:

(A) Care co-ordination;

(B) Case Management; and

History

Statutory/Other Authority: ORS 413.042, 428.205 - 428.270, 430.640 & 443.450
Statutes/Other Implemented: ORS 430.010, 430.205 - 430.210, 430.254 - 430.640, 430.850 - 430.955, 443.400 - 443.460, 443.991, 461.549 & 743A.168
BHS 25-2024, amend filed 10/25/2024, effective 10/27/2024
BHS 10-2024, temporary amend filed 05/21/2024, effective 05/21/2024 through 10/27/2024
BHS 8-2024, temporary amend filed 04/30/2024, effective 05/01/2024 through 10/27/2024
BHS 10-2023, amend filed 04/07/2023, effective 04/07/2023
MHS 4-2018, amend filed 02/27/2018, effective 03/01/2018
MHS 10-2017(Temp), f. 9-15-17, cert. ef. 9-15-17 thru 3-13-18
MHS 3-2014, f. & cert. ef. 2-3-14
MHS 10-2013(Temp), f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14

Or. Admin. R. 309-018-0145 Service Plan and Service Notes

(1) The Service Plan shall be a written, individualized plan to improve the individual’s condition to the point where the individual’s continued participation in the program or level of care is no longer necessary.

(2) Routine services may be provided prior to completion of a Service Plan. Per Services not documented in a Service Plan may be provided with documented explanation. The Service Plan is included in the individual’s service record and shall:

(a) Be started prior to the rendering of treatment services, and provider must document reason for any delay in the service record ;

(b) Reflect the assessment in its’ most updated form;

(d) Include a safety plan when the assessment indicates risk to the health and safety of the individual or to others and be updated as circumstances change. The safety plan may be a separate document from the Service Plan;

(e) Include the participation, and reflect agreement, of the individual and family members as applicable; and

(f) Be completed and signed by qualified program staff as follows:

(A) Supervisory or treatment staff in substance use disorders treatment and recovery programs; and

(B) Supervisory or treatment staff in problem gambling treatment and recovery programs.

(3) At minimum, each service plan, in addition to requirements in 309-018-0145 (2) above, each service plan shall include:

(a) Treatment goals that are:

(A) Individualized to meet the assessed needs of the individual.

(B) Completed within ten business days from entry.

(C)Measurable, with inclusion of baseline measurements, for the purpose of evaluating individual progress, as well as include;

(b) The specific services and supports that shall be used to meet the treatment objectives;

(d) A schedule for re-evaluating the service plan.

(3) Providers shall document in a service note each service and support that includes the following:

(a) The specific services rendered;

(b) The specific service plan objectives being addressed by the services provided;

(d) The personnel rendering the services, including the name, credentials and signature;

(e) The setting in which the services were rendered; and

(f) Periodic updates describing the individual’s progress.

History

Statutory/Other Authority: ORS 413.042, 428.205 - 428.270, 430.640 & 443.450
Statutes/Other Implemented: ORS 430.010, 430.205 - 430.210, 430.254 - 430.640, 430.850 - 430.955, 443.400 - 443.460, 443.991, 461.549 & 743A.168
BHS 25-2024, amend filed 10/25/2024, effective 10/27/2024
BHS 10-2024, temporary amend filed 05/21/2024, effective 05/21/2024 through 10/27/2024
BHS 8-2024, temporary amend filed 04/30/2024, effective 05/01/2024 through 10/27/2024
BHS 10-2023, amend filed 04/07/2023, effective 04/07/2023
MHS 4-2018, amend filed 02/27/2018, effective 03/01/2018
MHS 10-2017(Temp), f. 9-15-17, cert. ef. 9-15-17 thru 3-13-18
MHS 3-2014, f. & cert. ef. 2-3-14
MHS 10-2013(Temp), f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14

Or. Admin. R. 309-018-0150 Service Record

(1) Documentation shall be appropriate in quality and quantity to meet professional standards applicable to the provider and any additional standards for documentation in the provider’s policies and any pertinent contracts.

(2) All providers shall develop and maintain a Service Record for each individual. The record shall, at a minimum, include:

(a) Identifying information or documentation of attempts to obtain the information, including:

(A) The individual's first and last name, preferred name, address, telephone number, date of birth, sex, gender identity, and for adults, marital status, and military status;

(B) First and last name,, address, and telephone number of the parent or legal guardian, primary care giver or emergency contact; and

(b) Informed Consent for Service including medications or documentation specifying why the provider could not obtain consent by the individual or guardian as applicable;

(d) A signed fee agreement, when applicable;

(e) A personal belongings inventory created upon entry and updated whenever an item of significant value is added or removed or on the date of transfer;

(f) Background information including strengths and interests, all available previous mental health or substance use assessments, previous living arrangements, service history, behavior support considerations, education service plans if applicable, and family and other support resources;

(g) Medical information including a brief history of any health conditions, documentation from a LMP or other qualified health care professional of the individual's current physical health, and a written record of any prescribed or recommended medications, services, dietary specifications, and aids to physical functioning;

(h) Copies of documents relating to guardianship or any other legal considerations, as applicable;

(i) Documentation of the individual’s ability to evacuate the home consistent with the program’s evacuation plan developed in accordance with the Oregon Structural Specialty Code and Oregon Fire Code;

(j) Documentation of any safety risks;

(k) Documentation of follow-up actions and referrals when an individual reports symptoms indicating risk of suicide; and

(l) Critical Incidents shall be reported to the Division through submission of an incident report and as applicable, to the Office of Training Investigation and Safety (OTIS), and other authorities:

(A) In at least the following examples of circumstances:

(i) Death, including by suicide or overdose;

(ii) Severe injury, overdose resulting in hospitalization or needing medical attention, and emergency services needed;

(iii) Ongoing risk to health (for example: environmental risks such as certain molds that pose risks to health);

(iv) Police involvement;

(v) Extensive damage to the facility or other substantial change in living conditions; and

(vi) Where abuse or neglect is suspected, including unethical client and staff relationships; and

(vii) Relationships between individuals that result in harm to at least one individual or that are sexual in nature.

(B) Within 24 hours of the event;

(D) All incident reports shall be maintained in the corresponding service record and in a common file for quality improvement purposes and review by the Division; and

(E) In accordance with privacy rules and regulations, incident reports filed in service records shall not contain protected health information belonging to any other individual.

(3) Incident reports shall contain, at a minimum, the following information:

(a) The time and date of the event;

(b) The time and date of when the incident report form was completed;

(d) Identification of all staff involved in the incident and the response to the incident, and their titles;

(e) Identification of each individual involved;

(f) Description of event;

(g) Description of program response;

(h) Description of which policies and procedures were followed and when appliable, any that were not followed;

(i) Identification of staff who were notified, and their titles;

(j) Identification of which authorities the event was reported to; and

(k) Description of administrative response and follow-up.

(4) When medical services are provided by the program or a community provider, the following documents shall be part of the Service Record as applicable:

(a) Medication administration records as per these rules;

(b) Laboratory reports;

(d) Documentation of medical screenings, assessments, consultations, interventions, and procedures.

History

Statutory/Other Authority: ORS 413.042, 428.205 - 428.270, 430.640 & 443.450
Statutes/Other Implemented: ORS 430.010, 430.205 - 430.210, 430.254 - 430.640, 430.850 - 430.955, 443.400 - 443.460, 443.991, 461.549 & 743A.168
BHS 25-2024, amend filed 10/25/2024, effective 10/27/2024
BHS 10-2024, temporary amend filed 05/21/2024, effective 05/21/2024 through 10/27/2024
BHS 8-2024, temporary amend filed 04/30/2024, effective 05/01/2024 through 10/27/2024
BHS 10-2023, amend filed 04/07/2023, effective 04/07/2023
MHS 4-2018, amend filed 02/27/2018, effective 03/01/2018
MHS 10-2017(Temp), f. 9-15-17, cert. ef. 9-15-17 thru 3-13-18
MHS 3-2014, f. & cert. ef. 2-3-14
MHS 10-2013(Temp), f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14

Or. Admin. R. 309-018-0155 Transfer and Continuity of Care

(1) Providers shall maintain direct affiliation with or close coordination for referral to other levels of care and other types of services and supports to coordinate biomedical, psychological, pharmacotherapy, laboratory, community engagement, educational, vocational and other such services and supports that are not offered by the provider.

(2) Prior to transfer, providers shall:

(a) When applicable, coordinate and provide appropriate referrals for medical care and medication management. The transferring provider shall assist the individual to identify the medical provider who provides continuing care and to arrange an initial appointment with that provider;

(b) Document a transfer summary of treatment services; and

(3) A transfer summary of treatment services shall include:

(a) The date of transfer;

(b) The reason for the transfer;

(c) When transfer is to another provider, identify the provider where services are to be transferred, including contact information and date of admission or description of steps for the individual to access services;

(d) For substance use disorder treatment services, a summary of the current ASAM data for all dimensions, risk assessment, the ASAM assessed Level of Care established for the purposes of transfer of services, and any other recommendation(s) for the next assessed ASAM Level of Care, including other community services; and

(e) A summary statement describing the effectiveness of services to assist the individual and, when applicable, their family in achieving the objectives contained in the service plan.

(4) A transfer summary of support services shall be made available in writing to the individual as requested and include:

(a) Where appropriate, a plan for personal wellness and resilience, including relapse prevention;

(b) Identification of resources to assist the individual and family, if applicable, in accessing recovery and resiliency services and supports;

(d) When services are transferred due to the absence of the individual, the provider shall document outreach efforts made to re-engage the individual or document the reason why such efforts were not made.

(5) To the extent permitted or required by applicable confidentiality laws, when the transfer summary of treatment services is sent to another provider or level of care, it shall be sent in advance of the individual’s entry into services at another provider or the next level of care. To the extent permitted by law, all other documentation contained in the Service Record that is requested by the receiving provider shall be furnished, within 14 days of receipt of a written request for the documentation.

History

Statutory/Other Authority: ORS 413.042, 428.205 - 428.270, 430.640 & 443.450
Statutes/Other Implemented: ORS 430.010, 430.205 - 430.210, 430.254 - 430.640, 430.850 - 430.955, 443.400 - 443.460, 443.991, 461.549 & 743A.168
BHS 10-2023, amend filed 04/07/2023, effective 04/07/2023
MHS 4-2018, amend filed 02/27/2018, effective 03/01/2018
MHS 10-2017(Temp), f. 9-15-17, cert. ef. 9-15-17 thru 3-13-18
MHS 3-2014, f. & cert. ef. 2-3-14
MHS 10-2013(Temp), f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14

Or. Admin. R. 309-018-0160 Co-Occurring Mental Health and Substance Use Disorders (COD)

Services shall be integrated and address treatment and recovery for co-occurring Mental Health, Substance Use and/or Gambling Disorders. In addition to requirements in OAR Chapter 309, these rules specify standards and requirements for providers delivering co-occurring mental health, substance use disorder and problem gambling services and supports.

(1) Access to services shall:

(a) Be trauma informed, culturally relevant, linguistically, and developmentally appropriate, and utilize a harm reduction model where indicated and appropriate; and

(b) Be adapted for individuals with intellectual and developmental disabilities.

(2) All assessments shall:

(a) Be consistent with the most recent version of the ASAM (American Society of Addiction Medicine) criteria and document a level of care determination consistent with ASAM;

(b) Provide sufficient information to justify the presence of at least two behavioral health disorders --Mental Health Disorders, Substance Use Disorders and/or Gambling Disorder diagnoses that are the medically appropriate reason for services, using the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM); and

(3) Service Plans shall:

(a) Accommodate the individual’s identified holistic needs and preferences, as appropriate for Residential Level of Care;

(b) Utilize a harm reduction approach where indicated and appropriate for Residential Level of Care;

(d) Be in alignment with participant’s current stage of change in regard to substance use disorder recovery, gambling disorder recovery and mental health disorder recovery.

(4) The following services shall be made available, as indicated through assessment and service plan:

(a) Case Management ;

(b) Peer Support Services;

(d) Psychiatric medication and evaluation services.

(5) Integrated Co-Occurring Disorders Programs shall screen for gambling disorder at time of entry. Should Gambling Disorder be a identified;

(a) a diagnosis and supporting information will be documented in the assessment and service plan by a qualified Problem Gambling Counselor or Integrated Co-Occurring Disorders Problem Gambling Specialist;

(b) Problem Gambling shall be treated in Integrated Co-Occurring Disorders Residential setting by a qualified Problem Gambling Counselor or Integrated Co-Occurring Problem Gambling Specialist;

(c) Should Problem Gambling be identified as more severe than presenting co-occurring mental health and substance use disorders, participant shall be referred to a specialty problem gambling residential treatment provider.

(6) Integrated Co-Occurring Disorders Program Staff Qualifications shall align with the provisions described in 309-018-0125 and ensure that:

(a) All treatment staff providing Integrated Co-Occurring Disorders treatment services shall hold, at minimum, a qualifying credential to provide treatment services in mental health or substance use disorders treatment. Treatment staff holding one credential shall be limited to providing treatment services in alignment with their credential;

(b) Interns and student interns are permitted to provide services during the duration of their candidacy or internship as described in OAR 309-018-0105;

(d) The program must retain a credentialed problem gambling treatment provider OR designate a Co-Occurring Problem Gambling Specialist. A Co-Occurring Problem Gambling Specialist must have:

(A) Fourteen hours minimum of problem gambling specific training within twelve months of being named as a problem gambling provider, with a minimum of two hours in each of the following seven content areas; Gambling Client Assessment/Intake, Gambling Financial Planning and Budgeting, Gambling Counseling (Individual, Group, Family), Gambling Case Management, Professional Responsibility and Ethics in Gambling Counseling, Crisis Intervention in Gambling Counseling, Co-Occurring Disorders and Problem Gambling; and

(B) Documentation of required trainings shall be contained in the personnel file.

(e) Peer – Delivered Services providers shall be certified as Peer Wellness Specialists (PWS) or Peer Support Specialist (PSS);

(f) Supervisors must:

(A) Be credentialed in Mental Health and/or Substance Use Disorder treatment provision;

(B) Limit their supervision to providers within the scope of their professional credentials.

(C) Supervisors must demonstrate completion of 12 CEU’s in approved Problem Gambling training for supervisors within twelve months of beginning to supervise program staff rendering Problem Gambling Treatment Services in Integrated Co-Occurring Disorders Treatment programming;

(g) The program must employ or contract with a Licensed Medical Provider (LMP) that shall provide psychiatric medication services to program participants. The LMP shall acquire Division approved Integrated Co-Occurring Disorders training within twelve months of hire or appointment to these services. Approved training will be published by the Division on the OHA Integrated Co-Occurring Disorders website yearly on or before January 1st;

(h) The program shall be certified by the Division as either ASAM Co-Occurring Capable or ASAM Co-Occurring Enhanced;

(i) All Supervisors, Treatment Service Providers and Peer Services Providers delivering services in Integrated Co-Occurring Disorders Programs shall complete Integrated Co-Occurring Disorders trainings required and provided by OHA and shall ensure certificates of completion are documented in staff personnel files, according to the following conditions:

(A) Within twelve months of beginning to render Co-Occurring Disorders services or supports; and

(B) On a continuing two-year basis for all Supervisors and Treatment Providers and a continuing three-year basis for Peer Staff rendering Co-Occurring Disorders services or supports for more than one year.

(j) Continuing Education training required by the Oregon Health Authority (OHA) shall consist of at least two hours but no more than six hours every two years following the initial training year for supervisors and treatment providers, and every three years following the initial training year for peer services providers:

(A) Integrated Co-Occurring Disorders trainings required by OHA will be published by the Division yearly on or before January 1st on the OHA Integrated Co-Occurring Disorders website;

(B) OHA training will include – but will not be limited to – content relevant to providing integrated treatment, and specialty training on providing treatment services for community members who are marginalized, underserved, and oppressed by structural and systemic racism and injustices, Severe Mental Illness and Intellectual and Developmental Disabilities.

History

Statutory/Other Authority: ORS 413.042, 430.640 & 443.450
Statutes/Other Implemented: ORS 743A.168, ORS 430.010, 430.205 - 430.210, 430.254 - 430.640, 430.850 - 430.955, 443.400 - 443.460, 443.991 & 461.549
BHS 15-2023, amend filed 06/28/2023, effective 07/01/2023
MHS 4-2018, amend filed 02/27/2018, effective 03/01/2018
MHS 10-2017(Temp), f. 9-15-17, cert. ef. 9-15-17 thru 3-13-18
MHS 17-2016, f. 11-28-16, cert. ef. 11-30-16
MHS 10-2016(Temp), f. 6-29-16, cert. ef. 7-1-16 thru 12-27-16
MHS 3-2014, f. & cert. ef. 2-3-14
MHS 10-2013(Temp), f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14

Or. Admin. R. 309-018-0162 Residential Specialty Programs

Residential Specialty Programs focused on treatment programming and planning must be specialized to the population and individuals being served. The majority of the population being served within the program must fall within the specific specialty population. The Specialty populations recognized under publicly funded services and supports include:

(1) Pregnant and/or parenting with dependent children. Programs shall be designed to meet the unique service needs of this population and shall ensure:

(a) Individuals receiving services:

(A) That are pregnant or;

(B) Have their infant(s) and/or toddler(s)/ young child(ren) reside with them in the treatment facility, or;

(C) Are complying with a Department of Human Services (DHS) plan to regain custody of their child(ren) and have a recommendation from the DHS caseworker to attend a parenting program;

(b) Day Care be accessible for every infant and toddler;

(d) Family counseling is made available to all individuals;

(e) Screening and counseling services are made available for each child;

(f) School-aged children attend school regularly and are provided assistance with their schoolwork or a tutor or other support as identified by the school, parent, DHS or program;

(g) Transportation is arranged or provided for medical and educational and other necessities; and

(h) Peer-Delivered Services are made available.

(2) Culturally Specific programs shall be designed to meet the unique service needs of a specific culture and provide services designed to meet the needs of the majority of individuals representing that culture.

(a) Types of culturally specific programs include:

(A) LGBTQIA2S+;

(B) Specific cultural, racial and/or ethnic group(s) including tribal members;

(C) Military community members inclusive of those who have served in the Armed Forces or National Guard, and their families.

(b) All Culturally specific programs shall:

(A) Be approved and designated as culturally specific programs and meet all criteria in OAR 309-018-0170; and

(B) Provide Peer-Delivered Services.

(A) All individuals receiving care have received:

(i) Screening for brain injury;

(ii) Screening for military sexual trauma;

(iii) Information and instruction on lethal means safety planning;

(iv) Information on how to access Oregon Senior Health Insurance Benefits Assistance (SHIBA) if approaching 65, or older; and

(v) Appropriate referrals, as determined by screenings

(B) Transportation is arranged or provided for medical and educational and other necessities

(C) Individuals identifying as members of the military community are offered assistance to enroll in Veteran Health Administration (VHA) for the delivery of health and behavioral health services

(D) Staff delivering services to individuals of the military community have completed training on the subject of military culture

(E) The culturally specific program has an agreement establishing care coordination expectations with the nearest Department of Veterans Affairs medical center, independent clinic, drop-in center, or other facility of the Department

(F) Care provided to military community members is consistent with minimum clinical mental health guidelines promulgated by the VHA

History

Statutory/Other Authority: ORS 413.042 & ORS 430.640
Statutes/Other Implemented: ORS 413.042, ORS 430.640, ORS 414.025, ORS 414.065, ORS 430.640, ORS 430.705 & ORS 430.715
BHS 14-2022, adopt filed 07/20/2022, effective 07/20/2022

Or. Admin. R. 309-018-0165 Residential Problem Gambling Treatment Services

Residential problem gambling treatment services shall include group, individual, and family treatment consistent with the following requirements:

(1) Service sessions shall address the challenges of the individual as they relate, directly or indirectly, to the problem gambling behavior.

(2) Providers may provide telephone counseling when person-to-person contact involves an unwise delay, as follows:

(a) Individuals shall be currently enrolled in the problem gambling treatment program;

(b) Phone counseling shall be provided by a qualified program staff within their scope of practice;

(c) Service notes for phone counseling shall follow the same criteria as face-to-face counseling and identify the session was conducted by phone and the clinical rationale for the phone session;

(d) Telephone counseling shall meet HIPAA and 42 CFR standards for privacy; and

(e) There shall be an agreement of informed consent for phone counseling that is discussed with the individual and documented in the individual’s service record.

(3) Family counseling includes face-to-face or non-face-to-face service sessions between a program staff member delivering the service and a family member whose life has been negatively impacted by gambling:

(a) Service sessions shall address the problems of the family member as they relate directly or indirectly to the problem gambling behavior; and

(b) Services to the family shall be offered even if the individual identified as a problem gambler is unwilling or unavailable to accept services.

(4) Twenty-four hour crisis response shall be accomplished through agreement with other crisis services, on-call program staff, or other arrangement acceptable to the Division.

(5) A financial assessment shall be included in the entry process and documented in the assessment.

(6) The service plan shall include a financial component, consistent with the financial assessment.

(7) A risk assessment for suicide ideation shall be included in the entry process and documented in the assessment as well as appropriate referrals made.

(8) The service plan shall address suicidal risks if determined within the assessment process or throughout services.

(9) For individuals at risk, the service notes shall contain documented evidence that suicidal risk is continually assessed and that follow-up safety plan activities are being monitored.

History

Statutory/Other Authority: ORS 428.205 - 428.270, 430.640 & 443.450
Statutes/Other Implemented: ORS 430.010, 430.205 - 430.210, 430.254 - 430.640, 430.850 - 430.955, 443.400 - 443.460, 443.991, 461.549, 743A.168, 813.010 - 813.055 & 813.200 - 813.270
MHS 4-2018, amend filed 02/27/2018, effective 03/01/2018
MHS 10-2017(Temp), f. 9-15-17, cert. ef. 9-15-17 thru 3-13-18
MHS 3-2014, f. & cert. ef. 2-3-14
MHS 10-2013(Temp), f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14

Or. Admin. R. 309-018-0170 Culturally Specific Substance Use Disorders Treatment and Recovery Services

Programs approved and designated as culturally specific programs shall meet the following criteria:

(1) Serve a majority of individuals representing culturally specific populations;

(2) Maintain a current demographic and cultural profile of the community;

(3) Ensure that individuals from the identified cultural group receive effective and respectful care that is provided in a manner compatible with their cultural health beliefs, practices, and preferred language;

(4) Implement strategies to recruit, retain, and promote a diverse staff at all levels of the organization that are representative of the population being served;

(5) Ensure that staff at all levels and across all disciplines receive ongoing education and training in culturally and linguistically appropriate service delivery;

(6) Ensure that a majority of the substance use disorders treatment staff be representative of the specific culture being served;

(7) Ensure that individuals are offered customer satisfaction surveys that address all areas of service and that the results of the surveys are used for quality improvement;

(8) Consider race, ethnicity, and language data in measuring customer satisfaction;

(9) Develop and implement cultural competency policies;

(10) Ensure that data on individual’s race, ethnicity, and spoken and written language are collected in health records, integrated into the organization’s management information systems, and periodically updated;

(11) Develop and maintain a governing or advisory board as follows:

(a) Have a majority representation of the culturally specific group being served;

(b) Receive training concerning the significance of culturally relevant services and supports;

(d) Monitor agency quality improvement mechanisms and evaluate the ongoing effectiveness and implementation of culturally relevant services (CLAS) and supports within the organization.

(12) Maintain accessibility to culturally specific populations including:

(a) The physical location of the program shall be within close proximity to the culturally specific populations;

(b) Where available, public transportation shall be within close proximity to the program; and

(13) The physical facility where the culturally specific services are delivered shall be trauma informed for the group including:

(a) Materials displayed shall be culturally relevant; and

(b) Mass media programming (radio, television, etc.) shall be sensitive to cultural background.

(14) Other cultural differences shall be considered and accommodated when possible, such as the need or desire to bring family members to the facility, play areas for small children, and related accommodations; and

(15) Ensure that grievance processes are culturally and linguistically sensitive and capable of identifying, preventing and resolving cross-cultural conflicts or complaints.

History

Statutory/Other Authority: ORS 413.042, 428.205 - 428.270, 430.640 & 443.450
Statutes/Other Implemented: ORS 430.010, 430.205 - 430.210, 430.254 - 430.640, 430.850 - 430.955, 443.400 - 443.460, 443.991, 461.549 & 743A.168
MHS 4-2018, amend filed 02/27/2018, effective 03/01/2018
MHS 10-2017(Temp), f. 9-15-17, cert. ef. 9-15-17 thru 3-13-18
MHS 3-2014, f. & cert. ef. 2-3-14
MHS 10-2013(Temp), f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14

Or. Admin. R. 309-018-0180 Residential Substance Use Disorders Treatment and Recovery Programs

(1) Programs approved to provide residential substance use disorders treatment services shall meet the following standards:

(a) The assessment shall contain an evaluation that identifies and assesses needs such as social isolation, self-reliance, parenting issues, domestic violence, physical health, housing, and financial considerations;

(b) The service plan shall address all areas identified in the assessment and applicable service coordination details to address the identified needs;

(c) The program shall provide or coordinate services and supports that meet the special access needs such as childcare, mental health services, and transportation, as indicated; and

(d) The program shall provide or coordinate the following services and supports unless clinically contraindicated:

(A) Gender-specific services and supports;

(B) Family services, including therapeutic services for children in the custody of individuals in treatment;

(D) Peer delivered supports;

(E) Smoking cessation;

(F) Housing;

(G) Transportation; and

(H) Housing and Employment support services for those who qualify under OAR 309-019-0105.

(2) Services shall include the participation of family and other agencies as appropriate, such as social service, child welfare, or corrections agencies.

(3) The program shall coordinate services with the following, if indicated:

(a) Agencies providing services to individuals who have experienced physical abuse, sexual abuse, or other types of domestic violence; and

(b) Parenting training; and

(c) Continuing care treatment services shall be consistent with the ASAM PPC and shall include referrals to support groups where available.

(4) Providers that receive SAPT block grant funding shall provide or coordinate the following services for pregnant women and individuals with dependent children, including individuals who are attempting to regain custody of their children:

(a) Primary medical care, including referral for prenatal care and child care;

(b) Primary pediatric care, including immunizations for their children;

(c) Gender specific substance use treatment and other therapeutic interventions for individuals that may include but are not limited to:

(A) Relationship issues;

(B) Sexual and physical abuse;

(D) Access to child care while the individuals are receiving these services; and

(E) Therapeutic interventions for children in the custody of individuals in treatment that may include but are not limited to:

(i) Their developmental needs;

(ii) Any issues concerning sexual and physical abuse and neglect; and

(iii) Sufficient case management and transportation to ensure that individuals and their children have access to services.

(5) Providers who deliver adolescent substance use disorders treatment services or those with adolescent-designated service funding shall meet the following standards:

(a) Development of service plans and case management services shall include participation of parents, other family members, schools, children's services agencies, and juvenile corrections, as appropriate.

(b) Services or appropriate referrals shall include:

(A) Family counseling;

(B) Education services;

(D) Smoking cessation service.

(c) Continuing care services shall be of appropriate duration and designed to maximize recovery opportunities. The services shall include:

(A) Reintegration services and coordination with family and schools;

(B) Youth dominated self-help groups where available;

(D) Linkage to physical or sexual abuse counseling and support services when appropriate.

History

Statutory/Other Authority: ORS 413.042, 428.205 - 428.270, 430.640 & 443.450
Statutes/Other Implemented: ORS 430.010, 430.205 - 430.210, 430.254 - 430.640, 430.850 - 430.955, 443.400 - 443.460, 443.991, 461.549 & 743A.168
BHS 1-2022, amend filed 01/05/2022, effective 01/05/2022
MHS 4-2018, amend filed 02/27/2018, effective 03/01/2018
MHS 10-2017(Temp), f. 9-15-17, cert. ef. 9-15-17 thru 3-13-18
MHS 3-2014, f. & cert. ef. 2-3-14
MHS 10-2013(Temp), f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14

Or. Admin. R. 309-018-0181 SUD Residential ASAM Level of Care 3.1

Clinically Managed Low-Intensity Residential Substance Use Disorder Services ASAM Level of Care 3.1 In addition to any other requirements described in these rules and applicable statutes, programs licensed to render adolescent or adult residential ASAM Level of care 3.1 services shall, at a minimum, meet and maintain documentation demonstrating ongoing compliance with each of the following standards:

(1) ASAM Level 3.5 programs shall ensure:

(a) ASAM dimensional admission criteria:

(A) The individual meets ASAM dimensional admission criteria in each of the Dimensions;

(B) Dimensions 1, 2 and 3 symptoms are assessed as mild to moderate risk, or are stabilized by this 24-hour structured environment;

(D) Individual needs 24-hour structured environment to make therapeutic gains;

(E) Individual is able to tolerate and benefit from a planned program of therapeutic services and supports; and

(F) Individual meets diagnostic criteria for a moderate or severe substance use or addictive disorder, per DSM-5-TR, or the probability of such a diagnosis is determined through collateral information.

(b) Program is able to consult with an LMP daily.

(2) In addition to any other requirements described in these rules and applicable statutes, programs licensed to render residential adolescent Clinically Managed Low-Intensity Substance Use Disorder Residential Services, ASAM Level of care 3.1 services shall meet and maintain documentation demonstrating ongoing compliance with the following requirements:

(a) Adolescents may be placed in ASAM Level 3.1 while concurrently receiving ASAM Level 2.5 services;

(b) Adolescent ASAM dimensional admission criteria:

(A) Adolescent meets criteria in at least two of the Dimensions;

(B) Adolescent is able to tolerate and benefit from a planned program of therapeutic services and supports; and

(C) Adolescent meets diagnostic criteria for a moderate or severe substance use or addictive disorder, per DSM-5-TR, or the probability of such a diagnosis is determined through collateral information.

(A) Offer at least 5 hours per week of low-intensity substance use disorders treatment services and supports in a Recovery Environment to assist the individual in stabilization and developing recovery and relapse prevention skills;

(B) When clinically indicated, the program shall facilitate the continuation of or opportunity to obtain medications to treat opioid use disorders; and

(C) Facilitate individuals in obtaining low-barrier mental, physical, dental and other ancillary health care services and supports throughout the treatment episode of care.

(d) Staff are knowledgeable about adolescent development and in therapeutic engagement. Staffing shall be made available as follows:

(A) At least one milieu or program staff shall be present on the premises of the program and readily accessible and responsive to residents 24 hours a day, 7 days per week;

(B) Substance use disorders treatment staff are onsite rendering services 5 days per week;

(C) 24 hour, 7 day per week consultation available with a substance use disorders treatment staff, or a supervising or managing staff; and

(D) Program staff are able to consult with a LMP daily.

(e) Program shall offer an array of services and supports to meet the documented needs of the individual, including at minimum;

(A) Individual and group counseling sessions;

(B) Urinalysis screening when clinically indicated; and

(3) Co-occurring Capable ASAM Level of Care 3.1 license. Only programs licensed to render Clinically Managed Low-Intensity Residential Substance Use Disorder Services ASAM Level of Care 3.1 may choose to apply to also be licensed to render Co-Occurring Capable ASAM Level of Care 3.1 services. When licensed as such, in addition to all requirements for ASAM Level of Care 3.1 services, programs shall, at a minimum, meet and maintain documentation demonstrating ongoing compliance with each of the following requirements:

(a) Demonstrate that each individual placed at this ASAM Level of Care meets the following criteria:

(A) ASAM Dimensional criteria required for ASAM Level of Care 3.1;

(B) Describe how the individual meets diagnostic criteria for a co-occurring mental health disorder, per DSM-5-TR, that meet the stability criteria for placement in a co-occurring capable program, or emotional, behavioral or cognitive symptomology that are troubling or suggestive of a mental health disorder are causing the individual distress but do not meet the threshold for a DSM-5-TR diagnosis; and

(C) The mental health condition or symptoms are stable, or concerns are stabilized when in a 24-hour recovery environment.

(b) Offer mental health evaluation and counseling services;

(c) Offer or coordinate psychiatric services when clinically indicated, including medication management and the opportunity to obtain medications to treat mental health conditions; and

(d) Document within the service plan the individual’s mental health symptoms, the relationship between the mental health and substance use and addictive disorders and disorders, and describe the individual’s mental health status.

(4) Co-occurring Enhanced ASAM Level of Care 3.1 license. Only programs licensed to render Clinically Managed Low-Intensity Residential Substance Use Disorder Services ASAM Level of Care 3.1 may choose to apply to also be licensed to render Co-Occurring Enhanced ASAM Level of Care 3.1 services. When licensed as such, in addition to the requirements for ASAM Level of Care 3.1 services, programs shall, at a minimum, meet and maintain documentation demonstrating the ongoing compliance with the following requirements:

(a) Individuals placed at this ASAM Level of Care shall meet the following ASAM admission criteria:

(A) ASAM dimensional criteria required for ASAM Level of Care 3.1; and

(B) Individual meets diagnostic criteria for a co-occurring mental health disorder, per DSM-5-TR, that meet the stability criteria for placement in a co-occurring capable program or the probability of such a diagnosis is determined through collateral information.

(b) Offer mental health evaluation and counseling;

(c) Offer psychiatric services, including when clinically indicated, medication management and the opportunity to obtain medications to treat mental health conditions; and

(d) Document within the service plan the individual’s mental health symptoms, the relationship between the mental health and substance use and addictive disorders and describe the individual’s mental health status.

(5) Biomedical Enhanced ASAM Level of Care 3.1 license. Only programs licensed to render Clinically Managed Low-Intensity Residential Substance Use Disorder Services ASAM Level of Care 3.1 may choose to also apply to be licensed to render Biomedical Enhanced ASAM Level of Care 3.1 services. When licensed as such, in addition to all requirements for ASAM Level of Care 3.1 services, programs shall, at a minimum, meet and maintain documentation demonstrating ongoing compliance with each of the following requirements:

(a) Individuals placed at this ASAM Level of Care shall meet the following criteria:

(A) ASAM Dimensional criteria required for ASAM Level of Care 3.1; and

(B) Biomedical condition is stable or does not require medical or nursing monitoring and individual is capable of self-administering medications; or

(C) Biomedical condition is not severe enough to warrant impatient treatment but is sufficient to distract from treatment or recovery efforts and requires medical or nursing monitoring by the program or through an established arrangement with another provider.

(b) Medical treatment staff assess, treat and monitor biomedical disorders and monitor medication administration;

(d) Program staff have access to consult a LMP 24 hours a day, 7 days a week.

History

Statutory/Other Authority: ORS 161.390-161.400, 413.042, 428.205-428.270, 430.640 & 443.450
Statutes/Other Implemented: ORS 430.010, 430.205-430.210, 430.254-430.640, 430.850-430.955, 443.400-443.460, 443.991, 461.549 & 743A.168
BHS 10-2023, adopt filed 04/07/2023, effective 04/07/2023

Or. Admin. R. 309-018-0182 SUD Residential ASAM Level of Care 3.3

Clinically Managed Population-Specific High-Intensity Substance Use Disorder Residential Services, ASAM Level of Care 3.3 In addition to any other requirements described in these rules and applicable statutes, programs licensed to render residential adolescent and adult Clinically Managed Population-Specific High-Intensity Substance Use Disorder Residential Services, ASAM Level of Care 3.3 shall, at a minimum, meet and maintain documentation demonstrating ongoing compliance with each of the following standards programming:

(1) ASAM Level 3.3 programs shall ensure:

(a) ASAM dimensional admission criteria:

(A) Dimensions 1, 2 and 3 symptoms are assessed as mild to moderate risk, or are stabilized by this 24-hour structured environment;

(B) Dimensions 4, 5 and 6 are assessed as moderate to high risk;

(D) Individual is able to tolerate and benefit from a planned program of therapeutic services and supports; and

(E) Individual meets diagnostic criteria for a moderate or severe substance use or addictive disorder, per DSM-5-TR, or the probability of such a diagnosis is determined through collateral information.

(b) Provide a structured, supportive, recovery environment with a less intensive milieu that treats both the substance use and supports the functional limitations of a co-occurring cognitive disorder or impairment, and:

(A) Programs shall either accept documentation from a medical or mental health professional describing a cognitive condition, or a program staff working within their scope shall document the condition;

(B) Program shall match the pace of delivery of information and services to the cognitive ability of the individual;

(C) Program shall deliver concrete information in an intentionally repetitive manner to the extent assistive to the individual; and

(D) Program shall facilitate the individual in obtaining low-barrier access to mental, physical, dental and other ancillary health care services throughout the episode of care and in a timeframe that meets the urgency of the condition; and

(A) 24-hour, 7 day per week staffing that is responsive to the number of individuals present and the severity of symptoms;

(B) Program shall be trained in substance use disorders, able to identify signs and symptoms of concern as related to substance use, mental health and suicidality, and able to stabilize imminent danger; and

(d) The program shall offer services in a manner described above that include:

(A) Urinalysis screening when clinically indicated;

(B) Intensive case management;

(D) Group counseling and skill building services.

(2) Co-occurring Enhanced ASAM Level of Care 3.3 services are an additional type of ASAM Level of Care 3.3 services. Only programs licensed to render Clinically Managed Population-Specific High-Intensity Substance Use Disorder Residential Services, ASAM Level of Care 3.3 may apply to also be licensed to render Co-occurring Enhanced ASAM Level of Care 3.3 services. When licensed as such, in addition to all requirements for ASAM Level of Care 3.3 services, programs shall, at a minimum, meet and maintain documentation demonstrating ongoing compliance with each of the following requirements:

(a) Individuals placed at Co-occurring Enhanced ASAM Level of Care 3.3 shall meet the following criteria:

(A) ASAM Dimensional criteria required for ASAM Level of Care 3.3; and

(b) Offer psychiatric services:

(A) Including medication consultation and laboratory services;

(B) Psychiatric services shall be made available within 8 hours by telephone, or off-site within 24 hours. Off-site services shall be closely coordinated; and

(C) Be staffed by credentialed psychiatrists and behavioral health clinicians working within their scope. Program staff shall:

(i) Assess and treat co-occurring disorders; and

(ii) Have specialized training in behavior management techniques specific to assessing and treating co-occurring disorders.

(c) Program staff shall render a psychiatric history, examination, and diagnostic assessment within two weeks of entry and continue to reassess, as determined by the urgency of the individual’s mental health condition.

(3) Biomedical Enhanced ASAM Level of Care 3.3 services are an additional and optional type of ASAM Level of Care 3.3 services. Only programs licensed to render Clinically Managed Population-Specific High-Intensity Substance Use Disorder Residential Services, ASAM Level of Care 3.3 may apply to also be licensed to render Biomedical Enhanced ASAM Level of Care 3.3 services. When licensed as such, in addition to all requirements for ASAM Level of Care 3.3 services, programs shall, at a minimum, meet and maintain documentation demonstrating ongoing compliance with each of the following requirements:

(a) Individuals placed at Biomedical Enhanced ASAM Level of Care 3.3 shall meet the following criteria:

(A) ASAM Dimensional criteria required for ASAM Level of Care 3.3; and

(B) Individual meets diagnostic criteria for a co-occurring biomedical condition, that is sufficient to distract from treatment or recovery efforts and requires medical monitoring, or the probability of such a diagnosis is determined through documented collateral information.

(b) Ensure a physical examination is provided and documented within two weeks of entry, or sooner as determined by the individual’s medical condition;

(c) Be staffed by credentialed medical treatment staff who assess and treat co-occurring disorders and have access to consult a LMP 24 hours a day, 7 days a week; and

(d) Ensure nursing care and observation are provided and meet the intensity of the individual’s needs.

History

Statutory/Other Authority: ORS 161.390-161.400, 413.042, 428.205-428.270, 430.640 & 443.450
Statutes/Other Implemented: ORS 430.010, 430.205-430.210, 430.254-430.640, 430.850-430.955, 443.400-443.460, 443.991, 461.549 & 743A.168
BHS 10-2023, adopt filed 04/07/2023, effective 04/07/2023

Or. Admin. R. 309-018-0183 SUD Residential ASAM Level of Care 3.5

Adolescent Clinically Managed Medium-Intensity Substance Use Disorder Residential Services, ASAM Level of Care 3.5 and Adult Clinically Managed High-Intensity Substance Use Disorder Residential Services, ASAM Level of Care 3.5. In addition to any other requirements described in these rules and applicable statutes, programs licensed to render residential adolescent or adult Clinically Managed High-Intensity Substance Use Disorder Residential Services, ASAM Level of care 3.5 services shall, at a minimum, meet and maintain documentation demonstrating ongoing compliance with each of the following requirements:

(1) ASAM Level 3.5 programs shall ensure:

(a) ASAM dimensional admission criteria:

(A) Dimensions 1 and 2 are stable or can be managed at this Level of Care; and

(B) Dimensions 3, 4, 5 and 6 are rated as moderate to severe risk without the structure of this setting.

(b) ASAM Level of Care 3.5 programs shall ensure the structure of services includes each of the following:

(A) Provide a 24-hour, structured, supportive recovery environment that both treats the substance use and supports the functional limitations of an individual with co-occurring social and psychological conditions;

(B) Offer services and supports that are primarily habilitative, addressing educational and vocational limitations, and social and emotional dysfunctional behaviors through use of targeted interventions such as evidence based therapeutic interventions and skills training;

(D) Documentation shall include a description of the individual’s co-occurring condition(s), the relationship between the co-occurring condition(s) and substance use, and the individual’s mental health status.

(A) Utilize an interdisciplinary team approach as demonstrated through regular, documented meetings;

(B) Staff shall include substance use disorders treatment staff, milieu staff, and medical treatment staff including LMP;

(C) Program staff and milieu staff are on-site 24-hours, 7 days per week in staffing levels that are responsive to the number of the individuals present and the severity of symptoms, and at least one program staff is readily available to respond to and assist individuals;

(D) Medical treatment staff are knowledgeable about biomedical, mental health, substance use, and the interactions of those conditions, have training in behavior management techniques, and are staffed to meet the needs of each individual;

(E) LMP shall be available for consult 24-hours per day, 7 days per week; and

(F) Supervisory or Management staff who are trained in substance use disorders treatment are available on-site or by phone 24 hours per day, 7 days per week.

(d) A variety of services and supports shall be offered daily. Each week the services and supports offered shall include the following:

(A) Stabilization services;

(B) Motivational and engagement strategies and interventions;

(D) Skill building to address Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL):

(E) Health and medication education and management;

(F) Close observation and monitoring of the individual’s adherence to medications administered by the program;

(G) Relapse prevention, interpersonal, coping and community reintegration skills;

(H) Family services, including services just for families or identified support persons;

(I) Urinalysis screening when clinically indicated;

(J) Intensive case management; and

(K) Individual and group counseling sessions.

(2) In addition to any other requirements described in these rules and applicable statutes, programs licensed to render residential Adolescent Clinically Managed Medium-Intensity Substance Use Disorder Residential Services, ASAM Level of care 3.5 services shall, at a minimum, meet and maintain documentation demonstrating ongoing compliance with the following requirements:

(a) Adolescent ASAM dimensional admission criteria:

(A) The adolescent meets ASAM Diagnostic Admission Criteria specifications in at least two dimensions;

(B) If the adolescent is at risk of or experiencing acute or subacute intoxication or withdrawal, the symptoms are mild to moderate;

(D) The adolescent is able to tolerate and benefit from a planned program of therapeutic services and supports; and

(E) The adolescent meets diagnostic criteria for a moderate or severe substance use or addictive disorder, per DSM-5-TR, or the probability of such a diagnosis is determined through collateral information.

(b) The facility and milieu shall be a 24-hour, safe, contained, and structured recovery environment. Services and supports are primarily habilitative, addressing behavioral, social, and emotional dysfunction through use of targeted interventions such as evidence based, pro-social, therapeutic interventions and skills training to facilitate healthy reintegration into the community.

(A) Milieu staff are on-site 24-hours, 7 days per week in staffing levels that are responsive to the number of the individuals present and the severity of symptoms and at least one program staff is readily available to respond to and assist individuals;

(B) Behavioral health clinician(s) trained in recognizing the signs and symptoms of intoxication and withdrawal and the monitoring and treating of those conditions, and behavioral health crisis prevention and response;

(C) Medical treatment staff able to implement protocols are staffed to meet the intensity of the oversight and treatment of each individual’s needs;

(D) LMP with training in adolescence shall be available for emergency consult 24-hours per day, 7 days per week; and

(E) Supervisory or Management staff who are trained in substance use disorders treatment are available on-site or by phone 24 hours per day, 7 days per week.

(d) Services shall be offered daily and include the following:

(A) Educational services shall be provided in accordance with local regulations and provide opportunities to remedy educational deficits;

(B) Stabilization services, including:

(i) Daily monitoring of withdrawal symptoms; and

(ii) Close observation and monitoring of the individual’s adherence to medications administered by the program.

(D) Family services, including services just for families or identified support persons;

(E) Motivational and engagement strategies and interventions;

(F) Urinalysis screening when clinically indicated;

(G) Individual counseling sessions; and

(H) Skill building, including teaching and practicing pro-social behaviors.

(e) Address co-occurring conditions when applicable:

(A) Arrange for or provide appropriate medical procedures, including laboratory and toxicology testing;

(B) Arrange for or provide appropriate medical and psychiatric treatment through consultation, referral to a community provider or transfer to another Level of Care;

(D) Pace the delivering of information and services to the meet the ability of the adolescent; and

(E) Documentation shall include a description of the adolescent’s co-occurring conditions, the relationship between the co-occurring condition(s) and substance use, and the individual’s mental health status.

(3) Adolescent ASAM Level of Care 3.5-WM Withdrawal Management Services are an additional and optional version of ASAM Level of Care 3.5 services for adolescents. Only programs licensed to render Adolescent Clinically Managed Medium-Intensity Substance Use Disorder Residential Services, ASAM Level of Care 3.5 may also apply to be licensed to render Adolescent ASAM Level of Care 3.5-WM services. When licensed as such, in addition to all requirements for Adolescent ASAM Level of Care 3.5 services, programs shall, at a minimum, meet and maintain documentation demonstrating ongoing compliance with each of the following requirements:

(a) Medical protocols developed by a physician knowledgeable in withdrawal management that are used to:

(A) Determine the nature of the medical monitoring and other interventions required, such as when medical oversight or services are needed;

(B) Determine when to transfer to a higher or lower level of care; and

(b) Program staff provide an organized service that includes 24-hour supervision, observation and support to adolescents who are intoxicated or experiencing mild withdrawal;

(c) Program staff are trained to implement those ASAM Level of care 3.2-WM physician protocols that are not required to be rendered by medical staff and that include:

(A) Administration of over-the-counter medications for symptomatic relief;

(B) Monitoring withdrawal symptoms and alert medical staff as indicated;

(C) Identification when an adolescent requires a higher level of care and facilitate the transfer to that level of care; and

(D) Prompt communication with medical staff when there is an indication that medical care is needed.

(A) Provision of 24-hour per day, 7-days per week program staff access to medical consultation;

(B) Availability for 24-hour per day, 7-days per week medical evaluation; and

(d) There is an emphasis on staff, peer and social supports.

(4) Co-occurring Enhanced ASAM Level of Care 3.5 services are an additional and optional version of ASAM Level of Care 3.5 services. Only programs licensed to render Clinically Managed High-Intensity Substance Use Disorder Residential Services, ASAM Level of Care 3.5 may also apply to be licensed to render Co-occurring Enhanced ASAM Level of Care 3.5 services. When licensed as such, in addition to all requirements for ASAM Level of Care 3.5 services, programs shall, at a minimum, meet and maintain documentation demonstrating ongoing compliance with each of the following requirements:

(a) Individuals placed at this ASAM Level of Care shall meet the following criteria:

(A) ASAM Dimensional criteria required for ASAM Level of Care 3.5;

(B) The individual meets diagnostic criteria for a co-occurring mental health disorder, per DSM-5-TR, or the probability of such a diagnosis is determined through collateral information; and

(C) The individual is experiencing a range of psychiatric symptoms that require active monitoring that are assessed as posing a risk of harm to self or others if the individual is not contained within a 24-hour structured environment.

(b) Offer or coordinate psychiatric, medication evaluation, and laboratory services;

(A) Able to assess and treat co-occurring disorders;

(B) Trained in the biological and psychosocial aspects of substance use disorders and mental health disorders and treatment;

(D) Able to identify the signs and symptoms of acute psychiatric decompensation; and

(E) Ensure individuals receiving ASAM Level of Care 3.5 have access to a LMP 24 hours a day, 7 days a week for consultation.

(5) Biomedical Enhanced ASAM Level of Care 3.5 services are an additional and optional version of ASAM Level of Care 3.5 services. Only programs licensed to render Clinically Managed High-Intensity Substance Use Disorder Residential Services, ASAM Level of Care 3.5 may apply to be licensed to render Biomedical Enhanced ASAM Level of Care 3.5 services. When licensed as such, in addition to all requirements for ASAM Level of Care 3.5 services, programs shall, at a minimum, meet and maintain documentation demonstrating ongoing compliance with each of the following requirements:

(a) Individuals placed at this ASAM Level of Care shall meet the following criteria:

(A) ASAM Dimensional criteria required for ASAM Level of Care 3.5;

(C) The individual has a biomedical condition that requires a degree of staff attention by medical treatment staff that is not available in other Level 3.5 programs.

(b) Ensure a physical examination is provided and documented within two weeks of entry, sooner if determined by the individual’s medical symptoms and condition;

(c) Medical treatment staff assess and treat co-occurring disorders and have access to a LMP 24 hours a day, 7 days a week; and

(d) Ensure nursing care and observation meet the intensity of the individuals’ needs.

History

Statutory/Other Authority: ORS 161.390-161.400, 413.042, 428.205-428.270, 430.640 & 443.450
Statutes/Other Implemented: ORS 430.010, 430.205-430.210, 430.254-430.640, 430.850-430.955, 443.400-443.460, 443.991, 461.549 & 743A.168
BHS 10-2023, adopt filed 04/07/2023, effective 04/07/2023

Or. Admin. R. 309-018-0184 SUD Residential ASAM Level of Care 3.7

Medically Monitored Intensive Substance Use Disorder Inpatient Services, ASAM Level of Care 3.7. In addition to any other requirements described in these rules and applicable statutes, programs approved to render Adult Medically Monitored Intensive Inpatient Services, ASAM Level of Care 3.7, or Adolescent Medically Monitored High-Intensity Impatient Services, ASAM Level of Care 3.7, offer a planned and structured regimen of 24-hour professionally directed evaluation, observation, medically monitoring and substance use disorder treatment to in an inpatient setting, and shall, at a minimum, meet and maintain documentation demonstrating ongoing compliance with each of the following requirements:

(1) ASAM Level 3.7 programs shall ensure:

(a) ASAM dimensional admission criteria:

(A) Meet specifications for at least two of the six dimensions and one of those two dimensions is Dimension 1, 2, or 3.

(B) The individual meets diagnostic criteria for a co-occurring mental health disorder, per DSM-5-TR, that meet the stability criteria for placement in a co-occurring capable program, or are experiencing difficulties with mood, behavior, or cognition related to a substance use or mental health condition, or mood, behavior, or cognition symptoms are problematic but do not meet DSM-5-TR criteria for a mental health disorder; and

(D) Individual is able to tolerate and benefit from a planned program of therapeutic services and supports; and

(b) Biomedical assessment shall include:

(A) A comprehensive nursing assessment at the time of entry; and

(B) A physical examination, or a review of physical examination conducted within the past 7 calendar days, performed by a physician within 24 hours of entry.

(A) Program staff or milieu staff are on-site 24-hours, 7 days per week in staffing levels that are responsive to the number of the individuals present and the severity of symptoms and at least one program staff is readily available to respond to and assist individuals;

(B) Utilize an interdisciplinary team approach, as demonstrated through regular, documented meetings and by ensuring:

(i) LMP(s) trained in addiction medicine or addiction psychiatry oversee the treatment process and assures the quality of care, and shall be onsite daily and available for consultation 24-hours per day, 7 days per week;

(ii) Medical treatment staff that have training to identify signs and symptoms of acute psychiatric conditions, including psychiatric decompensation, and to intervene using crisis prevention and response protocols, shall be available on-site 24-hours per day, 7 days per week;

(iii) Supervisory or Management staff, which may include LMP, who are trained in substance use disorders treatment are available on-site or by phone 24 hours per day, 7 days per week; and

(iv) Behavioral health clinician(s) render services on-site at least 5 days per week.

(d) Program shall provide daily medical and behavioral services and supports that meet the documented needs of the individual as identified in the assessments and service plan, and include;

(A) Medical monitoring, including close observation and monitoring of the individual’s adherence to medications;

(B) Medical stabilization services when medical staffing meets the needs of the individuals; and

(C) Planned behavioral, skill building and other supportive service program activities that are adapted as needed to the individual’s level of comprehension and include;

(i) Health and medication education and management;

(ii) Individual and group counseling and skill building;

(iii) Motivational and engagement strategies and interventions;

(iv) Relapse prevention, interpersonal, coping and community reintegration skills;

(v) Urinalysis screening when clinically indicated; and

(vi) Intensive case management.

(e) Programs shall facilitate access to medical, psychiatric, laboratory, toxicology, mental health, physical, dental and other ancillary health care services and supports according to the severity of the individual’s condition and throughout the episode of care.

(2) In addition to any other requirements described in these rules and applicable statutes, programs licensed to render residential Adolescent Medically Monitored High-Intensity Inpatient Services, ASAM Level of Care 3.7 services shall meet and maintain documentation demonstrating ongoing compliance with, at a minimum, the following requirements:

(a) Adolescents placed at ASAM Level of Care 3.7 shall meet the following dimensional admission criteria:

(A) ASAM Diagnostic Admission Criteria specifications in at least two dimensions, one of which is Dimension 1, 2 or 3;

(B) Intoxication or withdrawal is manageable at this level of care, as described by The ASAM Criteria, Third Edition ;

(D) The adolescent meets diagnostic criteria for a moderate or severe substance use or addictive disorder, per DSM-5-TR, or the probability of such a diagnosis is determined through collateral information.

(A) Milieu staff are on-site 24-hours, 7 days per week in staffing levels that are responsive to the number of the individuals present and the severity of symptoms, and at least one milieu staff is readily available to respond to and assist adolescents;

(B) Behavioral health clinician(s) trained in adolescent development, recognizing the signs and symptoms of intoxication and withdrawal and the monitoring and treating of those conditions, and behavioral health crisis prevention and response;

(C) Medical treatment staff, knowledgeable about adolescent development, are able to implement protocols are staffed to meet the intensity of the oversight and treatment of each individual’s needs;

(D) LMP with training in adolescent development shall be available to assess the adolescent within 24 hours of admission and thereafter as medically necessary, and available for emergency consult 24-hours per day, 7 days per week; and

(E) Supervisory or Management staff who are trained in substance use disorders treatment are available for consult on-site or by phone 24 hours per day, 7 days per week.

(d) Services shall be offered daily and include the following:

(A) Educational services shall be provided in accordance with local regulations and provide opportunities to remedy educational deficits;

(B) Daily stabilization services by medical treatment staff, including, at a minimum:

(i) Daily assessment, treatment and close monitoring of withdrawal symptoms;

(ii) Close observation and monitoring of the adolescent’s adherence to medications administered by the program; and

(iii) Any adjustments to protocols made by LMP are documented.

(D) Family services, including services just for families or identified support persons;

(E) Motivational and engagement strategies and interventions;

(F) Urinalysis screening when clinically indicated;

(G) Individual counseling sessions; and

(H) Skill building, including teaching and practicing pro-social behaviors.

(e) Address co-occurring conditions when applicable:

(A) Arrange for or provide appropriate medical procedures, including laboratory and toxicology testing;

(B) Arrange for or provide appropriate medical and psychiatric treatment through consultation, referral to a community provider or transfer to another Level of Care;

(D) Pace the delivering of information and services to the meet the ability of the adolescent; and

(3) Co-occurring Enhanced ASAM Level of Care 3.7 services are an additional type of ASAM Level of Care 3.7 services. Only programs licensed to render Medically Monitored Intensive Substance Use Disorder Inpatient Services, ASAM Level of Care 3.7 may apply to be licensed to render Co-occurring Enhanced ASAM Level of Care 3.7 services to adolescents or adults. When licensed as such, in addition to all requirements for ASAM Level of Care 3.7 services, programs shall, at a minimum, meet and maintain documentation demonstrating ongoing compliance with each of the following requirements:

(a) Individuals placed at ASAM Level of Care 3.7 shall meet each of the following criteria:

(A) Dimensional admission specifications for 3.7;

(B) Diagnostic criteria for a co-occurring mental health disorder, per DSM-5-TR, or the probability of such a diagnosis is determined through collateral information;

(C) Experiencing a range of psychiatric symptoms that require active monitoring and which are assessed as posing a risk of harm to self or others if the individual is not contained within a 24-hour structured environment.

(b) Co-occurring Enhanced ASAM Level of Care 3.7 programs shall ensure the structure of services includes each of the following:

(A) Promote the stabilization of the individual’s substance and mental health needs and symptoms through integration and coordination of substance use, mental health and physical health services;

(B) Services are delivered by medical treatment staff and behavioral health clinicians who are trained to assess and treat co-occurring psychiatric disorders, and implement behavioral modification interventions;

(C) A comprehensive psychiatric history, an examination and a psychodiagnostic assessment are performed within a reasonable time, as determined by the individual’s needs;

(D) Active reassessment of the individual’s mental status at a frequency determined by the urgency of symptoms;

(E) Symptom management through mental health treatment and medication management services; and

(F) Document the individual’s co-occurring disorders, the relationship between the mental health and substance use disorders, and the overall assessment of functioning and mental health status

(4) Biomedical Enhanced ASAM Level of Care 3.7 services are an additional type of ASAM Level of Care 3.7 services. Only programs licensed to render Medically Monitored Intensive Substance Use Disorder Inpatient Services, ASAM Level of Care 3.7, may apply to be licensed to render Biomedical Enhanced ASAM Level of Care 3.7 services to adolescents or adults. When licensed as such, in addition to all requirements for ASAM Level of Care 3.7 services, programs shall, at a minimum, meet and maintain documentation demonstrating ongoing compliance with each of the following requirements:

(a) Individuals placed at ASAM Level of Care 3.7 have a biomedical condition that requires a degree of staff attention or intervention that is not available in other Level 3.7 programs;

(b) Ensure the services are delivered by medical treatment staff who can monitor, assess and treat co-occurring biomedical conditions;

(c) Ensure the intensity of nursing care and observation is adaptive to sufficiently meet the needs of all individuals; and

(d) Promote the stabilization of the individual’s behavioral and physical health needs and symptoms.

History

Statutory/Other Authority: ORS 161.390-161.400, 413.042, 428.205-428.270, 430.640 & 443.450
Statutes/Other Implemented: ORS 430.010, 430.205-430.210, 430.254-430.640, 430.850-430.955, 443.400-443.460, 443.991, 461.549 & 743A.168
BHS 10-2023, adopt filed 04/07/2023, effective 04/07/2023

Or. Admin. R. 309-018-0185 Medical Protocols in Residential Substance Use Disorders Treatment Programs

Medical protocols shall be approved by a medical director under contract with a program or written reciprocal agreement with a medical practitioner under managed care. The protocols shall:

(1) Require a medical history be included in the assessment;

(2) Designate those medical symptoms and conditions that, when found, require further investigation, physical examinations, treatment, or laboratory testing;

(3) Require that individuals admitted to the program who are currently injecting or intravenously using a drug, or have injected or intravenously used a drug within the past 30 days, or who are at risk of withdrawal from a drug, or who may be pregnant, shall be referred for a physical examination and appropriate lab testing within 30 days of entry to the program. This requirement may be waived by the medical director if these services have been received within the past 90 days and documentation is provided;

(4) Require pregnant women be referred for prenatal care within two weeks of entry to the program;

(5) Require that the program provide HIV and AIDS, TB, sexually transmitted disease, Hepatitis, and other infectious disease information and risk assessment, including any needed referral, within 30 days of entry;

(6) Specify the steps for follow up and coordination with physical health care providers in the event the individual is found to have an infectious disease or other major medical problem.

History

Statutory/Other Authority: ORS 413.042, 428.205 - 428.270, 430.640 & 443.450
Statutes/Other Implemented: ORS 430.010, 430.205 - 430.210, 430.254 - 430.640, 430.850 - 430.955, 443.400 - 443.460, 443.991, 461.549 & 743A.168
MHS 4-2018, amend filed 02/27/2018, effective 03/01/2018
MHS 10-2017(Temp), f. 9-15-17, cert. ef. 9-15-17 thru 3-13-18
MHS 3-2014, f. & cert. ef. 2-3-14
MHS 10-2013(Temp), f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14

Or. Admin. R. 309-018-0190 Administration of Medications

The following guidelines shall be followed in policies on administration of medications in residential programs:

(1) Medications prescribed for one individual may not be administered to or self-administered by another individual or program staff.

(2) When an individual self-administers medication in a residential program, self-administration shall be approved in writing by a physician and closely monitored by the residential program staff.

(3) No unused, outdated, or recalled drugs shall be kept in a program. On a monthly basis any unused, outdated, or recalled drugs shall be disposed of in a manner that assures they cannot be retrieved.

(4) A written record of all disposal of prescription drugs in a residential program shall be maintained in the program and shall include:

(a) A description of the drug, including the amount;

(b) The individual for whom the medication was prescribed;

(d) The method of disposal.

(5) All prescription drugs stored in the residential program shall be kept in a locked stationary container. Medications requiring refrigeration shall be stored in a refrigerator using a locked container.

(6) Written documentation of medications prescribed for the individual by an LMP shall be maintained in the Service Record. Documentation for each medication prescribed shall include the following:

(a) A copy or detailed written description of the signed prescription order;

(b) The name of the medication prescribed;

(d) The date medications were prescribed, reviewed, or renewed;

(e) The date and the signature and credentials of program staff administering or prescribing medications;

(f) Observed side effects including laboratory findings; and

(g) Medication allergies and adverse reaction.

History

Statutory/Other Authority: ORS 413.042, 428.205 - 428.270, 430.640 & 443.450
Statutes/Other Implemented: ORS 430.010, 430.205 - 430.210, 430.254 - 430.640, 430.850 - 430.955, 443.400 - 443.460, 443.991, 461.549 & 743A.168
MHS 4-2018, amend filed 02/27/2018, effective 03/01/2018
MHS 10-2017(Temp), f. 9-15-17, cert. ef. 9-15-17 thru 3-13-18
MHS 3-2014, f. & cert. ef. 2-3-14
MHS 10-2013(Temp), f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14

Or. Admin. R. 309-018-0200 Facility Standards for Substance Use Disorders and Problem Gambling Residential Treatment and Recovery Programs

(1) Residential programs shall meet the following standards:

(a) Maintain up-to-date documentation verifying that they meet and comply with all applicable local business license, zoning and building codes, and federal, state, and local fire and safety regulations. It is the responsibility of the provider to check with local government to make sure all applicable local codes have been met;

(b) Prior to construction of a new building or major alteration of or addition to an existing building:

(A) One set of plans and specifications shall be submitted to the State Fire Marshal for approval;

(B) Plans shall be in accordance with the State of Oregon Structural Specialty Code and Fire and Life Safety Regulations;

(C) Plans for construction containing 4,000 square feet or more shall be prepared and bear the stamp of an Oregon licensed architect or engineer; and

(D) The water supply, sewage, and garbage disposal system shall be approved by the agency having jurisdiction.

(2) All rooms used by individuals shall have floors, walls, and ceilings that meet the interior finish requirements of the State of Oregon Structural Specialty Code and Fire and Life Safety Regulations:

(a) A separate dining room or area shall be provided for exclusive use of individuals, program staff, and invited guests and shall:

(A) Seat at least one-half of the individuals at a time with a minimum of 15 square feet per occupant; and

(B) Be provided with adequate ventilation.

(b) A separate living room or lounge area shall be provided for the exclusive use of individuals, program staff, and invited guests and shall:

(A) Provide a minimum of 15 square feet per occupant; and

(B) Be provided with adequate ventilation.

(A) Be separate from the dining, living, multi-purpose, laundry, kitchen, and storage areas;

(B) Be an outside room with a window that can be opened and is at least the minimum required by the State Fire Marshal;

(D) Provide a minimum of 60 square feet per individual with at least three feet between beds;

(E) Provide permanently wired light fixtures located and maintained to give light to all parts of the room; and

(F) Provide a curtain or window shade at each window to assure privacy.

(d) Bathrooms shall be provided and conveniently located in each building containing a bedroom and shall:

(A) Provide a minimum of one toilet and one hand-washing sink for each eight individuals and one bathtub or shower for each ten individuals;

(B) Provide one hand-washing sink convenient to every room containing a toilet;

(D) Provide personal privacy for individuals;

(E) Provide a privacy screen at each window;

(F) Provide a mirror; and

(G) Be provided with adequate ventilation and reasonable measures to prevent mold. .

(e) A supply of hot and cold water installed and maintained in compliance with rules of the Authority, the Division, and Public Health Division shall be distributed to taps conveniently located throughout the residential program;

(f) All plumbing shall comply with applicable codes;

(g) Laundry facilities, when provided, shall be separate from:

(A) Resident living areas, including bedrooms;

(B) Kitchen and dining areas; and

(h) Storage areas shall be provided appropriate to the size of the residential program. Separate storage areas shall be provided for:

(A) Food, kitchen supplies, and utensils;

(B) Clean linens;

(D) Cleaning compounds and equipment; and

(E) Poisons, chemicals, insecticides, and other toxic materials that shall be properly labeled, stored in the original container, and kept in a locked storage area.

(i) Furniture shall be provided for each individual and shall include:

(A) A bed with a frame and a clean mattress and pillow;

(B) A private dresser or similar storage area for personal belongings that is readily accessible to the individual; and

(j) Linens shall be provided for each individual and shall include:

(A) Sheets and pillowcases;

(B) Blankets, appropriate in number and type for the season and the individual's comfort; and

(3) The residential program shall meet the requirements of the State of Oregon Sanitary Code for Eating and Drinking Establishments relating to the preparation, storage, and serving of food. At minimum:

(a) Menus shall be prepared in advance to provide a sufficient variety of foods served in adequate amounts for each resident at each meal;

(b) Records of menus as served shall be filed and maintained in the residential program records for at least 30 days;

(d) At least three meals shall be provided daily;

(e) Supplies of staple foods for a minimum of one week and of perishable foods for a minimum of a two-day period shall be maintained on the premises;

(f) Food shall be stored and served at proper temperature;

(g) All utensils, including dishes, glassware, and silverware used in the serving or preparation of drink or food for individuals shall be effectively washed, rinsed, sanitized, and stored after each individual use to prevent contamination in accordance with Division standards; and

(h) Raw milk and home-canned vegetables, meats, and fish may not be served or stored in a residential program.

(4) The residential program shall meet the following safety requirements:

(a) At no time shall the number of individuals served exceed the approved capacity;

(b) A written emergency plan shall be developed and posted next to the telephone used by program staff and shall include:

(A) Instructions for the program staff or designated resident in the event of fire, explosion, accident, death, or other emergency and the telephone numbers of the local fire department, law enforcement agencies, hospital emergency rooms, and the residential program's designated physician and on-call back-up program staff;

(B) The telephone number of the administrator or clinical supervisor and other persons to be contacted in case of emergency; and

(C) Instructions for the evacuation of individuals and program staff in the event of fire, explosion, or other emergency.

(c) The residential program shall provide fire safety equipment appropriate to the number of individuals served and meeting the requirements of the State of Oregon Structural Specialty Code and Fire and Life Safety regulations:

(A) Fire detection and protection equipment shall be inspected as required by the State Fire Marshal;

(B) All flammable and combustible materials shall be properly labeled and stored in the original container in accordance with the rules of the State Fire Marshal; and

(C) The residential program shall conduct unannounced fire evacuation drills at least monthly. At least once every three months the monthly drill shall occur between 10 p.m. and 6 a.m. Written documentation of the dates and times of the drills, time elapsed to evacuate, and program staff conducting the drills shall be maintained.

(d) At least one program staff who is trained in First Aid and CPR shall be onsite at all times.

(5) The residential program shall meet the following sanitation requirements:

(a) All floors, walls, ceilings, window, furniture, and equipment shall be kept in good repair, clean, neat, orderly, and free from odors;

(b) Each bathtub, shower, hand-washing sink, and toilet shall be kept clean and free from odors;

(c) The water supply in the residential program shall meet the requirements of the rules of the Public Health Division governing domestic water supplies;

(d) Soiled linens and clothing shall be stored in an area separate from kitchens, dining areas, clean linens and clothing, and unrefrigerated food;

(e) All measures necessary to prevent the entry into the program of mosquitoes and other insects shall be taken;

(f) All measures necessary to control rodents shall be taken;

(g) The grounds of the program shall be kept orderly and free of litter, unused articles, and refuse;

(h) Garbage and refuse receptacles shall be clean, durable, water-tight, insect- and rodent proof and kept covered with a tight-fitting lid;

(i) All garbage solid waste shall be disposed of at least weekly and in compliance with the rules of the Department of Environmental Quality; and

(j) Sewage and liquid waste shall be collected, treated, and disposed of in compliance with the rules of the Department of Environmental Quality.

History

Statutory/Other Authority: ORS 413.042, 428.205 - 428.270, 430.640 & 443.450
Statutes/Other Implemented: ORS 430.010, 430.205 - 430.210, 430.254 - 430.640, 430.850 - 430.955, 443.400 - 443.460, 443.991, 461.549 & 743A.168
MHS 4-2018, amend filed 02/27/2018, effective 03/01/2018
MHS 10-2017(Temp), f. 9-15-17, cert. ef. 9-15-17 thru 3-13-18
MHS 3-2014, f. & cert. ef. 2-3-14
MHS 10-2013(Temp), f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14

Or. Admin. R. 309-018-0205 Quality Assessment and Performance Improvement

Providers shall develop and implement a structured and ongoing process to assess, monitor, and improve the quality and effectiveness of services provided to individuals and their families.

History

Statutory/Other Authority: ORS 413.042, 428.205 - 428.270, 430.640 & 443.450
Statutes/Other Implemented: ORS 430.010, 430.205 - 430.210, 430.254 - 430.640, 430.850 - 430.955, 443.400 - 443.460, 443.991, 461.549 & 743A.168
MHS 4-2018, amend filed 02/27/2018, effective 03/01/2018
MHS 10-2017(Temp), f. 9-15-17, cert. ef. 9-15-17 thru 3-13-18
MHS 3-2014, f. & cert. ef. 2-3-14
MHS 10-2013(Temp), f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14

Or. Admin. R. 309-018-0210 Grievances and Appeals

(1) Any individual receiving services or the parent or guardian of the individual receiving services may file a grievance with the provider, the individual’s managed care plan, or the Division.

(2) The provider’s grievance process shall:

(a) Notify each individual or guardian of the grievance procedures by reviewing a written copy of the policy upon entry;

(b) Assist individuals and parents or guardians, as applicable, to understand and complete the grievance process and notify them of the results and basis for the decision;

(d) Complete an investigation of any grievance within 30 calendar days;

(e) Implement a procedure for accepting, processing, and responding to grievances including specific timelines for each;

(f) Designate a program staff person to receive and process the grievance;

(g) Document any action taken on a substantiated grievance within a timely manner; and

(h) Document receipt, investigation, and action taken in response to the grievance.

(3) The provider shall post a Grievance Process Notice in a common area stating the telephone numbers of:

(a) The Division;

(b) Disability Rights Oregon;

(d) The Governor’s Advocacy Office.

(4) In circumstances where the matter of the grievance is likely to cause harm to the individual before the grievance procedures outlined in these rules are completed, the individual or guardian of the individual may request an expedited review. The program administrator shall review and respond in writing to the grievance within 48 hours of receipt of the grievance. The written response shall include information about the appeal process.

(5) A grievant, witness, or staff member of a provider may not be subject to retaliation by a provider for making a report or being interviewed about a grievance or being a witness. Retaliation may include but is not limited to dismissal or harassment; reduction in services, wages or benefits; or basing service or a performance review on the action.

(6) The grievant is immune from any civil or criminal liability with respect to the making or content of a grievance made in good faith.

(7) Individuals and their legal guardians, as applicable, shall have the right to appeal entry, transfer, and grievance decisions as follows:

(a) If the individual or guardian is not satisfied with the decision, the individual or guardian may file an appeal in writing within ten working days of the date of the program administrator's response to the grievance or notification of denial for services as applicable. The appeal shall be submitted to the Division as applicable;

(b) If requested, program staff shall be available to assist the individual;

(d) If the individual or guardian is not satisfied with the appeal decision, he or she may file a second appeal in writing to the Division Director within ten working days of the date of the written response.

History

Statutory/Other Authority: ORS 413.042, 428.205 - 428.270, 430.640 & 443.450
Statutes/Other Implemented: ORS 430.010, 430.205 - 430.210, 430.254 - 430.640, 430.850 - 430.955, 443.400 - 443.460, 443.991, 461.549 & 743A.168
MHS 4-2018, amend filed 02/27/2018, effective 03/01/2018
MHS 10-2017(Temp), f. 9-15-17, cert. ef. 9-15-17 thru 3-13-18
MHS 17-2016, f. 11-28-16, cert. ef. 11-30-16
MHS 10-2016(Temp), f. 6-29-16, cert. ef. 7-1-16 thru 12-27-16
MHS 3-2014, f. & cert. ef. 2-3-14
MHS 10-2013(Temp), f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14

Or. Admin. R. 309-018-0215 Variances

(1) Variances may be granted to a provider holding a license under this rule:

(a) If there is a lack of resources to implement the standards required in these rules; or

(b) If implementation of the proposed alternative services, methods, concepts, or procedures results in improved outcomes for the individual.

(2) Application for a variance:

(a) Providers may submit their variance request directly to the Division;

(b) Providers requesting a variance shall submit a written application to the Division; and

(A) The section of the rule from which the variance is sought;

(B) The reason for the proposed variance;

(D) A proposal for the duration of the variance; and

(E) A plan and timetable for compliance with the section of the rule for which the variance applies.

(3) The Division shall approve or deny the request for a variance and shall notify the provider in writing of the decision to approve or deny the requested variance within 30 days of receipt of the variance. The written notification shall include the specific alternative practice, service, method, concept, or procedure that is approved and the duration of the approval.

(4) Appeal of the denial of a variance request shall be made in writing to the Chief Officer of the Division, whose decision shall be final and shall be provided in writing within 30 days of receipt of the appeal.

(5) The LMHA, CMHP, or provider may implement a variance only after written approval from the Division.

(6) The provider shall submit a request to extend a variance in writing prior to a variance expiring. Extensions shall be approved in writing by the Division.

(7) Granting a variance for one request does not set a precedent that shall be followed by the Division when evaluating subsequent requests for variance.

History

Statutory/Other Authority: ORS 413.042, 428.205 - 428.270, 430.640 & 443.450
Statutes/Other Implemented: ORS 430.010, 430.205 - 430.210, 430.254 - 430.640, 430.850 - 430.955, 443.400 - 443.460, 443.991, 461.549 & 743A.168
MHS 4-2018, amend filed 02/27/2018, effective 03/01/2018
MHS 10-2017(Temp), f. 9-15-17, cert. ef. 9-15-17 thru 3-13-18
MHS 17-2016, f. 11-28-16, cert. ef. 11-30-16
MHS 10-2016(Temp), f. 6-29-16, cert. ef. 7-1-16 thru 12-27-16
MHS 3-2014, f. & cert. ef. 2-3-14
MHS 10-2013(Temp), f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14

Division 19 OUTPATIENT BEHAVIORAL HEALTH SERVICES

Or. Admin. R. 309-019-0100 Purpose and Scope

(1) These rules prescribe minimum service delivery standards for services and supports provided by providers certified by the Health Systems Division (Division) of the Oregon Health Authority (Authority).

(2) In addition to applicable requirements in OAR 410-120-0000 through 410-120-1980 and 943-120-0000 through 943-120-1550, these rules specify standards for behavioral health treatment services and supports provided in:

(a) Outpatient Community Mental Health Services and Supports for Children and Adults;

(b) Outpatient Substance Use Disorders Treatment Services; and

History

Statutory/Other Authority: ORS 161.390, 413.042, 430.256 & 430.640
Statutes/Other Implemented: ORS 109.675, 161.390 - 161.400, 428.205 - 428.270, 430.010, 430.205 - 430.210, 430.640, 430.850 - 430.955, 461.549 & 743A.168
MHS 6-2017, f. & cert. ef. 6-23-17
MHS 18-2016, f. 11-28-16, cert. ef. 11-30-16
MHS 11-2016(Temp), f. 6-29-16, cert. ef. 7-1-16 thru 12-27-16
MHS 4-2014, f. & cert. ef. 2-3-14
MHS 6-2013(Temp), f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14

Or. Admin. R. 309-019-0105 Definitions

(1) "Abuse of an Adult" means the circumstances defined in ORS 430.735, OAR Chapter 943, Division 45 and OAR Chapter 407, Division 45 for abuse of an adult with mental illness or who is receiving residential substance use disorder treatment or withdrawal management services.

(2) “Abuse of a Child” means the circumstances defined in ORS 419B.005 and ORS 418.257.

(4) “Activities of Daily Living (ADL) or Instrumental Activities of Daily Living (IADL)” means those personal functional activities required by an individual for continued well-being, which are essential for health and safety. Activities include eating, dressing, and grooming, bathing and personal hygiene, mobility, toileting, and cognition.

(5) “Acute Care Psychiatric Hospital” means a hospital or facility that provides 24 hours-a-day psychiatric, multi-disciplinary, inpatient, or residential stabilization, care, and treatment.

(6) “Adolescent” means an individual from 12 through 21 years of age or those individuals determined to be developmentally appropriate for such services.

(7) "Adult" means an individual 18 years of age or older or an emancipated minor. An individual with Medicaid eligibility who needs services specific to children, adolescents, or young adults in transition shall be considered a child until age 21 for the purposes of these rules. Adults who are between the ages of 18 and 21 who are considered children for purposes of these rules shall have all rights afforded to adults as specified in these rules.

(8) “ASAM” means The American Society of Addiction Medicine (ASAM).

(9) "The ASAM Criteria" means the criteria in the Third Edition of The American Society of Addiction Medicine (ASAM) for the assessment, level of care placement and treatment of addictive, substance-related, and co-occurring conditions. The ASAM Criteria is a clinical guide to developing patient-centered service plans and making objective decisions about admission, continuing care, and transfer or discharge for individuals. The ASAM Criteria is incorporated by reference in these rules.

(10) “ASAM Co-Occurring Capable” means an array of psychiatric and mental health services that meet the individuals’ needs are made available to individuals when indicated, by the program or coordinated by the program.

(11) “ASAM Co-occurring Enhanced” means mental health services that include psychiatric evaluation, medication management and therapy are made available to the individuals, when indicated, by the program. Program staff are cross trained on substance use disorders and mental health treatment and can document the relationship between the disorders and the individual’s level of functioning.

(12) “ASAM Dimensional Criteria” means the documented data demonstrates that the individual meets the criteria per ASAM dimension, as described in The ASAM Criteria, for the ASAM Level of Care assessed.

(13) “ASAM Enhanced Service designation(s)” as described in The ASAM Criteria, Third Edition, includes service types per ASAM Level of Care that the program may choose to apply and be approved by the Division to render, to either adults or adolescents, when it corresponds to an ASAM Level of Care that is certified by the Division.

(14) “ASAM Level of Care” means one of several discrete intensities of services and supports, as described within The ASAM Criteria, Third Edition, within a substance use disorders program that are delivered in a structured, programmatic fashion, by a Division certified outpatient or licensed residential provider.

(a) “Early Intervention ASAM Level of Care 0.5 (ASAM Level 0.5)” means organized services designed to explore and address problems or risk factors that may be related to substance use and assist individuals in recognizing the harmful consequences of high-risk substance use and addictive behavior. ASAM Level 0.5 may be delivered as a Driving Under the Influence of Intoxicants (DUII) service where the length and number of contacts may be mandated, and completion of the program may be a prerequisite to the reinstatement of driving privileges. Individuals eligible for this ASAM level of care do not meet DSM-5-TR diagnostic criteria for a substance use disorder.

(b) “Outpatient Substance Use Disorder Services ASAM Level of Care 1” means organized services delivered in a variety of settings and include a vast array of outpatient services and supports, which are tailored to the severity and function of the individual and typically are less than 9 contact hours per week. ASAM Level 1 programs enhance access to care and facilitate earlier engagement into treatment. Services and supports address major lifestyle, attitudinal and behavioral issues related to the substance use that detract from progress towards service plan goals.

(c) “Intensive Outpatient Substance Use Disorder Services ASAM Level of Care 2.1” means structured services and supports, mostly comprised of counseling and education. Mental health services are either offered by the program or tightly coordinated with a community provided. When planning a transition to ASAM Level 1 services, a program may provide less than the minimum number of contact hours for up to two weeks: 9 for adults and 6 for children.

(d) “Partial Hospitalization Services ASAM Level of Care 2.5” means clinically intensive programming of 20 contact hours or more per week, which is specified by the service plan. Needs identified in Dimensions 1, 2 and 3 warrant daily monitoring or management within an outpatient or combined in a residential setting. Programs staff interdisciplinary teams and offer intensive case management. Psychiatric and medical services are either offered by the program or coordinated.

(15) “ASAM Risk Assessment Component” means the portions of a substance use disorders assessment that include an Immediate Need Profile and a rating of severity for each of the ASAM dimensions in a multidimensional assessment, which inform the Level of Care placement decision and the services and supports included in the service plan.

(16) “ASAM Service Types” means the ASAM Levels of Care, Co-occurring Capable services, Co-occurring Enhanced services, and any other defined service that is described in The ASAM Criteria and when approved, included within the certificate.

(17) “Assertive Community Treatment (ACT)” means an evidence-based practice designed to provide comprehensive treatment and support services to individuals with serious and persistent mental illness. ACT is intended to serve individuals who have severe functional impairments and who have not responded to traditional psychiatric outpatient treatment. ACT services are provided by a single multi-disciplinary team, which typically includes a psychiatrist, a nurse, and at least two case managers and are designed to meet the needs of each individual and to help keep the individual in the community and out of a structured service setting, such as residential or hospital care. ACT is characterized by the following:

(a) Low client to staff ratios;

(b) Providing services in the community rather than in the office;

(d) Twenty-four-hour staff availability;

(e) Direct provision of all services by the team (rather than referring individuals to other agencies); and

(f) Time-unlimited services.

(18) “Assessment” means the process of obtaining sufficient information through a face-to-face interview to determine a diagnosis and to plan individualized services and supports. For outpatient substance use disorders services, the assessment is multi-dimensional and consistent with The ASAM Criteria third edition.

(19) “Authority” means the Oregon Health Authority.

(20) “Baseline evaluation” means an identification of the current status that an individual expresses a desire to change in order to identify the starting point(s) for measuring progress by using pre-determined benchmarks, such as a Likert Scale. Progress can then be determined by using the same benchmarks to obtain additional ratings of the identified status and using the additional ratings to make comparisons between the starting rating and subsequent ratings, from which a measure of change can be assessed.

(21) “Behavioral health clinician” means a practitioner of behavioral health services whose authorized scope

of practice includes substance use and mental health diagnosis and treatment.

(22) “Behavioral Health Treatment” means treatment for mental health, substance use disorders, and problem gambling.

(23) "Behavior Support Plan" means the individualized proactive support strategies used to support positive behavior.

(24) “Behavior Support Strategies” means proactive supports designed to replace challenging behavior with functional, positive behavior. The strategies address environmental, social, neuro-developmental, and physical factors that affect behavior.

(25) “Best Practice Risk Assessment” has the meaning given that term in OAR 309-023-0110.

(26) “Board Registered Associate or Board Registered Intern” means a post-graduate who is listed as active on the applicable Oregon Board registry with one of the following qualifications:

(a) Psychologist Associate Residents as described in OAR 858-010-0037;

(b) Licensed Psychologist Associate under continued supervision as described in OAR 858-010-0038;

(c) Licensed Professional Counselor intern or Marriage and Family Therapist intern registered with the Oregon Board of Licensed Professional Counselors and Therapists as described in OAR 833-050-0011;

(d) Certificate of Clinical Social Work Associate issued by the Oregon Board of Licensed Social Workers as described in OAR 877-020-0009; or

(e) Registered Bachelor of Social Work issued by the Oregon Board of Licensed Social Workers as described in OAR 877-015-0105.

(27) “Brief Intervention” means an early intervention for individuals using substances, by utilizing tribal-based, evidence-based, or culturally based practice designed to engage and motivate individuals at risk of substance use disorder and related health problems to seek services and/or support. Brief interventions can also be used to encourage those with more serious dependence or disorders to accept more intensive treatment. Brief interventions are intended to address problematic or risky substance use that presents with or without a previous diagnosis.

(28) “Care Coordination” means a process-oriented activity to facilitate ongoing communication and collaboration to meet multiple needs. Care coordination includes facilitating communication between the person or family served, the family, natural supports, community resources, and involved providers and agencies; organizing, facilitating, and participating in team meetings; and providing for continuity of care by creating linkages to and managing transitions between levels of care and transitions for young adults in transition to adult services.

(29) "Case Management" or “Targeted Case Management” means the services provided to assist individuals who reside in a community setting or are transitioning to a community setting in gaining access to desired medical, social, educational, entitlement, and other applicable services.

(30) “Certificate of Approval” means the document issued by the Authority that identifies and declares certification of a provider pursuant to OAR chapter 309, division 008.

(31) “Chief Officer” means the Chief Health Systems Officer of the Division or designee.

(32) "Child" means an individual under the age of 18. An individual with Medicaid eligibility who needs services specific to children, adolescents, or young adults in transition shall be considered a child until age 21 for purposes of these rules.

(33) "Clinical Supervision" means oversight by a qualified clinical supervisor of the rendering of physical health, substance use, problem gambling, and mental health services and supports, according to these rules, including ongoing evaluation and improvement of the effectiveness of those services and supports.

(34) "Clinical Supervisor" means program staff qualified to oversee and evaluate the rendering of physical health, substance use, problem gambling, or mental health services and supports.

(35) "Cognition" refers to how the individual is able to use information, make decisions, and ensure their daily needs are met. There are four components to cognition: self-preservation, decision-making, ability to make one’s self understood, and unsafe behaviors.

(36) “Cognitive Ability” means a general mental capability involving reasoning, problem solving, planning, abstract thinking, complex idea comprehension and learning from experience.

(37) “Cognitive Impairment” means a behavioral health condition or disability which impacts the individual’s cognitive abilities to perform Activities of Daily Living (ADL) or Instrumental Activities of Daily Living (IADL), regardless of whether the individual may be physically capable of performing ADLs or IADLs. For example, a cognitive impairment could prevent an individual from knowing when or how to carry out the task.

(38) “Collaborative Educational Agreement” means an individualized written arrangement between an accredited college or university and a Division-certified provider pertaining to a student’s internship or field placement experience.

(39) “Co-occurring Capable Substance Use Disorder Programs” means, consistent with The ASAM Criteria, arrangements are in place for coordination and collaboration between addiction and mental health services, internally and with external community partners. Program staff must be trained and qualified to address the interaction between mental health symptoms or conditions and the substance use disorder, and the interactional effect on readiness to change, the severity of risk and the subsequent planning of services and supports.

(40) “Co-occurring Enhanced Substance Use Disorder Programs” means, consistent with The ASAM Criteria, Third edition, a setting where integrated services address concurrently unstable mental health and substance use disorder conditions. There is a focus on the integration of mental health and substance use disorders throughout the staffing, services, and program content, as well as the use of Motivational Enhancement therapies throughout services.

(41) “Co-occurring Substance Use, Problem Gambling, and Mental Health Disorders (COD)” means the existence of a diagnosis for a substance use disorder, problem gambling disorder, and/or a mental health disorder.

(42) “Community Health Worker (CHW)” means a person who meets qualification criteria adopted by the authority under ORS 414.665 and who is certified pursuant to the requirements in OAR 410-180-0310.

(43) "Community Mental Health Program (CMHP)" an entity that is responsible for planning and delivery of safety net services for persons with mental or emotional disturbances, drug abuse problems, and alcoholism and alcohol abuse in a specific geographic area of the state under a contract with the Division or a local mental health authority and pursuant to OAR Chapter 309, Division 014.

(44) "Conditional Release" means placement by a court or the Psychiatric Security Review Board (PSRB) of an individual found eligible under ORS 161.327 or 161.336 for supervision and treatment in a community setting.

(45) “Consistent with ASAM Criteria” means a documented intervention containing information that demonstrates use of and adherence to the description of components contained within The ASAM Criteria, Third Edition.

(46) “Coordinated Care Organization (CCO)” means a corporation, governmental agency, public corporation, or other legal entity that is certified as meeting the criteria adopted by the Authority under ORS 414.625 to be accountable for care management and to provide integrated and coordinated health care for each of the organization’s members.

(47) "Court" means a criminal court, drug court, circuit court, juvenile court or last convicting or ruling court in this state with jurisdiction over the individual.

(48) "Criminal Records Check" means documenting the criminal background check results for all employees, contracted staff, interns and volunteers considered to be program staff that render medical or behavioral health services and supports or have access to protected health information such as service records or billing information.

(49) "Crisis" means either an actual or perceived urgent or emergent situation that occurs when an individual’s stability or functioning is disrupted, and there is an immediate need to resolve the situation to prevent a serious deterioration in the individual’s mental or physical health or to prevent referral to a significantly higher level of care or death.

(50) “Crisis Intervention” has the meaning given that term in OAR 309-023-0110.

(51) “Crisis Line Services” means phone-based services that establish immediate communication links and provide supportive interventions and information for individuals in an urgent or emergent situation.

(52) “Crisis Plan” means an individualized document designed in collaboration with the individual served to help anticipate and prevent future crisis episodes and direct interventions in the instance of a crisis.

(53) “Crisis Stabilization Services” means providing evaluation and treatment to individuals experiencing a crisis. Crisis Services may be provided prior to completion of an intake. These services are intended to stabilize the individual in crisis, prevent further deterioration, and provide immediate treatment and intervention in a location best suited to meet the needs of the individual and in the least restrictive environment available.

(54) "Cultural Competence" means the process by which people and systems respond respectfully and effectively to people of all cultures, languages, classes, races, ethnic backgrounds, disabilities, religions, genders, sexual orientations, and other diversity factors in a manner that recognizes, affirms, and values the worth of individuals, families, and communities and protects and preserves the dignity of each.

(55) “Culturally Responsive” means services that are respectful of and relevant to the beliefs, practices, culture and linguistic needs of diverse consumer/client populations and communities whose members identify as having particular cultural or linguistic affiliations. Cultural responsiveness describes the capacity to respond to the issues of diverse communities and requires knowledge and capacity at different levels of intervention: systemic, organizational, professional, and individual.

(56) “Culturally Specific Program” means a program designed to meet the unique service needs of a specific culture and that provides services to a majority of individuals representing that culture.

(57) "Declaration for Mental Health Treatment" means a written statement of an individual’s preferences concerning their mental health treatment. The declaration is made when the individual is able to understand and legally make decisions related to such treatment. It is honored, as clinically appropriate, in the event the individual becomes unable to make such decisions.

(58) "Diagnosis" means the principal mental health, substance use, or problem gambling diagnosis listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth edition (DSM-5-TR). The diagnosis is determined through the assessment and any examinations, tests, or consultations suggested by the assessment and are medically necessary reason for services.

(59) “Division” means the Health Systems Division of the Oregon Health Authority, or its designee.

(60) “Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5-TR)” means the textbook used to diagnose and classify mental disorders that is published by the American Psychiatric Association.

(61) “Driving Under the Influence of Intoxicants (DUII) Substance Use Disorders Rehabilitation Program” means a program of treatment and therapeutically oriented education services for an individual who is either:

(a) A violator of ORS 813.010 (Driving Under the Influence of Intoxicants); or

(b) A defendant participating in a diversion agreement under ORS 813.200.

(62) “Emergent” means the onset of symptoms requiring attention within 24 hours to prevent serious deterioration in mental or physical health or threat to safety.

(63) “Employment Support Services” means services approved by Division, determined to be necessary and provided to an individual to obtain and maintain employment in the community as they are transitioning from an inpatient or residential facility that provides substance use disorder treatment.

(64) “Enhanced Care Services (ECS)” and “Enhanced Care Outreach Services (ECOS)” means intensive behavioral and rehabilitative mental health services to eligible individuals who reside in Aging and People with Disabilities (APD) licensed homes or facilities.

(65) “Entry” means the act or process of acceptance and enrollment into services regulated by this rule.

(66) “Face to Face” means a personal interaction where both words can be heard and facial expressions can be seen in person or through telehealth services where there is a live streaming audio and video, if clinically appropriate.

(67) "Family" means the biological or legal parents, siblings, other relatives, foster parents, legal guardians, spouse, domestic partner, caregivers, and other primary relations to the individual whether by blood, adoption, or legal or social relationships. Family also means any natural, formal, or informal support persons identified as important by the individual.

(68) "Family Support" means the provision of peer-delivered services to people defined as family to the individual. It includes support to caregivers at community meetings, assistance to families in system navigation and managing multiple appointments, supportive home visits, peer support, parent mentoring and coaching, advocacy, and furthering efforts to develop natural and informal community supports.

(69) “Gender Identity” means an individual's self-identification of gender without regard to legal or biological identification including but not limited to individuals identifying themselves as male, female, transgender, gender transitioning and transitioned, non-binary, intersex, and gender diverse.

(70) “Gender Expression” means the external characteristics and behaviors that are socially defined as masculine, feminine, or androgynous such as dress, mannerisms, speech patterns, and social interactions.

(71) "Geographic Service Area" means the geographic area within the county boundaries in which the CMHP operates.

(72) "Grievance" means a formal complaint submitted to a provider verbally or in writing by an individual or the individual’s representative.

(73) "Guardian" means an individual appointed by a court of law to act as guardian of a minor or a legally incapacitated individual. Guardian may also mean legal representative.

(74) “Health Insurance Portability and Accountability Act (HIPAA)” means the federal Health Insurance Portability and Accountability Act of 1996 and the regulations published in Title 45, parts 160 and 164, of the Code of Federal Regulations (CFR).

(75) “Health Systems Services and Supports” means all services and supports including but not limited to Outpatient Community Mental Health Services and Supports for Children and Adults, Intensive Treatment Services for Children, Outpatient and Residential Substance Use Disorders Treatment Services, and Outpatient and Residential Problem Gambling Treatment Services.

(76) “Housing Support Services” means services approved by Division, provided to an individual to obtain and reside in an independent community setting and are tailored to the goal of maintaining an individual’s personal health and welfare in a home and community-based setting as they are transitioning from an inpatient or residential facility that provides substance use disorder treatment.

(77) “Immediate Need Profile” means the portion of an assessment that includes the identification of the most severe and destabilizing or life-threatening conditions, in order to inform the determination of the level of risk, the level of care placement and need for immediate intervention(s).

(78) “Incident” means any event involving an individual or child of an individual receiving services occurring on the premises of the program or involving program staff or any individual occurring on the premises of the program, or during a Service Plan activity and including but not limited to death, injury, major illness, accident, act of physical aggression, medication error, suspected abuse or neglect, or any other type unusual or critical event that presents a risk to health and safety of any persons. Critical incidents are reported to the Division.

(79) “Incident Report” means a written description of any incident.

(80) “Institutions of Mental Disease (IMD)” means a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, which includes substance use disorders (SUDs).

(81) “Individual” means any individual being considered for or receiving services and supports regulated by these rules.

(82) "Informed Consent for Services" means that the service options, risks and benefits have been explained to the individual and guardian, if applicable, in a manner that they comprehend, and the individual and guardian, if applicable, have consented to the services on, or prior to, the first date of service.

(83) “Institution” means an establishment that furnishes (in single or multiple facilities) food, shelter, and some treatment or services to four or more persons unrelated to the proprietor.

(84) “Intensive In-Home Behavioral Health Treatment (IIBHT) for Children” means an intensive, community-based level of care for youth ages 0-20 years with complex mental health needs who are at risk for an out of home placement or who are stepping down from a higher level of care. IIBHT includes access to an array of services including individual and family therapy, case management, psychiatric services, skills training, peer-delivered services, and proactive 24 hours 7 days a week crisis response. A Certificate of Approval from the Oregon Health Authority is required to render IIBHT services to eligible youth and families. For the purposes of IIBHT, “in home” means services delivered in the home, school, or other community setting, as specified by the individual and family.

(85) “Intensive Outpatient Services and Supports (IOSS)” means a specialized set of comprehensive in-home and community-based supports and mental health treatment services for children that are developed by the child and family team and delivered in the most integrated setting in the community.

(86) “Interdisciplinary Team (IDT)” means a group of program staff that have primary responsibility for the development of a Service Plan for an individual receiving services.

(87) “Interim Referral and Information Services” means services provided by a substance use disorders treatment provider to individuals on a waiting list and whose services are funded by the Substance Use, Prevention, Treatment and Recovery (SUPTR) block grant to reduce the adverse health effects of substance use, promote the health of the individual, and reduce the risk of disease transmission.

(88) “Juvenile Psychiatric Security Review Board (JPSRB)” means the entity described in ORS 161.385.

(89) “Legal Representative” means a person who has been legally designated by court order to make financial or health care decisions for another individual. The legal representative only has authority to act within the scope and limits of the legal representative’s authority as designated by the court or other agreement. Legal representatives acting outside of the legal representative’s authority or scope shall meet the definition of authorized representative.

(90) "Level of Care" means the type, frequency, and duration of medically necessary services provided from the most integrated setting to the most restrictive and intensive inpatient setting

(91) "Licensed Health Care Professional" means a practitioner of the healing arts acting within the scope of their practice under State law who is licensed by a recognized governing board in Oregon.

(92) "Licensed Medical Practitioner (LMP)” means a person who meets the following minimum qualifications as documented by the Local Mental Health Authority (LMHA) or designee:

(a) Physician licensed to practice in the State of Oregon;

(b) Nurse practitioner licensed to practice in the State of Oregon; or

(d) Whose training, experience, and competence demonstrate the ability to conduct a medical exam, a mental health assessment and provide medication management; and

(e) For IOSS and ITS providers, a Board-Certified or Child and Adolescent Psychiatrist licensed to practice in the State of Oregon or a Psychiatric Nurse Practitioner under the consultation of a board-certified or board-eligible child and adolescent psychiatrist licensed to practice in the State of Oregon.

(93) “Linkage agreement” has the meaning given that term in OAR 309-032-0860.

(94) “Local Mental Health Authority (LMHA)” means one of the following entities:

(a) The board of county commissioners of one or more counties that establishes or operates a CMHP;

(b) The tribal council in the case of a federally recognized tribe of Native Americans that elects to enter into an agreement to provide mental health services; or

(95) "Mandatory Reporter" means anyone required by law, as defined in ORS 419B.005 or 430.735, who is required to report suspected abuse or neglect of a child, elderly person, or other adult as required by law in ORS 430.765, or ORS 419B.010, or ORS 124.060.

(96) "Medicaid" means the federal grant-in-aid program to state governments to provide medical assistance to eligible individuals under Title XIX of the Social Security Act.

(97) "Medical Director" means a physician licensed to practice medicine in the State of Oregon and is designated by a substance use disorders treatment program to be responsible for the program's medical services, either as an employee or through a contract.

(98) “Medical Treatment Staff” means medical personnel directly responsible for the delivery or oversight of client care and treatment, and who are properly trained, educated, and credentialed to deliver withdrawal management and substance use disorders services.

(99) “Medically Necessary” means health services and items that are required for an individual to address one or more of the following:

(a) The prevention, diagnosis, or treatment of an individual’s condition or disorder that results in behavioral health impairments; or

(b) The ability for a client or member to achieve age-appropriate growth and development; and

(100) “Medication Assisted Treatment (MAT)” means the use of medication in combination with counseling and behavioral therapies for the treatment of substance use disorders.

(101) “Mental Health Intern” means program staff who meet qualifications for QMHA and are currently enrolled in a graduate program approved by the Division-approved certification or licensing body but does not have the necessary graduate degree in psychology, social work, or related field of behavioral science, or have an equivalent degree as determined by the Division-approved certification or licensing body. The program staff shall:

(a) Be enrolled in a graduate program that will result in a degree in psychology, social work, or related field of behavioral science, or an equivalent degree as evidenced by providing transcripts indicating applicable coursework meeting the required competencies and approved by the OHA-approved certification or licensing body;

(b) Have a collaborative educational agreement between the Division-certified provider and the graduate program for the student; and

(c) Work under the direct and active supervision of a qualified supervisor employed or contracted by the provider of services, within the scope of practice and competencies identified by the collaborative educational agreement, and within the policies and procedures for the credentialing of program staff as established by the provider.

(102) "Mobile Crisis Services" means mental health services for individuals in crisis provided by mental health practitioners who respond to behavioral health crises onsite at the location in the community where the crisis arises and who provide a face-to-face therapeutic response. The goal of mobile crisis services is to help an individual resolve a psychiatric crisis in the most integrated setting possible and to avoid unnecessary hospitalization, inpatient psychiatric treatment, involuntary commitment, and arrest or incarceration.

(103) "Mobile Crisis Response Time" means the time from the point when a professional decision is made that a face-to-face intervention is required to the time the actual face-to-face intervention takes place in the community.

(104) “Mobility” means assisting the individual with mobility, transfers and repositioning including turning or adjusting padding for physical comfort or pressure relief and encouraging or assisting with range of motion exercises and the use of devises that assist with mobility.

(105) “Motivational Enhancement Therapy” (MET) means a person-centered approach to therapy that focuses on improving an individual's motivation to change.

(106) “Motivational Therapies” means evidence-based interventions for people experiencing substance use disorder, such as motivational interviewing, cognitive behavioral therapy, and motivational enhancement therapy.

(107) “Non-Institutions of Mental Disease (non-IMD)” means a hospital, nursing facility, or other institution with less than 16 beds that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, which includes substance use disorders (SUDs).

(108) “Non-Medicaid Service Data” means data collected through the mandated state data system regarding services paid for by any source other than Medicaid and includes, but is not limited to:

(a) Diagnosis;

(b) Date of service;

(d) Procedure code;

(e) Modifier;

(f) Number of service units; and

(g) Billed charges.

(109) “Nursing Services” means services that are provided by a registered nurse (RN) or a licensed practical nurse (LPN) within the scope of practice as defined in OAR chapter 851 division 045.

(110) “Outpatient Problem Gambling Treatment Services” means all outpatient treatment services and supports provided to individuals with gambling related problems and their families.

(111) "Outreach" means the delivery of behavioral health services, referral services, and case management services in non-traditional settings including but not limited to the individual's residence, shelters, streets, jails, transitional housing sites, drop-in centers, single room occupancy hotels, child welfare settings, educational settings, or medical settings. It also means attempts made to engage or re-engage an individual in services by such means as letters or telephone calls.

(112) “Partial Hospitalization or Day Treatment Substance Use Disorder (SUD) Services ASAM Level 2.5” means a planned, structured array of services and supports, consistent with The ASAM Criteria for Level of Care 2.5, that offer 20 or more therapeutic contact hours of high intensity treatment per week. Contact is in a less restrictive level of care than residential SUD treatment, 24-hour care is not required.

(113) “Peer” means program staff supporting an individual or the individual's family member who has similar life experience, either as a current or former recipient of mental health or substance use, problem gambling, or mental health services, or as a family member of an individual who is a current or former recipient of substance use, problem gambling, or mental health services.

(114) “Peer-Delivered Services” are community-based services and supports provided by peers, peer support specialists, and peer wellness specialists to individuals or family members with similar lived experience. These services are intended to support individuals and families to engage individuals in ongoing treatment and to live successfully in the community.

(115) “Peer-Delivered Services Supervisor" means qualified program staff, with at least one year of experience as a PSS or PWS in behavioral health services, who is responsible for evaluating and guiding PSS and PWS program staff in the delivery of peer-delivered services and supports.

(116) “Peer Support Specialist (PSS)” means a qualified program staff providing peer-delivered services to an individual or family member with similar life experience under the supervision of a qualified clinical supervisor and a qualified peer-delivered services supervisor as resources are made available.

(117) “Peer Support and Peer Wellness Specialist Supervision" means supervision by a qualified clinical supervisor and a qualified peer-delivered services supervisor as resources are available. The supports provided include guidance in the unique discipline of peer-delivered services and the roles of peer support specialists and peer wellness specialists.

(118) “Peer Wellness Specialist (PWS)” means s program staff who supports an individual in identifying behavioral health service and support needs through community outreach, assisting individuals with access to available services and resources, addressing barriers to services, and providing education and information about available resources and behavioral health issues in order to reduce stigma and discrimination toward consumers of behavioral health services and to provide direct services to assist individuals in creating and maintaining recovery, health, and wellness under the supervision of a qualified clinical supervisor and a qualified peer-delivered services supervisor as resources are made available.

(119) “Pre-engagement Services” means services delivered prior to completion of an assessment, service plan, and/or commencement of formal treatment in order to engage high risk/high need individuals in ongoing treatment services and to avoid crisis events and higher levels of care.

(120) “Problem Gambling Approved Certification Consultant” means individual who is a Certified Gambling Addiction Counselor, level II (CGACII) for a minimum of two years and has a minimum of 12 hours of clinical supervision education. The purpose of the position is to provide consultation for CGAC candidates on 1) Fundamentals of Problem Gambling Treatment case conceptualization 2) the process and requirements of earning certification as a CGAC. This is a Mental Health and Addiction Certification Board of Oregon (MHACBO) distinction.

(121) “Problem Gambling Treatment Staff” means program staff certified or licensed by a Division recognized credentialing body to provide problem gambling treatment services that include assessment, development of a Service Plan, group and family counseling.

(122) "Program" means an organized system of services and supports delivered by a provider designed to address the treatment needs of individuals and families.

(123) "Program Administrator" or "Program Director" means program staff with appropriate professional qualifications and experience who is designated to manage the operation of a program.

(124) "Program Staff" means personnel who renders a clinical service or support. Program staff could include, for example, be an employee, contractor, intern, or volunteer who is rendering or assisting with rendering clinical services or supports.

(125) “Provider” means an organizational entity or qualified person that is certified or licensed by the Division for the direct delivery of substance use, problem gambling, or mental health services and supports.

(126) "Psychiatric Security Review Board (PSRB)" means the entity described in ORS 161.295 through 161.400.

(127) Psychiatrist" means a physician licensed by the Oregon Medical Board and who has completed an approved residency training program in psychiatry.

(128) "Psychologist" means a person who is currently licensed to practice psychology by the Oregon Board of Psychology.

(129) “Publicly Funded” means financial support, in part or in full, with revenue generated by a local, state, or federal government.

(130) "Qualified Mental Health Associate (QMHA)” means mental health program staff delivering services under the direct supervision of a QMHP who meets the minimum qualifications as authorized by the LMHA or designee and specified in OAR 309-019-0125.

(131) "Qualified Mental Health Professional (QMHP)" means mental health program staff LMP or any other program staff meeting the minimum qualifications as authorized by the LMHA or designee and specified in OAR 309-019-0125.

(132) "Qualified Person" means program staff who is a QMHP or a QMHA and is identified by the PSRB and JPSRB in its Conditional Release Order. This individual is designated by the provider to deliver or arrange and monitor the provision of the reports and services required by the Conditional Release Order.

(133) "Quality Assessment and Performance Improvement" means the structured, internal monitoring and evaluation of services to improve processes, service delivery, and service outcomes.

(134) “Recovery” means a process of healing and transformation for an individual to achieve their full human potential and personhood in leading a meaningful life as they define it in communities of their choice.

(135) "Representative" means someone who acts on behalf of an individual at the individual’s request with respect to a grievance including but not limited to a relative, friend, Division employee, attorney, or legal guardian.

(136) “Resilience” means the universal capacity that an individual uses to prevent, minimize, or overcome the effects of adversity. Resilience reflects an individual’s strengths as protective factors and assets for positive development.

(137) "Respite Care" means planned and emergency supports designed to provide temporary relief from care giving to maintain a stable and safe living environment. Respite care may be provided in or out of the home. Respite care includes supervision and behavior support consistent with the strategies specified in the service plan.

(138) "Risk Assessment" means an evaluation of the level or severity of risk the individual is experiencing and how each interact, resulting in an overall risk assessment rating.

(139) “Safety Plan” means a best practice, research-based, individualized and directive document developed through a collaborative process in which the provider assists the individual in listing actions to use when self-harm, harm to others or suicide ideation is elevated or following suicidal behavior.

(140) "Screening" means the process to determine whether the individual needs further assessment to identify circumstances requiring referrals or additional services and supports.

(141) “Screening Specialist” means a person who possesses valid certification issued by the Division to conduct DUII evaluations.

(142) "Service Plan" means a comprehensive plan for services and supports provided to or coordinated for an individual and their family, as applicable, that is reflective of the assessment and the intended outcomes of service.

(143) “Service Note” means the written record of services and supports provided, including documentation of progress toward intended outcomes consistent with the timelines stated in the service plan.

(144) “Service Record” means the written or electronic documentation regarding an individual and resulting from entry into services, assessment, orientation, services and supports planning, services and supports provided, and transfer.

(145) "Services" means those activities and treatments described in the service plan and rendered, that are intended to support the individual's transition to recovery from a substance use disorder, problem gambling disorder, or mental health condition and to promote resiliency and rehabilitative and functional individual and family’s desired outcomes.

(146) “Signature” means any written or electronic means of entering the name, date of authentication, and credentials of the program staff providing a specific service or the individual authorizing services and supports. Signature also means any written or electronic means of entering the name and date of authentication of the individual, guardian, or any authorized representative of the individual receiving services.

(147) "Skills Training" or “Skills Restoration" means providing information and training to individuals and families designed to assist with the development of skills in areas including but not limited to anger management, stress reduction, conflict resolution, self-esteem, parent-child interactions, personal relationships, drug and alcohol awareness, behavior support, symptom management, accessing community services, and daily living.

(148) “Stabilization” means the application of medical and psychosocial services and supports and in a manner that results in the reduction of symptomology and increase in skill level to support and redirect patients to the most appropriate and least restrictive setting. Services are directed at restoring patient’s ability to maintain safety while enhancing their recovery, so they can successfully reintegrate into identified community settings.

(149) “Status Data” means data collected through the mandated state data system and includes, but is not limited to:

(a) Initial admission, diagnostic, and demographics data;

(b) Updates and changes as needed through the individual’s enrollment in services; and

(150) “Student Intern” or “Intern” means a program staff who provides a paid or unpaid program service and does not qualify as a Mental Health Intern.

(151) "Substance Use, Prevention, Treatment and Recovery Block Grant” or “SUPTR Block Grant” or “SUPTR” means the federal block grants for prevention and treatment of substance abuse under Public Law 102-321 (31 U.S.C. 7301-7305) and the regulations published in Title 45 Part 96 of the Code of Federal Regulations.

(152) "Substance Use Disorders (SUDs)" as defined in DSM-5-TR, means disorders related to the taking of a drug of abuse including alcohol, the side effects of a medication, or a toxin exposure. The disorders include substance use disorders and substance-induced disorders, which include substance intoxication and withdrawal, and substance-related disorders such as delirium, neuro-cognitive disorders, and substance-induced psychotic disorder.

(153) “Substance Use Disorders Treatment and Recovery Services” means outpatient, intensive outpatient, and residential services and supports for individuals with substance use disorders.

(154) “Substance Use Disorders Treatment Staff” means one type of program staff certified by a Division-approved certification body to render substance use disorders treatment services.

(155) “Subsyndromal symptomology” means the individual demonstrates or complains of symptoms, suggesting a particular disorder or condition, that do not meet the threshold of the defined criteria for that disorder or condition, and so a diagnosis of that disorder or condition cannot be assigned.

(156) “Successful DUII Completion” means that the DUII program has documented in its records that for the period of service deemed necessary by the program, the individual has:

(a) Met the completion criteria approved by the Division;

(b) Met the terms of the fee agreement between the provider and the individual; and

(157) “Suicide Risk Assessment” means a comprehensive evaluation, usually performed by a clinician, to evaluate suspected suicide risk in an individual, estimate the immediate danger, and decide on a course of treatment. May also be called Risk Assessment.

(158) “Suicide Screening” means a procedure in which a validated tool, or protocol is used to identify individuals who may be at risk for suicide.

(159) “Supports” means activities, referrals, and supportive relationships designed to enhance the services delivered to individuals and families for the purpose of facilitating progress toward intended outcomes.

(160) “Transfer” means the process of assisting an individual to transition from the current services to the next identified setting or ASAM level of care.

(161) “Transitioning” means a 90-day period which begins when an individual is discharged from an inpatient or residential stay back to a community setting.

(162) “Trauma Informed Services” means services that reflect the consideration and evaluation of the role that trauma plays in the lives of people seeking mental health, substance use, or problem gambling services, including recognition of the traumatic effect of misdiagnosis and coercive treatment. Services are responsive to the vulnerabilities of trauma survivors and are delivered in a way that avoids inadvertent re-traumatization and facilitates individual direction of services.

(163) "Treatment" means the planned, individualized program of medical, psychological, and rehabilitative procedures, experiences, and activities designed to remediate symptoms of a DSM-5-TR diagnosis.

(164) “Triage” means a classification process to determine priority needs.

(165) "Urinalysis Test" means a sensitive, rapid, and inexpensive immunoassay screen that identifies the presence of a specific drug or metabolite in a urine specimen to eliminate "true negative" specimens from further consideration.

(166) "Urgent" means the onset of symptoms requiring attention within 24 hours to prevent a serious deterioration in an individual's mental or physical health or threat to safety.

(167) "Variance" means an exception from a provision of these rules granted in writing by the Division pursuant to the process regulated by OAR 309-008-1600 upon written application from the provider. Approval and duration of a variance is determined on a case-by-case basis.

(168) "Volunteer" means a person who performs a service willingly and without pay.

(169) “Warm Handoff” has the meaning given that term in OAR 309-032-0860.

(170) “Wellness” means an approach to healthcare that emphasizes good physical and mental health, preventing illness, and prolonging life.

(171) “Wraparound” means a high-fidelity model of team-based intensive care coordination for children and their families based on National Wraparound Initiative values and principles.

(172) “Young Adult in Transition” means an individual who is developmentally transitioning into independence, sometime between the ages of 14 and 25.

History

Statutory/Other Authority: ORS 161.390, 413.042, 430.256 & 430.640
Statutes/Other Implemented: ORS 161.390 - 161.400, 428.205 - 270, 430.010, 430.205- 430.210, 430.254 - 430.640, 430.850 - 430.955, 743A.168 & 414.665
BHS 12-2023, amend filed 05/16/2023, effective 05/16/2023
BHS 11-2023, amend filed 04/07/2023, effective 04/07/2023
BHS 27-2022, amend filed 12/20/2022, effective 12/20/2022
BHS 1-2022, amend filed 01/05/2022, effective 01/05/2022
BHS 11-2021, amend filed 06/16/2021, effective 06/16/2021
MHS 4-2018, amend filed 02/27/2018, effective 03/01/2018
MHS 10-2017(Temp), f. 9-15-17, cert. ef. 9-15-17 thru 3-13-18
MHS 6-2017, f. & cert. ef. 6-23-17
MHS 26-2016(Temp), f. 12-27-16, cert. ef. 12-28-16 thru 6-23-17
MHS 18-2016, f. 11-28-16, cert. ef. 11-30-16
MHS 11-2016(Temp), f. 6-29-16, cert. ef. 7-1-16 thru 12-27-16
MHS 4-2014, f. & cert. ef. 2-3-14
MHS 6-2013(Temp), f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14

Or. Admin. R. 309-019-0110 Provider Policies

(1) All providers shall develop and implement written service delivery policies and specific procedures for office-based, community-based and telehealth services and supports compliant with these rules, to be made available to individuals and family members upon request, and shall include, at a minimum, the following:

(a) Personnel qualifications, credentialing, and training;

(b) Mandatory abuse reporting compliant with ORS 430.735 - 430.768 and OAR chapter 943, division 45;

(c) Criminal Records Checks that address program and volunteer staff, compliant with ORS 181.533 through 181.575 and OAR 943-007-0001 through 0501, where applicable;

(d) Fraud, waste, and abuse in federal Medicaid and Medicare programs compliant with OAR 410-120-1380 and 410-120-1510;

(e) Alcohol, Drug and Gambling Free Workplace;

(f) Fee agreements;

(g) Confidentiality and compliance with HIPAA, Federal Confidentiality Regulations (42 CFR, Part 2), and state confidentiality regulations as specified in ORS 179.505 and 192.518 through 192.530;

(h) Compliance with Title 2 of the Americans with Disabilities Act of 1990 (ADA);

(i) Per ORS 413.046; Grievances and appeals, including an example grievance form;

(j) Individual rights;

(k) Quality assessment and performance improvement;

(l) Trauma informed service delivery consistent with the Division Trauma Informed Services Policy;

(m) Provision of culturally and linguistically appropriate services;

(n) Crisis prevention and response;

(o) Incident reporting;

(p) Peer delivered services;

(q) Prevention of communicable disease transmission;

(r) Emergency evacuation;

(s) Delivery of substance use disorders treatment services and supports consistent with The ASAM Criteria for each certified level of care;

(t) Code of conduct that includes professional boundaries and ethics;

(u) Referral, Care Coordination and Transfer of Services

(v) Medical Protocols consistent with these rules; and

(w) Urinalysis Testing.

(x) Opportunity for individuals over the age of 18 to declare advanced directive for their mental health treatment.

(y) Opportunity for individuals over the age of 18 to register to vote by making voter registration cards available.

(z) Quality Assurance Review process overseen and approved by designated Clinical Supervisor that includes, at minimum, quarterly review of;

(A) A pre-determined number of service plans for participants newly admitted to the program;

(B) A pre-determined number of service plans for participants engaged in services for more than one year; and

(C) A pre-determined number of assessments and other documentation demonstrating a medically necessary reason for services.

(2) All written service delivery policies and specific procedures shall prohibit the following:

(a) Psychological and physical abuse of an individual;

(b) Seclusion, personal restraint, mechanical restraint, and chemical restraint;

(d) Discipline of one individual receiving services by another; and

(e) Titration of medications prescribed for the treatment of opioid dependence as a condition of receiving or continuing to receive treatment.

(3) Providers of Enhanced Care Services (ECS) services shall develop behavior support policies consistent with OAR 309-019-0155(3).

(4) Community Mental Health Programs shall develop policies for linkage agreements compliant with OAR 309-032-0870.

History

Statutory/Other Authority: ORS 161.390, 413.042, 430.256 & 430.640
Statutes/Other Implemented: ORS 161.390 - 161.400, 179.505, 413.520 - 413.522, 428.205 - 428.270, 430.010, 430.205 - 430.210, 430.254 - 430.640, 430.850 - 430.955 & 743A.168
BHS 24-2024, amend filed 10/25/2024, effective 10/27/2024
BHS 11-2023, amend filed 04/07/2023, effective 04/07/2023
BHS 11-2021, amend filed 06/16/2021, effective 06/16/2021
BHS 8-2020, temporary amend filed 04/30/2020, effective 04/30/2020 through 10/26/2020
MHS 4-2018, amend filed 02/27/2018, effective 03/01/2018
MHS 10-2017(Temp), f. 9-15-17, cert. ef. 9-15-17 thru 3-13-18
MHS 6-2017, f. & cert. ef. 6-23-17
MHS 26-2016(Temp), f. 12-27-16, cert. ef. 12-28-16 thru 6-23-17
MHS 18-2016, f. 11-28-16, cert. ef. 11-30-16
MHS 11-2016(Temp), f. 6-29-16, cert. ef. 7-1-16 thru 12-27-16
MHS 4-2014, f. & cert. ef. 2-3-14
MHS 6-2013(Temp), f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14

Or. Admin. R. 309-019-0115 Individual Rights

(1) In addition to all applicable statutory and constitutional rights, every individual receiving services has the right to:

(a) Choose from services and supports that are consistent with the assessment and service plan, culturally competent, provided in the most integrated setting in the community and under conditions that are least restrictive to the individual’s liberty, that are least intrusive to the individual, and that provide for the greatest degree of independence;

(b) Be treated with dignity and respect;

(c) Participate in the development of a written service plan, receive services consistent with that plan and participate in periodic review and reassessment of service and support needs, assist in the development of the plan, and receive a copy of the written service plan;

(d) Have all services explained, including expected outcomes and possible risks;

(e) Confidentiality and the right to consent to disclosure in accordance with ORS 107.154, 179.505, 179.507, 192.515, 192.507, 42 CFR Part 2 and 45 CFR Part 205.50;

(A) Under age 18 and lawfully married;

(B) Age 16 or older and legally emancipated by the court; or

(g) Inspect their service record in accordance with ORS 179.505;

(h) Refuse participation in experimentation;

(i) Receive medication specific to the individual’s diagnosed clinical needs, including medications used to treat opioid dependence;

(j) Receive prior notice of transfer, unless the circumstances necessitating transfer pose a threat to health and safety;

(k) Be free from abuse or neglect and to report any incident of abuse or neglect without being subject to retaliation;

(L) Have religious freedom;

(m) Be free from seclusion and restraint;

(n) Be informed at the start of services and periodically thereafter of the rights guaranteed by this rule;

(p) Have family and guardian involvement in service planning and delivery;

(q) Have an opportunity to make a declaration for mental health treatment, when legally an adult;

(r) File grievances, including appealing decisions resulting from the grievance;

(s) Exercise all rights set forth in ORS 109.610 through 109.697 if the individual is a child, as defined by these rules;

(t) Exercise all rights set forth in ORS 426.385 if the individual is committed to the Authority; and

(u) Exercise all rights described in this rule without any form of reprisal or punishment.

(2) The provider shall give to the individual and, if appropriate, the guardian a document that describes the applicable individual’s rights as follows:

(a) Information given to the individual shall be in written form or, upon request, in an alternative format or language appropriate to the individual’s need;

(b) The rights and how to exercise them shall be explained to the individual, and if applicable the guardian; and

History

Statutory/Other Authority: ORS 161.390, 413.042, 430.256, 426.495, 430.640 & 443.450
Statutes/Other Implemented: ORS 109.675, 161.390 - 161.400, 179.505, 413.520 - 413.522, 426.380- 426.395, 426.490 - 426.500, 428.205 - 428.270, 430.010, 430.205 - 430.210, 430.254 - 430.640, 430.850 - 430.955, 443.400 - 443.460 & 743A.168
MHS 4-2018, amend filed 02/27/2018, effective 03/01/2018
MHS 10-2017(Temp), f. 9-15-17, cert. ef. 9-15-17 thru 3-13-18
MHS 6-2017, f. & cert. ef. 6-23-17
MHS 26-2016(Temp), f. 12-27-16, cert. ef. 12-28-16 thru 6-23-17
MHS 4-2014, f. & cert. ef. 2-3-14
MHS 6-2013(Temp), f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14

Or. Admin. R. 309-019-0125 Staff Qualifications

Provider must ensure that staff in the following positions meet applicable qualifications, credentialing, andlicensing/certification standards and competencies, including those set forth in these rules:

(1) Program staff as identified in (21)(a-u) of this rule, providing treatment services and/or supports in mental health treatment programs, substance use disorders treatment programs, or problem gambling treatment programs must be trained in and familiar with strategies for the delivery of trauma informed and culturally responsive treatment services and supports in compliance with the program’s respective policies. All treatment services and supports must be provided in a trauma informed and culturally responsive manner. All Program staff must meet one of the following:

(a) Be licensed in Oregon by a Division recognized Oregon board:

(A) Oregon Medical Board;

(B) Oregon Board of Nursing;

(D) Oregon Board of Licensed Professional Counselors and Therapists;

(E) Oregon Board of Licensed Social Workers;

(F) Oregon Occupational Therapy Licensing Board;

(b) Be an Associate registered by a Division recognized Oregon board as identified in (1)(D-E) of this rule and be physically present in Oregon at the time of providing services or supports.

(c) Effective July 1, 2027, be under the outpatient (OAR 309, Division 019) certificate of approval (COA) if providing services to individuals under Medicaid;

(d) Be credentialed by an OHA approved entity and

(e) Be physically present in Oregon at the time of providing services or supports under the outpatient (OAR 309, Division 019) certificate; or.

(f) Credentialed as a QMHP or a QMHA as identified in (14) or (15) of this rule, and credentialed by the specific OHA-certified behavioral health program the individual is employed by, consistent with the program’s policy, and be physically present in Oregon.

(2) Program administrators and program directors must demonstrate competence in leadership, cultural responsiveness, program planning and budgeting, fiscal management, supervision of program staff, personnel management, program staff performance assessment, use of data, reporting, program evaluation, quality assurance, and developing and coordinating community resources.

(3) Medical Directors must be licensed under ORS 677 or 685 and may perform health maintenance and restoration measures consistent with generally recognized and accepted principles of medicine, including but not limited to:

(a) Administering, dispensing, or writing prescriptions for medications;

(b) Recommending the use of specific and appropriate over-the-counter pharmaceuticals;

(d) Perform tasks required by OAR 309-019-0200.

(4) Clinical supervisors in all programs must demonstrate competence in leadership, cultural responsiveness, oversight and evaluation of services, staff development, assessment, person-centered treatment planning, case management and coordination, utilization of community resources; group, family, and individual therapy or counseling; documentation and rationale for services to promote intended outcomes; and implementation of all provider policies.

(5) Clinical supervisors in mental health programs must meet, at a minimum, Qualified Mental Health Professional (QMHP) requirements and have completed two years equivalent of post-graduate clinical experience in a mental health treatment setting. All clinical supervisors must:

(a) Be licensed in Oregon by a Division recognized Oregon board as identified in (1)(A-F) of this rule: or

(b) Be certified as a Qualified Mental Health Professional (QMHP) by an OHA approved entity, or per policy as described in (1)(d) of this rule, and be physically present in Oregon at the time of providing services or supports under the outpatient (OAR 309, Division 019) certificate.

(6) Clinical supervisors in substance use disorders treatment programs must be:

(a) Licensed in Oregon by a Division recognized Oregon board as identified in (1)(A-F) of this rule and be physically present in Oregon at the time of providing services, supports, and/or clinical supervision, under the outpatient (OAR 309, Division 019) certificate, or

(b) Be certified by a Division approved entity and be physically present in Oregon at the time of providing services, supports, and/or clinical supervision, under the outpatient (OAR 309, Division 019) certificate.

(c) For clinical supervisors holding a certification through an OHA approved entity in substance use disorder counseling, qualifications for the certification must have included at least:

(A) 4000 hours of supervised experience in substance use counseling;

(B) 300 contact hours of education and training in substance use related subjects; and

(C) Successful completion of a professional psychometric examination by a an OHA approved entity. A substantively equivalent portfolio evaluation by an OHA approved entity may be accepted in lieu of a professional psychometric examination as approved by the Division.

(d) Clinical supervisors not holding a certification in substance use disorder counseling must have a health or allied provider license. The license must have been issued in Oregon by a Division recognized Oregon board as identified in (1)(A-F) of this rule and the supervisor must possess documentation of at least 120 contact hours of academic or continuing professional education in the treatment of substance use disorders.

(e) Additionally, clinical supervisors in substance use disorders programs must have one of the following qualifications:

(A) Five years of paid full-time experience in the field of substance use disorders counseling; or

(B) A Bachelor's degree and four years of paid full-time experience in the social services field with a minimum of two years of direct substance use disorders counseling experience; or

(C) A Master's degree and three years of paid full-time experience in the social services field with a minimum of two years of direct substance use or co-occurring disorders counseling experience.

(7) Clinical supervisors in problem gambling treatment programs must meet the requirements for clinical supervisors in either mental health or substance use disorders treatment programs and have completed twelve hours of gambling specific training within six months of designation as a problem gambling services supervisor.

(8) Peer Delivered Services Supervisors must be a certified Peer Support Specialist (PSS) or Peer Wellness Specialist (PWS) with at least one year experience as a PSS or PWS in behavioral health treatment services and must:

(a) Be licensed in Oregon by a Division recognized Oregon board as identified in (1)(A-F) of this rule; or:

(b) Be an Associate registered by a Division recognized Oregon board as identified in (1)(D-E) of this rule and be physically present in Oregon at the time of providing services or supports.

(c) Be certified by an OHA approved entity and be physically present in Oregon at the time of providing services or supports under the outpatient (OAR 309, Division 019) certificate.

(9) Substance use disorders treatment staff must:

(a) Be licensed in Oregon by a Division recognized Oregon board as identified in (1)(A-F) of this rule;

(b) Be an Associate registered by a Division recognized Oregon board as identified in (1)(D-E) of this rule and be physically present in Oregon at the time of providing services or supports.

(c) Effective July 1, 2027, be under the outpatient (OAR 309, Division 019) certificate of approval (COA) if providing services to individuals under Medicaid;

(d) Be certified by OHA approved entity and be physically present in Oregon at the time of providing services or supports under the outpatient (OAR 309, Division 019) certificate.

(e) Demonstrate competence in the use of The ASAM Criteria, Third Edition, in treatment of substance-use disorders including individual assessment to include identification of health and safety risks to self or others; individual, group, family and other counseling techniques; program policies and procedures for service delivery and documentation and identification; development of a safety plan; implementation and coordination of services identified to facilitate intended outcomes; and

(f) Receive clinical supervision that documents progress towards certification and recertification; or

(g) At the date of first hire to provide substance use disorder treatment, if the program staff is not certified to provide substance use disorder treatment, they must register with the Division recognized credentialing body within 30 days of hire and obtain professional substance use disorder treatment certification within two years from the date of first hire unless they obtain a variance from the Division before that time has elapsed;

(h) For program staff holding certification in substance use disorder counseling, qualifications for certification must have included at least:

(A) 1000 hours of supervised experience in substance use counseling;

(B) 150 contact hours of education and training in substance use related subjects; and

(C) Successful completion of a professional psychometric examination by an OHA approved entity. A substantively equivalent portfolio evaluation by an OHA approved entity may be accepted in lieu of a professional psychometric examination using procedures approved by the Division.

(i) Program staff not holding certification/credential from an OHA approved entity in substance use disorder counseling must be licensed in Oregon by an Oregon board as identified in (1)(A-F) and at least 60 contact hours of academic or continuing professional education in the treatment of substance use disorders. (10) Problem Gambling treatment staff must:

(A) Be licensed in Oregon by a Division recognized Oregon board as identified in (1)(A-F) of this rule; or

(B) Be an Associate registered by a Division recognized Oregon board as identified in (1)(D-E) of this rule and be physically present in Oregon at the time of providing services or supports.

(C) Effective July 1, 2027, be under the outpatient (OAR 309, Division 019) certificate of approval (COA) if providing services to individuals under Medicaid; or

(D) Be certified by an OHA approved entity and be physically present in Oregon at the time of providing services or supports under the outpatient (OAR 309, Division 019) certificate.

(j) Demonstrate competence in the following areas: treatment of problem gambling and gambling disorder including individual assessment to include identification of health and safety risks to self or others; individual, group, family, and other counseling techniques; program policies and procedures for service delivery and documentation, implementation and coordination of services identified to facilitate intended outcomes and cultural responsiveness;

(k) Complete a minimum of two hours every two years or three hours every three years of training in suicide risk screening, suicide risk assessment, treatment and management;

(l) Receive clinical supervision that documents progress towards certification and recertification;

(m) At the date of first hire to provide problem gambling treatment, if the program staff is not certified to provide problem gambling treatment, they must register with the Division recognized credentialing body within 30 days of hire and obtain professional problem gambling treatment certification within two years from the date of first hire unless they obtain a variance from the Division before that time has elapsed;

(n) For program staff holding certification in gambling addiction counseling, qualifications for certification must include at least:

(A) 500 hours of supervised experience in gambling addiction counselor domains;

(B) 30 contact hours of education and training in problem gambling;

(C) 24 hours of face-to-face, telephone, or video conferencing communication, of certification consultation from a problem gambling approved certification consultant; and

(E) Program staff not holding a certification/credential in gambling addiction counseling by an OHA approved entity must have at least 30 contact hours of academic or continuing professional education in the treatment of gambling addiction. The license or registration must be issued in Oregon by a Division approved Oregon board as identified in (1)(A-F) of this rule.

(10) Rehabilitative Behavioral Health Service Providers, including medical treatment staff, must demonstrate cultural responsiveness and meet the requirements and qualifications in OAR 410-172-0660.

(11) Behavioral health clinicians must have one of the following corresponding license or designation:

(a) A licensed psychiatrist;

(b) A licensed psychologist;

(d) A licensed clinical social worker;

(e) A licensed professional counselor or licensed marriage and family therapist;

(f) A professional counselor associate

(g) A marriage and family therapist associate

(h) A certified clinical social work associate (CSWA);

(i) A Mental Health Intern as described in (14)(a-g) of this rule;

(j) A psychology resident who is working under a board-approved supervisory contract in a clinical mental health field;

(k) A Qualified Mental Health Practitioner (QMHP); or

(l) Any other clinician whose authorized scope of practice includes mental health diagnosis and treatment.

(12) A Board Registered Associate must:

(a) Be physically present in Oregon at the time of providing services or supports under the outpatient (OAR 309, Division 019) certificate;

(b) Be an Associate registered by a Division recognized Oregon board as identified in (1)(D-E) of this rule and be physically present in Oregon at the time of providing services or supports.

(c) Effective July 1, 2027, be under the outpatient (OAR 309, Division 019) certificate of approval (COA) if providing services to individuals under Medicaid;

(d) Provide services consistent with the QMHP scope of work;

(e) Demonstrate the following minimum competencies: cultural responsiveness, effective communication, care coordination, inter- and intra-agency collaboration, working alliances with individuals, suicide and other risk assessments and interventions, creating and monitoring safety plans, completion of bio-psycho-social assessments and additional assessments, updating assessments when clinical circumstances change, generating a differential DSM-5-TR diagnosis, prioritizing health, wellness, and recovery needs, writing measurable service objectives, creating, monitoring and revising service plans, delivery of mental health and recovery treatment services in individual, group and family formats within their scope, gathering and recording data that measures progress toward the service objectives and documenting services, supports, and other information supportive of the service plan;

(f) Render services and supports within their scope to individuals engaged in a Division approved behavioral health services program if billing or rendering services under Medicaid; and

(g) Document a minimum of two hours every two years or three hours every three years of suicide risk screening, suicide risk assessment, treatment and management training.

(13) Qualified Mental Health Associates (QMHA) program staff must:

(a) Be credentialed by an OHA approved entity and be physically present in Oregon at the time of providing services or supports under the outpatient (OAR 309, Division 019) certificate; or

(b) Be credentialed as a QMHA by the specific OHA-certified behavioral health program the individual is employed by, consistent with the program’s policy and be physically present in Oregon at the time of providing services or supports under the outpatient (OAR 309, Division 019) certificate;

(c) Demonstrate the following minimum competencies: cultural responsiveness, effective communication, care coordination, inter- and intra-agency collaboration, working alliances with individuals, assist in the gathering and compiling of information to be included in the assessment, screen for suicide and other risks, and implement timely interventions, teach skill development strategies, case management, and transition planning;

(d) Render services and supports within their scope to individuals engaged in a Division approved behavioral health services provider; and

(e) Must meet the following minimum qualifications:

(A) Bachelor's degree in psychology, social work, or behavioral science field and documentation of a minimum of two hours every two years or three hours every three years of suicide risk screening, Intervention, and management training;

(B) An equivalent degree as evidenced by providing transcripts indicating applicable coursework meeting the required competencies and approved by a Division certified behavioral health provider and documentation of a minimum of two hours every two years or three hours every three years of suicide risk screening, Intervention and management training; or

(C) A combination of at least three years of relevant work, education, training, or experience and documentation of a minimum of two hours every two years or three hours every three years of suicide risk screening, Intervention and management training.

(f) Receive clinical supervision that documents progress towards certification and recertification.

(14) Qualified Mental Health Professional QMHP program staff must:

(a) Be credentialed by an OHA approved entity and be physically present in Oregon at the time of providing services or supports under the outpatient (OAR 309, Division 019) certificate; or

(b) Be credentialed as a QMHP by the specific OHA-certified behavioral health program the individual is employed by, consistent with the program’s policy and be physically present in Oregon at the time of providing services or supports under the outpatient (OAR 309, Division 019) certificate;

(c) Demonstrate the following minimum competencies: cultural responsiveness, effective communication, care coordination, inter- and intra-agency collaboration, working alliances with individuals, suicide and other risk assessments and interventions, creating and monitoring safety plans, completion of bio-psycho-social assessments and additional assessments, updating assessments when clinical circumstances change, generating a differential DSM-5-TR diagnosis, prioritizing health, wellness and recovery needs, writing measurable service objectives, creating, monitoring and revising service plans, delivery of mental health and recovery treatment services in individual, group and family formats within their scope, gathering and recording data that measures progress toward the service objectives and documenting services, supports and other information supportive of the service plan.

(d) Render services and supports within their scope to individuals engaged in a Division approved behavioral health services program;

(e) Document a minimum of two hours every two years or three hours every three years of suicide risk screening, suicide risk assessment, treatment and management training;

(f) Meet the following minimum qualifications:

(B) Bachelor’s degree in occupational therapy and licensed by the State of Oregon;

(D) An equivalent degree as evidenced by providing transcripts indicating applicable coursework meeting the required competencies

(g) Receive clinical supervision that documents progress towards certification and recertification.

(15) Mental Health Intern (MHI) program staff must:

(a) Be currently enrolled in a graduate program for a master’s degree in psychology, social work, or related field of behavioral science;

(b) Have a collaborative educational agreement between the provider and the graduate program for the student;

(d) Demonstrate cultural responsiveness, effective communication and competence in care coordination, development of working alliances with individuals, inter- and intra-agency collaboration, and the rendering of services and supports within their scope and in accordance with the service plan, including transition planning; and

(e) Work within the scope of practice and competencies identified by collaborative educational agreement and the policies and procedures for the credentialing of clinical staff as established by the provider and the graduate program;

(f) Document of a minimum of two hours every two years or three hours every three years of suicide risk screening, suicide risk assessment, treatment and management training.

(16) Student Intern program staff must:

(a) Be physically present in Oregon while providing services or supports;

(b) Be currently enrolled in an educational program for an undergraduate degree in a behavioral health field; or

(d) Have a collaborative education agreement between the Division certified provider and the educational institute for the student;

(e) Work within the scope of practice and competencies identified by the collaborative educational agreement and the policies and procedures for the credentialing of clinical staff as established by the provider; and

(f) Receive, at a minimum, weekly individual supervision by a qualified clinical supervisor employed by the provider of services.

(17) Intern program staff must:

(a) Render services and supports under the direct supervision of a qualified supervisor employed by the provider of services, within the scope of practice and competencies identified by the collaborative educational agreement.

(b) Be physically present in Oregon at the time of providing services or supports.

(d) Receive, at a minimum, weekly individual supervision by a qualified clinical supervisor employed by the provider of services; and

(e) Demonstrate cultural responsiveness, effective communication and competence in care coordination, development of working alliances with individuals, inter-and intra-agency collaboration, and the rendering of services and supports within their scope and in accordance with the service plan, including transition planning.

(18) Peer Support Specialists, Peer Wellness Specialists, Youth Support Specialists, and Family Support Specialists working or volunteering in health treatment programs must be certified by OHA’s Equity and Inclusion Division and be physically present in Oregon at the time of providing services or supports under the outpatient (OAR 309, Division 019) certificate of approval.

(19) Behavioral Health program staff include, but are not limited to:

(a) Licensed Medical Professional (LMP);

(b) Licensed Practical Nurse (LNP);

(d) Advanced Practice Nurse including Clinical Nurse Specialist and Certified Nurse Practitioner licensed by the Oregon Board of Nursing;

(e) Psychologist licensed by the Oregon Board of Psychology;

(f) Professional Counselor (LPC) or Marriage and Family Therapist (LMFT) licensed by the Oregon Board of Licensed Professional Counselors and Therapists;

(g) Clinical Social Worker (CSW) licensed by the Oregon Board of Licensed Social Workers;

(h) Licensed Master Social Worker (LCSW) licensed by the Oregon Board of Licensed Social Workers as described in OAR 877-015-0105;

(i) Licensed Psychologist Associate granted independent status as described in OAR 858-010-0039;

(j) Licensed Occupational Therapist licensed by the Oregon Occupational Therapy Licensing Board;

(k) Board registered associates, including:

(A) Psychologist Associate Residents as described in OAR 858-010-0037;

(B) Licensed Psychologist Associate under continued supervision as described in OAR 858-010-0038;

(C) Professional Counselor Associate or Marriage and Family Therapist Associate registered with the Oregon Board of Licensed Professional Counselors and Therapists as described in OAR 833-050-0011;

(D) Certificate of Clinical Social Work Associate issued by the Oregon Board of Licensed Social Workers as described in OAR 877-020-0009;

(E) Registered Bachelor of Social Work issued by the Oregon Board of Licensed Social Workers as described in OAR 877-015-0105.

(l) Qualified Mental Health Professional (QMHP) as defined in OAR 309-019-0105;

(m) Qualified Mental Health Associate (QMHA) as defined in OAR 309-019-0105;

(n) Mental health intern as defined in OAR 309-019-0105;

(o) Student intern as defined in OAR 309-019-0105;

(p) Problem Gambling treatment staff registered with an OHA approved entity include:

(A) Certified Gambling Addiction Counselor-Registered (CGAC-R);

(B) Certified Gambling Addiction Counselor-I (CGAC-I); Certified Gambling Addiction Counselor-II (CAGC-II).

(q) SUD Treatment Staff credentialed/registered by an OHA approved entity include:

(A) Certified Alcohol and Drug Counselor-Registered (CADC-R);

(B) Certified Alcohol and Drug Counselor-I (CADC-I);

(D) Certified Alcohol and Drug Counselor-III (CADC-III).

(r) Behavioral Health treatment Staff credentialed by the OHA Equity and Inclusion Division include:

(A) Peer Wellness Specialist

(B)Youth Support Specialist

History

Statutory/Other Authority: ORS 161.390, 413.042, 430.256 & 430.640
Statutes/Other Implemented: ORS 428.205-428.270, 430.010, 430.254-430.640, 430.850-430.955 & 743A.168
BHS 18-2026, amend filed 06/30/2026, effective 07/01/2026
BHS 24-2024, amend filed 10/25/2024, effective 10/27/2024
BHS 12-2023, amend filed 05/16/2023, effective 05/16/2023
BHS 11-2023, amend filed 04/07/2023, effective 04/07/2023
BHS 27-2022, amend filed 12/20/2022, effective 12/20/2022
BHS 1-2022, amend filed 01/05/2022, effective 01/05/2022
BHS 11-2021, amend filed 06/16/2021, effective 06/16/2021
BHS 15-2020, temporary amend filed 12/17/2020, effective 12/18/2020 through 06/15/2021
BHS 14-2020, amend filed 11/12/2020, effective 11/12/2020
BHS 8-2020, temporary amend filed 04/30/2020, effective 04/30/2020 through 10/26/2020
MHS 4-2018, amend filed 02/27/2018, effective 03/01/2018
MHS 10-2017(Temp), f. 9-15-17, cert. ef. 9-15-17 thru 3-13-18
MHS 6-2017, f. & cert. ef. 6-23-17
MHS 26-2016(Temp), f. 12-27-16, cert. ef. 12-28-16 thru 6-23-17
MHS 18-2016, f. 11-28-16, cert. ef. 11-30-16
MHS 11-2016(Temp), f. 6-29-16, cert. ef. 7-1-16 thru 12-27-16
MHS 3-2015, f. & cert. ef. 5-28-15
MHS 1-2015(Temp), f. & cert. ef. 3-25-15 thru 9-20-15
MHS 4-2014, f. & cert. ef. 2-3-14
MHS 6-2013(Temp), f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14

Or. Admin. R. 309-019-0130 Personnel Documentation, Training, and Supervision

(1) All program staff who render services and supports or bill for services and supports and all personnel who have access to protected health information that are associated with the Certificate must be identified on the provider’s organizational chart through a hierarchical chart or through a spreadsheet. If utilizing a spreadsheet, must also indicate reporting structure that demonstrates who is supervising the position. Information must include the individuals:

(a) Full legal name;

(b) Licensure and/or credential (based on their certification);

(d) Full-time or part-time status;

(e) Remote, Office, or Hybrid

(2) Providers must maintain personnel records for each program staff that contains all of the following documentation:

(a) The results of a criminal records check applicable to the current position or title, and:

(A) For personnel who render mental health services or have access to mental health protected health information such as service records or billing information, the program must use The Oregon Criminal Records Check and those processes and procedures required by OAR 943-007-0001 through 0501; and

(B) For personnel who render only substance use disorder treatment services or have access to only substance use disorder protected health information such as service records or billing information, the program must use national and state-wide criminal records check processes.

(b) A current job description that includes applicable competencies;

(c) Copies of relevant licensure or certification, registration for licensure or certification, diploma, or certified transcripts from an accredited college, indicating that the program staff meets applicable qualifications;

(d) Documentation of Employment Eligibility Verification, form I-9;

(e) Documentation of a minimum of two hours every two years or three hours every three years of training in suicide risk screening suicide risk assessment, treatment and management;

(f) Periodic performance appraisals;

(g) Program orientation documentation;

(h) Disciplinary documentation;

(i) Documentation of trainings required by this or other applicable rules; and

(j) Documentation of clinical supervision.

(3) Program Orientation: Providers must ensure that program staff receive training applicable to the specific population for whom services are planned, delivered, or supervised. The Provider must document that the following orientation was completed for each program staff providing or supervising services or supports within 30 days of the hire date, unless otherwise specified. At a minimum, program orientation and training for all program staff must include but not be limited to:

(a) A review of crisis prevention and response procedures;

(b) A review of emergency evacuation procedures;

(c) A review of program policies and procedures, including the procedures for each certified ASAM Level of Care for substance use disorder treatment program staff;

(d) A review of rights for individuals receiving services and supports;

(e) A review of mandatory abuse reporting procedures;

(f) A review of confidentiality policies and procedures;

(g) A review of Fraud, Waste and Abuse policies and procedures;

(h) A review of care coordination policies and procedures;

(i) A review of and agreement to abide by the Code of Conduct;

(j) Substance use disorders treatment staff and substance use disorders clinical supervisors must complete a training on The ASAM Criteria within the first three months of employment rendering substance use disorder services or supports or have it documented as completed within the most recent two years; and

(k) For Enhanced Care Services, positive behavior support training.

(4) Clinical Supervision is required for all program staff. providing direct services or supports and must receive documented clinical supervision by a qualified clinical supervisor related to the development, implementation, and outcome of services. Staff licensed by an Oregon Board must be clinically supervised by another individual licensed by an Oregon Board. Unlicensed staff must be clinically supervised by an individual who is licensed by an Oregon Board and who is is physically present in Oregon at the time of clinical supervision, or a QMHP that qualifies as a clinical supervisor and who is physically present in Oregon at the time the services and supports are provided, and while providing clinical supervision. Part time staff must receive supervision no less than, half the total supervision hours required for full time staff. Individual face-to face contact may include real time, two-way audio or audio-visual conferencing, and:

(a) Documentation must include:

(A) The date;

(B) Amount of time per session; and

(b) Clinical Supervision must be provided to assist staff to:

(A) Increase their skills within their scope of practice;

(B) Improve quality of services to individuals; and

(A) Non-licensed program staff, including Board Registered Associates, must receive at least two hours per month of clinical supervision. The two hours must include at minimum one hour of individual face-to-face supervision, and may include one hour of group supervision;

(B) Mental Health Interns and Student Interns must receive one-hour of individual clinical supervision per week; and

(C) When available, a qualified Peer Delivered Services Supervisor must provide one of the two hours of required monthly supervision to program staff providing direct Peer Delivered Services. Remaining hours of supervision must be provided by a qualified clinical supervisor.

(d) Mental Health Interns and Student Interns must render services and supports under the active supervision of a qualified supervisor, as defined in these rules; and

(e) Individualized non-clinical supervision must be utilized as needed and documented.

History

Statutory/Other Authority: ORS 161.390, 413.042, 430.256 & 430.640
Statutes/Other Implemented: ORS 109.675, 428.205 - 428.270, 430.010, 430.205 - 430.210, 430.254 - 430.640, 430.850 - 430.955 & 743A.168
BHS 18-2026, amend filed 06/30/2026, effective 07/01/2026
BHS 12-2023, amend filed 05/16/2023, effective 05/16/2023
BHS 11-2023, amend filed 04/07/2023, effective 04/07/2023
BHS 27-2022, amend filed 12/20/2022, effective 12/20/2022
BHS 11-2021, amend filed 06/16/2021, effective 06/16/2021
MHS 4-2018, amend filed 02/27/2018, effective 03/01/2018
MHS 10-2017(Temp), f. 9-15-17, cert. ef. 9-15-17 thru 3-13-18
MHS 6-2017, f. & cert. ef. 6-23-17
MHS 26-2016(Temp), f. 12-27-16, cert. ef. 12-28-16 thru 6-23-17
MHS 18-2016, f. 11-28-16, cert. ef. 11-30-16
MHS 11-2016(Temp), f. 6-29-16, cert. ef. 7-1-16 thru 12-27-16
MHS 4-2014, f. & cert. ef. 2-3-14
MHS 6-2013(Temp), f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14

Or. Admin. R. 309-019-0135 Entry and Assessment

(1) The provider must utilize and document an entry procedure that at a minimum must ensure the following:

(a) Individuals must be considered for entry without regard to race, ethnicity, gender, gender identity, gender expression, sexual orientation, religion, creed, national origin, age (except when program eligibility is restricted to children, adults, or older adults), familial status, marital status, source of income, and disability;

(b) The provider will not deny entry to individuals based on their decision to continue currently prescribed or dispensed medications for opioid use disorder (MOUD) while receiving outpatient behavioral health services and supports;

(d) The provider must develop and maintain service records and other documentation that demonstrates the amount, duration and scope of each specific services and supports provided for each individual.

(e) The provider must submit the identified status and service data, including Non-Medicaid Service Data where required, in the mandated state data system according to the timelines required by the Division for each individual whose services are paid for in-full or in-part by public funds and for individuals enrolled in DUII services as soon after entry as possible but no later than 90 day from date of entry;

(f) The provider must obtain an authorization for the release of information for the release of any confidential information concerning the individual being considered for or receiving services;

(g) Except as permitted by law in emergencies, the provider must obtain written, voluntary informed consent for services from the individual, or guardian if applicable prior to – or at the start of services.

(h) Prior to or at the start of treatment services, the program must offer to the individual and guardian, if applicable, written description of services provided. The written description must be in the individual’s preferred language and must include disclosures regarding risks and benefits to services provided. The written program information shall include:

(A) Disclosure of availability of assistance by program in completing a Declaration for Mental Health Treatment, including information on how to request assistance.

(B) A description of individual rights consistent with these rules, and;

(D) If written program description information, disclosures, notice of privacy practices, consents and individual rights documents are not provided prior or at the start of treatment services, the reason, and any further attempts to provide written information and consent, must be documented in the service record.

(2) Entry requirements for providers that receive the Substance Use Prevention, Treatment and Recovery (SUPTR) Block Grant:

(a) Document that individuals are prioritized for entry in the following order:

(A) Individuals who are pregnant and using substances intravenously;

(B) Individuals who are pregnant;

(D) Individuals or families with dependent children.

(b) Individuals using substances intravenously must receive interim resource recommendations and information prior to entry to reduce the adverse health effects of substance use, promote the health of the individual, and reduce the risk of transmission of disease. At a minimum, interim resource recommendations and informational services must include:

(A) An opportunity for the individual to engage in counseling through care coordination, peer services or other interactive supports.

(C) Educational information and resources about steps that can decrease the likelihood of Hepatitis, HIV, STD, and TB transmission;

(D) For pregnant individuals, counseling and educational information addressing the likelihood of blood borne pathogen transmission as well as the effects of alcohol, tobacco, and other drug use on the fetus and referral for prenatal care; and

(E) Peer Delivered Services that address parenting and youth in transition support, as indicated

(3) At the time of entry, an assessment must be initiated by qualified program staff.

(a) An assessment may be completed over more than one session and must be completed within 90 days.

(b) Assessments must record diagnostic information derived from any combination of clinical observation, self-report interview, or collateral information (such as assessments from other programs or previous treatment episodes).

(c) Providers may reduce the number and length of assessments through use of collateral information to inform the current assessment, such as previous assessments on file.

(d) Any changes to the ASAM Level of Care placement decision must be justified within an update to the multidimensional assessment on file, including the ASAM Dimensional Admission Criteria;

(e) Providers must update assessments within the scope of their practice when there are changes in clinical circumstances;

(f) For mental health treatment services, documentation demonstrating an ongoing medically necessary reason for services and progression in treatment must be completed at least annually by qualified program staff.

(4) When an assessment is completed in more than one encounter, documentation from the first encounter must include, at a minimum :

(a) A medically necessary reason for services, including supporting information. Medical necessity includes a DSM-5-TR diagnosis that is evidenced by diagnostic criteria and the symptoms that support each identified criteria.

(b) If the provider cannot document a DSM-5-TR diagnosis as part of a medically necessary reason for services at entry, the provider must -- at minimum -- document a screening for suicide risk, immediate needs, safety risk and current impacts of trauma on daily functioning..

(d) Suicide and other current safety risk(s);

(e) Immediate need(s);

(f) Identification of current physical and psychological trauma; and

(g) Intoxication and withdrawal symptoms, when applicable;

(h) Referrals to meet risk and immediate needs, including withdrawal management services, when applicable.

(5) Assessments and assessment updates are considered complete when the following information is contained in assessment documentation:

(a) Clinically relevant current and historical biological, psychological, social information;

(b) Documentation of the presence of a DSM-5-TR that is the medically necessary reason for services, including identification of each diagnostic criteria established per diagnosis, and the symptoms supporting each criteria;

(d) The identification of psychological and physical trauma and risk to the individual or to others.

(e) Current Substance use, in mental health assessments when an ASAM Dimensional assessment is not needed;

(f) Current Problem Gambling Behavior;

(g) Current Mental Health conditions, including currently prescribed psychiatric medications, as clinically relevant;

(h) Current Medical conditions, including currently prescribed treatments and medications, as clinically relevant;

(i) When indicated, documentation must contain recommendations for each identified need, indicating further assessment, planning, and intervention from an appropriate professional, either with the same provider or with a collaborative community provider.

(j) In addition, for individuals entering substance use disorder services, each complete assessment and update thereof must be a multidimensional assessment that is consistent with The ASAM Criteria, Third Edition, and include, at a minimum, the following components, each consistent with The ASAM Criteria, Third Edition :

(A) ASAM Level of Care determination per ASAM Dimension;

(B) An overall ASAM Level of Care determination, with justification for any applicable discrepancies between level of care assessed and level of care placement;

(D) Historical and present substance use-related risk(s);

(E) A severity of risk for each dimension; and

(F) An overall determination of the severity of risk the individual currently is experiencing.

History

Statutory/Other Authority: ORS 161.390, 413.042, 430.256 & 430.640
Statutes/Other Implemented: ORS 161.390 - 161.400, 428.205 - 428.270, 430.010, 430.205- 430.210, 430.254 - 430.640, 430.850 - 430.955 & 743A.168
BHS 24-2024, amend filed 10/25/2024, effective 10/27/2024
BHS 11-2024, temporary amend filed 05/21/2024, effective 05/21/2024 through 10/27/2024
BHS 9-2024, temporary amend filed 04/30/2024, effective 05/01/2024 through 10/27/2024
BHS 11-2023, amend filed 04/07/2023, effective 04/07/2023
BHS 11-2021, amend filed 06/16/2021, effective 06/16/2021
MHS 4-2018, amend filed 02/27/2018, effective 03/01/2018
MHS 10-2017(Temp), f. 9-15-17, cert. ef. 9-15-17 thru 3-13-18
MHS 6-2017, f. & cert. ef. 6-23-17
MHS 26-2016(Temp), f. 12-27-16, cert. ef. 12-28-16 thru 6-23-17
MHS 18-2016, f. 11-28-16, cert. ef. 11-30-16
MHS 4-2014, f. & cert. ef. 2-3-14
MHS 6-2013(Temp), f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14

Or. Admin. R. 309-019-0140 Service Plan and Service Notes

(1) The service plan must be a written, individualized plan designed to improve the individual’s condition to the point where the individual’s continued participation in the program or level of care is no longer necessary.

(a) Service plans shall be started following the completion of an assessment, or portion thereof, and prior to treatment services being rendered. Provider must document reason for any delay in the service record.

(b) Routine services may be rendered prior to a completion of a service plan or documentation of a medically necessary reason for services. These services can be provided without a service plan or medical necessity, or at any time during a treatment episode:

(i) Care Coordination

(ii) Case Management

(iii) Peer Services

(d) Address areas of concern identified in the current assessment that the individual or guardian – if relevant and appropriate -- agrees to address;

(e) Include a safety plan when the assessment indicates risk to the health and safety of the individual or to others and be updated as circumstances change. The safety plan may be a separate document from the service plan;

(f) Include the participation, and reflect agreement, of the individual and family members, as applicable;

(g) Be completed and signed by qualified program staff as follows:

(A) A QMHP or appropriately licensed provider in mental health programs;

(B) Supervisory or treatment staff in substance use disorders treatment programs; and

(h) Approval of services and supports shall be demonstrated through operationalization of provider policy described above, in OAR 309-019-0110 (1)(z).

(2) At minimum, each service plan must include:

(a) Treatment goals that are individualized;

(b) Treatment goals that meet the assessed needs of the individual.

(3) Service plans must reflect the most updated assessments on file, and must include:

(a) Goals that are measurable for the purpose of evaluating individual progress – including baseline measurement as well as include;

(b) The specific services and supports that will be used to meet the treatment goals;

(d) A schedule for re-evaluating the service plan; and

(e) the type of personnel that will be furnishing each of the services.

(4) Providers must document the following in a service note for each service and support :

(a) The specific service or support rendered;

(b) The relationship of the services to the treatment regimen described in the service plan;

(d) The personnel rendering the services, including their name, credentials, and signature;

(e) The setting in which the service or support was rendered; and

(f) Periodic updates describing the individual’s progress, or lack thereof

(5) Decisions to transfer individuals must be documented including:

(a) The date of the transfer;

(b) The reason for the transfer;

(c) For substance use disorder and co-occurring services, ASAM level of care recommendation and overall determination of the severity of risk the individual is experiencing at the time of transfer;

(d) Referrals to follow up services and other behavioral health providers; and

(e) Outreach efforts made as applicable and as defined in these rules.

History

Statutory/Other Authority: ORS 161.390, 413.042, 430.256 & 430.640
Statutes/Other Implemented: ORS 161.390 - 161.400, 428.205 - 428.270, 430.010, 430.205- 430.210, 430.254 - 430.640, 430.850 - 430.955 & 743A.168
BHS 24-2024, amend filed 10/25/2024, effective 10/27/2024
BHS 13-2024, temporary amend filed 06/11/2024, effective 06/11/2024 through 10/27/2024
BHS 11-2024, temporary amend filed 05/21/2024, effective 05/21/2024 through 10/27/2024
BHS 9-2024, temporary amend filed 04/30/2024, effective 05/01/2024 through 10/27/2024
BHS 11-2023, amend filed 04/07/2023, effective 04/07/2023
BHS 5-2022, amend filed 03/04/2022, effective 03/18/2022
BHS 19-2021, temporary amend filed 09/14/2021, effective 09/14/2021 through 03/12/2022
MHS 4-2018, amend filed 02/27/2018, effective 03/01/2018
MHS 10-2017(Temp), f. 9-15-17, cert. ef. 9-15-17 thru 3-13-18
MHS 6-2017, f. & cert. ef. 6-23-17
MHS 26-2016(Temp), f. 12-27-16, cert. ef. 12-28-16 thru 6-23-17
MHS 18-2016, f. 11-28-16, cert. ef. 11-30-16
MHS 11-2016(Temp), f. 6-29-16, cert. ef. 7-1-16 thru 12-27-16
MHS 4-2014, f. & cert. ef. 2-3-14
MHS 6-2013(Temp), f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14

Or. Admin. R. 309-019-0145 Co-Occurring Mental Health and Substance Use Disorders (COD)

This rule is effective January 1, 2023. Services shall be integrated and address treatment and recovery for co-occurring Mental Health, Substance Use and/or Gambling Disorders. In addition to requirements in OAR Chapter 309, these rules specify standards and requirements for providers delivering co-occurring mental health, substance use disorder and problem gambling services and supports.

(1) Access to services shall:

(a) Be trauma informed, culturally relevant, linguistically, and developmentally appropriate, and utilize a harm reduction model where needed; and

(b) Be adapted for individuals with intellectual and developmental disabilities.

(2) All assessments shall:

(a) Be consistent with the most recent version of the ASAM (American Society of Addiction Medicine) criteria and document a level of care determination consistent with ASAM;

(b) Provide sufficient information to justify the presence of the Mental Health and Addiction (Substance Use Disorders and/or Gambling Disorder) diagnoses that are the medically appropriate reason for services, using the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM); and

(3) Service Plans shall:

(a) Accommodate the individual’s holistic needs and preferences;

(b) Utilize a harm reduction approach where indicated;

(d) Be in alignment with participant’s current stage of change in regard to both addiction disorder recovery and mental health disorder recovery.

(4) The following services shall be made available:

(a) Case Management & Service navigation support;

(b) Harm reduction services;

(d) Family therapy services; and

(e) Psychiatric medication and evaluation services, as indicated.

(5) Integrated Co-Occurring Disorders Program Staff Qualifications shall align with the provisions described in 309-019-0125 and ensure that:

(b) Registrants and student interns are permitted to provide services during the duration of their candidacy or internship as described in OAR 309-019-0105;

(d) The program must retain a credentialed problem gambling treatment provider OR designate a Co-Occurring Problem Gambling Specialist. A Co-Occurring Problem Gambling Specialist must have:

(B) Documentation of required trainings shall be contained in the personnel file.

(e) Peer providers shall be certified as Peer Wellness Specialists (PWS) or Peer Support Specialist (PSS);

(f) Supervisors must:

(A) Be credentialed in Mental Health and/or Substance Use Disorder treatment provision;

(B) Limit their supervision to providers within the scope of their professional credentials.

(g) The program must employ or contract with a Licensed Medical Provider (LMP) that shall acquire Division approved Integrated Co-Occurring Disorders training within twelve months of hire or appointment to these services. Approved training will be published by the Division on the OHA Integrated Co-Occurring Disorders website yearly on or before January 1st;

(h) All Supervisors, Treatment Service Providers and Peer Services Providers delivering services in Integrated Co-Occurring Disorders Programs shall complete Integrated Co-Occurring Disorders trainings required and provided by OHA and shall ensure certificates of completion are documented in staff personnel files, according to the following conditions:

(A) Within twelve months of beginning to render Co-Occurring Disorders services or supports; and

(B) On a continuing two-year basis for all Supervisors and Treatment Providers and a continuing three year basis for Peer Staff rendering Co-Occurring Disorders services or supports for more than one year.

(i) Continuing Education training required by the Oregon Health Authority (OHA) shall consist of at least two hours but no more than six hours every two years following the initial training year for supervisors and treatment providers, and every three years following the initial training year for peer services providers.

(A) Integrated Co-Occurring Disorders trainings required by OHA will be published by the Division yearly on or before January 1st on the OHA Integrated Co-Occurring Disorders website;

(B) OHA training will include – but will not be limited to – content relevant to providing integrated treatment, and specialty training on providing treatment services for community members who are marginalized, underserved and oppressed by structural and systemic racism and injustices, Severe Mental Illness and Intellectual and Developmental Disabilities.

History

Statutory/Other Authority: ORS 413.042 & 430.640
Statutes/Other Implemented: ORS 430.010, 430.205 - 430.210, 430.254 - 430.640 & 430.850 - 430.955
BHS 1-2023, amend filed 01/11/2023, effective 01/11/2023
MHS 4-2018, amend filed 02/27/2018, effective 03/01/2018
MHS 10-2017(Temp), f. 9-15-17, cert. ef. 9-15-17 thru 3-13-18
MHS 6-2017, f. & cert. ef. 6-23-17
MHS 26-2016(Temp), f. 12-27-16, cert. ef. 12-28-16 thru 6-23-17
MHS 18-2016, f. 11-28-16, cert. ef. 11-30-16
MHS 11-2016(Temp), f. 6-29-16, cert. ef. 7-1-16 thru 12-27-16
MHS 4-2014, f. & cert. ef. 2-3-14
MHS 6-2013(Temp), f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14

Or. Admin. R. 309-019-0150 Community Mental Health Programs (CMHP)

(1) Crisis services must be provided directly or through linkage to a local crisis services provider and must include the following:

(a) Twenty-four hours, seven days per week telephone or face-to-face screening within one hour of notification of the crisis event to determine an individual's need for immediate community mental health services; and

(b) Twenty-four hours, seven days per week capability to conduct, by or under the supervision of a QMHP, an assessment, resulting in a plan that includes the crisis services necessary to assist the individual and family to stabilize and transition to the appropriate level of care.

(2) Case management services must be provided to assist individuals with the following:

(a) Gaining access to and maintaining resources such as Social Security benefits, general assistance, food stamps, vocational rehabilitation, and housing;

(b) Arrangement of transportation to help them apply for benefits;

(c) Referral and coordination to help individuals gain access to services and supports identified in the service plan to include but may not be limited to individuals at risk of suicide;

(d) Care coordination and warm handoff processes; and

(e) Assist with a follow-up visit within seven days of discharge from an acute care psychiatric hospital.

(3) When significant health and safety concerns are identified, program staff must ensure that necessary services or actions occur to address the identified health and safety needs for the individual, including services to individuals at imminent risk of suicide as determined by the assessment.

(4) Peer Delivered Services must be made available.

History

Statutory/Other Authority: ORS 413.042
Statutes/Other Implemented: ORS 430.630, 109.675, 161.390 - 161.400, 413.520 - 413.522, 430.010, 430.205 - 430.210, 430.254 - 430.640, 430.850 - 430.955, 461.549 & 743A.168
BHS 27-2025, amend filed 12/23/2025, effective 01/01/2026
BHS 20-2025, temporary amend filed 09/15/2025, effective 09/15/2025 through 03/13/2026
BHS 33-2024, temporary amend filed 12/27/2024, effective 01/01/2025 through 06/29/2025
MHS 4-2018, amend filed 02/27/2018, effective 03/01/2018
MHS 10-2017(Temp), f. 9-15-17, cert. ef. 9-15-17 thru 3-13-18
MHS 6-2017, f. & cert. ef. 6-23-17
MHS 1-2017(Temp), f. 1-17-17, cert. ef. 1-18-17 thru 7-16-17
MHS 26-2016(Temp), f. 12-27-16, cert. ef. 12-28-16 thru 6-23-17
MHS 4-2014, f. & cert. ef. 2-3-14
MHS 6-2013(Temp), f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14

Or. Admin. R. 309-019-0155 Enhanced Care Services (ECS) and Enhanced Care Outreach Services (ECOS)

(1) To be eligible for Enhanced care Services (ECS) an individual shall:

(a) Be Medicaid eligible;

(b) Meet the diagnostic criteria of severe mental illness with complex behaviors and be approved by the enhanced care services team;

(d) Have a history of unsuccessful placements due to complex behaviors; and

(e) be at risk of psychiatric hospitalization; and

(f) have a history of or be currently exhibiting two or more of the following: self-endangering behavior, aggressive behavior, intrusive behavior, refractory psychiatric symptoms, complex medication needs, sexually inappropriate behavior, and elopement behavior.

(2) ECS providers shall:

(a) provide staffing to support the behavioral health needs of the clients within Enhanced Care Unit as outlined in the MOU, with no fewer than four hours a day for programs with 8 or less beds and no fewer than six hours per day for programs with 9-16 beds. ECS mental health staffing shall be available seven days per week provided by or arranged for by the contracted mental health provider;

(b) ECS programs who are not able to meet staff hour requirements must submit in writing to the State Enhanced Care Providers a plan of how services are going to delivered and a plan of how they are going to correct the issue.

(c) Coordinate weekly interdisciplinary team meetings (IDT) to develop the service plan, and to coordinate care planning with the Department of Human Services (Department) licensed provider staff, APD case manager, QMHP, prescriber, individual consumer, or their representative and related professionals such as the Department licensed facility or program direct care staff, the Department licensed facility RN, and facility administrator.

(d) Coordinate quarterly behavioral health trainings as agreed upon in the MOU for Department-licensed providers and related program staff providing services to ECS; and

(e) Ensure the availability of consultation and crisis services staffed by a QMHP/QMHA or the local CMHP, with an accessible written plan on how to access these services available to the ECS provider and the Department licensed facility direct care staff 24-hours per day

(f) provide reports of critical incidences to the Enhanced Care State Coordinators within 72 business hours. A critical incident can be defined as an actual or alleged event or behavior that can or does result in a negative outcome for a consumer including- Death from unknown causes; Emergency Medical Care; Missing Person; Unplanned Hospitalization; Neglect/Abuse/Exploitation/Mistreatment; Damage or theft of property; medication management issues; criminal justice involvement. ; and

(g) submit monthly census reports to the Enhanced Care State Coordinators no later than the 10th day of every calendar month; and

(h) submit referral outcome forms within 7 calendar days of date sent referral to the Enhanced Care State Coordinators; and

(i) submit Database I forms within 15 calendar days of an individual’s admission to the program; and

(j) submit Database II forms within 15 calendar days of an individual’s discharge from the program; and

(k) Provide collaboration and support to ODHS Department-licensed providers on their development of behavior support plans.

(3) ECS program staffing requirements include:

(a) Each ECS program may have services provided by a QMHPs, QMHA’s, CADCs, Peer Delivered Services, and LMP’s. ECS programs staff are responsible for coordinating program entries, transitions, and required IDT’s; assuring the completion of individual assessments and mental health service; ECS programs are responsible for providing supervision of QMHP’s and QMHA’s; and coordinating services and trainings with facility staff;

(b) Each CMHP ECS program shall have a QMHA or QMHP available during CMHP ECS provider program hours as outlined in the MOU;

(c) Each ECS program shall have LMP consultation available. For ECS programs serving more than ten individuals, the LMP shall participate.

(d) ECS programs who are not able to meet staffing requirements must submit in writing to the State Enhanced Care Providers a plan of how services are going to delivered and a plan of how they are going to correct the problem.

(4) In ECS programs, the CMHP and the Department licensed provider shall develop a written collaborative agreement that addresses at a minimum: risk management, census management, staff levels, training, treatment and activity programs, entry and transition procedures, a process for reporting and evaluating critical incidents, record keeping, policy and procedure manuals, dispute resolution, and service coordination. This should be reviewed on an annual basis.

History

Statutory/Other Authority: ORS 161.390, 413.042, 430.640 & 443.450
Statutes/Other Implemented: ORS 161.390 - 161.400, 428.205 - 428.270, 430.010, 430.205 - 430.210, 430.254 - 430.640, 430.850 - 430.955 & 743A.168
BHS 23-2024, amend filed 10/14/2024, effective 10/15/2024
MHS 4-2018, amend filed 02/27/2018, effective 03/01/2018
MHS 10-2017(Temp), f. 9-15-17, cert. ef. 9-15-17 thru 3-13-18
MHS 6-2017, f. & cert. ef. 6-23-17
MHS 26-2016(Temp), f. 12-27-16, cert. ef. 12-28-16 thru 6-23-17
MHS 4-2014, f. & cert. ef. 2-3-14
MHS 6-2013(Temp), f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14

Or. Admin. R. 309-019-0157 Enhanced Care Outreach Services (ECOS)

(1) To be eligible for Enhanced Care Outreach Services (ECOS), an individual must:

(a) Be Medicaid eligible;

(b) Meet the diagnostic criteria of severe mental illness with complex behaviors or be approved by the enhanced care services team;

(c) Require intensive community mental health services to accomplish or maintain community integration in the least restrictive environment;

(d) Be at risk of losing or have a history of failed placement.

(e) Have a history of or currently exhibiting two or more of the following: self-endangering behavior, aggressive behavior, intrusive behavior, refractory psychiatric symptoms, complex medication needs, sexually inappropriate behavior, and elopement behavior;

(f) Be placed in a community-based residential setting or attempting to gain access to a community-based residential setting that is approved under state or local authorities;

(g) Or be at risk of being denied placement due to a history of these factors.

(2) ECOS providers must:

(a) Provide person-centered, individualized services outlined in the service plan.

(b) Provide Care Coordination based on individual needs;

(c) Offer resources or trainings specific to the behavioral health needs to in-home or Department licensed facility staff.

(d) Ensure the availability of consultation and crisis services staffed by a QMHP/A or the local CMHP available to ECOS provider and the Department licensed facility direct care staff 24-hours per day.

(e) Provide services that are in the residence or community based to the fullest extent possible. These services shall be available based off the consumers preference and choice;

(f) Provide reports of critical incidences to the Enhanced Care State Coordinators within 72 business hours. A critical incident can be defined as an actual or alleged event or behavior that can or does result in a negative outcome for a consumer including- Death from unknown causes; Emergency Medical Care; Missing Person; Unplanned Hospitalization; Neglect/Abuse/Exploitation/Mistreatment; Damage or theft of property; medication management issues; criminal justice involvement;

(g) Submit monthly census reports to Enhanced Care State Coordinators no later than the 10th day of every calendar month.

(3) Staffing requirements include:

(a) Each ECOS program may have services provided by QMHPs, QMHAs, CADCs, Peer delivered services, and LMPs as indicated in the individual service plan;

(b) Each ECOS program must have LMP consultation available;

(c) ECOS providers must ensure that CMHP program staff, contractors, volunteers, and interns providing ECOS services are trained and familiar with strategies for delivery of trauma informed and culturally responsive services.

History

Statutory/Other Authority: ORS 161.390, 413.042, 430.640 & 443.450
Statutes/Other Implemented: ORS 161.390 - 161.400, 428.205 - 428.270, 430.010 - 430.210, 430.254 -430.640, 430.850 - 430.955 & 743A.168
BHS 23-2024, adopt filed 10/14/2024, effective 10/15/2024

Or. Admin. R. 309-019-0160 Psychiatric Security Review Board and Juvenile Psychiatric Security Review Board

(1) Services and supports must include all appropriate services, including peer delivered services, determined necessary to assist the Individual in maintaining community placement that are consistent with Conditional Release Orders and the Agreement of Conditional Release.

(2) Providers of PSRB services acting through the designated qualified Individual must submit reports to the PSRB as follows:

(a) For Individuals under the jurisdiction of the PSRB, providers must take the following action upon receipt of an Order for Evaluation of Conditional Release from the PSRB:

(A) Must appoint a Qualified Mental Health Professional (QMHP) to schedule and complete the evaluation interview;

(B) Following completion of the evaluation interview, the QMHP must submit the Evaluation Report and, if the Individual is accepted to the placement, the Summary of Conditional Release Plan (SCRP), as follows:

(i) The Evaluation Report and the SCRP, when applicable, must be submitted to OHA, the Oregon State Hospital (OSH), or other treatment provider, and the PSRB;

(ii) When submitting the Evaluation Report and the SCRP when applicable to OHA, the provider must use the cover sheet provided by OHA and;

(iii) The Evaluation Report and the SCRP, when applicable, must be complete and submitted within 30 days of the receipt of the PSRB Order for Evaluation of Conditional Release.

(C) If supervision by the provider is recommended, notify the PSRB of the name of the Individual designated to serve as the Individual’s qualified person who will be primarily responsible for delivering or arranging for the delivery of services and the submission of reports under these rules.

(b) Monthly reports consistent with PSRB reporting requirements as specified in the Conditional Release Order that summarize the Individual’s adherence to Conditional Release requirements and general progress; and

(c) Interim reports including immediate reports by phone, if necessary, to ensure the public or Individual’s safety including:

(A) At the time of any significant change in the Individual’s health, legal, employment, or other status that may affect compliance with Conditional Release orders;

(B) Upon noting major symptoms requiring psychiatric stabilization or hospitalization;

(D) Upon learning of any violations of the Conditional Release Order; and

(E) At any other time when in the opinion of the qualified person, such an interim report is needed to assist the Individual.

(3) An Annual Comprehensive Review must be completed each 364 days to determine if an Individual’s current Conditional Release Order is in alignment with the Individual’s current level of care. If upon completion of the Annual Comprehensive Review it is determined the current Conditional Release Order is not in alignment with the Individuals current level of care, a modification request must be submitted to the PSRB.

(4) Providers must submit copies of interim reports to the PSRB.

(5) Providers must submit copies of interim reports to the Division upon request.

(6) Providers must include the following documents as part of the Individual’s service record:

(a) Monthly reports;

(b) Interim reports;

(d) The Individual’s most recent Conditional Release Evaluation; and

(e) The Individual’s most recent Conditional Release Order.

(f) All copies of submissions to the PSRB for modifications of the Conditional Release Order.

(g) The electronic submission of the Annual Comprehensive Review that includes an attestation from the provider that verifies the required Collateral Documentation has been reviewed when completing the annual review. The following is the list of Collateral Documentation that must be in the Individual’s service record for each year the Annual Comprehensive Review is completed.

(A) Mental Health Treatment Plan that must have not been completed more than 364 days prior to the date of the Annual Comprehensive Review.

(B) Conditional Release Order that has been approved by the PSRB.

(C) Short-Term Assessment of Risk and Treatability (START) that has been completed no more than 180 days prior to the date of the Annual Comprehensive Review.

History

Statutory/Other Authority: 430.640, 443.450, 426.490 - 426.500, ORS 161.390, 413.042, 430.256, 426.490 - 426.500 & HB 2804 (2024)
Statutes/Other Implemented: ORS 161.390 - 161.400, 179.505, 426.380 - 426.395, 426.490 - 426.500, 428.205 - 428.270, 430.010, 430.205 - 430.210, 430.254 - 430.640, 430.850 - 430.955 & 443.400 - 443.460
BHS 1-2026, amend filed 03/03/2026, effective 03/03/2026
BHS 16-2025, amend filed 06/25/2025, effective 06/30/2025
BHS 6-2025, temporary amend filed 02/28/2025, effective 03/01/2025 through 08/27/2025
MHS 4-2018, amend filed 02/27/2018, effective 03/01/2018
MHS 10-2017(Temp), f. 9-15-17, cert. ef. 9-15-17 thru 3-13-18
MHS 6-2017, f. & cert. ef. 6-23-17
MHS 26-2016(Temp), f. 12-27-16, cert. ef. 12-28-16 thru 6-23-17
MHS 4-2014, f. & cert. ef. 2-3-14
MHS 6-2013(Temp), f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14

Or. Admin. R. 309-019-0162 Youth Wraparound Definitions

(1) "Child and Adolescent Needs and Strengths Assessment or CANS" means a multi-purpose tool developed to support decision making, including level of care and person-centered service planning, to facilitate quality improvement initiatives, and to monitor outcomes of services and supports. It utilizes a communication perspective to facilitate the linkage between the assessment process and the design of individualized Wraparound plans of care, including the application of evidence-based practices.

(2) "Child-Serving Systems" means agencies that serve children, youth and families. Agencies include but are not limited to: DHS Child Welfare, Intellectual/Developmental Disabilities, Education, Juvenile Justice, Oregon Youth Authority, Behavioral Health programs, tribal entities, agencies serving homeless youth, and Primary Care.

(3) "Crisis and Safety Plan" means a document developed by the youth and family and the Wraparound team to address potential crises that could occur for the youth and their family, and to ensure everyone's safety. It shall include 24-hour, 7-days-a-week response; formal, informal, and natural supports; respite or back-up care; details leading to crises; successful strategies that have worked in the past; and strength-based strategies that prevent escalation and maintain safety. Crisis stabilization occurs during the first phase of Wraparound and crisis and safety planning occurs in phase two.

(4) "Family Partner" means an individual certified and listed on the registry as a Family Support Specialist in accordance with ORS 410-180-0305, and who has completed specialized training approved by the Authority, in the Wraparound process. A Family Partner is a formal member of the Wraparound team whose role is to support the family.

(5) "Fidelity" means the degree to which the principles, phases, core elements and activities of Wraparound, and supports at the organizational and system level, are implemented as recommended through training, consultation and best practices dissemination.

(6) "Formal Supports" means services and supports provided by professionals or individuals who are financially compensated for their time.

(7) "Informal Supports" means supports provided by individuals or organizations through citizenship and work on a volunteer basis under a structure of certain qualifications, training and oversight.

(8) "Linguistically Responsive" means that individuals are informed of the availability of language assistance services in their preferred language, both verbally and in writing. Individuals are provided with easy to understand print and multi-media materials and signage appears in the languages commonly used by the populations in the service area.

(9) "Natural Supports" means individuals or organizations in the youth and family's own community, social, cultural or spiritual networks, such as friends, extended family members, neighbors, and other individuals as identified by the youth and family, providing supports, who are not financially compensated for their time.

(10) "Oregon Health Plan or OHP" has the meaning provided for in OAR 410-120-0000(170).

(11) "Peer Partner Coach" means an individual with Youth Partner or Family Partner expertis certified and listed on the registry in accordance with OAR 410-180-0300, who has a specific intentional focus in supporting Youth Partners or Family Partners to ensure the meaningful engagement of youth and family voices in the Wraparound plan, to develop their practice skills in Wraparound principles and participation in the Wraparound process and who works in connection with other Peer Support Specialists or peer delivered services.

(12) "Phases of Wraparound" means the four distinct phases of Wraparound: Engagement, initial plan development, implementation, and transition. The activities within each phase of Wraparound are part of fidelity practice.

(13) "Strength-based" means based on functional assets, skills, capacities, and talents of a person, family or group.

(14) "Strengths and Needs Summary" means a comprehensive "strengths and needs assessment” and summary process that begins immediately when a youth and their family are referred into Wraparound. This process is complemented by other Division-approved assessment tools, such as the Child and Adolescent Needs and Strengths Assessment (CANS).

(15) "Ten Wraparound Principles" means these principles associated with Wraparound supports: family- driven and youth-guided, collaboration, persistence, culturally and linguistically responsive, community based, team based, natural supports, individualized, strength-based, and outcome-based.

(16) "Wraparound" means a voluntary and definable care planning process that results in a unique set of community services and supports individualized for a youth and family to achieve a positive set of outcomes.

(17) "Wraparound Care Coordinator or WCC" means a QMHA or QMHP, as defined in OAR 309-019-0125, who is completing or has completed a Division-approved Wraparound foundational training program. The WCC is a member of the Wraparound team specifically trained to coordinate and facilitate the components of a Wraparound team meeting to fidelity, in each phase of the Wraparound process, for an individual family.

(18) "Wraparound Coach" means an individual with Wraparound expertise in relation to Wraparound principles and in strategies to facilitate a Wraparound meeting to fidelity. Wraparound Coaches provide clear and constructive feedback regarding fidelity components and facilitation skills to Wraparound Care Coordinators.

(19) "Wraparound Flexible Funding" means a financial resource for purchasing one-time or occasional needed goods or services for youth or their families, when the goods and services cannot be provided by another funding source, and the services or goods are directly tied to meeting needs and outcomes in the Wraparound plan of care.

(20) "Wraparound Plan of Care" means a dynamic document which describes the youth, the family, the team, and the goals and action plan to be undertaken to meet the youth and family's needs, achieve the team mission and work toward the family's long-term vision.

(21) “Wraparound Provider” means a certified entity that hires and trains staff to provide coordination and facilitation of Fidelity Wraparound for youth and families.

(22) "Wraparound Review Committee" means a local community group representing Child Welfare, Juvenile Justice, Intellectual Developmental Disabilities, Education, Behavioral Health, Federally Recognized Tribes or tribal entities, Youth and Family members or youth and family advocates who convene with the goal of reviewing and determining Wraparound eligibility.

(23) "Wraparound Supervisor" means an individual responsible for supervising a Wraparound Care Coordinator, Wraparound Coach, Family Partner, or Youth Partner through their respective agency.

(24) "Wraparound Team" means a group of people chosen by the youth and family and connected to them through natural, community, and formal supports. The Wraparound team develops and implements the youth and family's plan, addresses unmet needs, and works toward the family's vision and team mission together with the youth and family.

(25) "Wraparound Team Meeting" means a meeting where members of the Wraparound team convene to address the family and youth's mission, vision, strengths and needs identified by the team.

(26) "Youth" means a person who participates in Wraparound. Youth is the accepted term in statewide Wraparound to describe children, adolescents, teenagers and young adults. Youth who participate in Wraparound may remain in Wraparound as young adults if they entered/ enrolled prior to age 18.

(27) "Youth Partner" means an individual certified and on the registry as a Youth Support Specialist in accordance with OAR 410-180-0305. A Youth Partner is a formal member of the Wraparound team whose role is to support the youth.

(28) "Youth Support Specialist" has the meaning defined in OAR 410-180-0305. Youth support specialists provide peer delivered services, as defined in these rules.

History

Statutory/Other Authority: ORS 430.630 & ORS 413.042
Statutes/Other Implemented: ORS 430.630 & ORS 413.042
BHS 20-2022, amend filed 11/30/2022, effective 11/30/2022
BHS 20-2021, renumbered from 309-019-0324, filed 10/14/2021, effective 10/14/2021
BHS 3-2020, adopt filed 02/14/2020, effective 02/14/2020

Or. Admin. R. 309-019-0163 Youth Wraparound Program Rules

(1) Wraparound providers shall:

(a) Make eligibility criteria and referral processes available to the public. At a minimum, the following categories of youth shall be eligible:

(A) Youth served in two or more child-serving systems and experiencing complex needs;

(B) Youth who have been approved by the Wraparound Review Committee.

(b) Obtain a mental health assessment within one year of Wraparound referral for youth being served under Medicaid;

(d) Implement peer delivered services in accordance with OAR chapter 410, division 180 for youth and families participating in Wraparound;

(e) Ensure that youth have access to Wraparound if they are Medicaid-eligible and enrolled in any of the following: Secure Children's Inpatient Program, Secure Adolescent Inpatient Program, Psychiatric Residential Treatment Services, or the Commercial Sexually Exploited Children's residential program funded by the Division;

(f) Ensure that program staff, contractors, volunteers, and interns providing Wraparound programs are trained in and familiar with strategies for delivery of trauma informed and culturally responsive treatment services. At a minimum, completion of an online foundational course for trauma informed care approved by the Division shall be required of program staff, contractors, volunteers and interns;

(g) Ensure that Youth Partner and Family Partner services have been offered to the youth and family;

(h) Ensure team members are selected with the youth and family’s direct involvement and approval;

(i) Provide capacity to serve all eligible OHP members into Wraparound.

(2) Wraparound providers may not:

(a) Require Medicaid-eligible youth to receive services or supports prior to receiving Wraparound;

(b) Place any youth on a waitlist.

(3) Wraparound team meetings shall:

(a) Be facilitated face-to-face or by two-way audio-visual conference or by telephone;

(b) Be conducted in the preferred language of the youth and family. Professional interpretation services must be used, if requested by the youth and family;

(d) Ensure decisions are made with the youth and family’s direct involvement and approval.

(4) The Wraparound team shall include a Wraparound Care Coordinator (WCC). The WCC shall:

(a) Facilitate the Wraparound process to fidelity standards, in accordance with any procedures and standards established by the Authority;

(b) Implement the Wraparound process in collaboration with Youth Partners, Family Partners, and other Wraparound team members;

(d) Provide other service or support roles for youth on the Wraparound team they facilitate only when a variance has been approved;

(e) Complete a Division-approved Wraparound foundational training within 90 days of the hire date;

(f) Receive clinical supervision in accordance with OAR chapter 309, division 019; and

(g) Receive orientation and shadowing opportunities, be observed, have documents reviewed, and be coached by a Wraparound Coach as defined in these rules and in accordance with any procedures and standards established by the Authority.

(5) Family Partners shall meet the requirements for Family Support Specialists outlined in OAR 410-180-0305. They may receive support or technical assistance from a family organization and shall, at a minimum:

(a) Complete a Division-approved Wraparound foundational training within 90 days of the hire date;

(b) Receive peer supervision in accordance with OAR 309-019-0130;

(d) Support family members and guardians to:

(A) Navigate the child-, youth-, and family-serving systems;

(B) Communicate effectively with family members, their support system, and agency representatives; and

(e) Provide individual and group support to enable and facilitate meaningful engagement with Wraparound team and service providers; and

(f) Assist in connecting the family to resources within the community, support the family through barriers, help family members to acquire tools and strategies for success and advocate for the family's needs, interests, voice, and vision to be heard and thoughtfully considered.

(6) Youth Partners shall meet the requirements outlined for Youth Support Specialists in OAR 410-180-0305. They may receive support or technical assistance from a youth organization, and shall, at a minimum:

(a) Complete a Division-approved Wraparound foundational training within 90 days of the hire date;

(b) Receive peer supervision in accordance with OAR 309-019-0130;

(d) Have at least one year of relevant lived experience, knowledge of the child- and youth-serving systems, and the ability to navigate the system;

(e) Assist the youth to engage in the Wraparound process and support them in expressing themselves to members of their Wraparound team;

(f) Assist the youth in identifying community resources, navigating barriers, acquiring tools and strategies for success and bridging the gap between the youth and the adults on the Wraparound team; and

(g) Advocate for the youth's needs, interests, voice and vision to be heard.

(7) The Wraparound provider shall, gather and compile a strengths and needs summary that is complemented by the Division-approved assessment tools for ages 0-5 and 6-20, as described below as a part of Fidelity Wraparound. Strengths and needs information to gather and compile shall include:

(a) Conversations with the youth and family, which shall be conducted at a reasonable time and location chosen by the youth and family;

(b) Conversations with team members including formal and natural supports;

(d) Consideration of each one of the following domains: family and relationships, home and a place to live, psychological and emotional, health and medical, crisis and safety, financial, educational and vocational, legal, cultural and spiritual, daily living, substance abuse and addictions, social and recreational.

(8) The Wraparound provider shall conduct a strengths and needs assessment tool for each youth enrolled in Wraparound services and supports. The assessment tool shall:

(a) Be started within 30 days of enrollment in Wraparound, and updated at least every 90 days thereafter and upon a change in clinical circumstances or other significant event;

(b) Be a Division-approved strengths and needs assessment tool for ages 0-5 and 6-20;

(c) Be completed by a Wraparound Care Coordinator, Family Partner, or Youth Partner certified in the Division-approved strengths and needs assessment tool;

(d) Include strengths and needs of the youth;

(e) Incorporate input from the youth, family, and all team members; and

(f) Be used to develop a Wraparound plan of care.

(9) Wraparound Crisis and Safety Plans shall at a minimum:

(a) Be developed and approved by the youth and family in consultation with the Wraparound team;

(b) Document the youth and family's definition of crisis;

(c) Include within the initial crisis and safety plan at least one strategy to prevent a crisis situation and at least one strategy to use during a crisis situation;

(d) Include a list of triggers, warning signs, and recommended de-escalation strategies and supports identified by the youth and family in consultation with the Wraparound Team;

(e) Document strategies for risk prevention for existing or anticipated safety concerns; this shall include strategies developed through lethal means counseling to help individuals at risk for suicide and their families to reduce access to lethal means, including but not limited to firearms;

(f) Include strength-based strategies for addressing the youth and family's needs when in crisis;

(g) Document natural and formal supports approved by the youth and family for crisis response;

(h) Be updated at the request of the youth or family, or when clinical circumstances change, including following any placement change, psychiatric crisis, overdose, suicide attempt, police involvement, or other situations identified by the youth or family;

(i) Document safety requirements from other child-serving or legal systems;

(j) Be culturally and linguistically responsive;

(k) Include contact information for resources that the youth and family may use before or during a crisis event;

(l) Be provided to the youth and family in a format chosen by the youth and family; and

(m) Be available to Wraparound team members.

(10) A Wraparound Plan of Care shall:

(a) Include a family vision statement developed by the youth and family;

(b) Include a team mission statement developed by the Wraparound team;

(c) Include strengths and needs derived from the youth, family, the Child and Adolescent Strengths and Needs Assessment, and the strengths and needs summary;

(d) Include goals(s) for each prioritized need;

(e) Include strategies to achieve the desired outcomes;

(f) Include action steps that team members will undertake to meet the needs identified by the youth and family;

(g) Documented use of Wraparound flexible funding that supports the mission statement, needs and goals;

(h) Be reviewed and updated at each team meeting;

(i) Be culturally and linguistically responsive;

(j) Be approved by the youth and family;

(k) Be made available to the youth and family within five business days of the Wraparound team meeting in the format and language chosen by the youth and family;

(l) If desired by the youth or family, include a blend of formal and informal supports;

(m) Include a list of team members and contact information; and

(n) Be present and discussed at each team meeting.

(11) Peer Partner Coaches shall:

(a) Be a certified Family Support Specialist or a certified Youth Support Specialist who has, at a minimum, two years of experience as a Traditional Health Worker as defined in OAR 410-180-0305;

(b) Demonstrate understanding of the core elements of Fidelity Wraparound such as the ten Wraparound principles and the four phases of Wraparound;

(c) Provide peer supervision in accordance with OAR 309-019-0130, including face to face individual and group coaching to Youth or Family Partners a minimum of one time per month;

(d) Uphold Wraparound principles as evidenced by coaching notes;

(e) Be rater certified in use of the Division-approved assessment tools for ages 0-5 and 6-20;

(f) Ensure that Youth and Family Partners are delivering Wraparound to youth and families in a culturally and linguistically responsive manner;

(g) Create documentation which demonstrates that coaching is responsive to diverse cultural beliefs, practices, languages, learning styles, and communication as evidenced by written feedback from Youth and Family Partners and Peer Delivered Service Supervisors;

(h) be available to provide coaching in the language spoken by the family, when possible, to bilingual Youth and Family Partners and be able to observe meetings and perform document review in the family's primary language without impact on the youth, family or WCC;

(i) seek out additional resources when the coach does not have lived experience to provide culturally specific coaching to the Youth or Family Partner;

(j) Adapt caseload size to provide adequate time to complete tasks if a WCC is working with a youth or family that requires an interpreter, bilingual services, and other accessibility needs.

(12) Wraparound Coaches shall:

(a) Have at a minimum two years of experience as a Wraparound Care Coordinator;

(b) Demonstrate understanding of the core elements of Fidelity Wraparound such as the ten Wraparound principles, the four phases of Wraparound, and the activities associated with each phase of Wraparound;

(d) Meet with the Wraparound Supervisor at least monthly;

(e) Provide the following coaching to Wraparound Care Coordinators:

(A) For WCCs with less than one year of Wraparound experience:

(i) 20 hours of individual coaching, 10 hours of group coaching, and five hours of document review within one year of the WCC's hire date, using the coaching model approved by the Division;

(ii) At least 5 of the 20 hours of individual coaching shall occur within the 90-day period before the WCC receives the Division approved foundational training; if the Division approved foundational training is not available or if the WCC is unable to attend during the first 90 days of employment, the WCC must receive biweekly individual coaching until the foundational training takes place;

(iii) Within the first twelve months of the WCC beginning to work with youth and families, observe four Wraparound team meetings for each WCC, including one meeting representing each phase of the Wraparound process.

(B) For WCCs with at least one year of Wraparound experience, provide 10 hours of individual coaching, 10 hours of group coaching and two to four Wraparound team meeting observations within one calendar year.

(f) Utilize the coaching plan created with the Wraparound coach and document to include the names of the Coach and the WCC, the date, and the content of the coaching session;

(h) Be available to provide coaching to bilingual WCCs inf the language spoken by the family and be able to observe meetings and perform document review in the family's primary language without impact on the youth, family;

(i) Seek out additional resources when the Coach does not have shared lived experience to provide culturally responsive coaching to a WCC; and

(j) Be rater-certified in the use of the Division-approved assessment tools for ages 0-5 and 6-20.

(13) Wraparound Supervisors shall:

(a) Demonstrate through experience the ability to understand and articulate core elements of Fidelity practice such as the ten Wraparound principles, the four Wraparound phases, and facilitation components associated with each phase of Wraparound;

(b) Be informed of and implement their agency's Wraparound policies and procedures;

(c) Complete a Division-approved Wraparound foundational training and Wraparound Coaches and Supervisors training within 90 days of the hire date;

(d) Conduct or provide for clinical supervision, in accordance with OAR 309-019-0130, of Wraparound Care Coordinators, Wraparound Coaches, Family Partners, and Youth Partners, and uphold Wraparound principles as evidenced by notes in a supervision log that includes: name, date, and content of supervision;

(e) Ensure coaching is provided by the Wraparound Coach and Peer Support Coach;

(f) Ensure a coaching plan is written for each WCC, Family Partner, and Youth Partner per the Division-approved Coaches and Supervisor training;

(g) Ensure that the provision of Wraparound is culturally and linguistically responsive to the needs of Wraparound Care Coordinators, Youth Partners, Family Partners, youth and families;

(h) Adapt caseload size to provide adequate time to complete tasks if a WCC is working with a youth or family that requires an interpreter, bilingual services, or if there are other accessibility needs;

(i) Ensure Wraparound Coaches implement coaching plans that are culturally and linguistically responsive; and

(j) Be rater-certified in use of the Division-approved assessment tools for ages 0-5 and 6-20.

(14) A Fidelity Monitoring Tool (FMT) approved by the Division shall be used to assess fidelity to Wraparound;

(a) The FMT shall be offered to youth and caregivers no sooner than six months after a youth has been enrolled in Wraparound;

(b) Any youth over the age of eleven may complete the FMT;

(c) A parent, guardian, or legal caregiver who knows the youth best and has also participated in Wraparound may complete the FMT;

(d) The youth and parent, guardian or legal caregiver shall complete the FMT without the team's Wraparound Care Coordinator present;

(e) The FMT shall be offered to wraparound team members when approved of by the youth or family;

(f) The FMT shall be administered electronically or in written form, as chosen by the youth and family; and

(g) Other approved fidelity tools in addition to the FMT may be administered by the Division.

(15) Transitions from Wraparound:

(a) Upon completing the Wraparound team's mission statement, the team shall create a transition plan outlining the tasks required for Wraparound to be completed and shall implement the plan;

(b) The Wraparound transition plan shall:

(A) Outline the mix of formal and natural supports that the youth and family have chosen; and

(B) Include a post-transition crisis management plan.

(c) The WCC supports the team in creating a transition document that summarizes and highlights the youth and family's functional strengths, lessons learned and successfully used strategies;

(d) The team conducts a culturally appropriate activity that acknowledges the end of formal Wraparound;

(e) A young adult shall not be made to transition out of Wraparound solely due to attaining the age of 18. Young adults who reach the age of 18 while enrolled in Wraparound shall be offered the option to remain in Wraparound until their mission statement is achieved.

History

Statutory/Other Authority: ORS 413.042 & ORS 430.630
Statutes/Other Implemented: ORS 413.042 & ORS 430.630
BHS 20-2022, amend filed 11/30/2022, effective 11/30/2022
BHS 20-2021, renumbered from 309-019-0326, filed 10/14/2021, effective 10/14/2021
BHS 19-2019, adopt filed 12/24/2019, effective 12/27/2019
BHS 7-2019, temporary adopt filed 06/21/2019, effective 07/01/2019 through 12/27/2019

Or. Admin. R. 309-019-0170 Outpatient Problem Gambling Treatment and Recovery Services

Outpatient problem gambling treatment services include group, individual, and family treatment consistent with the following requirements:

(1) Service sessions shall address the challenges of the individual as they relate directly or indirectly to the problem gambling behavior.

(2) Providers may provide telephone counseling when face-to-face contact involves an unwise delay, as follows:

(a) The individual shall be currently enrolled in the problem gambling treatment program;