OAR Chapter 415 — Oregon Health Authority, Health Systems Division: Addiction Services

Division 1 PROCEDURAL RULES

Or. Admin. R. 415-001-0000 Model Rules of Procedure

The Oregon Health Authority (Authority), Health Systems Division (Division), Addiction Services, chapter 415, 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
ADS 2-2018, adopt filed 03/21/2018, effective 04/11/2018

Division 12 LICENSURE OF SUBSTANCE USE DISORDERS AND PROBLEM GAMBLING RESIDENTIAL TREATMENT AND RECOVERY SERVICES

Or. Admin. R. 415-012-0000 Purpose and Scope

(1) These rules establish procedures for the residential licensure of the following:

(a) Any substance use disorder service provider that is or seeks to be contractually affiliated with the Health Systems Division (HSD), a Coordinated Care Organization (CCO), or a local mental health authority for providing residential substance use disorders and problem gambling treatment and recovery services;

(b) Any service provider using public funds in the provision of residential substance use disorder prevention, intervention, or treatment services in Oregon;

(d) Organizations seeking approval from the Division for provision of residential services as provided in ORS 430.010 and 443.400 or detoxification services under ORS 430.306;

(e) Alcohol and drug evaluation specialists designated to do Driving Under the Influence of Intoxicants (DUII) diagnostic screenings and assessments under ORS 813.020 and 813.260; or

(f) Child and Adolescent Integrated Psychiatric and Substance Use Disorders Residential Treatment (IPSR) Programs.

(2) These rules do not establish procedures for regulating the following:

(a) Behavioral health care practitioners that are otherwise licensed to render behavioral health care services in accordance with applicable statutes;

(b) Practices exclusively comprised of behavioral healthcare practitioners that are otherwise licensed to render behavioral healthcare services in accordance with applicable statutes;

History

Statutory/Other Authority: ORS 413.042 & ORS 430.256
Statutes/Other Implemented: ORS 430.010, ORS 430.306, ORS 430.397, ORS 430.405, ORS 430.450, ORS 430.590, ORS 430.630, ORS 430.850 & ORS 443.400
ADS 6-2018, amend filed 12/26/2018, effective 01/09/2019
ADS 5-2018, temporary amend filed 07/17/2018, effective 08/01/2018 through 01/27/2019
ADS 4-2018, amend filed 05/10/2018, effective 05/10/2018
ADS 3-2017, temporary amend filed 12/01/2017, effective 12/01/2017 through 05/29/2018
ADS 8-2016, f. & cert. ef. 12-14-16
ADS 2-2016(Temp), f. 6-28-16, cert. ef. 7-1-16 thru 12-27-16
ADS 3-2014, f. 6-10-14, cert. ef. 6-19-14
ADS 1-2014(Temp), f. & cert. ef. 1-28-14 thru 7-21-14
ADS 4-2013, f. & cert. ef. 5-3-13
ADS 2-2013(Temp), f. & cert. ef. 1-14-13 thru 7-12-13
ADS 2-2008, f. & cert. ef. 11-13-08
ADAP 2-1993, f. & cert. ef. 11-5-93

Or. Admin. R. 415-012-0010 Definitions

(1) "Applicant" means any individual or entity who has requested, in writing, a license.

(2) "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 chapter 309, division 14.

(3) "Contract" means the document describing and limiting the relationship and respective obligations between an organization other than a county and the Division for the purposes of operating a substance use disorder or problem gambling service within a county's boundaries, or operating a statewide, regional, or specialized service.

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

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

(6) “Individual” means the individual requesting or receiving services addressed in these rules.

(7) "Intergovernmental Agreement" or "Agreement" means the document describing and limiting the contractual relationship and respective obligations between a county or other government organization and the Division for the purpose of operating a substance use disorder or problem gambling service.

(8) "License" means a license issued by the Division to applicants who are in substantial compliance with applicable administrative rules for substance use disorder or problem gambling treatment in a residential setting and that is renewable every two years.

(9) “Licensed Child Care Facility” means a facility licensed under ORS 657A.280.

(10) "Non-Funded Provider" means an organization not contractually affiliated with the Division, a CCO, a CMHP, or other Division contractor.

(11) “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.

(12) "Provider" means an organization licensed under these rules to provide substance use disorder or problem gambling prevention, intervention, or treatment services under contract with the Division or under subcontract with a local entity or public body or otherwise receiving public funds for these services.

(13) "Provisional" means a license issued for one year or less pending completion of specified requirements because of substantial failure to comply with applicable administrative rules.

(14) "Quality Assurance" means the process of objectively and systematically monitoring and evaluating the quality and appropriateness of care to identify and resolve identified problems.

(15) "Restriction" means any limitations placed on a license such as age of individuals or number of individuals to be served.

(16) "Revocation" means the removal of authority for a provider to provide certain services under a license.

(17) “School Attended Primarily by Minors” means an existing public or private elementary, secondary, or career school attended primarily by individuals under age 18.

(18) "Service Element" means a distinct service or group of services for individuals with substance use or problem gambling disorders defined in administrative rule and included in a contract or agreement issued by the Division.

(19) "Substantial Compliance" means a level of adherence to applicable administrative rules that, even if not meeting one or more of the requirements, does not in the determination of the Division:

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

(b) Constitute a willful, repeated, or ongoing violation of administrative rules; or

(20) "Substantial Failure to Comply" means a level of adherence to applicable administrative rules, statutes, and 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, repeated, or ongoing violation of administrative rules; or

(21) "Suspension" means a temporary removal of authority for a provider to operate under a license issued under OAR chapter 415, division 012.

(22) "Temporary" means a license issued for 185 days to a program approved for the first time. A temporary license may not be extended.

(23) "Variance or Exception" means a waiver of a regulation or provision of these rules granted by the Division upon written application.

History

Statutory/Other Authority: ORS 413.042 & ORS 430.256
Statutes/Other Implemented: ORS 430.010 - 430.030, ORS 430.306, ORS 430.397, ORS 430.405, ORS 430.450, ORS 430.630, ORS 430.850 & ORS 443.400
ADS 4-2018, amend filed 05/10/2018, effective 05/10/2018
ADS 3-2017, temporary amend filed 12/01/2017, effective 12/01/2017 through 05/29/2018
ADS 2-2017, f. 6-29-17, cert. ef. 7-1-17
ADS 1-2017(Temp), f. & cert. ef. 2-2-17 thru 7-31-17
ADS 8-2016, f. & cert. ef. 12-14-16
ADS 2-2016(Temp), f. 6-28-16, cert. ef. 7-1-16 thru 12-27-16
ADS 4-2013, f. & cert. ef. 5-3-13
ADS 2-2013(Temp), f. & cert. ef. 1-14-13 thru 7-12-13
ADS 2-2008, f. & cert. ef. 11-13-08
ADAP 1-2001, f. 3-29-01, cert. ef. 4-1-01
ADAP 2-1993, f. & cert. ef. 11-5-93

Or. Admin. R. 415-012-0020 General Requirements

(1) Every provider that operates a residential service element by contract with the Division or subcontracts with a local entity or public body or receives public funds for providing substance use disorder or problem gambling prevention, intervention, or treatment services shall have a license and:

(a) Providers may not represent themselves as conducting any service described in this rule without first obtaining a license;

(b) A provider that does not have a license for conducting a service described in this rule may not admit an individual needing that service; and

(2) Licensed providers shall also maintain a current certificate of approval for the provision of outpatient behavioral health treatment services pursuant to OAR 309-008-0100 to 1600 if also providing an outpatient service.

(3) Any facility that meets the definition of a residential treatment facility under ORS 443.400 or a detoxification center as defined in ORS 430.306 shall be licensed by the Division:

(a) No individual or entity may represent themselves as a residential treatment facility or as a detoxification center without being licensed;

(b) A residential treatment facility or a detoxification center that is not licensed may not admit individuals needing residential or detoxification care or treatment; and

(4) Approval or licensure of a service element pursuant to this rule does not create an express or implied contract in the absence of a fully executed written contract.

History

Statutory/Other Authority: ORS 413.042 & ORS 430.256
Statutes/Other Implemented: ORS 430.010-430.030, ORS 430.306, ORS 430.397, ORS 430.405, ORS 430.450, ORS 430.630, ORS 430.850 & ORS 443.400
ADS 6-2018, amend filed 12/26/2018, effective 01/09/2019
ADS 5-2018, temporary amend filed 07/17/2018, effective 08/01/2018 through 01/27/2019
ADS 4-2018, amend filed 05/10/2018, effective 05/10/2018
ADS 3-2017, temporary amend filed 12/01/2017, effective 12/01/2017 through 05/29/2018
ADS 2-2017, f. 6-29-17, cert. ef. 7-1-17
ADS 1-2017(Temp), f. & cert. ef. 2-2-17 thru 7-31-17
ADS 8-2016, f. & cert. ef. 12-14-16
ADS 2-2016(Temp), f. 6-28-16, cert. ef. 7-1-16 thru 12-27-16
ADS 4-2013, f. & cert. ef. 5-3-13
ADS 2-2013(Temp), f. & cert. ef. 1-14-13 thru 7-12-13
ADS 2-2008, f. & cert. ef. 11-13-08
ADAP 2-1993, f. & cert. ef. 11-5-93

Or. Admin. R. 415-012-0030 Application Procedures

(1) The Division shall mail an application packet to all applicants seeking residential licensure.

(2) All programs applying for the first time for a residential license to operate a treatment or prevention program shall schedule a meeting with the Division for the purpose of receiving needed technical assistance regarding the approval and licensure criteria and procedures.

(3) A separate application must be submitted for each location where the provider intends to operate a residential treatment facility.

(4) The applicant may withdraw the application at any time during the application process by notifying the Division in writing. At such time, all materials shall be returned to the applicant.

History

Statutory/Other Authority: ORS 430.256 & ORS 413.032
Statutes/Other Implemented: ORS 430.010-430.030, ORS 430.306, ORS 430.397, ORS 430.405, ORS 430.450, ORS 430.630, ORS 430.850 & 443.400
ADS 4-2018, amend filed 05/10/2018, effective 05/10/2018
ADS 3-2017, temporary amend filed 12/01/2017, effective 12/01/2017 through 05/29/2018
ADS 2-2017, f. 6-29-17, cert. ef. 7-1-17
ADS 1-2017(Temp), f. & cert. ef. 2-2-17 thru 7-31-17
ADS 8-2016, f. & cert. ef. 12-14-16
ADS 2-2016(Temp), f. 6-28-16, cert. ef. 7-1-16 thru 12-27-16
ADS 4-2013, f. & cert. ef. 5-3-13
ADS 2-2013(Temp), f. & cert. ef. 1-14-13 thru 7-12-13
ADS 2-2008, f. & cert. ef. 11-13-08
ADAP 2-1993, f. & cert. ef. 11-5-93

Or. Admin. R. 415-012-0032 Application Information

An applicant for a license shall submit the information listed below on forms provided by the Division:

(1) Name and address of the applicant;

(2) Name, address, and qualifications of the executive director or administrator;

(3) Outline of the staff organization with names and qualifications;

(4) Articles of incorporation and bylaws;

(5) Names and addresses of the board of directors, sponsors, or advisory boards of the program;

(6) Names and addresses of physicians, other professionally trained personnel, medical facilities, and other individuals or organizations with whom the program has a direct referral agreement or is otherwise affiliated;

(7) Description of the treatment services provided by the program setting forth program philosophy, goals, objectives, and a description of the treatment methodology for each service element;

(8) Materials demonstrating compliance with the administrative rules governing the specific service provided;

(9) Materials showing compliance with all related federal, state and local acts, ordinances, rules and amendments such as State Fire Marshal rules, board of health and building zoning codes, and the American Disabilities Act;

(10) Materials substantiating compliance with distance requirements subject to ORS 430.590 for programs using methadone to treat opioid addiction. These application procedures apply to new programs and existing programs moving to a new location after 1-14-2013;

(11) Materials substantiating compliance with other licensing authorities such as the Child Welfare Division for residential adolescent services or the Drug Enforcement Administration and a federally approved accreditation agency for methadone treatment services;

(12) For residential treatment and detoxification facilities, the maximum individual capacity requested;

(13) Source of funds used to finance the program such as an annual budget of the organization or a copy of the most current fiscal audit or review;

(14) Written evidence of applicable insurance such as liability insurance;

(15) Floor plan for the proposed facility;

(16) Representative sample individual file;

(17) Written nondiscrimination policy including:

(a) Explanation of methods used to disseminate the policy;

(b) Description of procedures used to communicate with sensory impaired person or persons of limited English proficiency;

(d) Written grievance procedure for handling discrimination complaints.

(18) Identification of any individual, including stockholders or other legal entities, who have an ownership interest of any person, property or structure representing five percent or more. For purposes of these rules, an individual with a five percent or more ownership interest 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;

(19) 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.

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

History

Statutory/Other Authority: ORS 413.042 & ORS 430.256
Statutes/Other Implemented: ORS 430.010-430.030, ORS 430.306, ORS 430.397, ORS 430.405, ORS 430.450, ORS 430.630, ORS 430.850 & ORS 443.400
ADS 4-2018, amend filed 05/10/2018, effective 05/10/2018
ADS 3-2017, temporary amend filed 12/01/2017, effective 12/01/2017 through 05/29/2018
ADS 4-2013, f. & cert. ef. 5-3-13

Or. Admin. R. 415-012-0035 Responses 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 shall contact the applicant to schedule an onsite licensure review; or

(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) If an application is denied:

(a) The Division shall issue a written notice of denial within 14 days of the determination;

(b) The applicant shall be entitled to a contested case hearing consistent with ORS 183 if the applicant requests a hearing in writing within 60 days of the receipt of the notice;

(c) If no written request for a hearing is received within the 60-day timeline, the notice of denial shall become the final order by default, and the Division may designate its file as the record for purposes of order by default.

History

Statutory/Other Authority: ORS 413.042 & ORS 430.256
Statutes/Other Implemented: ORS 430.010-430.030, ORS 430.306, ORS 430.397, ORS 430.405, ORS 430.450, ORS 430.630, ORS 430.850 & ORS 443.400
ADS 4-2018, amend filed 05/10/2018, effective 05/10/2018
ADS 3-2017, temporary amend filed 12/01/2017, effective 12/01/2017 through 05/29/2018
ADS 2-2017, f. 6-29-17, cert. ef. 7-1-17
ADS 1-2017(Temp), f. & cert. ef. 2-2-17 thru 7-31-17
ADS 8-2016, f. & cert. ef. 12-14-16
ADS 2-2016(Temp), f. 6-28-16, cert. ef. 7-1-16 thru 12-27-16
ADS 4-2013, f. & cert. ef. 5-3-13

Or. Admin. R. 415-012-0040 Licenses

(1) The Division may issue a residential license under these rules for a duration not to exceed two years.

(2) Renewal of licenses shall be contingent upon demonstration of compliance with applicable administrative rules:

(a) A program may continue to operate until final determination of its approval or licensure status is made by the Division;

(b) Failure to demonstrate compliance may result in the issuance of a provisional license, nonrenewal, suspension, or revocation.

(3) Programs with provisional licenses upon demonstrating substantial compliance with appropriate administrative rules may be eligible for a two-year license. However, the provider's failure to demonstrate substantial compliance may result in an extension, suspension, or revocation of the provisional license.

(4) 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 licenses to specialized programs to assure maximum benefit for special populations, in which case the Division may identify that special population in the license and impose applicable program criteria.

(5) Restrictions that may be attached to a license include:

(a) Limiting the total number of individuals (in residential or detoxification treatment);

(b) Defining the age level of individuals (i.e., youth or adult) to be admitted into the facility;

(d) Assuring compliance with other licensing entities such as the Child Welfare Division, the State Public Health Division, or the Food and Drug Administration; or

(e) Other restrictions as required by the Division.

(6) Restrictions may be imposed for the extent of the approval period or limited to some other shorter period of time. If the restriction corresponds to the licensing period, the reasons for the restriction shall be considered at the time of renewal to determine if the restrictions are still appropriate.

(7) The effective date and expiration date of the restriction shall be indicated on the license.

(8) A license issued by the Division for the operation of a residential substance use disorder or problem gambling program applies both to the applicant program and the premises upon which the program is to be operated. A license is not transferable to another person, entity, or to any other location:

(a) Any person or other legal entity acquiring an approved licensed facility for the purpose of operating a substance use disorder or problem gambling program shall make an application as provided herein for a new license;

(b) Any person or legal entity having been issued a license and desiring to fundamentally alter the treatment philosophy or transfer to different premises must notify the Division 30 days prior to doing so in order for the Division to review the program or site change and to determine further necessary action.

(9) If the administrator of the program changes during the period covered by the license:

(a) A request for a change must be submitted to the Division within 15 days, along with the qualifications of the proposed new administrator;

(b) Upon a determination that the administrator meets the requirements of applicable administrative rules, a revised license shall be issued with the name of the new administrator.

(10) When a program is discontinued, its current license is void immediately, and the license shall be returned to the Division. A discontinued program is one that has terminated its services for which it has been approved or licensed. A program planning to discontinue services must:

(a) Notify the Division 60 days prior to a voluntary closure of a facility with written notice of how the provider will comply with OAR 309-014-0035(4) and 42 CFR Part 2, Federal Confidentiality Regulations, regarding the preservation of all individual records; and

(b) Provide individuals 30 days written notice and shall be responsible for making reasonable efforts to obtain treatment placement of individuals as appropriate.

History

Statutory/Other Authority: ORS 430.256
Statutes/Other Implemented: ORS 430.397, ORS 430.010-430.030, ORS 430.306, ORS 430.405, ORS 430.450, ORS 430.630, ORS 430.850 & ORS 443.400
ADS 4-2018, amend filed 05/10/2018, effective 05/10/2018
ADS 3-2017, temporary amend filed 12/01/2017, effective 12/01/2017 through 05/29/2018
ADS 8-2016, f. & cert. ef. 12-14-16
ADS 2-2016(Temp), f. 6-28-16, cert. ef. 7-1-16 thru 12-27-16
ADS 4-2013, f. & cert. ef. 5-3-13
ADS 2-2008, f. & cert. ef. 11-13-08
ADAP 1-2001, f. 3-29-01, cert. ef. 4-1-01
ADAP 2-1993, f. & cert. ef. 11-5-93

Or. Admin. R. 415-012-0050 Onsite Reviews and Access Requirements

(1) The Division shall inspect the facilities and must review procedures utilized:

(a) Before issuing a license to an applicant; and

(b) Before renewal of an existing license.

(2) The Division may conduct onsite inspections:

(a) Upon receipt of verbal or written complaints of violations that allege conditions that may threaten the health, safety, or welfare of individuals or for any other reason to be concerned for individual welfare; or

(b) Any time the Division has reason to believe it is necessary to assure if a provider is in compliance with the administrative rules or with conditions placed upon the license.

(3) The review may include but is not limited to case record audits and interviews with staff and individuals, consistent with the confidentiality safeguards of state and federal laws.

(4) Each applicant or provider agrees, as a condition of license approval:

(a) To permit designated representatives of the Division to inspect premises of programs to verify information contained in the application or to assure compliance with all laws, rules, and regulations during all hours of operation of the facility and at any other reasonable hour;

(b) To permit properly designated representatives of the Division to audit and collect statistical data from all records maintained by the approved or licensed program; and

(c) That such right of immediate entry and inspection shall, under due process of law, extend to any premises on which the Division has reasons to believe a program is being operated by the provider in violation of these rules.

(5) An applicant or provider shall not be granted licensing that does not permit inspection by the Division or examination of all records, including financial records as appropriate, methods of administration, the disbursement of drugs and method of supply, and any other records the Division considers to be relevant to the establishment of such a program.

(6) Each applicant or provider agrees as a condition of license approval that:

(a) State or local fire inspectors shall be permitted access to enter and inspect the facility regarding fire safety upon the request of the Division; and

(b) State or local health inspectors shall be permitted access to enter and inspect the facility regarding health safety upon the request of the Division.

(7) The Division may conduct inspections with or without advance notice to the administrator, staff, or individuals:

(a) The Division is not required to give advance notice of any onsite inspection if the Division reasonably believes that notice might obstruct or seriously diminish the effectiveness of the inspection or enforcement of these administrative rules; and

(b) If Division staff are not permitted access for inspection, a search warrant may be sought.

History

Statutory/Other Authority: ORS 430.256
Statutes/Other Implemented: ORS 430.397, ORS 430.010-430.030, ORS 430.306, ORS 430.405, ORS 430.450, ORS 430.630, ORS 430.850 & ORS 443.400
ADS 1-2020, temporary amend filed 04/22/2020, effective 04/22/2020 through 10/18/2020
ADS 4-2018, amend filed 05/10/2018, effective 05/10/2018
ADS 3-2017, temporary amend filed 12/01/2017, effective 12/01/2017 through 05/29/2018
ADS 8-2016, f. & cert. ef. 12-14-16
ADS 2-2016(Temp), f. 6-28-16, cert. ef. 7-1-16 thru 12-27-16
ADS 4-2013, f. & cert. ef. 5-3-13
ADS 2-2008, f. & cert. ef. 11-13-08
ADS 2-2007, f. & cert. ef. 5-25-07
ADAP 2-1993, f. & cert. ef. 11-5-93

Or. Admin. R. 415-012-0052 Onsite Investigations By the Office of Training, Investigations and Safety (OTIS)

The Office of Training, Investigations and Safety (OTIS) shall be permitted access to enter to review incidents of alleged abuse in adult Residential Substance Use Disorders Treatment and Recovery Services Programs and Alcohol Detoxification Centers covered by ORS 430.735 through 430.765.

(1) This rule is effective January 1, 2020.

(2) Reported complaints of alleged abuse shall be investigated in accordance with OAR 407-045-1000 through OAR 407-045-1110; and

(3) As a health care oversight and evaluation entity for the State of Oregon, the Division delegates the investigation to the State of Oregon, Office of Training, Investigations and Safety (OTIS), consistent with ORS 430.743 and ORS 430.745.

History

Statutory/Other Authority: ORS 413.032, ORS 413.036, ORS 413.042 & ORS 430.256
Statutes/Other Implemented: ORS 430.010-430.030, ORS 430.306, ORS 430.397, ORS 430.405, ORS 430.450, ORS 430.630, ORS 430.731-430.768, ORS 430.850 & ORS 443.400
ADS 1-2021, adopt filed 05/26/2021, effective 05/26/2021

Or. Admin. R. 415-012-0055 Conduct of Licensure 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) Review of documents pursuant to this rule; 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 Division staff during a licensure review.

(3) Within 30 days following the completion of each discretionary review, the Division may at their 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 licensure 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 licensure 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 final onsite review report. The Division may issue up to a 90-day extension to the existing licensure 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, Division staff 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 license. Upon the Division’s approval of the POC, the Division shall issue the appropriate licensure;

(e) The Division may deny or revoke an applicant or provider’s licensure if the provider fails to submit an adequate POC within the timeframes established in this rule.

History

Statutory/Other Authority: ORS 413.042 & ORS 430.256
Statutes/Other Implemented: ORS 430.010-430.030, ORS 430.306, ORS 430.397, ORs 430.405, ORS 430.450, ORs 430.630, ORS 430.850 & ORS 443.400
ADS 4-2018, amend filed 05/10/2018, effective 05/10/2018
ADS 3-2017, temporary amend filed 12/01/2017, effective 12/01/2017 through 05/29/2018
ADS 8-2016, f. & cert. ef. 12-14-16
ADS 2-2016(Temp), f. 6-28-16, cert. ef. 7-1-16 thru 12-27-16
ADS 4-2013, f. & cert. ef. 5-3-13

Or. Admin. R. 415-012-0057 Organizational Provider Assessment Information

In addition to the review procedures outlined in Section 415-012-0055, the Division will ensure that the following minimum information will be obtained during the site reviews;

(1) A current program description that reflects the type and scope of behavioral health services provided by the applicant;

(2) Provider policies regarding credentialing practices of individual practitioners. The policies must reflect current credentialing standards as defined by nationally accepted accrediting bodies such as The Joint Commission, the National Committee for Quality Assurance, and/or URAC;

(3) Copies of the provider’s liability insurance coverage;

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

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

History

Statutory/Other Authority: ORS 413.042 & 430.256
Statutes/Other Implemented: ORS 430.01030, 430.306, 430.397, 430.405, 430.450, 430.630, 430.850, 443.400, 813.020, 813.260 & 813.500
ADS 3-2014, f. 6-10-14, cert. ef. 6-19-14
ADS 8-2013(Temp), f. & cert. ef. 12-20-13 thru 6-18-14

Or. Admin. R. 415-012-0058 Availability of Information to Coordinated Care Organizations and Other Health Plans

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

(1) A current program description that reflects the type and scope of behavioral health services provided by the applicant;

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

(3) Statements of provider’s liability insurance coverage;

(4) An attestation from the Authority verifying that the provider has passed a screening and meets the minimum requirements to Medicaid provider;

(5) Reports detailing the findings of the Division’s site review of the provider;

(6) The provider’s Medicaid Vendor Identification Number issued by the Authority;

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

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

History

Statutory/Other Authority: ORS 413.042 & ORS 430.256
Statutes/Other Implemented: ORS 430.010-430.030, ORS 430.306, ORS 430.397, ORS 430.405, ORS 430.450, ORS 430.630, ORS 430.850 & ORS 443.400
ADS 4-2018, amend filed 05/10/2018, effective 05/10/2018
ADS 3-2017, temporary amend filed 12/01/2017, effective 12/01/2017 through 05/29/2018
ADS 3-2014, f. 6-10-14, cert. ef. 6-19-14
ADS 8-2013(Temp), f. & cert. ef. 12-20-13 thru 6-18-14

Or. Admin. R. 415-012-0060 Denial, Revocation, or Nonrenewal

The Division shall deny an application, a request for renewal, or revoke a license when it finds any of the following:

(1) There is a threat to the health, welfare, or safety of an individual or the public;

(2) There is substantiated evidence of abuse, neglect, or mistreatment by the applicant, provider, or provider staff;

(3) The applicant or provider has substantially failed to comply with applicable administrative rules or with local codes and ordinances or any other state or federal law or regulation;

(4) The applicant or provider has had a prior license to operate a substance use disorder or problem gambling treatment program denied, revoked, or refused to be renewed in Oregon within three years preceding the present application for reason of abuse or neglect of individuals:

(a) If a prior denial, revocation, or nonrenewal occurred more than three years from the present action, the applicant or provider shall establish to the Division by clear and convincing evidence of the applicant’s, provider’s, or administrator’s ability and fitness to operate a treatment program;

(b) If the applicant or provider does not provide such evidence, the Division shall deny the application.

(5) The applicant or provider submits fraudulent or untrue information to the Division;

(6) The applicant or provider has a history of or currently demonstrates financial insolvency such as filing for bankruptcy, foreclosures, eviction due to failure to a pay rent, termination of utility services due to failure to pay bills, failure to pay taxes such as employment or social security in a timely manner;

(7) The applicant or provider refuses to allow immediate access and onsite inspection by the Division;

(8) The applicant or provider fails to maintain a number of qualified staff sufficient to meet the treatment and safety needs of individuals or fails to comply with staff qualification requirements;

(9) The applicant or provider fails to comply with one or more restrictions or conditions on the license; or

(10) The applicant or provider fails to submit or implement a plan of correction sufficient to comply with these and other applicable rules or regulations.

History

Statutory/Other Authority: ORS 413.042 & ORS 430.256
Statutes/Other Implemented: ORS 430.397, ORS 430.010-430.030, ORS 430.306, ORs 430.405, ORS 430.450, ORs 430.630, ORS 430.850 & ORS 443.400
ADS 4-2018, amend filed 05/10/2018, effective 05/10/2018
ADS 3-2017, temporary amend filed 12/01/2017, effective 12/01/2017 through 05/29/2018
ADS 2-2017, f. 6-29-17, cert. ef. 7-1-17
ADS 1-2017(Temp), f. & cert. ef. 2-2-17 thru 7-31-17
ADS 8-2016, f. & cert. ef. 12-14-16
ADS 2-2016(Temp), f. 6-28-16, cert. ef. 7-1-16 thru 12-27-16
ADS 4-2013, f. & cert. ef. 5-3-13
ADS 2-2008, f. & cert. ef. 11-13-08
ADAP 1-1997, f. & cert. ef. 12-18-97
ADAP 2-1993, f. & cert. ef. 11-5-93

Or. Admin. R. 415-012-0065 Suspension of License

(1) The Division may impose an immediate suspension order as described in section (2) or may issue a notice of intent to suspend as described in section (3).

(2) Immediate suspension orders take effect prior to the opportunity for a hearing. The provider has the opportunity to request a hearing after the immediate suspension order takes effect:

(a) For all licenses under these rules, if the Division finds that the health, safety, or welfare of the public are seriously endangered by continued operation of a treatment or prevention program and sets forth specific reasons for its findings, immediate suspension of a license may be ordered. The provider may request a hearing to contest the immediate suspension order. Requests for a hearing must be received by the Division within 90 days from the date the 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;

(b) For licenses issued under ORS 443.400-443-465, the Division may also order an immediate suspension if the Division finds that there is imminent danger to the health or safety of the residents, pending a fair hearing not later than the 10th day after such suspension pursuant to ORS 443.440.

(3) When the Division issues a notice of intent to suspend, the provider has the opportunity to request a hearing prior to the Division ordering the suspension. The Division may issue a notice of intent to suspend a license for any of the following reasons:

(a) Violation by the program, its director, or staff of any rule promulgated by the Division;

(b) Permitting, aiding or abetting the commitment of an unlawful act within the facilities maintained by the program, or permitting, aiding or abetting the commitment of an unlawful act involving chemical substances within the program;

(c) Conduct or practices found by the Division to be detrimental to the general health or welfare of one or more individuals in the program; or

(d) Deviation by the program from the plan of operation originally approved or licensed that in the judgment of the Division adversely affects the character, quality, or scope of services intended to be provided to individuals within the program.

History

Statutory/Other Authority: ORS 413.042 & ORS 430.256
Statutes/Other Implemented: ORS 430.010-430.030, ORS 430.306, ORS 430.397, ORS 430.405, ORS 430.450, ORS 430.630, ORS 430.850 & ORS 443.400-443.465
ADS 4-2018, amend filed 05/10/2018, effective 05/10/2018
ADS 3-2017, temporary amend filed 12/01/2017, effective 12/01/2017 through 05/29/2018
ADS 8-2016, f. & cert. ef. 12-14-16
ADS 2-2016(Temp), f. 6-28-16, cert. ef. 7-1-16 thru 12-27-16
ADS 4-2013, f. & cert. ef. 5-3-13

Or. Admin. R. 415-012-0067 Response to Criminal Records

(1) The Division may deny, refuse to renew, suspend, or revoke a license if:

(a) Any of the program's staff within the previous three years has been convicted of:

(A) Any crime or violation under ORS chapter 475 including but not limited to the Uniform Controlled Substances Act or under ORS 813.010 driving under the influence of intoxicants;

(B) A substantially similar crime or violation in any other state; or

(b) Any of the program's staff has entered into within the past three years a diversion agreement under ORS 813.010 or 135.907 through 135.921 or a diversion agreement under a substantially similar law in any other state.

(2) The Division may make criminal record inquiries necessary to ensure implementation of these rules.

History

Statutory/Other Authority: ORS 413.042 & ORS 430.256
Statutes/Other Implemented: ORS 430.010-430.030, ORS 430.306, ORS 430.397, ORS 430.405, ORS 430.450, ORS 430.630, ORS 430.850 & ORS 443.400
ADS 4-2018, amend filed 05/10/2018, effective 05/10/2018
ADS 3-2017, temporary amend filed 12/01/2017, effective 12/01/2017 through 05/29/2018
ADS 8-2016, f. & cert. ef. 12-14-16
ADS 2-2016(Temp), f. 6-28-16, cert. ef. 7-1-16 thru 12-27-16
ADS 4-2013, f. & cert. ef. 5-3-13

Or. Admin. R. 415-012-0070 Hearings

(1) If a license is subject to a notice of intent to suspend, nonrenew, or revoke:

(a) The provider shall be entitled to a hearing, as outlined in ORS chapter 183, preceding the effective date of the denial, suspension, nonrenewal, or revocation if requested in writing within 21 days after receipt of the notice;

(b) If no timely written request is received, the notice shall become the final order by default and the assistant director may designate the Division file as the record for purposes of order by default.

(2) Programs that wish to contest the suspension, nonrenewal, or revocation of their license shall have an opportunity for a hearing by the Division according to the Attorney General's Model Rules of Procedure.

History

Statutory/Other Authority: ORS 430.256
Statutes/Other Implemented: ORS 430.397, ORS 430.010-430.030, ORS 430.306, ORS 430.405, ORS 430.450, ORS 430.630, ORS 430.850 & ORS 443.400
ADS 4-2018, amend filed 05/10/2018, effective 05/10/2018
ADS 3-2017, temporary amend filed 12/01/2017, effective 12/01/2017 through 05/29/2018
Reverted to ADS 4-2013, f. & cert. ef. 5-3-13
ADS 2-2016(Temp), f. 6-28-16, cert. ef. 7-1-16 thru 12-27-16
ADS 4-2013, f. & cert. ef. 5-3-13
ADS 2-2008, f. & cert. ef. 11-13-08
ADAP 2-1993, f. & cert. ef. 11-5-93

Or. Admin. R. 415-012-0075 Licensure Conditions

(1) The Division may at any time and at its discretion impose conditions on a license upon a finding that:

(a) There is a threat to the health, welfare, or safety of an individual or the public;

(b) There is substantiated evidence of abuse, neglect, or mistreatment by the applicant, provider, or provider staff;

(c) 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 substantially fails to comply with these rules, service delivery rules, or other applicable law; or

(e) The applicant or provider fails to fully implement a Plan of Correction (POC) or adequately maintain a POC.

(2) When deciding whether to impose conditions rather than denying, suspending, refusing to renew, or revoking a license, the Division shall consider all of the circumstances including but not limited to the following criteria:

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

(b) The submitted 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 license with conditions as an alternative to revocation or refusal to award a license; or

(d) The applicant or provider’s historical compliance with Division rules or orders, previous conditions placed on licenses, and previous plans of correction.

(3) Conditions to the license may include:

(a) Requiring corrective actions with timeframes for completion to correct areas of non-compliance or concern 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 these or other applicable administrative rules and laws.

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

(a) The Division may issue the conditions With Notice by issuing a Notice of Impending Imposition of License Condition (Notice) at least 48 hours prior to issuing an Order Imposing License Condition (Order) to a provider or applicant. After the Order is issued, the Division shall revise the license 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 and the Division determines it is not safe or practical to give an applicant or provider advance notice. The Division may impose the conditions without notice by issuing an Order to a provider or applicant. After the Order is issued, the Division shall revise the license to indicate the conditions that have been ordered.

(5) The Notice shall be provided in writing or orally with subsequent written notice. 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. The Notice shall:

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

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

(d) Identify an individual within the Division who 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) Inform the applicant or provider that they may request an informal conference prior to the issuance of the Order, 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 the Division determines it to be appropriate, 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 requested timely, the informal conference shall be held within seven days of the request. The Order may be issued at any time after the informal conference;

(b) If an Order is issued without a prior Notice, the applicant or provider may within two business days 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 license condition;

(f) Right to request a contested case hearing under ORS Chapter 183;

(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 waive the right to a hearing under ORS Chapter 183;

(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 license condition is warranted; and,

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

(8) Hearing:

(a) If the Division issues an Order, the applicant or provider may request a contested case hearing pursuant to ORS Chapter 183;

(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 waive the right to a hearing under ORS Chapter 183;

(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 license or limited to a shorter period of time. If the condition corresponds to the license 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 license.

(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 reoccur, 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 reoccur, the condition shall be withdrawn, and the Division shall revise the license 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 license 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 shall include information of the right to a contested case hearing pursuant to ORS Chapter 183. Nothing in this rule is intended to limit the Division’s authority to inspect facilities at any time.

(13) The Division may deny, suspend, refuse to renew, or revoke the license when the provider or applicant fails to timely comply with one or more conditions.

(14) When the Division orders a condition be placed on a license With Notice or Without Notice, the applicant or provider may 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 under ORS Chapter 183 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 413.042, ORS 430.256 & ORS 430.357
Statutes/Other Implemented: ORS 413.032, ORS 430.010, ORS 430.256, ORS 430.306, ORS 430.397, ORS 430.405, ORS 430.450, ORS 430.630, ORS 430.850 & ORS 443.400 to 443.455
ADS 4-2018, amend filed 05/10/2018, effective 05/10/2018
ADS 3-2017, temporary amend filed 12/01/2017, effective 12/01/2017 through 05/29/2018
ADS 2-2017, f. 6-29-17, cert. ef. 7-1-17
ADS 1-2017(Temp), f. & cert. ef. 2-2-17 thru 7-31-17

Or. Admin. R. 415-012-0080 Complaints

(1) Any person who believes that administrative rules have been violated may file a complaint with the Division:

(a) The Division may require that complainant exhaust grievance procedures available to them through the provider prior to initiation of an investigation;

(b) The Division shall investigate complaints and notify the provider of the results of the investigation and any proposed action.

(2) A record shall be maintained by the Division of all complaints and any action taken on the complaint and shall:

(a) Be placed into the public file. Any information regarding the investigation of the complaint may not be filed in the public file until the investigation has been completed;

(b) Protect the identification of the complainant; and

(3) Any person may inspect and receive a photocopy of the public complaint files maintained by the Division upon requesting an appointment to do so. A fee shall be charged in accordance with OAR chapter 407, division 003.

(4) Providers who acquire substantiated complaints pertaining to the health, safety, or welfare of individuals may have their licenses suspended, revoked, or not renewed and arrangements made to move the individuals.

(5) The provider shall not retaliate against any individual for filing a complaint with the Division by:

(a) Increasing charges, decreasing services, rights, or privileges;

(b) Threatening to increase charges or decrease services, rights, or privileges;

(d) Abusing or threatening to harass or abuse an individual in any manner.

(6) The provider may not retaliate against any complainant, witness, or employee of a facility for making a report to or being interviewed by the Division about a complaint including restriction to access to the service or to an individual or, if an employee, to dismissal or harassment.

History

Statutory/Other Authority: ORS 430.256
Statutes/Other Implemented: ORS 430.010-430.030, ORS 430.306, ORS 430.397, ORS 430.405, ORS 430.450, ORS 430.630, ORS 430.850 & ORS 443.400
ADS 4-2018, amend filed 05/10/2018, effective 05/10/2018
ADS 3-2017, temporary amend filed 12/01/2017, effective 12/01/2017 through 05/29/2018
ADS 4-2013, f. & cert. ef. 5-3-13
ADS 2-2008, f. & cert. ef. 11-13-08
ADS 2-2007, f. & cert. ef. 5-25-07
ADAP 2-1993, f. & cert. ef. 11-5-93

Or. Admin. R. 415-012-0090 Variances

(1) A variance request must be made in writing:

(a) For an initial application, it should be included with the application documents;

(b) If the provider is an agency under contract with the local mental health authority, it must submit the request through the local mental health authority to the Division; and

(c) If the provider is not under contract to the local mental health authority, the request should be submitted directly to the Division.

(2) The request should include the following:

(a) The reason for the proposed variance or exception;

(b) The alternative practice proposed; and

(c) For an exception, a plan and timetable for compliance with the section of the rule from which the exception is sought.

(3) The Division whose decision shall be final shall approve or deny the request for variance or exception.

(4) The Division shall notify the provider requesting the variance or exception and the community mental health program of the decision.

(5) A variance granted by the Division shall be attached to and become part of the license. Continuance of the variance shall be reviewed at the time the license is considered for renewal.

History

Statutory/Other Authority: ORS 430.256
Statutes/Other Implemented: ORS 430.010-430.030, ORS 430.306, ORS 430.397, ORS 430.405, ORS 430.450, ORS 430.630, ORS 430.850 & ORS 443.400
ADS 4-2018, amend filed 05/10/2018, effective 05/10/2018
ADS 3-2017, temporary amend filed 12/01/2017, effective 12/01/2017 through 05/29/2018
ADS 8-2016, f. & cert. ef. 12-14-16
ADS 2-2016(Temp), f. 6-28-16, cert. ef. 7-1-16 thru 12-27-16
ADS 4-2013, f. & cert. ef. 5-3-13
ADS 2-2008, f. & cert. ef. 11-13-08
ADAP 2-1993, f. & cert. ef. 11-5-93

Division 20 STANDARDS FOR OUTPATIENT OPIOID TREATMENT PROGRAMS

Or. Admin. R. 415-020-0000 Purpose

These rules prescribe standards for the development and operation of Opioid Treatment Programs approved by the Health Systems Division of the Oregon Health Authority.

History

Statutory/Other Authority: ORS 430.256
Statutes/Other Implemented: ORS 430.010(4)(b) & 430.560 - 430.590
ADS 9-2016, f. & cert. ef. 12-14-16
ADS 6-2016(Temp), f. & cert. ef. 8-10-16 thru 2-5-17
ADS 2-2008, f. & cert. ef. 11-13-08
ADS 1-2003, f. 6-13-03, cert. ef. 7-1-03
ADAP 3-1995, f. 12-1-95, cert. ef. 3-1-96
HR 17-1993, f. & cert. ef. 7-23-93, Renumbered from 410-006-0000
HR 4-1988, f. & cert. ef. 5-10-88

Or. Admin. R. 415-020-0005 Definitions

(1) "Accreditation" means the process of review and acceptance by an accreditation body.

(2) "Accreditation Body" means an organization that has been approved by the Substance Abuse and Mental Health Services Administration (SAMHSA) to accredit opioid treatment programs that use opioid agonist treatment medications.

(3) "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.

(4) “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.

(5) “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

(6) “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, The ASAM Criteria level of care and approved service delivery locations of the certificate.

(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 chapter 309, division 014.

(8) "Comprehensive maintenance treatment" means opioid agonist medication treatment that includes a broad range of clinically appropriate medical and rehabilitative services.

(9) "Diversion Control Plan" means a plan implemented by the opioid treatment program that contains specific measures to reduce the possibility of diversion of controlled substances from legitimate treatment use.

(10) "Division" means the Health Systems Division of the Oregon Health Authority (OHA) or its designee.

(11) "Employee" means an individual who provides a program service or who takes part in a program service and who receives wages, a salary, or is otherwise paid by the program for providing the service.

(12) "Federal Protocols" means the standards established by the United States Secretary of Health and Human Services that determines whether an opioid treatment program is qualified to engage in opioid treatment.

(13) "Interim Maintenance Treatment" means treatment provided in conjunction with appropriate medical services while a patient is awaiting transfer to a program that provides comprehensive maintenance treatment.

(14) "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.

(15) "Maintenance Treatment" means the administration of an opioid agonist treatment medication at stable dosage levels for a period longer than 21 days.

(16) "Medical Director" means a physician licensed to practice medicine in the State of Oregon who is designated by the opioid treatment program to be responsible for the program's medical services.

(17) "Medically Supervised Withdrawal" means the administration of an opioid agonist treatment medication in decreasing doses to an individual to alleviate adverse physical or psychological effects incident to withdrawal from the continuous or sustained use of an opioid drug and as a method of bringing the individual to a drug free state.

(18) "Medically Supervised Withdrawal Treatment" means treatment for a period of more than 30 days but not exceeding 180 days.

(19) "Medical Professional" means a medical or osteopathic physician, physician's assistant licensed by the Board of Medical Examiners, or a registered nurse or nurse practitioner licensed by the Board of Nursing.

(20) "Opiate Addiction" means a cluster of cognitive, behavioral, and physiological symptoms in which the individual continues use of opiates despite significant opiate-induced problems. Opiate addiction is characterized by repeated self-administration that usually results in tolerance, withdrawal symptoms, and compulsive drug taking.

(21) "Opioid Agonist Medication" means any drug that is approved by the Food and Drug Administration under Section 505 of Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355) for use in the treatment of opiate addiction.

(22) "Opioid Treatment Program (OTP) means a program that dispenses and administers opioid agonist medications in conjunction with appropriate counseling, supportive, and medical services.

(23) "Patient" means any individual who receives services in an opioid treatment program.

(24) "Patient Record" means the official legal written file for each patient, containing all the information required to demonstrate compliance with these rules. Information in program records maintained in electronic format must be able to be produced in a printed form, authenticated by signature, whether physical or digital, and date of the person who provided the service, and placed in the patient record.

(25) "Program" means an organized system of services and supports delivered by a provider designed to address the treatment needs of individuals and families.

(26) "Quality Assurance" means the process of objectively and systematically monitoring and evaluating the appropriateness of patient care to identify and resolve identified problems.

(27) "Rehabilitation" means those services, such as vocational rehabilitation or academic education, which assist in overcoming the problems associated with drug abuse or drug dependence and which enable the patient to function at their highest potential.

(28) "State Opioid Treatment Authority" means the State Opioid Treatment Authority designated pursuant to section 409 of Public Law 92-255, the Drug Abuse Office and Treatment Act of 1972, or in lieu thereof, any other State authority designated by the Governor for purposes of exercising the authority under this section. The State Opioid Treatment Authority for Oregon is the Oregon Health Authority designee to serve in that role.

(29) "Treatment" means the specific medical and non-medical therapeutic techniques employed to assist the patient in recovering from drug abuse or drug dependence.

(30) "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.

(31) "Volunteer" means a person who performs a service willingly and without pay.

History

Statutory/Other Authority: ORS 430.256
Statutes/Other Implemented: ORS 430.010(4)(b) & 430.560 - 430.590
ADS 2-2023, amend filed 04/07/2023, effective 04/07/2023
ADS 1-2022, amend filed 03/25/2022, effective 03/28/2022
ADS 3-2021, temporary amend filed 09/29/2021, effective 10/01/2021 through 03/29/2022
ADS 2-2021, temporary amend filed 09/21/2021, effective 10/01/2021 through 03/29/2022
ADS 9-2016, f. & cert. ef. 12-14-16
ADS 6-2016(Temp), f. & cert. ef. 8-10-16 thru 2-5-17
ADS 5-2013, f. & cert. ef. 6-7-13
ADS 2-2008, f. & cert. ef. 11-13-08
ADS 1-2003, f. 6-13-03, cert. ef. 7-1-03
ADAP 3-1995, f. 12-1-95, cert. ef. 3-1-96
HR 17-1993, f. & cert. ef. 7-23-93, Renumbered from 410-006-0005
HR 4-1988, f. & cert. ef. 5-10-88

Or. Admin. R. 415-020-0010 Program Approval

(1) Letter of Approval: No person or governmental entity shall operate an Opioid Treatment Program (OTP) without a letter of approval from the State Opioid Treatment Authority in Oregon.

(2) Application: To receive a certificate for the provision of behavioral health treatment services an OTP must meet the criteria under OAR 309-008-0100 to 309-008-1600; in addition, the OTP must:

(a) Meet the standards set forth in these rules and any other administrative rules applicable to the program;

(b) Comply with the federal regulations contained in 42 CFR Part 2 and 42 CFR Part 8;

(c) Submit documentation of accreditation as an opioid treatment program by an accreditation body approved by the Federal Substance Abuse and Mental Health Services Administration (SAMHSA) under 42 CFR Part 8; and

(d) Specify in the application the identity and financial interest of any person (if the person is a corporation, the name of any stockholder holding stock representing an interest of 5 percent or more) or other legal entity who has an interest of 5 percent or more or 5 percent of a lease agreement for the facility.

(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.

(5) Federal Protocols: The program shall be responsible for filing and maintaining all necessary protocols and documentation required by the National Institute on Drug Abuse (NIDA), the Federal Substance Abuse and Mental Health Services Administration (SAMHSA), and the Federal Drug Enforcement Administration (DEA).

History

Statutory/Other Authority: ORS 430.256
Statutes/Other Implemented: ORS 430.010(4)(b) & 430.560 - 430.590
ADS 2-2023, amend filed 04/07/2023, effective 04/07/2023
ADS 1-2022, amend filed 03/25/2022, effective 03/28/2022
ADS 3-2021, temporary amend filed 09/29/2021, effective 10/01/2021 through 03/29/2022
ADS 2-2021, temporary amend filed 09/21/2021, effective 10/01/2021 through 03/29/2022
ADS 9-2016, f. & cert. ef. 12-14-16
ADS 6-2016(Temp), f. & cert. ef. 8-10-16 thru 2-5-17
ADS 2-2008, f. & cert. ef. 11-13-08
ADS 1-2003, f. 6-13-03, cert. ef. 7-1-03
ADAP 3-1995, f. 12-1-95, cert. ef. 3-1-96
HR 17-1993, f. & cert. ef. 7-23-93, Renumbered from 410-006-0010
HR 4-1988, f. & cert. ef. 5-10-88

Or. Admin. R. 415-020-0015 Administrative Requirements

(1) Administrative Rules: An Opioid Treatment Program which obtains reimbursement for publicly funded services shall comply with the public contracting rules including but not limited to:

(a) OAR 309-013-0020;

(b) OAR 309-013-0075 to 309-013-0105;

(d) OAR 309-016-0000 to 309-016-0130;

(e) OAR 410-120-0000 through 410-120-1980; and

(f) OAR 410-141-0000 through 410-141-0860.

(2) Policies and Procedures: An Opioid Treatment Program shall develop and implement written policies and procedures, which describe program operations. This shall include a quality assurance process that ensures that patients receive appropriate treatment services and that the program is in compliance with relevant administrative rules.

(3) Personnel Policies: If two or more staff provide services, the program shall have and implement the following written personnel policies and procedures which are applicable to program staff:

(a) Rules of program staff conduct and standards for ethical practices of treatment program practitioners;

(b) Standards for program staff use and abuse of alcohol and other drugs with procedures for managing incidences of use and abuse that, at a minimum, comply with Drug Free Workplace Standards; and

(c) Compliance with the federal and state personnel regulations including the Civil Rights Act of 1964 as amended in 1972, Equal Pay Act of 1963, the Age Discrimination in Employment Act of 1967, Title I of the Americans with Disabilities Act, Oregon civil rights laws related to employment practices, and any subsequent amendments effective on or before the effective date of these rules. The opioid treatment program shall give individualized consideration to all job applicants who, with or without reasonable accommodation, can perform the essential functions of the job position.

(4) Personnel Records: Personnel records for each member of the program's work force, including staff or volunteers shall be kept and shall include:

(a) Resume or employment application, and job description;

(b) Documentation of applicable qualification standards as described in OAR 415-020-0075;

(c) For volunteers or interns or students, the record need only include information required by subsection (a) of this rule and the written work plan for such person.

(5) Confidentiality and Retention: Personnel records shall be maintained and utilized in such a way as to ensure program staff confidentiality and shall be retained for a period of three years following the departure of a program staff person.

(6) Disabilities Act: Programs receiving public funds must comply with Title 2 of the Americans with Disabilities Act of 1990, 42 USC § 1231 et al.

(7) Insurance: Each program shall maintain malpractice and liability insurance and be able to demonstrate evidence of current compliance with this requirement. If the program is operated by a public body, the program shall demonstrate evidence of insurance or a self-insurance fund pursuant to ORS 30.282.

(8) Prevention of Duplicate Dispensing: Opioid Treatment Programs will participate in any procedures, developed by the Division in consultation with opioid treatment providers, for preventing simultaneous dispensing of opioid agonist medications to the same patient by more than one program.

History

Statutory/Other Authority: ORS 430.256
Statutes/Other Implemented: ORS 430.010(4)(b) & 430.560 - 430.590
ADS 5-2013, f. & cert. ef. 6-7-13
ADS 2-2008, f. & cert. ef. 11-13-08
ADS 1-2003, f. 6-13-03, cert. ef. 7-1-03
ADAP 3-1995, f. 12-1-95, cert. ef. 3-1-96
HR 17-1993, f. & cert. ef. 7-23-93, Renumbered from 410-006-0015
HR 4-1988, f. & cert. ef. 5-10-88

Or. Admin. R. 415-020-0017 Patient Records

(1) Patient Recordkeeping: Each program shall:

(a) Accurately record all information about patients as required by these rules in the permanent patient record;

(b) Maintain each patient record to assure identification, accessibility, uniform organization, and completeness of all components required by these rules and in a manner to protect against damage or separation from the permanent patient or program record;

(c) Keep all documentation current .unless specified otherwise, within seven days of delivering the service or obtaining the information;

(d) Include the signature of the person providing the documentation and service;

(e) Not falsify, alter, or destroy any patient information required by these rules to be maintained in a patient record or program records;

(f) Document all procedures in these rules requiring patient consent and the provision of information to the patient on forms describing what the patient has been asked to consent to or been informed of, and signed and dated by the patient. If the program does not obtain documentation of consent or provision of required information, the reasons must be specified in the patient record and signed by the person responsible for providing the service to the patient;

(g) Require that errors in the permanent record be corrected by lining out the incorrect data with a single line in ink, adding the correct information, and dating and initialing the correction. Errors may not be corrected by removal or obliteration through the use of correction fluid or tape so they cannot be read; and

(h) Permit inspection of patient records upon request by the Division to determine compliance with these rules.

(2) Patient and Fiscal Record Retention: Patient records shall be kept for a minimum of seven years. If a program is taken over or acquired by another program, the original program is responsible for assuring compliance with the requirements of 42 CFR § 2.19(a)(1) or (b), whichever is applicable. If a program discontinues operations, the program is responsible for:

(a) Transferring fiscal records required to be maintained under section (1) of this rule to the Division if it is a direct contract or to the community mental health program or managed care plan administering the contract, whichever is applicable; and

(b) Destroying patient records or, with patient consent, transferring patient records to another program.

History

Statutory/Other Authority: ORS 430.256
Statutes/Other Implemented: ORS 430.010(4)(b) & 430.560 - 430.590
ADS 5-2013, f. & cert. ef. 6-7-13

Or. Admin. R. 415-020-0020 Patient Rights

(1) Patient Record Confidentiality: An Opioid Treatment Program (OTP) shall comply with federal regulations (42 CFR part 2, 45 CFR 205.50) and state statutes (ORS 179.505 and 430.399) pertaining to confidentiality of patient records.

(2) Informed Consent: Participation in an OTP shall be voluntary. Patients shall be fully informed concerning possible risks and side effects associated with the use of opioid agonist medications, including the effects of alcohol and other drugs taken in combination with these drugs. Programs must inform patients of the differences between the action of all drugs dispensed. The program shall ensure that all relevant facts concerning the use of opioid agonist medications are clearly and adequately explained to the patient and that the patient gives written informed consent to treatment. A copy of the information above, signed by the patient, must be placed in the patient record.

(3) Allowable Restrictions: No person shall be denied services or 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.

(4) Policies and Procedures: Each patient shall be assured the same civil and human rights as other persons. Each program shall develop and implement and inform patients of written policies and procedures which protect patients' rights, including:

(a) Protecting patient privacy and dignity;

(b) Assuring confidentiality of records consistent with federal and state laws;

(d) Prohibiting sexual abuse or sexual contact between patients and staff, including volunteers, interns, and students; and

(e) Providing adequate treatment or care.

(5) Services Refusal: The patient shall have the right to refuse service, including any specific procedure. If consequences may result from refusing the service, such as termination from other services or referral to a person having supervisory authority over the patient, that fact must be explained verbally and in writing to the patient.

(6) Access to Records: Access includes the right to obtain a copy of the record within five days of requesting it and making payment for the cost of duplication. The patient shall have the right of access to the patient's own records except:

(a) When the medical director of the program determines that disclosure of records would constitute immediate and grave detriment to the patient's treatment; or

(b) If confidential information has been provided to the program on the basis that the information not be redisclosed.

(7) Informed Participation in Treatment Planning: The patient and others of the patient's choice shall be afforded an opportunity to participate in an informed way in planning the treatment services, including the review of progress toward treatment goals and objectives. Patients shall be free from retaliation for exercising their rights to participate in the treatment planning process.

(8) Informed Consent to Fees for Services: The amount and schedule of any fees or co-payments to be charged must be disclosed in writing and agreed to by the patient. The fee agreement shall include but is not limited to a schedule of rates, conditions under which the rates can be changed, and the program's policy on refunds at the time of discharge or departure.

(9) Grievance Policy: The program shall develop, implement, and fully inform patients of policy and procedure regarding grievances, which provide for:

(a) Receipt of written grievances from patients or persons acting on their behalf;

(b) Investigation of the facts supporting or disproving the written grievance;

(d) Documentation in the patient's record of the receipt, investigation, and any action taken regarding the written grievance.

(10) Barriers to Treatment: Where there is a barrier to services due to culture, language, illiteracy, or disability, the program shall develop a holistic treatment approach to address or overcome those barriers. This may include:

(a) Making reasonable modifications in policies, practices, and procedures to avoid discrimination (unless the program can demonstrate that doing so would fundamentally alter the nature of the service, program, or activity) such as:

(A) Providing individuals capable of assisting the program in minimizing barriers (such as interpreters);

(B) Translation of written materials to appropriate language or method of communication;

(D) To the degree possible, acknowledging cultural and other values, which are important to the patient.

(b) Not charging patients for costs of the measures, such as the provision of interpreters, that are required to provide nondiscriminatory treatment to the patient; and

(c) Referring patients to another provider if that patient requires treatment outside of the referring program's area of specialization and if the program would make a similar referral for an individual without a disability.

(11) Patient Work Policy: Any patient labor performed as part of the patient's treatment plan or standard program expectations or in lieu of fees shall be agreed to, in writing, by the patient

(12) Voter Registration: All publicly funded programs primarily engaged in providing services to persons with disabilities must provide onsite voter registration and assistance. Program staff providing voter registration services may not seek to influence an applicant's political preference or party registration or display any such political preference or party allegiance, such as buttons, expressing support for a particular political party or candidates for partisan political office. However, such program staff may wear buttons or otherwise display their preference on nonpartisan political matters and issues.

History

Statutory/Other Authority: ORS 430.256
Statutes/Other Implemented: ORS 430.010(4)(b) & 430.560 - 430.590.
ADS 2-2023, amend filed 04/07/2023, effective 04/07/2023
ADS 2-2008, f. & cert. ef. 11-13-08
ADS 1-2003, f. 6-13-03, cert. ef. 7-1-03
ADAP 3-1995, f. 12-1-95, cert. ef. 3-1-96
HR 17-1993, f. & cert. ef. 7-23-93, Renumbered from 410-006-0020
HR 4-1988, f. & cert. ef. 5-10-88

Or. Admin. R. 415-020-0025 Admission Policies and Procedures

(1) Admission Criteria: The Opioid Treatment Program (OTP) shall have written criteria for accepting or rejecting admission requests. The criteria shall be available to patients, staff, and the community, and require:

(a) Evidence of current physical dependence on narcotics or opiates as determined by the program physician, medical director, or a qualified nurse practitioner, or physicians’ assistant;

(b) A one-year history, immediately prior to admission, of a continuous physical dependence on narcotics or opiates as documented by medical records, records of arrests for possession of narcotics, or records from drug treatment programs; or

(c) Documentation that medically supervised withdrawal or medically supervised withdrawal with acupuncture and counseling has proven ineffective or that a physician licensed by the Oregon Medical Board has documentation in the patient record that there is a medical need to administer opioid agonist medications;

(d) Documentation that an initial urinalysis test has been completed and screened for opiates, methadone, benzodiazepines, barbiturates, cocaine, amphetamines, and Tetrahydrocannabinol (THC);

(e) That each patient voluntarily chooses opioid treatment and that all relevant facts concerning the use of an opioid agonist drug have been clearly and adequately explained;

(f) Documentation that the patient has provided written informed consent to treatment.

(2) Admission Criteria Exceptions: If clinically appropriate, the program physician may waive the requirement for a one-year history of opioid addiction for patients who:

(a) Have been released from a corrections facility within the previous six months;

(b) Are pregnant and whose pregnancy has been verified by the program physician;

(d) Has a resent history of overdose or release from hospital or other acute care setting due complications of opioid use or opioid overdose.

(3) Refusing Admissions: A patient may be refused opioid treatment even if the patient meets admission standards if, in the professional judgment of the medical director, a particular patient would not benefit from opioid treatment. The reasons for the refusal must be documented in the patient file within seven days following the refusal decision.

(4) Minors: No person under 18 years of age may be admitted to an OTP unless:

(a) A parent, legal guardian, or responsible adult designated by the State provides written consent for treatment; and

(b) The program can document two unsuccessful attempts at short-term medically supervised withdrawal or drug free treatment within a 12-month period.

(5) Pregnant Patients: Admission and treatment of pregnant patients regardless of age is allowed under the following conditions:

(a) The patient has had a documented narcotic dependency in the past and may be in direct jeopardy of returning to narcotic dependency. For such patients, evidence of current physiological dependence on narcotic drugs is not needed if a program physician certifies the pregnancy and, in their reasonable clinical judgment, finds treatment to be medically justified. Evidence of all findings and the criteria used to determine the findings are required to be recorded in the patient's record by the admitting program physician, or by program personnel supervised by the admitting program physician;

(b) The patient undergoes a prenatal exam and health check to verify the pregnancy and identify any health problems;

(c) The patient is given the opportunity for prenatal care either by the program or by referral to appropriate health care providers. If a program cannot provide direct prenatal care for pregnant patients in treatment, the program shall establish a system for informing the patient of the publicly or privately funded prenatal care opportunities available. If there are no publicly funded prenatal referral opportunities and the program cannot provide such services or the patient cannot afford them or refuses them, then the treatment program shall, at a minimum, offer her basic prenatal instruction on maternal, physical, and dietary care as part of its counseling service;

(d) The patient is fully informed concerning risks to themself and their unborn child from the use of methadone and other drugs, including alcohol.

(6) Intake Procedures: The program shall utilize a written intake procedure. The procedure shall require:

(a) Documentation that the medical director has:

(A) Examined and approved all admissions;

(B) Recorded in the patient's record the criteria used to determine the patient's current dependence and history of addiction; and

(b) A specific time limit within which the initial patient assessment must be completed on each patient prior to the initial dose of an opioid agonist treatment medication;

(7) Orientation Information: The program shall give to, and document the receipt of, written program orientation information. The program shall also make the information available to others. The information given shall include:

(a) The program's philosophical approach to treatment;

(b) A description of the program's stages of treatment;

(d) Information on the rules governing patient behavior and those infractions that may result in discharge or other actions. As a minimum these rules shall state the consequence of alcohol and other drug use, absences from appointments, non-payment of fees, criminal behavior, and failure to participate in the planned treatment program including school, work, or homemaker activities;

(e) Information on the specific hours of service available, methods to accommodate patient needs before and after normal working hours, and emergency services information; and

(f) A schedule of fees and charges.

(8) Patient Record: The following information shall be recorded in each patient's record at the time of admission:

(a) Name, address, and telephone number;

(b) Whom to contact in case of an emergency;

(d) If the patient refuses to provide necessary information, documentation of that fact in the patient file.

(9) Initial Medical Examination Services: OTPs shall require each patient to undergo a complete, fully documented physical evaluation by a physician, or medical professional under the supervision of a physician before admission to the program. The laboratory tests must be completed within 14 days of admission and must include:

(a) A skin test for tuberculosis, followed by a chest x-ray if the test is positive;

(b) A screening test for syphilis; and

History

Statutory/Other Authority: ORS 430.256
Statutes/Other Implemented: ORS 430.010(4)(b) & 430.560 - 430.590
ADS 2-2023, amend filed 04/07/2023, effective 04/07/2023
ADS 1-2022, amend filed 03/25/2022, effective 03/28/2022
ADS 3-2021, temporary amend filed 09/29/2021, effective 10/01/2021 through 03/29/2022
ADS 2-2021, temporary amend filed 09/21/2021, effective 10/01/2021 through 03/29/2022
ADS 2-2008, f. & cert. ef. 11-13-08
ADS 1-2003, f. 6-13-03, cert. ef. 7-1-03
ADAP 3-1995, f. 12-1-95, cert. ef. 3-1-96
HR 17-1993, f. & cert. ef. 7-23-93, Renumbered from 410-006-0025
HR 4-1988, f. & cert. ef. 5-10-88

Or. Admin. R. 415-020-0030 Diagnostic Assessment

(1) Written Procedure: The Opioid Treatment Program shall develop and implement a written procedure for assessing each patient's treatment needs consistent with The ASAM Criteria .

(2) The diagnostic assessment shall be documented in the permanent patient record. It shall consist of the elements described in The ASAM Criteria and documentation of the patient's self-identified cultural background. Cultural information documented should include level of acculturation, knowledge of own culture, primary language, spiritual or religious interests, and cultural attitudes toward alcohol and other drug use.

History

Statutory/Other Authority: ORS 430.256
Statutes/Other Implemented: ORS 430.010(4)(b) & 430.560 - 430.590
ADS 2-2023, amend filed 04/07/2023, effective 04/07/2023
ADS 2-2008, f. & cert. ef. 11-13-08
ADS 1-2003, f. 6-13-03, cert. ef. 7-1-03
ADAP 3-1995, f. 12-1-95, cert. ef. 3-1-96
HR 17-1993, f. & cert. ef. 7-23-93, Renumbered from 410-006-0030
HR 4-1988, f. & cert. ef. 5-10-88

Or. Admin. R. 415-020-0035 Treatment Planning and Documentation of Treatment Progress

(1) The Opioid Treatment Program (OTP) shall develop treatment plans, progress notes, and discharge plans consistent with The ASAM Criteria .

(2) Treatment Plan: The OTP shall develop an individualized treatment plan within 30 days of admission and shall be documented in the patient's record. The treatment plan shall:

(a) Describe the primary patient-centered issues;

(b) Focus on one or more individualized treatment plan objectives that are consistent with the patient's strengths and abilities and that address the primary obstacles to recovery;

(c) Define the treatment approach, which shall include services and activities to be used to achieve the individualized objectives;

(d) Document the participation of significant others in the planning process and the treatment where appropriate; and

(e) Document the patient's participation in developing the content of the treatment plan and any subsequent modifications, with the patient's signature.

(3) Documentation of Progress: The treatment staff shall document in the permanent record any current obstacles to recovery and the patient's progress toward achieving the individualized objectives in the treatment plan.

(4) Treatment Plan Review: The permanent patient record shall document that the treatment plan is reviewed and modified continuously as needed and as clinically appropriate, consistent with The ASAM Criteria,

(5) Modifications: Changes in the patient's treatment needs identified by the review process must be addressed by modifications in the treatment plan. Any modifications to the treatment plan shall be made in conjunction with the patient.

(6) Treatment Summary: No later than 30 days after the last service contact, the program shall document in the permanent patient record a summary describing the contact and the patient’s progress toward the treatment objectives, consistent with The ASAM Criteria and any reason for discharge.

(7) Discharge Plan: Upon successful completion or planned interruption of the treatment services, the treatment staff and patient shall jointly develop a discharge plan. The discharge plan shall include a relapse prevention plan, which has been jointly developed by the counselor and patient.

History

Statutory/Other Authority: ORS 430.256
Statutes/Other Implemented: ORS 430.010(4)(b) & 430.560 - 430.590
ADS 2-2023, amend filed 04/07/2023, effective 04/07/2023
ADS 2-2008, f. & cert. ef. 11-13-08
ADS 1-2003, f. 6-13-03, cert. ef. 7-1-03
ADAP 3-1995, f. 12-1-95, cert. ef. 3-1-96
HR 17-1993, f. & cert. ef. 7-23-93, Renumbered from 410-006-0035
HR 4-1988, f. & cert. ef. 5-10-88

Or. Admin. R. 415-020-0040 Treatment Services General

(1) Treatment Services: The Opioid Treatment Program (OTP) shall provide patients the following services and activities and document the time or manner of each service or activity in the patient record:

(a) Dispensing of approved opioid agonist medications;

(b) Individual group, or family counseling, as clinically indicated;

(d) HIV, AIDS, tuberculosis, sexually transmitted diseases, and other infectious disease information;

(e) Completion of HIV, TB, STD risk assessment within 30 days of admission;

(f) Relapse prevention training; and

(g) For pregnant patients in a treatment program who were not admitted under OAR 415-020-0025(5), a treatment program shall give them the opportunity for prenatal care. If a program cannot provide direct prenatal care for pregnant patients in treatment, it shall establish a system of referring them for prenatal care, which may be either publicly or privately funded. If there is no publicly funded prenatal care available to which a patient may be referred, and the program cannot provide such services, or the patient cannot afford or refuses prenatal care services, then the treatment program shall, at a minimum, offer them basic prenatal instruction on maternal, physical, and dietary care as a part of its counseling service.

(2) Community Resources: The program, to the extent of community resources available and as clinically indicated, shall provide patients with information and referral to the following services:

(a) Self-help groups and other support groups;

(b) Educational services;

(d) Prevocational, occupational, and vocational rehabilitation;

(e) Life skills training;

(f) Legal services;

(g) Smoking cessation programs;

(h) Medical services;

(i) Housing assistance;

(j) Financial assistance counseling programs;

(k) Crisis intervention; and

(l) Comprehensive drug education.

(3) Non-compliance: Patients who are non-compliant with program rules may be discharged following medically supervised withdrawal. Clinical justification for medically supervised withdrawal schedules of less than 21 days must be documented in the patient record. For discharges because of failure to pay fees, detoxification periods of less than 21 days are not permitted.

(4) Testing for Drug Use: The program shall use observed urine drug screening as an aid in monitoring and evaluating a patient's progress in treatment. The urine drug screening shall include;

(a) A sensitive, rapid, and inexpensive immunoassay screen to eliminate "true negative" specimens; and

(b) If the initial test is positive, a confirmatory test, which is a second analytical procedure used to identify the presence of a specific drug or metabolite in a urine specimen. The confirmatory test must be conducted by a different analytical method from that of the initial test, to ensure reliability and accuracy.

(5) Standards for Urine Tests: All urine tests shall be performed by laboratories meeting the licensing standards of OAR 333-024-0305 through 333-024-0365.

(6) All urine tests shall, at a minimum, screen for synthetic opiates, opiates, amphetamines, cocaine, and benzodiazepines..

(7) Frequency of urine testing: The OTP must provide adequate testing or analysis for drugs of abuse, including at least eight random drug abuse tests per year, for each patient in maintenance treatment, in accordance with generally accepted clinical practice. More frequent drug testing shall be done if clinically indicated. The program shall document in the patient record the results of any tests and interventions made by the program to address those tests which are positive for illicit substances.

History

Statutory/Other Authority: ORS 430.256
Statutes/Other Implemented: ORS 430.010(4)(b) & 430.560 - 430.590
ADS 2-2023, amend filed 04/07/2023, effective 04/07/2023
ADS 2-2008, f. & cert. ef. 11-13-08
ADS 1-2003, f. 6-13-03, cert. ef. 7-1-03
ADAP 3-1995, f. 12-1-95, cert. ef. 3-1-96
HR 17-1993, f. & cert. ef. 7-23-93, Renumbered from 410-006-0040
HR 4-1988, f. & cert. ef. 5-10-88

Or. Admin. R. 415-020-0050 Transitional Treatment

(1) The Opioid Treatment Program shall provide transitional care for patients for who continued opioid agonist medication maintenance is no longer deemed appropriate.

(2) Transitional treatment services shall be provided with the purpose of assisting the patient to establish and maintain a stable, drug-free lifestyle. Transitional treatment will help prepare the patient to begin a reduction in opioid agonist medication dosage and shall be continued while the patient undergoes reduction in doses. The treatment shall continue following the final dose of opioid agonist medication, consistent with the clinical needs of the patient and consistent with The ASAM Criteria .

History

Statutory/Other Authority: ORS 430.256
Statutes/Other Implemented: ORS 430.010(4)(b) & 430.560 - 430.590
ADS 2-2023, amend filed 04/07/2023, effective 04/07/2023
ADS 2-2008, f. & cert. ef. 11-13-08
ADS 1-2003, f. 6-13-03, cert. ef. 7-1-03
ADAP 3-1995, f. 12-1-95, cert. ef. 3-1-96
HR 17-1993, f. & cert. ef. 7-23-93, Renumbered from 410-006-0050
HR 4-1988, f. & cert. ef. 5-10-88

Or. Admin. R. 415-020-0053 Unsupervised Use of Opioid Agonist Medications

(1) Any patient in comprehensive maintenance treatment may receive a single take-home dose for a day that the clinic is closed for business, including Sundays, and state or federal holidays.

(2) Decisions on dispensing opioid treatment medications to patients for unsupervised use shall be made by the program medical director. In determining whether a patient is responsible in handling opioid medications and may be permitted unsupervised use, the medical director shall consider the following criteria;

(a) Absence of drugs of abuse, including alcohol;

(b) Regularity of program attendance;

(d) Absence of criminal activity while enrolled at the program;

(e) Stability of the patient's home environment and social relationships;

(f) Length of time in comprehensive maintenance treatment;

(g) Assurance that take-home medication can be safely stored in the patient's home; and

(h) Whether the rehabilitative benefit the patient derives from decreasing the frequency of program attendance outweighs the potential risks of diversion.

(3) Decisions to approve unsupervised use of opioid medications, including the rationale for the approval, shall be documented in the patient record.

(4) If it is determined that a patient is responsible in handling opioid agonist medications, the supply shall be limited to the following schedule;

(a) During the first 90 days of treatment, the take-home supply is limited to a single dose each week, in addition to take-home doses allowed when the clinic is closed;

(b) During the second 90 days of treatment, the take-home supply is limited to two doses per week, in addition to take-home doses allowed when the clinic is closed;

(c) During the third 90 days of treatment, the take-home supply is limited to three doses per week, in addition to take-home doses allowed when the clinic is closed;

(d) In the remaining months of the first year, a patient may be given a maximum 6-day supply of take-home medication;

(e) After one year of continuous abstinence in treatment, a patient may be given a maximum two-week supply of take-home medication;

(f) After two years of continuous abstinence treatment, a patient may be given a maximum one-month supply of take-home medication.

(5) The dispensing restrictions set forth in 4(a) through 4(f) of this rule do not apply to the partial agonist opioid medication, buprenorphine and buprenorphine products. Patients must meet criteria established in 2(a) through 2(h) of this rule for unsupervised use of buprenorphine and buprenorphine products.

History

Statutory/Other Authority: ORS 413.042 & 430.256
Statutes/Other Implemented: ORS 430.010 & 430.560 - 430.590
ADS 5-2013, f. & cert. ef. 6-7-13
ADS 1-2013(Temp), f. 1-11-13, cert. ef. 1-14-13 thru 7-12-13
ADS 2-2008, f. & cert. ef. 11-13-08
ADS 1-2003, f. 6-13-03, cert. ef. 7-1-03

Or. Admin. R. 415-020-0054 Diversion Control Plan

Each Opioid Treatment Program shall have a diversion control plan to reduce possibilities for diversion of controlled substances from legitimate treatment to illicit use. The plan shall include the following;

(1) A mechanism for continuous monitoring of clinical and administrative activities, to reduce the risk of medication diversion; and

(2) A mechanism for problem identification, prevention, and correction of diversion problems.

History

Statutory/Other Authority: ORS 430.256
Statutes/Other Implemented: ORS 430.010(4)(b) & 430.560 - 430.590
ADS 2-2008, f. & cert. ef. 11-13-08
ADS 1-2003, f. 6-13-03, cert. ef. 7-1-03

Or. Admin. R. 415-020-0060 Medically Supervised Withdrawal

(1) This section contains special provisions that apply to medically supervised withdrawal. Except as otherwise noted in this section, all requirements in the other sections of this rule apply to medically supervised withdrawal as well as comprehensive maintenance treatment patients.

(2) Admission Criteria: The opioid treatment program must establish current physical dependence on narcotics or opiates by way of grade 2 withdrawal symptoms. A one year history of dependence is not required for medically supervised withdrawal.

(3) Readmissions: Patients with two or more unsuccessful medically supervised withdrawal episodes within a 12 month period must be assessed by the Opioid Treatment Program physician for other forms of treatment. A program shall not admit a patient for more than two medically supervised withdrawal episodes in one year.

(4) Medically Supervised Withdrawal Contract: Before initial dosing of the patient, the program shall develop a contract with the patient that shall be dated and signed by the counselor and the patient, and shall specify:

(a) Maximum length of medically supervised withdrawal treatment, which may not exceed 180 days, and a rationale for the length chosen. Subsequent changes in length of medically supervised withdrawal must also be accompanied by a rationale.

(b) Required abstinence from alcohol and other drugs during medically supervised withdrawal treatment;

(d) Take-out dose limits;

(e) Consequences regarding missed doses;

(f) Urine drug screening procedures;

(g) Consequences of failure to carry out the medically supervised withdrawal contract including involuntary termination;

(h) Criteria for involuntary termination

(5) Assessment: The program shall develop and implement a written procedure for assessing each patient's medically supervised withdrawal needs following initial dosing. The procedure shall specify that the assessment and evaluation is the responsibility of a member of the treatment staff, shall be recorded in the patient record, and shall include:

(a) Alcohol and drug use and problems history;

(b) Psychological history;

(d) History of previous treatment.

(6) Planning: Individualized medically supervised withdrawal planning shall occur and be documented in the patient's record within seven working days to include:

(a) Initial dose level and a planned reduction schedule that shall be completed within 180 days;

(b) Referral to appropriate agencies for needs identified during the intake assessment and procedure; and

(7) Treatment: Each patient shall be assigned a counselor who shall:

(a) Meet at least weekly with the patient;

(b) Monitor the patient's response to the withdrawal schedule;

(d) Maintain the patient's record; and

(e) Monitor patient compliance with the medically supervised withdrawal contract.

(8) Take-Out Doses: Take-home medication is not allowed for medically supervised withdrawal treatment planned for 30 days or less. For medically supervised withdrawal treatment planned for longer than 30 days the program shall use the time frames and criteria established for maintenance patients.

(9) Discharge: An opioid treatment program shall discharge a patient who misses two consecutive doses unless an adequate explanation for the absences has been reviewed and approved by the medical director.

(10) Urinalysis: The program shall collect and test one random urine drug screen for each patient per week. Documentation of a specific clinical intervention shall accompany documentation of any positive urine sample and shall be followed by documentation of the effectiveness of the intervention in subsequent progress notes.

History

Statutory/Other Authority: ORS 430.256
Statutes/Other Implemented: ORS 430.010(4)(b) & 430.560 - 430.590
ADS 5-2013, f. & cert. ef. 6-7-13
ADS 2-2008, f. & cert. ef. 11-13-08
ADS 1-2003, f. 6-13-03, cert. ef. 7-1-03
ADAP 3-1995, f. 12-1-95, cert. ef. 3-1-96
HR 17-1993, f. & cert. ef. 7-23-93, Renumbered from 410-006-0060
HR 4-1988, f. & cert. ef. 5-10-88

Or. Admin. R. 415-020-0065 Opioid Agonist Medication Administration

(1) The Opioid Treatment Program (OTP) shall meet the following standards for opioid agonist medication for administration:

(a) Methadone shall be administered only in oral form and shall be formulated in such a way as to reduce its potential for abuse by injection and accidental ingestion;

(b) Packaged for outpatient use in special packaging as required by 16 CFR Part 1700.14.

(2) Methadone Take-Out Doses: For take-out doses, the Poison Prevention Act (P.L. 91-601, 15 USC 1471 et seq.) must be followed. Any take-out medication must be in oral form, either liquid or diskette and shall be labeled with the OTP name, address, telephone number, and medical director. All labeling shall be in compliance with the Oregon Board of Pharmacy standards.

(3) OTPs shall maintain current procedures to ensure that each opioid agonist treatment medication used by the program is administered in accordance with its approved product labeling.

(4) Records: Accurate records traceable to specific patients shall be maintained showing dates, quantity, and any other Board of Pharmacy required identification for the drug administered and shall be retained for a period of seven years.

(5) Security: The program shall meet security standards for the distribution and storage of controlled substances as required by the Federal Drug Enforcement Administration, Department of Justice.

(6) Who May Administer Opioid Agonist Treatment Medications: Medications shall be administered by:

(a) A practitioner licensed or registered under appropriate State or Federal law to order narcotic drugs for patients; or

(b) A person licensed or approved by the State Board of Nursing or the State Board of Pharmacy, supervised by and pursuant to the order of the practitioner.

(7) Responsibility: The licensed practitioner is fully accountable and personally responsible for the amounts of opioid agonist treatment medications administered.

(8) Documentation: All changes in dosage schedule will be recorded and signed by the licensed practitioner.

(9) Medical Director: The medical director shall:

(a) Assume responsibility for the amounts of opioid agonist treatment medications administered; and

(b) Review each patient's dosage level at least once every 90 days.

(10) Initial Dose: The initial dose of methadone should not exceed 30 milligrams and the total dose for the first day should not exceed 40 milligrams unless the program medical director documents in the patient's record that 40 milligrams did not suppress opiate abstinence symptoms. The initial dose of opioid agonist treatment medication to a patient whose tolerance for the drug is unknown shall not exceed 40 milligrams.

(11) Maintenance Dose: The maintenance dose should be individually determined with careful attention to the information provided by the patient. The dose should be determined by a physician, nurse practitioner, or physicians’ assistant experienced in addiction treatment and should be adequate to achieve the desired effects for 24 hours or more. The desired effects are;

(a) Preventing the onset of opioid abstinence syndrome;

(b) Reducing drug cravings or hunger; and

(12) All changes ordered by a physician, nurse practitioner, or physicians’ assistant in the opioid agonist treatment medication shall be documented in the patient record, and each change in the dosage schedule shall be recorded, dated, and signed in each patient's record.

(13) Methadone Take Out Schedule: A patient may be permitted a temporary or permanently increased take-out schedule if it is the reasonable clinical judgment of the program physician and documented in the records that:

(a) A patient is found to have a physical disability which interferes with the patient's ability to conform to the applicable take-out schedule; or

(b) A patient, because of critical circumstances such as illness, personal or family crises, or other hardship is unable to conform to the applicable takeout schedule; and

(14) Patient Treatment at Another Program: The patient shall report to the same OTP unless prior written approval is obtained from the program physician allowing the patient to receive treatment at another program. If permission is granted, the programs involved shall meet the following requirements:

(a) The program referring the patient shall notify and obtain, in writing, permission from the other program for the patient to attend;

(b) During attendance at another program the patient may not receive more opioid agonist treatment medication take-out doses than currently authorized by their regular program; and

(c) The program making the referral shall provide the patient with positive identification for presentation to the other program.

History

Statutory/Other Authority: ORS 430.256
Statutes/Other Implemented: ORS 430.010(4)(b) & 430.560 - 430.590
ADS 2-2023, amend filed 04/07/2023, effective 04/07/2023
ADS 1-2022, amend filed 03/25/2022, effective 03/28/2022
ADS 3-2021, temporary amend filed 09/29/2021, effective 10/01/2021 through 03/29/2022
ADS 2-2021, temporary amend filed 09/21/2021, effective 10/01/2021 through 03/29/2022
ADS 2-2008, f. & cert. ef. 11-13-08
ADS 1-2003, f. 6-13-03, cert. ef. 7-1-03
ADAP 3-1995, f. 12-1-95, cert. ef. 3-1-96
HR 17-1993, f. & cert. ef. 7-23-93, Renumbered from 410-006-0065
HR 4-1988, f. & cert. ef. 5-10-88

Or. Admin. R. 415-020-0070 Medical Services

(1) There shall be at least one program physician, licensed nurse practitioner or licensed physicians’ assistant available to supervise the initial medical evaluation, supervise follow-up care and to supervise the patient medication schedules, who is licensed under the appropriate State law and registered under the appropriate State and Federal laws to order narcotic drugs for patients.

(2) The licensed physician, licensed nurse practitioner or licensed physicians’ assistant assumes responsibility for the amounts of narcotic drugs administered or dispensed and shall record and countersign all changes in the dosage schedule.

(3) Licensed nurse practitioners or licensed physicians’ assistants are only allowed to order and approve dosages or changes in dosage schedule if the program in question has received prior approval from the State Opioid Treatment Authority or their designated alternate.

(4) Administering of narcotic agonist medications shall be performed by a registered nurse, licensed practical nurse, or other healthcare professional authorized by federal and state law to administer narcotic agonist medications under the direction and supervision of the program administrator.

(5) Dispensing services shall be provided under the direction and supervision of the program physician, provided that the agent is a pharmacist or other healthcare professional authorized under federal and state law to dispense narcotic agonist medications.

(6) The medical director shall assure that the program's medical services are in full compliance with the standards, ethics, and licensure requirements of the medical profession and these rules.

(7) The program shall adopt, maintain, and implement written procedures for acquiring patient physical examinations including medical histories and any laboratory tests or other special examination required by the medical director including the required content of those examinations and procedures. The medical director shall review and approve all such examination procedures. Physical examinations shall be completed before administering the first dose of an opioid agonist medication.

(8) The opioid treatment program shall adopt, maintain, and implement a policy and procedure to maintain the health and safety of patients and staff. This shall include:

(a) Control measures for infectious diseases such as hepatitis, tuberculosis, and AIDS;

(b) Informed consent for testing and medical treatment; and

History

Statutory/Other Authority: ORS 430.256
Statutes/Other Implemented: ORS 430.010(4)(b) & 430.560 - 430.590
ADS 1-2022, amend filed 03/25/2022, effective 03/28/2022
ADS 3-2021, temporary amend filed 09/29/2021, effective 10/01/2021 through 03/29/2022
ADS 2-2021, temporary amend filed 09/21/2021, effective 10/01/2021 through 03/29/2022
ADS 2-2008, f. & cert. ef. 11-13-08
ADS 1-2003, f. 6-13-03, cert. ef. 7-1-03
ADAP 3-1995, f. 12-1-95, cert. ef. 3-1-96
HR 17-1993, f. & cert. ef. 7-23-93, Renumbered from 410-006-0070
HR 4-1988, f. & cert. ef. 5-10-88

Or. Admin. R. 415-020-0075 Specific Staff Qualifications and Competencies

(1) Medical Director Qualifications: The Medical Director must be a physician licensed by the Oregon Board of Medical Examiners and whose license enables him or her to order, dispense, and administer opioid agonist medications. In addition, the Opioid Treatment Program (OTP) shall document that the Medical Director has completed a minimum of 12 hours per year of continuing education specific to the treatment of addiction disorder.

(2) Administrator — Qualifications: Each OTP shall be directed by a person with the following qualifications at the time of hire and continuously throughout employment as the program administrator:

(a) Five years of paid full-time experience in the field of substance use treatment, including experience in an OTP with at least one year in a paid administrative capacity; or

(b) A Bachelor's degree in a relevant field and four years of paid full-time experience in the field of alcohol and drug treatment, including experience in an OTP with at least one year in a paid administrative capacity; or

(c) A Master's degree in a relevant field and three years of paid full-time experience in the field of alcohol and drug treatment, including experience in an OTP with at least one year in a paid administrative capacity.

(3) Management Staff — Competency: The management staff shall:

(a) Have knowledge and experience demonstrating competence in the performance of the following essential job functions: program planning and budgeting, fiscal management, supervision of staff, personnel management, employee performance assessment, data collection, reporting, program evaluation, quality assurance, and developing and maintaining community resources;

(b) Demonstrate by their conduct the competencies required by this rule and compliance with the program policies and procedures implementing these rules.

(4) Clinical Supervisor — Qualifications: Each OTP shall have an identified clinical supervisor who has one of the following qualifications at the time of hire:

(a) Five years of paid full-time experience in the field of alcohol and other drug treatment, including experience in an OTP, with a minimum of two years of direct alcohol and other drug treatment experience; or

(b) A Bachelor's degree in a relevant field and four years of paid full-time experience, with a minimum of two years of direct alcohol and other drug treatment experience including experience in an OTP; or

(c) A Master's degree in a relevant field and three years of paid full-time experience, with a minimum of two years of direct alcohol and other drug treatment experience including experience in an OTP.

(5) Clinical Supervisor — Competency: All supervisors shall:

(a) Have knowledge and experience demonstrating competence in the performance of the following essential job functions: supervision of treatment staff including staff development, use of The ASAM Criteria , treatment planning, case management, and utilization of community resources including self-help groups; preparation and supervision of patient assessment procedures; preparation and supervision of case management procedures for client treatment; conducting of individual, group, family, and other counseling; and assurance of the clinical integrity of all patient records for cases under their supervision, including timely entry or correctness of records and requiring adequate clinical rationale for decisions in admission and assessment records, treatment plans and progress notes, and discharge records;

(b) Demonstrate by their conduct the competencies required by this rule and compliance with the program policies and procedures implementing these rules; and

(c) Except as provided in this rule, hold a current certification or license in addiction counseling or hold a current license as a health or allied provider issued by a state licensing body.

(6) Clinical Supervisors — Certification: For supervisors holding a certification or license in addiction counseling, qualifications for the certificate or license must have included at least:

(a) 4,000 hours of supervised experience in substance use counseling;

(b) 300 contact hours of education and training in substance use related subjects; and

(7) Clinical Supervisor — Licensure: For supervisors holding a health or allied provider license, such license shall have been issued by one of the following state bodies 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:

(a) Board of Medical Examiners;

(b) Board of Psychologist Examiners;

(d) Board of Licensed Professional Counselors and Therapists; or

(e) Board of Nursing.

(8) Clinical Supervisors — Existing Staff: Supervisors not having a credential or license that meets the standards identified in this rule must apply to a qualified credentialing organization or state licensing board within 90 days of the effective date of this rule and achieve certification or licensure meeting the standards of this rule, within 24 months of the application date.

(9) Administrator as Clinical Supervisor: If the program's administrator meets the qualifications of the clinical supervisor, the administrator may be the clinical supervisor.

(10) Treatment Staff — Competency: All treatment staff shall:

(a) Have knowledge, skills, and abilities demonstrating competence in the following essential job functions: The ASAM Criteria , treatment of substance use disorders including patient assessment and individual, group, family, and other counseling techniques; program policies and procedures for client case management and record keeping; and accountability for recording information in the patient files assigned to them consistent with those policies and procedures and these rules;

(b) Demonstrate by conduct the competencies required by this rule and compliance with the program policies and procedures implementing these rules;

(c) Except as provided in this rule, hold a current certification or license in addiction counseling or hold a current license as a health or allied provider issued by a state licensing body.

(11) Treatment Staff — Certification: For treatment staff holding a certification or license in addiction counseling, qualifications for the certificate or license must have included at least:

(a) 1,000 hours of supervised experience in substance use counseling;

(b) 150 contact hours of education and training in substance use related subjects; and

(12) Treatment Staff — Licensure: For treatment staff holding a health or allied provider license, such license shall have been issued by one of the following state bodies and the staff person must possess documentation of at least 60 contact hours of academic or continuing professional education in the treatment of substance use disorders:

(a) Board of Medical Examiners;

(b) Board of Psychologist Examiners;

(d) Board of Licensed Professional Counselors and Therapists; or

(e) Board of Nursing.

(13) Treatment Staff — Existing Staff: Existing staff who do not hold a certificate or license that meets the standards identified in section of this rule must apply to a qualified credentialing organization or state licensing board within 90 days of the effective date of this rule and achieve certification or licensure meeting the standards of section of this rule within 36 months of the application date.

(14) Treatment Staff — New Hires: New hires need not hold a qualified certificate or license, but those who do not must make application within six months of employment and receive the credential or license within 36 months of the application.

(15) The OTP shall provide a minimum of two hours per month of clinical supervisor consultation for each staff person or volunteer who is responsible for the delivery of treatment services. One hour of the supervision must be individual, face-to-face, and address clinical skill development. The supervision or consultation is to assist staff and volunteers to increase their treatment skills, improve quality of services to patient, and ensure compliance with program policies and procedures implementing these rules.

History

Statutory/Other Authority: ORS 430.256
Statutes/Other Implemented: ORS 430.010(4)(b) & 430.560 - 430.590
ADS 2-2023, amend filed 04/07/2023, effective 04/07/2023
ADS 1-2022, amend filed 03/25/2022, effective 03/28/2022
ADS 3-2021, temporary amend filed 09/29/2021, effective 10/01/2021 through 03/29/2022
ADS 2-2021, temporary amend filed 09/21/2021, effective 10/01/2021 through 03/29/2022
ADS 5-2013, f. & cert. ef. 6-7-13
ADS 2-2008, f. & cert. ef. 11-13-08
ADS 1-2003, f. 6-13-03, cert. ef. 7-1-03
ADAP 3-1995, f. 12-1-95, cert. ef. 3-1-96
HR 17-1993, f. & cert. ef. 7-23-93, Renumbered from 410-006-0075
HR 4-1988, f. & cert. ef. 5-10-88

Or. Admin. R. 415-020-0080 Volunteers

An Opioid Treatment Program utilizing volunteers shall have the following standards for volunteers:

(1) Policy Required: A written policy regarding the use of volunteers that shall include:

(a) Specific tasks and responsibilities of volunteers;

(b) Procedures and criteria used in selecting volunteers, including sobriety requirements for individuals recovering from the disease of alcohol or other drug abuse;

(d) Specific procedure for reviewing the performance of volunteers and providing direct feedback to them.

(2) Orientation and Training: The program shall document that the volunteers complete an orientation and training program specific to their responsibilities before they participate in assignments. The orientation and training shall:

(a) Include a review of the program's philosophical approach to treatment;

(b) Include information on confidentiality regulations and patient's rights;

(d) Explain the program's channels of communication, reporting requirements, and accountability requirements for volunteers;

(e) Explain the procedure for reviewing the volunteer's performance and providing feedback to the volunteer; and

(f) Explain the procedure for discontinuing a volunteer's participation.

History

Statutory/Other Authority: ORS 430.256
Statutes/Other Implemented: ORS 430.010(4)(b) & 430.560 - 430.590
ADS 2-2008, f. & cert. ef. 11-13-08
ADS 1-2003, f. 6-13-03, cert. ef. 7-1-03
ADAP 3-1995, f. 12-1-95, cert. ef. 3-1-96
HR 17-1993, f. & cert. ef. 7-23-93, Renumbered from 410-006-0080
HR 4-1988, f. & cert. ef. 5-10-88

Or. Admin. R. 415-020-0085 Building Requirements

(1) Applicable Codes: Each Opioid Treatment Program shall maintain up-to-date documentation verifying that they meet applicable building codes, and state and local fire and safety regulations. The program must check with local government to make sure all applicable local codes have been met.

(2) Space Where Services Provided: Each Opioid Treatment Program shall provide space for services including but not limited to intake, assessment and , counseling, and telephone conversations that assures the privacy and confidentiality of clients and is furnished in an adequate and comfortable fashion including plumbing, sanitation, heating, and cooling.

(3) Disabled Accessibility: Programs shall be accessible to persons with disabilities pursuant to Title II of the Americans with Disabilities Act if the program receives any public funds or Title III of the Act if no public funds are received.

(4) Emergency Procedures: Programs shall adopt and implement emergency policies and procedures, including an evacuation plan and emergency plan in case of fire, explosion, accident, death or other emergency. The policies and procedures and emergency plans shall be current and posted next to the telephone used by staff. In addition, programs shall maintain a 24 hour telephone answering capability to respond to facility and patient emergencies;

(5) Disaster Plan: The program must develop and regularly update a disaster plan that outlines the program response to disasters of human or natural origin that may render the program's facility unusable. The plan must address the following;

(a) How emergency dosing will be implemented; and

(b) Identification of emergency links to other community agencies.

History

Statutory/Other Authority: ORS 430.256
Statutes/Other Implemented: ORS 430.010(4)(b) & 430.560 - 430.590
ADS 5-2013, f. & cert. ef. 6-7-13
ADS 2-2008, f. & cert. ef. 11-13-08
ADS 1-2003, f. 6-13-03, cert. ef. 7-1-03
ADAP 3-1995, f. 12-1-95, cert. ef. 3-1-96
HR 17-1993, f. & cert. ef. 7-23-93, Renumbered from 410-006-0085
HR 4-1988, f. & cert. ef. 5-10-88

Or. Admin. R. 415-020-0090 Variances

Requirements and standards for requesting and granting variances or exceptions are found in OAR 309-008-1600.

History

Statutory/Other Authority: ORS 430.256
Statutes/Other Implemented: ORS 183, 430.560 & 430.590
ADS 9-2016, f. & cert. ef. 12-14-16
ADS 6-2016(Temp), f. & cert. ef. 8-10-16 thru 2-5-17
ADS 2-2008, f. & cert. ef. 11-13-08
ADAP 3-1995, f. 12-1-95, cert. ef. 3-1-96
HR 17-1993, f. & cert. ef. 7-23-93, Renumbered from 410-006-0090
HR 4-1988, f. & cert. ef. 5-10-88

Or. Admin. R. 415-020-0096 Mobile Opioid Treatment Programs and Medication Units

(1) Letter of Approval: No person or governmental entity shall operate a Mobile Opioid Treatment Program or medication unit without a letter of approval and certification from the State Opioid Treatment Authority in Oregon.

(2) Application Requirement: All entities seeking to operate a Mobile Opioid Treatment Program or Medication Unit must submit to the Division an application request and receive a certificate of approval for the provision of behavioral health treatment services as a Mobile Opioid Treatment Program or Medication Unit. The Mobile Opioid Treatment Program or Medication Unit must meet the criteria under OAR 309-008-0100 to 309-008-1600; in addition, these programs must:

(a) Meet the standards set forth in these rules and any other administrative rules applicable to the program;

(b) Be affiliated or subsidiary of an established, licensed non-mobile Opioid Treatment Program in the State of Oregon, in good standing at the time of application with no sanctions, penalties or disciplinary actions in place;

(c) Comply with the federal regulations contained in 42 CFR Part 2, 42 CFR Part 8, 21 CFR 1300, 21 CFR 1301, and 21 CFR 1304;

(d) Develop operational plans for each mobile unit or medication unit operated by the program, which shall be reviewed annually. Operational plans shall at a minimum address the following areas:

(A) Staffing;

(B) Security;

(D) Mechanical issues or failure of the unit;

(E) Unexpected closure of the unit due to any other circumstance, including human caused events;

(F) Communication to clients and public related to mobile site location(s) or closures.

(3) Renewal: The renewal of a certificate shall be governed by OAR 309-008-0100 to 309-008-1600.

(5) Location: All Mobile Opioid Treatment Programs and Medication Units must be affiliated or a subsidiary of an established non-mobile opioid treatment program or non-medication unit, in the State of Oregon, currently certified by Oregon Health Authority (OHA) and the Federal Government:

(a) All Mobile Opioid Treatment Programs must return to the opioid treatment program they are linked to, daily, unless the program has received a waiver from the Federal government to locate the mobile unit at an alternate location at the close of business each day;

(b) Mobile Opioid Treatment Programs are not allowed to cross state lines to provide services.

(6) Federal Protocols: The Mobile Opioid Treatment Program or Medication Unit shall be responsible for filing and maintaining all necessary protocols and documentation required by the US Health and Human Services/Substance Abuse and Mental Health Services Administration, and the US Drug Enforcement Administration.

History

Statutory/Other Authority: ORS 430.256
Statutes/Other Implemented: ORS 430.010(4)(b) & 430.560-430.590
ADS 3-2022, adopt filed 11/08/2022, effective 11/08/2022

Division 50 STANDARDS FOR ALCOHOL DETOXIFICATION CENTERS

Or. Admin. R. 415-050-0100 Purpose

These rules prescribe standards for the development and operation of withdrawal management programs approved by the Division.

History

Statutory/Other Authority: ORS 413.042 & 430.256
Statutes/Other Implemented: 430.345 - 430.375 & ORS 430.306
ADS 3-2023, amend filed 04/07/2023, effective 04/07/2023
ADS 1-2023, renumbered from 415-050-0000, filed 01/20/2023, effective 01/20/2023
ADS 6-2013, f. & cert. ef. 8-1-13
ADS 3-2013(Temp), f. & cert. ef. 2-4-13 thru 8-2-13
ADS 2-2008, f. & cert. ef. 11-13-08
ADAP 3-1993, f. & cert. ef. 12-6-93, Renumbered from 309-050-0000
MHD 15-1983, f. 7-27-83, cert. ef. 10-25-83, Renumbered from 309-052-0000(1) & (2)
MHD 45, f. & cert. ef. 7-20-77
MHD 15(Temp), f. 1-16-74, cert. ef. 2-1-74

Or. Admin. R. 415-050-0105 Definitions

The following definitions apply to 415-050-0100 through 415-050-0195.

(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) “Admission” means the act or process of enrollment into services regulated by these rules.

(3) “ASAM” means The American Society of Addiction Medicine, Third Edition (ASAM).

(4) “The ASAM Criteria " means the criteria in the Third Edition of The American Society of Addiction Medicine (ASAM) Criteria 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 patients. The ASAM Criteria is incorporated by reference in these rules.

(5) “ASAM Dimensional Admission Criteria” means the specifications described in the ASAM Criteria for determining that a patient 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.

(6) “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 certified outpatient or licensed residential provider.

(7) “Adolescent” means an individual from 12 through 21 years of age or those individuals who are determined to be developmentally appropriate for such services.

(8) “Adolescent ASAM Level 3.7-WM Medically Monitored Withdrawal Management (ASAM Level 3.5-WM)” means a medical, inpatient setting as described in The ASAM Criteria, Third Edition that provides 24-hour medically monitored intensive inpatient withdrawal management services for adolescent patients assessed at ASAM Level 3.7-WM. Adolescent patients meeting criteria to be admitted to this level of care experience moderate to severe withdrawal syndrome and therefore require 24-hour nursing care and LMP visits as needed.

(9) "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.

(10) “Adult ASAM Level 3.2-WM Clinically Managed Residential Withdrawal Management (ASAM Level 3.2-WM)” means a setting as described in The ASAM Criteria, Third Edition in which patients experience moderate withdrawal symptoms and need 24-hour support to complete withdrawal management and increase the likelihood of continuing treatment or recovery. Clinically managed services are directed by non-physician addiction specialists rather than medical and nursing personnel. This level emphasizes peer and social support and is for patients whose intoxication is sufficient to warrant 24-hour support or whose withdrawal symptoms are sufficiently severe to require primary medical nursing care services.

(11) “Adult ASAM Level 3.7-WM Medically Monitored Withdrawal Management (ASAM Level 3.7-WM)” means a medical, inpatient setting as described in The ASAM Criteria, Third Edition that provides 24-hour medically monitored intensive inpatient treatment services for patients assessed at ASAM Level 3.7-WM. Patients who meet criteria for admission to this level of care experience severe withdrawal syndrome and need 24-hour nursing care and LMP visits as needed.

(12) “Assessment” means the process of obtaining sufficient information through one or more face-to-face interview(s) to determine a diagnosis and to plan individualized services and supports.

(13) “Oregon Health Authority (Authority) or (OHA)” means the Oregon Health Authority of the state of Oregon.

(14) “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.

(15) “Care Coordination” means a process-oriented activity to facilitate ongoing communication and collaboration to meet multiple needs. Care coordination includes facilitating communication between 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 or transitions for young adults in transition to adult services.

(16) "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.

(17) "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.

(18) “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.

(19) “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.

(20) “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.

(21) “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 Oregon Health 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.

(22) "County" means the board of county commissioners or its representatives.

(23) "Criminal Records Check" means documenting the criminal background check results for all employees, contracted staff and interns that render medical or behavioral health services and supports or have access to protected health information such as service records or billing information.

(24) “Critical Incident” means any unanticipated event that threatens health, safety or the structural integrity of the facility and is documented in an Incident Report. Critical Incidents are reported to the Division.

(25) "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 patients, families, and communities and protects and preserves the dignity of each.

(26) “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. It thus requires knowledge and capacity at different levels of intervention: systemic, organizational, professional, and patient.

(27) "Diagnosis" means the principal substance use disorder diagnosis consistent with 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 is the medically necessary reason for services.

(28) "Division" means the Health Systems Division of the Oregon Health Authority, or its designee.

(29) “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.

(30) “Episode of Care" means the period of care that begins at admission and ends at discharge.

(31) "Grievance" means a formal complaint submitted to a provider verbally, or in writing, by a patient, or the patient’s chosen representative.

(32) “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.

(33) “Health Insurance Portability and Accountability” (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).

(34) “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 during a stabilization plan or care coordination plan activity and including but not limited to injury, major illness, accident, act of physical aggression, medication error, suspected abuse or neglect, or any other unusual or critical event that presents a risk to health and safety. Critical incidents are reported to the Division.

(35) “Incident Report” means a written description of any incident.

(36) "Informed Consent for Services" means that the service options, risks and benefits have been explained to the patient and guardian, if applicable, in a manner and language that they comprehend, and the patient and guardian, if applicable, have consented to the services or prior to or on the first date of service.

(37) “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).

(38) "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.

(39) “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.

(40) "Licensed Medical Practitioner (LMP)” means an individual 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 demonstrate the ability to conduct a medical exam, a mental health assessment and provide medication management.

(41) “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

(42) "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, ORS 419B.010, or ORS 124.060.

(43) "Medicaid" means the federal grant-in-aid program to state governments to provide medical assistance to eligible patients under Title XIX of the Social Security Act.

(44) “Medical Assessment” means an assessment by or under the direction of a physician who is licensed to practice medicine in Oregon. The medical assessment includes a complete physical examination and a thorough comprehensive health history, which includes review of behavioral and physical health diagnoses, a description of behavior problems, prior evaluations, and treatment history. The medical assessment also reviews current use of prescription and over-the-counter medications.

(45) "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.

(46) "Medical Treatment" means the planned, medically necessary, individualized program of medical procedures and counseling services designed to address symptoms of a DSM-5-TR diagnosis.

(47) “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

(48) "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.

(49) "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.

(50) “Medication Administration Record (MAR)” means the documentation of the administration of written or verbal orders for medication, laboratory and other medical procedures issued by a LMP acting within the scope of their license.

(51) “Medications for Assisted Treatment (MAT)” means the use of medication in combination with counseling and behavioral therapies for the treatment of substance use disorders.

(52) “Motivational Enhancement Therapy” (MET) means a person-centered approach to therapy that focuses on improving a patient's motivation to change.

(53) “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 individuals with mental diseases, which includes substance use disorders (SUDs).

(54) “Non-Medical Program Staff” means an individual who, by employment, contract, or volunteer agreement, or internship agreement with the program, provides a service or support within their scope of practice that is not medical and who has the applicable competencies, qualifications, or certification required in this rule to provide the corresponding non-medical service or support.

(55) “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.

(56) “On-site” means staff are physically present within the licensed facility, on duty, readily accessible and available to assist individuals.

(57) "Patient" means an individual receiving withdrawal management services.

(58) “Peer” means any person supporting a patient or the patient’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 a patient who is a current or former recipient of substance use, problem gambling, or mental health services.

(59) "Peer Support Specialist (PSS)” means a qualified program staff providing peer-delivered services to a patient 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.

(60) “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.

(61) “Peer-Delivered Services Supervisor" means a 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.

(62) “Peer Wellness Specialist (PWS)” means a program staff who supports a patient in identifying behavioral health service and support needs through community outreach, assisting patients 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 patients 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.

(63) "Program" means an organized system of services and supports delivered by a provider designed to address the treatment needs of patients and families.

(64) "Program Administrator" or "Program Director" means program staff with appropriate professional qualifications and experience who is designated to manage the operation of a program.

(65) "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.

(66) "Provider" means an organizational entity or qualified individual that is certified or licensed by the Division for the direct delivery of substance use, problem gambling, or mental health services and supports.

(67) “Publicly Funded” means financially supported, in part or in full, with revenue from a local, state or federal government.

(68) "Psychiatrist" means a physician licensed by the Oregon Medical Board and who has completed an approved residency training program in psychiatry.

(69) "Psychologist" means an individual who is currently licensed to practice psychology by the Oregon Board of Psychology.

(70) "Quality Assessment and Performance Improvement" means the structured, internal monitoring and evaluation of services to improve processes, service delivery, and service outcomes.

(71) "Representative" means someone who acts on behalf of a patient at the patient’s request with respect to a grievance, including but not limited to a relative, friend, employee of the Division, attorney, or legal guardian.

(72) "Restraints" means any chemical or physical methods or devices that are intended to restrict or inhibit the movement, functioning, or behavior of a patient.

(73) "Screening" means the process to determine whether the patient needs further assessment to identify need for referrals or services and supports.

(74) "Seclusion" means the involuntary confinement of a resident alone in a room or an area from which the resident is physically prevented from leaving.

(75) “Service Delivery Rules” means the OAR describing specific regulatory standards for the possible array of services covered by licenses issued under Chapter 415, Division 012.

(76) “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 stabilization or care coordination plan.

(77) “Service Record” means the documentation, written or electronic, regarding a patient and resulting from admission, assessment, stabilization services and supports planning, stabilization services and supports provided, and transfer.

(78) "Services" means those activities and treatments described in the Stabilization or care coordination Plan that are intended to assist the patient's stabilization, withdrawal management and transition to recovery from a substance use disorder.

(79) “Signature” means any written or electronic means of entering the name, date of authentication and credentials of the individual 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 patient receiving services, the guardian of the patient receiving services, or any authorized representative of the patient receiving services.

(80) “Stabilization” means the application of medical and psychosocial services and supports, through a services plan, 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 patients’ ability to maintain safety while enhancing their recovery, so they can successfully reintegrate into identified community settings.

(81) “Stabilization Plan” means an individualized plan of medical interventions that sufficiently resolve the withdrawal symptoms or syndrome, and identifies the conditions needed for the patient to safely transition to the next identified ASAM Level of Care.

(82) “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 indicated through the patient’s enrollment in services; and

(83) “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.

(84) “Substance Use Disorders (SUD)” as defined in DSM-5-TR means disorders related to the taking of a drug of abuse including alcohol, to 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.

(85) "Substance Use Prevention and Treatment and Recovery Block Grant” or “SUPTR Block Grant” 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.

(86) “Substance Use Disorders (SUD) Treatment Staff” means one type of program staff certified by a Division-approved certification body to render substance use disorders treatment services:

(87) “Supports” means activities, referrals and supportive relationships designed to enhance the services delivered to patients and families for the purpose of facilitating progress toward intended outcomes.

(88) “Transfer” means the process of assisting a patient to transition from the current services to the next identified setting or ASAM level of care.

(89) “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 and addictions 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 patient direction of services.

(90) "Treatment" means the planned, medically necessary, individualized program of medical, psychological, and rehabilitative procedures, experiences and activities designed to remediate symptoms of a medical condition or DSM-5-TR diagnosis.

(91) “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.

(92) "Urinalysis Test" means a urine sample provided by a patient that is tested by the program using a sensitive, rapid, and inexpensive immunoassay screen to eliminate "true negative" specimens from further consideration.

(93) "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.

(94) "Volunteer" means a person who performs a service willingly and without pay.

(95) “Withdrawal Management Technician” means personnel who supports program staff in the promotion of maintaining a safe and orderly subacute environment and who may provide direct patient care.

History

Statutory/Other Authority: ORS 413.042 & 430.256
Statutes/Other Implemented: 430.345 - 430.375 & ORS 430.306
ADS 3-2023, amend filed 04/07/2023, effective 04/07/2023
ADS 1-2023, renumbered from 415-050-0005, filed 01/20/2023, effective 01/20/2023
ADS 6-2013, f. & cert. ef. 8-1-13
ADS 3-2013(Temp), f. & cert. ef. 2-4-13 thru 8-2-13
ADS 2-2008, f. & cert. ef. 11-13-08
ADAP 3-1993, f. & cert. ef. 12-6-93, Renumbered from 309-050-0005
MHD 15-1983, f. 7-27-83, cert. ef. 10-25-83, Renumbered from 309-052-0000(3)
MHD 45, f. & cert. ef. 7-20-77
MHD 15(Temp), f. 1-16-74, cert. ef. 2-1-74

Or. Admin. R. 415-050-0110 Licensing Standards

(1) Withdrawal management programs must be licensed by the Division in accordance with OAR 415-012-0000 to render detoxification services under ORS 430.306, henceforth referred to as withdrawal management services. A License issued to a program must 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 must meet the standards set forth in these rules and all applicable statutes.

(2) In addition to any other information requested by the Division, applicants for renewal or initial licensure must provide sufficient detail in their application that the Division may determine the IMD status. Effective January 1, 2022, the IMD status must be determined by the Division to be either:

(a) IMD Withdrawal Management; or

(b) Non-IMD Withdrawal Management.

(3) Currently licensed providers must submit complete withdrawal management applications to render each selected ASAM Level(s) of Care no later than October 1, 2023.

(4) Division approved ASAM level(s) of Care must be added to the withdrawal management licenses starting January 1, 2024.

(5) In addition to any other information requested by the Division, applicants for renewal or initial licensure must identify in their application the ASAM Level(s) of Care. Effective April 1, 2024, all withdrawal management programs must have a valid license designating one or more of the following ASAM Levels of Care approved by the Division:

(a) Adult Clinically Managed Residential Withdrawal Management Services, ASAM Level of Care 3.2-WM;

(b) Adult Medically Monitored Inpatient Withdrawal Management Services, ASAM Level of Care 3.7-WM; or

(6) Adolescent and adult programs must be licensed separately.

(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 Adult Medically Monitored Inpatient Withdrawal Management, ASAM Level of Care 3.7-WM may render Adult Clinically Managed Residential Withdrawal Management, ASAM Level 3.2-WM.

(8) The license must be posted in a common area, able to be viewed at all times.

(9) At least every two years the Division must inspect the facility and conduct a review of the program.

History

Statutory/Other Authority: ORS 430.256
Statutes/Other Implemented: 430.345 - 430.375 & ORS 430.306
ADS 3-2023, amend filed 04/07/2023, effective 04/07/2023
ADS 1-2023, renumbered from 415-050-0010, filed 01/20/2023, effective 01/20/2023
ADS 6-2013, f. & cert. ef. 8-1-13
ADS 2-2008, f. & cert. ef. 11-13-08
ADAP 3-1993, f. & cert. ef. 12-6-93, Renumbered from 309-050-0010
MHD 15-1983, f. 7-27-83, cert. ef. 10-25-83, Renumbered from 309-052-0000
MHD 45, f. & cert. ef. 7-20-77
MHD 15(Temp), f. 1-16-74, cert. ef. 2-1-74

Or. Admin. R. 415-050-0115 Policies, Procedures and Protocols

(1) All providers must develop and implement written policies and procedures, compliant with OAR 415-050.

(2) Policies must be available upon request.

(3) Providers must develop and implement written policies and procedures including, but not limited to:

(a) The Program's philosophical approach to withdrawal management;

(b) Code of conduct that includes professional boundaries and ethics;

(d) Criminal Records Checks that are conducted using a national and state-wide process for all employees, contracted staff and interns that render medical or behavioral health services and supports or have access to protected health information such as service records or billing information;

(e) Fraud, waste and abuse in Federal Medicaid and Medicare programs compliant with OAR 410-120-1380 and 410-120-1510;

(f) Fee agreements;

(g) Confidentiality and compliance with HIPAA, Federal Confidentiality Regulations (42 CFR, Part 2 and HIPAA), 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) Grievances and Appeals, consistent with these rules;

(j) Policy and procedure containing criteria in accordance with ORS 430.397 through 430.401 for the voluntary admission of patient to a withdrawal management program;

(k) Care coordination and the transition of care;

(l) Patient Rights, consistent with these rules;

(m) Crisis prevention and response;

(n) Incident and critical incident reporting;

(o) Trauma-informed service delivery, consistent with the Division’s Trauma Informed Services Policy;

(p) Provision of culturally and linguistically appropriate services;

(q) Medical Protocols;

(r) Medication Administration, Storage and Disposal;

(s) Delivery of services and supports consistent with these rules and The ASAM Criteria for each licensed Level of Care;

(t) Facility Standards; and

(u) General Safety and Emergency Procedures including providing immediate transportation of a patient to a general hospital in case of a medical emergency.

(4) The Program must utilize a written admissions procedure in accordance with these rules, which includes at minimum:

(a) Screening for admission, including SUPTR prioritization when applicable;

(b) Attempting to gain informed consent and documenting accordingly;

(d) Steps for making referrals for patients not admitted to the Program;

(e) Steps for coordinating care with payers and entities responsible for care coordination;

(f) A history and physical (H&P) assessment; and

(g) A stabilization plan.

(5) Additionally, providers must establish and implement written policies that:

(a) Prohibit physical or other forms of aversive action to discipline a patient;

(b) Prohibit seclusion, personal restraint, mechanical restraint and chemical restraint;

(d) Prohibit discipline of one patient 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.

History

Statutory/Other Authority: ORS 413.042 & ORS 430.256
Statutes/Other Implemented: ORS 430.306 & ORS 430.345-430.375
ADS 3-2023, adopt filed 04/07/2023, effective 04/07/2023

Or. Admin. R. 415-050-0120 Patient Rights

(1) In addition to all applicable statutory and constitutional rights, every patient receiving services has the right to:

(a) Choose from available services and supports, those that are consistent with the stabilization and care coordination plans, culturally competent, provided in the most integrated setting in the community and under conditions that are least restrictive to the patient’s liberty, that are least intrusive to the patient, and that provide for the greatest degree of independence;

(b) Be treated with dignity and respect;

(c) Participate in the development of a written stabilization Plan, receive services consistent with that plan, and participate in periodic review and reassessment of service and support needs, and receive a copy of the written stabilization and care coordination plans;

(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 as otherwise permitted by law.

(g) Inspect their Service Record in accordance with ORS 179.505 and applicable law;

(h) Refuse participation in experimentation;

(i) Receive medication specific to the patient’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 stabilization and care coordination planning and delivery;

(q) File grievances, including appealing decisions resulting from the grievance;

(r) Exercise all rights set forth in ORS 109.610 through 109.697 if the patient is a child, as defined by these rules;

(s) Exercise all rights set forth in ORS 426.385 if the patient is committed to the Authority; and

(t) 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 patient receiving services has the right to:

(a) A safe, secure, and sanitary 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 patient or others from harm, provided that notice of this restriction is given to patients 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) Not be required to perform labor;

(g) Have access to a variety of food choices 24 hours per day, 7 days per week and three meals per day; and

(h) A reasonable accommodation or transfer if, due to a disability, services are not sufficiently accessible.

(3) The provider must give to the patient and, if appropriate, the guardian, a document that describes the applicable patient rights as follows:

(a) Information given to the patient must be in written form or, upon request, in an alternative format or language appropriate to the patient’s need;

(b) The rights and how to exercise them must be explained to the patient, and if appropriate, to their guardian; and

History

Statutory/Other Authority: ORS 430.256
Statutes/Other Implemented: 430.345 - 430.375 & ORS 430.306
ADS 3-2023, amend filed 04/07/2023, effective 04/07/2023
ADS 1-2023, renumbered from 415-050-0020, filed 01/20/2023, effective 01/20/2023
ADS 6-2013, f. & cert. ef. 8-1-13
ADS 2-2008, f. & cert. ef. 11-13-08
ADAP 3-1993, f. & cert. ef. 12-6-93, Renumbered from 309-050-0020
MHD 15-1983, f. 7-27-83, ef. 10-25-83

Or. Admin. R. 415-050-0125 Personnel Records

(1) Providers must maintain personnel records for each program staff and withdrawal management technician that contains, at a minimum, all of the following documentation:

(a) The results of national and state-wide criminal records check processes applicable to the current position or title for personnel who render substance use disorder treatment services or have access to substance use disorder protected health information such as service records or billing information;

(b) A current position description that includes applicable qualifications, including credentials and competencies;

(c) When applicable to the position, copies of relevant licensure or certification, diploma, or certified transcripts from an accredited college, indicating that the personnel meets applicable qualifications;

(d) Copies of any action on the credentials as reported by the certification or Licensing Board or body;

(e) Periodic performance appraisals that, when deficiencies are noted, contain a performance improvement and training plan, including completion of any required training(s) and resolution of the performance plan;

(f) Orientations and trainings required in OAR 415-050;

(g) Disciplinary documentation;

(h) Active First Aid and CPR certification for each non-medical personnel; and

(i) Results of a Tuberculosis screening as per OAR 333-071-0057.

(2) Providers must ensure each program staff receives training applicable to the specific population for whom services are planned, delivered, or supervised. The program must document orientation training for each program staff or individual providing services within 30 days of the hire date. At minimum, orientation 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;

(d) A review of rights for patients 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 and agreement to abide by the Code of conduct;

(j) Training in de-escalation; and

(k) Training in motivational enhancement.

(3) Providers must ensure that withdrawal management technician staff receive the following trainings. The program must document orientation training for each withdrawal management staff within 30 days of the hire date. At minimum, orientation 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;

(d) A review of rights for patients receiving services and supports;

(e) A review of mandatory abuse reporting procedures;

(f) A review of confidentiality policies and procedures;

(g) A review and agreement to abide by the Code of conduct;

(h) Training in de-escalation; and

(i) Training in motivational enhancement.

(4) Medical treatment staff rendering or assisting with medical interventions, including applicable interns, must have the following trainings documented within one week of active employment in such a role:

(a) Medical protocols;

(b) Use of COWS, CIWA-AR and other evidence-based screening tools.

(5) Non-medical program staff must be certified for first aid/ CPR within 6 weeks of active employment.

(6) Supervision: all staff who are responsible for the delivery of services or supports must receive documented supervision and oversight by a qualified supervisor or manager, as applicable and as defined in OAR 415-050. Individual face-to face contact may include real time, two-way audio or audio-visual conferencing. Part time program staff must receive supervision prorated to reflect the average number of hours worked.

(a) Supervision must be related to the development of the staff and the services, and the implementation and outcome of the services. Supervision must be provided to assist staff to:

(A) Increase their skills within their scope of practice;

(B) Improve quality of services or supports to patients; and

(b) Documentation must include the date, amount of time per session and a brief description of the topics addressed and must demonstrate the following minimum amount of supervision occurred:

(A) One hour per month of documented group supervision and consultation to medical treatment staff, non-medical treatment staff, withdrawal management technician, substance use disorder treatment staff, peer support or wellness specialist, and volunteer who is responsible for the delivery of services or supports; and

(B) Interns and student interns must receive one-hour of individual clinical supervision per week.

(c) Supervision must assist supervisees to ensure safety, increase their skills, improve quality of services to patients, and address understanding of and adherence to program protocols, policies, procedures and code of conduct;

(d) When available, a qualified Peer-delivered Services Supervisor must provide the required monthly supervision to program staff providing direct Peer-delivered Services. Otherwise, supervision must be provided by a qualified supervisor;

(e) Interns and student interns must render services and supports under the active supervision of a qualified supervisor; and

(f) Individualized non-clinical supervision must be utilized as needed and documented.

History

Statutory/Other Authority: ORS 413.042 & ORS 430.256
Statutes/Other Implemented: ORS 430.306 & ORS 430.345-430.375
ADS 3-2023, adopt filed 04/07/2023, effective 04/07/2023

Or. Admin. R. 415-050-0130 Staffing Standards

Providers are responsible for all program staff. Programs must maintain the following minimum staffing standards:

(1) Program staff in the following positions must meet applicable credentialing or licensing standards, including those set forth in OAR 415-050.

(2) Program administrators or program directors must demonstrate competence in leadership, 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. Professional qualifications and experience must include:

(a) Five years of paid full-time experience in withdrawal management, with at least one year in a paid administrative capacity; or

(b) A Bachelor's degree in a relevant field and four years of paid full-time experience in withdrawal management with at least one year in a paid administrative capacity; or

(c) A Master's degree in a relevant field and three years of paid full-time experience in withdrawal management with at least one year in a paid administrative capacity; and

(d) Knowledge and experience demonstrating competence in planning and budgeting, fiscal management, supervision, personnel management, employee performance assessment, data collection, and reporting.

(3) Supervisors, including clinical supervisors in all programs must demonstrate competence in leadership, wellness, oversight and evaluation of services, staff development, stabilization and care coordination planning, case management and coordination, utilization of community resources, group, family and patient therapy or counseling, documentation and rationale for services to promote intended outcomes and implementation of all provider policies.

(4) Programs must utilize a written staffing plan that adheres to these rules, reflects the licensed ASAM Level(s) of care, specifies typical staffing patterns and instructs how staff coverage will be added throughout high acuity and emergency situations, and must ensure at a minimum:

(a) The level of nursing care is appropriate to the number of patients and severity of patient needs;

(b) Medical treatment staff rendering medical services are credentialed medical personnel who are trained and competent to implement physician-approved protocols for patient observation and supervision, and facilitation of patient’s transition to continuing care; and

(c) Medical treatment staff who assess and treat patients must be able to obtain and interpret information regarding the medical presentation and needs of patients. Such knowledge includes the signs and symptoms of alcohol and other drug intoxication and withdrawal, as well as the stabilization and monitoring of those conditions and how to facilitate entry into ongoing care.

(5) Medical Treatment Staff must be:

(a) Qualified to assess and treat patients;

(b) Trained and competent to implement physician-approved protocols for patient observation and supervision;

(d) Able to obtain and interpret information regarding the medical presentation and needs of patients. Such knowledge includes the signs and symptoms of alcohol and other drug intoxication and withdrawal, as well as the stabilization and monitoring of those conditions and how to facilitate entry into ongoing care:

(6) Medical Treatment Staff includes, but is not limited to:

(a) Licensed Medical Professional (LMP) licensed by the Oregon Medical Board;

(b) Licensed Practical Nurse (LPN) licensed by the Oregon State Board of Nursing;

(d) Advanced Practice Nurse including Clinical Nurse Specialist and Certified Nurse Practitioner licensed by the Oregon Board of Nursing.

(7) Certified Nursing Assistants (nursing assistant or CNA) support the medical treatment staff in the observation, monitoring and response to medical symptoms, and other duties assigned that are within the scope of their qualifications, training and credentials.

(8) Each program must maintain, at a minimum, the following qualified staff to oversee operations and who demonstrate the following at the time of hire:

(a) Medical Director with specialty credentialing, training or experience in addiction medicine or addiction psychiatry and is actively credentialed in the State of Oregon; and

(b) Nursing Manager currently licensed by the Oregon Board of Nursing, or verified documentation the following education and/or work experience; and

(c) Program Administrator or Program Director with professional qualifications and experience meeting those described in these rules, who is designated to manage the administrative operations of a withdrawal management program.

(9) When applicable to the staffing pattern of the withdrawal management program, clinical supervisors of substance use disorder treatment services must meet qualification and credentialing requirements detailed in OAR 309-018.

(10) When applicable to the staffing pattern of the withdrawal management program, there must be a Peer-delivered Services Supervisor 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, for programs that offer Peer services.

(11) The substance use disorders treatment staff must:

(a) Have training knowledge or experience demonstrating competence in the treatment of substance use disorders, including the management of substance withdrawal; patient evaluation; motivational counseling techniques; and de-escalation;

(b) Operate within the scope of their credential, training and education; and

(12) The Withdrawal Management Technician staff are not required to be credentialed and there are no qualifying prerequisites. When working as a withdrawal management technician, the following conditions apply:

(a) Have knowledge of or experience in, or be trained by the Program in recognizing the signs and symptoms of withdrawal, motivational enhancement techniques, and de-escalation; and

(b) Operate within the scope of their training, education and assigned duties.

(13) The Student Intern or Intern 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, and within the policies and procedures for the credentialing of program staff as established by the provider; and

(b) The Student Intern program staff must:

(A) Be currently enrolled in an undergraduate education program for a degree in psychology, social work, or other related field of behavioral science; or

(B) Have a collaborative educational agreement between the Division-certified provider and the educational program for the student; or

(14) Peer Support Specialists and Peer Wellness Specialists, including family and youth support and wellness specialists, must meet the requirements in OAR 410-180-0300 to 0380 for certification and continuing education.

(a) A Peer Support Specialist and Peer Wellness Specialist must 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 behavioral health barrier.

(b) A Peer Support Specialist and Peer Wellness Specialist must 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

(15) Volunteer is a program staff who provides, or assists with providing, a service who is not an employee of the program and is not paid for services. The services must not be behavioral health or medical unless the program staff has the required qualifications or credentials to provide the corresponding service or support. When the service is behavioral health or medical, the volunteer is classified as a Program Staff and is held to all the standards of a Program Staff within these rules.

(16) Program staff include, but are not limited to the following credentials and titles:

(a) Licensed Medical Professional (LMP) licensed by the Oregon Medical Board;

(b) Licensed Practical Nurse (LPN) licensed by the Oregon State 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.

(l) Registered Bachelor of Social Work issued by the Oregon Board of Licensed Social Workers as described in OAR 877-015-0105; or

(m) Substance Use Disorders (SUD) Treatment Staff, which includes, but is not limited to:

(A) Master Addiction Counselor (MAC) certified by NAADAC, the Association for Addiction Professionals;

(B) Certified Alcohol and Drug Counselor-Registered (CADC-R);

(D) Certified Alcohol and Drug Counselor-II (CADC-II); and

(E) Certified Alcohol and Drug Counselor-III (CADC-III).

(n) Peer-Support Specialist (PSS) as defined in OAR 410-180-0305;

(o) Peer-delivered Services Supervisor;

(p) Peer Wellness Specialist;

(q) Student Intern;

(r) Withdrawal Management Technician; and

(s) Volunteer.

History

Statutory/Other Authority: ORS 413.042 & ORS 430.256
Statutes/Other Implemented: ORS 430.306 & ORS 430.345-430.375
ADS 3-2023, adopt filed 04/07/2023, effective 04/07/2023

Or. Admin. R. 415-050-0135 Quality Assurance and Performance Improvement

Providers must develop and implement a structured and ongoing process to assess, monitor, and improve the quality and effectiveness of services provided to patients, including:

(1) The program must document a quality assurance and performance improvement process that occurs at least quarterly and, at a minimum, addresses:

(a) Process improvement projects;

(b) Incident reports; and

(2) Critical Incidents must 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) Including, but not limited to the following circumstances:

(A) Death, including by suicide or overdose;

(B) Severe injury, including injury leading to hospitalization, injury resulting in medical attention needed or no medical attention needed, overdose resulting in hospitalization or needing medical attention, and emergency services needed;

(D) Police involvement;

(E) Extensive damage to the facility or other substantial change in living conditions; and

(F) Where abuse or neglect is suspected, including unethical client and staff relationships; and

(G) 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 must be maintained in the corresponding service record and in a common, secure 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 must not contain protected health information belonging to any other individual.

(3) Incident reports must 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) The program must document the Medical Director’s involvement in the development and review of medical standing orders, medical and medication protocols and operating procedures within the first three months of hire for a new Medical Director and annually thereafter.

(5) The provider must develop and maintain service records for each patient that demonstrates the specific services and supports, including:

(a) Identifying information or documentation of attempts to obtain the information;

(b) Informed Consent for Services including medications or documentation specifying why the provider could not obtain consent by the patient 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) Copies of documents relating to guardianship or any other legal considerations, as applicable;

(g) Documentation of the patient’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;

(h) Documentation of any safety risks;

(i) Documentation of follow-up actions and referrals when patient reports symptoms indicating risk of suicide;

(j) Incident reports involving the patient; and

(k) Report the status date for the entry of all patients on the mandated state data system.

(6) When medical services are provided, the following documents must 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;

(e) The administration of nursing and withdrawal assessments as indicated throughout the episode to safely complete acute withdrawal from each substance of concern;

(f) The administration or dispensing of medication in accordance with current orders;

(g) All changes to protocol, including medical rationale must be noted by the LMP or their designee;

(h) Any deviation from protocol, including circumstance or rationale must be noted in the service record by the responsible program staff;

(i) The medical stabilization plan;

(j) Motivational Enhancement services;

(k) Care coordination, case management, and referral activities and plans; and

(l) The patient's involvement in stabilization activities and progress toward achieving objectives contained in the patient's stabilization plan.

History

Statutory/Other Authority: ORS 413.042, 428.205 - 428.270, 430.640 & 443.450
Statutes/Other Implemented: ORS 430.010, 430.205- 430.410, 430.254-430.640, 430.850 - 430.955, 443.400-443.460, 443.991, 461.549 & 743A.168
ADS 3-2023, adopt filed 04/07/2023, effective 04/07/2023

Or. Admin. R. 415-050-0140 Admission

The program must utilize an admission procedure that at a minimum must ensure the provision and documentation of the following:

(1) Program orientation information must be offered in written format in a language understood by the patient. The orientation information must include:

(a) A written description of the Program's services, including the Program's philosophical approach to stabilization;

(b) Rights;

(d) Grievance procedures;

(e) Consent to services; and

(f) Notice of Privacy Practices.

(2) In accordance with ORS 179.505, 42 CFR Part 2, and HIPAA, an authorization for the release of information mustbe obtained for any confidential information concerning the patient being considered for, or receiving, services.

(3) Screening for admission must meet the following requirements:

(a) Patients must be considered for admission 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) When the patient is being treated for withdrawal from substance(s) other than the medication prescribed or dispensed to treat opioid dependence:

(A) The provider may not deny admission to patients for the reason of a prescribed or dispensed medication to treat opioid dependence; and

(B) The provider must support the continuation of access to the medication prescribed or dispensed to treat opioid dependence during the episode of care.

(c) For patients receiving services funded by the SUPTR Block Grant, admission of pregnant patients to services must occur no later than 48 hours from the date of first contact, and no less than 14 days after the date of first contact for patients using substances intravenously. If services are not available within the required timeframe, the provider must document the reason and provide interim referral and informational services as defined in these rules, within 48 hours.

(d) Admission of patients whose services are funded by the SUPTR Block Grant must be prioritized prior to admission in the following order through use of a screening that is documented in the service record:

(A) Patients who are pregnant and using substances intravenously;

(B) Patients who are pregnant;

(D) Patients with dependent children.

(e) The admission screening service must be completed prior to rendering services and must document the rationale to recommend assessment for withdrawal management services.

(4) Admission documentation must contain:

(a) Substance use history;

(b) Initial CIWA-Ar, COWS and/or other evidence-based measure of the severity of withdrawal symptoms;

(d) Urinalysis collection and on-site testing of a urinary sample using a testing cup, stick or other on-site method; and

(e) Decision by medical treatment staff to begin admission or to offer services on another date and/ or care coordination for other services. When services are not offered, the patient must be provided a list of community service organizations that may be of assistance.

(5) The provider must report the admission and exit status, and any other data required by the Division in the mandated state data system for each patient whose services are paid for using public funding.

History

Statutory/Other Authority: ORS 413.042 & 430.256
Statutes/Other Implemented: 430.345 - 430.375 & ORS 430.306
ADS 3-2023, amend filed 04/07/2023, effective 04/07/2023
ADS 1-2023, renumbered from 415-050-0025, filed 01/20/2023, effective 01/20/2023
ADS 6-2013, f. & cert. ef. 8-1-13
ADS 3-2013(Temp), f. & cert. ef. 2-4-13 thru 8-2-13
ADS 2-2008, f. & cert. ef. 11-13-08
ADAP 3-1993, f. & cert. ef. 12-6-93, Renumbered from 309-050-0025
MHD 15-1983, f. 7-27-83, cert. ef. 10-25-83, Renumbered from 309-052-0000(6)
MHD 45, f. & cert. ef. 7-20-77
MHD 15(Temp), f. 1-16-74, cert. ef. 2-1-74

Or. Admin. R. 415-050-0145 Medical Services

(1) At a minimum, programs must ensure each of the following:

(a) Sufficient medical treatment staff staffing with the ability to transfer or admit patients to ASAM Level 3.7-WM program or a hospital as necessary;

(b) A LMP must be available daily for onsite evaluation of patients;

(d) Medical treatment staff, onsite and readily available 24 hours a day, 7 days per week, that are trained and competent to:

(A) Facilitate entry into withdrawal management services;

(B)Recognize the signs and symptoms of intoxication and withdrawal;

(D) Monitor conditions;

(E) Implement LMP-approved protocols for patient; and

(F) Facilitate the transfer of patients to other ASAM Levels of Care.

(2) Medications must be administered in accordance with physician or LMP orders, or nursing orders that are in accordance with LMP orders.

(3) The medical assessment and examination must:

(a) Contain a complete physical examination and a thorough comprehensive health history, which includes review of behavioral and physical health diagnoses, a description of behavior problems, prior evaluations, treatment history and a review of current use of prescription and over-the-counter medications.

(b) Be completed by a LMP within 24 hours of entry for each patient in ASAM Level 3.7-WM programs; or

(d) Documentation must include:

(A) The ASAM Level of Care placement determination utilizing ASAM Dimensions 1, 2 and 3;

(B) Use of the ASAM dimensional admission criteria and documentation that demonstrates the patient meets ASAM 3.7-WM level of care by justifying the patient is:

(i) Experiencing severe intoxication or withdrawal and needs 24-hour nursing care and daily access to a LMP;

(ii) In addition, may be experiencing severe risk in Dimensions 2 and 3; and

(iii) Unlikely to complete withdrawal management without medical monitoring.

(D) A recommended length of stay;

(E) Medication orders;

(F) Current protocols; and

(G) Identification of the patient’s medical needs relevant to stabilization.

(4) A medical stabilization plan must be informed by the medical assessment and:

(a) Be completed by a medical treatment staff;

(b) Identify initial orders for the stabilization of each identified substance for withdrawal;

(c) Identify criteria for meeting safe completion of medical protocols for acute withdrawal management services per substance being treated, including the recommended length of services;

(d) Note the extent of the patient's participation in developing the content of the stabilization plan;

(e) Document any modifications; and

(f) The inclusion or notification of significant others in the stabilization planning process, when applicable.

(5) The following information must be recorded in the patient’s service record at the time of admission:

(a) Name, address, and telephone number;

(b) Contact information for individual to contact in case of an emergency or unplanned exit of services, when a corresponding release of information, compliant with 42 CFR part 2 and HIPAA, is also on file and valid;

(d) The time and date of admission;

(e) The name and credentials of program staff completing the admission documentation;

(f) Documentation of the patient’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;

(g) Documentation of any safety risks;

(h) Documentation of follow-up actions and referrals when an patient reports symptoms indicating risk of suicide; and

(i) When medical services are provided, the following documents must be part of the Service Record as applicable:

(A) Medication administration records as per these rules;

(B) Laboratory reports; and

(6) At the time of transition from withdrawal management services, a medical stabilization summary must be completed by medical treatment staff. The medical stabilization summary must contain:

(a) Final evaluation of the patient's progress toward stabilization for each of the substances treated;

(b) Identification of any unresolved withdrawal symptoms;

(d) Where applicable, a medical opinion of the patient’s capacity to resolve the identified issue(s) due to any known or observed cause, such as a co-occurring behavioral or medical condition.

History

Statutory/Other Authority: ORS 413.042 & ORS 430.256
Statutes/Other Implemented: ORS 430.306 & ORS 430.345-430.375
ADS 3-2023, adopt filed 04/07/2023, effective 04/07/2023

Or. Admin. R. 415-050-0150 Supportive Stabilization Services

The Program must offer the following services to support stabilization:

(1) Motivational counseling, care coordination and case management services.

(2) Information to assist patient choice to remain in services for the duration determined by the stabilization plan, including:

(a) Health education applicable to the patient’s medical condition, which may include:

(A) Information about current medications, side effects of abrupt cessation, and which medications can be removed from the facility by the patient when exiting the program;

(B) Information about the potential danger of continued withdrawal in a non-medical setting;

(D) Ability to return to withdrawal management services.

(b) Option to communicate with a support individual when a valid release of information is on file; and

(3) Program staff or translators fluent in the language and sensitive to the special needs of the population served must be provided as necessary to assist in the delivery of services.

(4) Program staff must document a care coordination plan for each patient that is able to engage in such a process during the episode. When this is not possible, the reason(s) must be documented. The care coordination plan must:

(a) Identify the patient’s preferences for transition;

(b) Contain contact information for any specific referrals made; and

History

Statutory/Other Authority: ORS 413.042 & 430.256
Statutes/Other Implemented: 430.345 - 430.375 & ORS 430.306
ADS 3-2023, amend filed 04/07/2023, effective 04/07/2023
ADS 1-2023, renumbered from 415-050-0035, filed 01/20/2023, effective 01/20/2023
ADS 6-2013, f. & cert. ef. 8-1-13
ADS 3-2013(Temp), f. & cert. ef. 2-4-13 thru 8-2-13
ADS 2-2008, f. & cert. ef. 11-13-08
ADAP 3-1993, f. & cert. ef. 12-6-93, Renumbered from 309-050-0035
MHD 15-1983, f. 7-27-83, cert. ef. 10-25-83, Renumbered from 309-052-0000(6)
MHD 45, f. & cert. ef. 7-20-77
MHD 15(Temp), f. 1-16-74, cert. ef. 2-1-74

Or. Admin. R. 415-050-0155 Management of Medications

Each Program must have:

(1) A written order signed by a physician, a physician's standing order, or a physician's order received by phone and signed by the physician at the earliest opportunity before any medication is administered or dispensed to or self-administered by any patient.

(2) The program must have a policy that requires, at a minimum, each of the following:

(a) Assurances that medications prescribed for one patient must not be administered to or self-administered by another patient or employee;

(b) All prescription drugs stored in the program must be kept in a locked container. Only those medications requiring refrigeration must be stored in a refrigerator;

(c) Stored not yet prescribed controlled substance including records and maintain inventories in conformance with 21 U.S.C. Section 827; 21CFR 1304.02 through 1304.11; 1304.21 through 1304.26; 1304.31 through 1304.33; except that a written inventory of all controlled substances must be taken by registrants annually within 365 days of the last written inventory. All such records must be maintained for a period of three years;

(d) In the case where a patient self-administers their own medication, self-administration must be recommended by the Program, approved in writing by the Medical Director, and closely monitored by the medical treatment staff;

(e) No unused, outdated, wasted or recalled medications, confiscated substances or objects used for substance consumption must be kept by the program or in the facility;

(f) All unused, outdated, wasted or recalled medications, and confiscated substances and objects must be disposed of in a manner that assures that they cannot be retrieved within 21 days of identifying need for destruction;

(g) A written record of all disposals of medications, substances and objects must be maintained in the Program and must include:

(A) A description of the drug, medication or substance including the amount;

(B) The patient for whom the medication was prescribed, or from whom the medication, substance or object was confiscated from;

(D) The method of disposal including:

(i) Medications that are outdated, damaged, deteriorated, misbranded, or adulterated must be quarantined and physically separated from other medications until they are destroyed or returned to their supplier; and

(ii) Controlled substances which are expired, deteriorated or unwanted must be disposed of in conformance with 21 CFR 1307.21.

(E) The destruction must be documented and signed by the witnesses and the document retained at the facility for a period of at least three years. Destruction must be jointly witnessed on the premises by any two of the following:

(i) The consultant pharmacist or registered nurse designee;

(ii) The Director of Nursing Services or supervising nurse designee;

(iii) The administrator of the facility or an administrative designee; or

(iv) A Registered Nurse employed by the facility.

(h) Documentation of each prescription medication dispensed, administered to, or self-administered by any patient. This written record must include, at a minimum:

(A) A copy or detailed written description of the signed prescription order, including;

(i) Patient's name;

(ii) The date medications were prescribed, reviewed, or renewed;

(iii) Prescribing physician's name and credential;

(iv) Description of the medication, including the medication name and prescribed dosage; and

(v) Method of administration.

(B) Known allergies to medication(s);

(C) Verification in writing by medical treatment staff that the medication was taken, and the times and dates the medication was dispensed, administered, or self-administered;

(D) Observed side effects including laboratory findings;

(E) Any adverse reactions to the medication; and

(F) Continuing evaluation of the patient's ability to self-administer the medication.

History

Statutory/Other Authority: ORS 413.042 & 430.256
Statutes/Other Implemented: 430.345 - 430.375 & ORS 430.306
ADS 3-2023, amend filed 04/07/2023, effective 04/07/2023
ADS 1-2023, renumbered from 415-050-0045, filed 01/20/2023, effective 01/20/2023
ADS 6-2013, f. & cert. ef. 8-1-13
ADS 3-2013(Temp), f. & cert. ef. 2-4-13 thru 8-2-13
ADS 2-2008, f. & cert. ef. 11-13-08
ADAP 3-1993, f. & cert. ef. 12-6-93, Renumbered from 309-050-0045
MHD 15-1983, f. 7-27-83, cert. ef. 10-25-83, Renumbered from 309-052-0000(6)
MHD 45, f. & cert. ef. 7-20-77
MHD 15(Temp), f. 1-16-74, cert. ef. 2-1-74

Or. Admin. R. 415-050-0160 Clinically Managed Residential Withdrawal Management, ASAM Level 3.2-WM

In addition to any other requirements described in these rules and applicable statutes, programs approved to render Clinically Managed Residential Withdrawal Management Services, ASAM Level of Care 3.2-WM to adults and must, at a minimum, meet and maintain documentation demonstrating ongoing compliance with each of the following requirements:

(1) Programs must render a planned and structured regimen of 24-hour professionally directed evaluation, observation and support for patients who are intoxicated or experiencing moderate substance use withdrawal management to in a residential setting. These programs emphasize peer and social supports.

(2) Clinically Managed Residential Withdrawal Management, ASAM Level 3.2-WM Programs that are co-located within a Residential Substance Use Disorders Treatment and Recovery facility licensed by the Division do not require additional licensure under these rules. Patients placed at this ASAM Level of Care must meet the following ASAM dimensional assessment criteria required for ASAM Level of Care 3.2-WM:

(a) The patient is experiencing signs and symptoms of moderate withdrawal or there is evidence, based on history or other relevant factors, that moderate withdrawal syndrome is imminent;

(b) The moderate withdrawal syndrome is assessed as manageable at this level of care; and

(c) The patient scores within a defined range on CIWA-Ar, COWs or other assessment metric for the drug(s) identified for withdrawal management services and meets physician-defined protocol for admission at this Level of Care.

(3) Services must include:

(a) On-site, active oversight and responsive support 24 hours per day, 7 days per week;

(b) Services that safely assist patients through withdrawal without the need for continuous on-site medical personnel; and

History

Statutory/Other Authority: ORS 413.042 & ORS 430.256
Statutes/Other Implemented: ORS 430.306 & ORS 430.345-430.375
ADS 3-2023, adopt filed 04/07/2023, effective 04/07/2023

Or. Admin. R. 415-050-0165 Medically Monitored Inpatient Withdrawal Management, ASAM Level of Care 3.7-WM

In addition to any other requirements described in these rules and applicable statutes, programs approved to render Medically Monitored Inpatient Withdrawal Management Services, ASAM Level of Care 3.7-WM to adolescents or adults must, at a minimum, meet and maintain documentation demonstrating ongoing compliance with each of the following requirements:

(1) Render a planned and structured regimen of 24-hour professionally directed services delivered by medical treatment staff that include evaluation, observation, medical monitoring, and withdrawal management in an inpatient setting, under a defined set of physician approved and monitored medical procedures and protocols.

(2) Patients must meet the following ASAM dimensional assessment criteria required for placement in ASAM Level of Care 3.7-WM:

(a) The patient is experiencing signs and symptoms of severe withdrawal or there is evidence, based on history or other relevant factors, that severe withdrawal syndrome is imminent;

(b) The severe withdrawal syndrome is assessed as manageable at this level of care; and

(3) Medical services must include:

(a) A LMP onsite daily to render medical assessments, provide monitoring of care and further evaluation;

(b) A Medical treatment staff onsite and readily available 24 hours a day, 7 days per week, to oversee the monitoring of the patient’s progress and medication administration on an hourly basis, or as needed; and

(c) Medical staff must have access to specialized clinical consultation and supervision for biomedical, emotional, or behavioral issues related to intoxication and withdrawal management.

(4) Starting April 1, 2024 the following standards are in effect: ASAM Level 3.7-WM Programs must maintain a 24-hour, daily minimum of on-site medical staffing as follows:

(a) Minimum licensed nurse staffing:

(A) A medical treatment staff must be on each shift 24 hours per day;

(B) An LNP must serve as the licensed charge nurse for no less than eight consecutive hours between the start of day shift and the end of evening shift, seven days a week; and

(C) Section (4)(e) of this rule may be variance by the Division. The request for variance must comply with OAR 415-012-0090 and must be reviewed annually. The variance shall be considered by the Division if the program attests that:

(i) The program has been unable to recruit appropriate personnel despite diligent efforts, including offering wages at the community prevailing rate for withdrawal management facilities;

(ii) The variance does not endanger the health or safety of patients; and

(iii) An RN or physician is available and obligated to immediately respond to telephone calls from the program and respond on-site when medically necessary.

(b) Minimum Certified Nursing Assistant (nursing assistant) staffing ratios:

(A) Day shift: 1 nursing assistant per 8 patients;

(B) Evening shift: 1 nursing assistant per 10 patients; and

(A) When the census is between 9-20; and

(B) For each additional 10 patients or part thereof when the census is 21 or higher.

(d) Providers are responsible for assuring appropriate staffing and must increase the number of medical treatment staff present beyond the minimum levels set forth above, as necessary to safely monitor and treat patients. Providers must consider patient acuity and medical treatment staff responsibilities when determining the appropriate levels of additional staffing.

(5) The following staffing standards are in effect until March 31, 2024:

(a) ASAM Level 3.7-WM Programs must be staffed by:

(A) LMPs who are available 24 hours a day by telephone, available to assess the patient within 24 hours of admission, or earlier, (if medically necessary), and available to provide on –site monitoring of care and further evaluation on a daily basis;

(B) A licensed and credentialed nurse must be available to conduct a nursing assessment upon admission and to oversee the monitoring of the patient’s progress and medication administration on an hourly basis, if needed;

(C) Appropriately licensed and credentialed staff must be available to administer medications in accordance with physician orders; and

(D) The level of nursing care must be appropriate to the severity of patient needs.

(b) The Program must maintain a minimum ratio of paid full-time staff to bed capacity as follows:

(A) 1 through 8 beds — 1 staff person on duty;

(B) 9 through 18 beds — 2 staff persons on duty;

(D) 31 beds and above — One additional staff person beyond the three staff required above for each additional 15 beds or part thereof.

(c) The Program’s written staffing plan must address the provision of appropriate and adequate staff coverage during emergency and high demand situations.

(d) The Program must provide a minimum of one hour per month of personal clinical supervision and consultation for each staff person and volunteer who is responsible for the delivery of treatment services. The clinical supervision must relate to the individual's skill level with the objective of assisting staff and volunteers to increase their treatment skills and quality of services to individuals.

(6) Adolescent ASAM Level of Care 3.7-WM Withdrawal Management Services are a version of Medically Monitored Inpatient Withdrawal Management, ASAM Level of Care 3.7-WM services, designed specifically for adolescents. When licensed as such, in addition to all requirements for Medically Monitored Inpatient Withdrawal Management, ASAM Level of Care 3.7-WM, programs must, 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 and preferably knowledgeable about adolescent development and medicine;

(b) LMPs monitor the delivery of procedures and protocols;

(c) Adolescents placed at this level of care must be experiencing withdrawal signs and symptoms that are moderate to severe and thus require 24-hour medical inpatient care;

(d) Identification of when an adolescent requires a higher level of care and facilitation of the transfer to that level of care; and

(e) Medical services must include:

(A) Provision of 24-hour per day, 7-days per week access to LMP consultation;

(B) Availability for 24-hour per day, 7-days per week LMP evaluation of adolescents; and

(C) 24-hour per day, 7-days per week medical monitoring of the safety and outcome of the withdrawal management services; and

(D) Medical treatment staff provide 24-hour per day, 7-days per week organized, on-site services that include medical supervision, observation and treatment.

History

Statutory/Other Authority: ORS 413.042 & ORS 430.256
Statutes/Other Implemented: ORS 430.306 & ORS 430.345-430.375
ADS 3-2023, adopt filed 04/07/2023, effective 04/07/2023

Or. Admin. R. 415-050-0170 Building Requirements

In addition to the building requirements for outpatient Alcohol and Other Drug treatment programs, withdrawal management programs must meet the following standards:

(1) Prior to construction of a new building or major alteration of or addition to an existing building:

(a) One set of plans and specifications must be submitted to the State Fire Marshal for approval;

(b) Plans must 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 must be prepared and bear the stamp of an Oregon licensed architect or engineer; and

(d) The water supply, sewage, and garbage disposal system must be approved by the agency having jurisdiction.

(2) Interiors: All rooms used by patient(s) must 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 must be provided for exclusive use of patient, program staff, and invited guests, and must:

(A) Seat at least one-half of the number of patients 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 must be provided for the exclusive use of patient, program staff, and invited guests and must:

(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 patient, 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 must be provided and conveniently located in each building containing a bedroom and must:

(A) Provide a minimum of one toilet and one hand-washing sink for each eight patients, and one bathtub or shower for each ten patient;

(B) Provide one hand-washing sink convenient to every room containing a toilet;

(D) Provide arrangements for personal privacy for patient;

(E) Provide a privacy screen at each window;

(F) Provide a mirror; and

(G) Be provided with adequate ventilation.

(e) A supply of hot and cold water installed and maintained in compliance with rules of, the Authority, Health Services, Office of Public Health Systems, must be distributed to taps conveniently located throughout the withdrawal management program;

(f) All plumbing must comply with applicable codes;

(g) Laundry facilities, when provided, must be separate from:

(A) Resident living areas, including bedrooms;

(B) Kitchen and dining areas; and

(h) Storage areas must be provided appropriate to the size of the withdrawal management program. Separate storage areas must 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, which must be properly labeled, stored in the original container, and kept in a locked storage area.

(i) Effective July 1, 2012, programs both licensed and funded by AMH must not allow tobacco use in program facilities and on program grounds.

History

Statutory/Other Authority: ORS 413.042 & 430.256
Statutes/Other Implemented: 430.345 - 430.375 & ORS 430.306
ADS 3-2023, amend filed 04/07/2023, effective 04/07/2023
ADS 1-2023, renumbered from 415-050-0070, filed 01/20/2023, effective 01/20/2023
ADS 6-2013, f. & cert. ef. 8-1-13
ADS 3-2013(Temp), f. & cert. ef. 2-4-13 thru 8-2-13
ADS 2-2008, f. & cert. ef. 11-13-08
ADAP 3-1993, f. & cert. ef. 12-6-93, Renumbered from 309-050-0070
MHD 15-1983, f. 7-27-83, cert. ef. 10-25-83, Renumbered from 309-052-0000(6)
MHD 45, f. & cert. ef. 7-20-77
MHD 15(Temp), f. 1-16-74, cert. ef. 2-1-74

Or. Admin. R. 415-050-0175 Client Furnishings and Linens

(1) Each Program must provide furniture for each patient which must include:

(a) A bed with a frame and a clean mattress and pillow; and

(b) A private dresser or similar storage area for personal belongings which is readily accessible to the patient.

(2) Linens must be provided for each patient and must include:

(a) Sheets and pillowcases;

(b) Blankets, appropriate in number and type for the season and the patient's comfort; and

(3) A locked or otherwise secure storage area, managed by the program and not readily accessible to patient, for safe storage of such items as money and jewelry, or other items the program identifies as not safe to remain in the withdrawal management services area.

History

Statutory/Other Authority: ORS 413.042 & 430.256
Statutes/Other Implemented: 430.345 - 430.375 & ORS 430.306
ADS 3-2023, amend filed 04/07/2023, effective 04/07/2023
ADS 1-2023, renumbered from 415-050-0075, filed 01/20/2023, effective 01/20/2023
ADS 6-2013, f. & cert. ef. 8-1-13
ADS 3-2013(Temp), f. & cert. ef. 2-4-13 thru 8-2-13
ADS 2-2008, f. & cert. ef. 11-13-08
ADAP 3-1993, f. & cert. ef. 12-6-93, Renumbered from 309-050-0075
MHD 15-1983, f. 7-27-83, ef. 10-25-83, Renumbered from 309-052-0000(6)
MHD 45, f. & cert. ef. 7-20-77
MHD 15(Temp), f. 1-16-74, cert. ef. 2-1-74

Or. Admin. R. 415-050-0180 Safety

The program must the following safety requirements:

(1) At no time must the number of patients served exceed the approved capacity;

(2) A written emergency plan must be developed and posted next to the telephone used by program staff and must include:

(a) Instructions for the program staff or designated patient 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 withdrawal management program's designated physician and on-call back-up program staff;

(b) The telephone number of the administrator or supervisor and other individuals to be contacted in case of emergency; and

(3) The withdrawal management program must provide fire safety equipment appropriate to the number of patients served, and meeting the requirements of the State of Oregon Structural Specialty Code and Fire and Life Safety Regulations:

(a) The facility and the fire detection and protection equipment must be inspected as required by the State Fire Marshal, and current documentation must be maintained;

(b) All flammable and combustible materials must be properly labeled and stored in the original container in accordance with the rules of the State Fire Marshal; and

(c) The withdrawal management program must conduct unannounced fire evacuation drills at least monthly. At least once every three months the monthly drill must 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 must be maintained.

(4) At least one program staff who is trained in First Aid and CPR must be onsite at all times

History

Statutory/Other Authority: ORS 430.256
Statutes/Other Implemented: 430.345 - 430.375 & ORS 430.306
ADS 3-2023, amend filed 04/07/2023, effective 04/07/2023
ADS 1-2023, renumbered from 415-050-0080, filed 01/20/2023, effective 01/20/2023
ADS 6-2013, f. & cert. ef. 8-1-13
ADS 2-2008, f. & cert. ef. 11-13-08
ADAP 3-1993, f. & cert. ef. 12-6-93, Renumbered from 309-050-0080
MHD 15-1983, f. 7-27-83, cert. ef. 10-25-83, Renumbered from 309-052-0000(6)
MHD 45, f. & cert. ef. 7-20-77
MHD 15(Temp), f. 1-16-74, cert. ef. 2-1-74

Or. Admin. R. 415-050-0185 Sanitation

Each Program must comply with the following sanitation standards:

(1) All floors, walls, ceilings, window, furniture, and equipment must be kept in good repair, clean, neat, orderly, and free from odors.

(2) Each bathtub, shower, hand-washing sink, and toilet must be kept clean and free from odors.

(3) The water supply in the withdrawal management program must meet the requirements of the rules of the Health Division governing domestic water supplies.

(4) Soiled linens and clothing must be stored in an area separate from kitchens, dining areas, clean linens and clothing and unrefrigerated food.

(5) All measures necessary to prevent the entry into the program of mosquitoes and other insects must be taken.

(6) All measures necessary to control rodents must be taken.

(7) The grounds of the program must be kept orderly and free of litter, unused articles, and refuse.

(8) Garbage and refuse receptacles must be clean, durable, water-tight, insect- and rodent proof and kept covered with a tight-fitting lid.

(9) All garbage solid waste must be disposed of at least weekly and in compliance with the rules of the Department of Environmental Quality.

(10) Sewage and liquid waste must be collected, treated and disposed of in compliance with the rules of the Department of Environmental Quality.

History

Statutory/Other Authority: ORS 413.042 & 430.256
Statutes/Other Implemented: 430.345 - 430.375 & ORS 430.306
ADS 3-2023, amend filed 04/07/2023, effective 04/07/2023
ADS 1-2023, renumbered from 415-050-0085, filed 01/20/2023, effective 01/20/2023
ADS 6-2013, f. & cert. ef. 8-1-13
ADS 2-2008, f. & cert. ef. 11-13-08
ADAP 3-1993, f. & cert. ef. 12-6-93, Renumbered from 309-050-0085
MHD 15-1983, f. 7-27-83, cert. ef. 10-25-83, Renumbered from 309-052-0000(6)
MHD 45, f. & cert. ef. 7-20-77
MHD 15(Temp), f. 1-16-74, cert. ef. 2-1-74

Or. Admin. R. 415-050-0190 Food Service

The withdrawal management program must 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:

(1) Menus must be prepared in advance to provide a sufficient variety of foods served in adequate amounts for each resident at each meal.

(2) Records of menus as served must be filed and maintained in the withdrawal management program records for at least 30 days.

(3) All modified or special diets must be ordered by an LMP.

(4) At least three meals must be provided daily.

(5) A variety of snack food options must be accessible to the patients 24 hours per day, 7 days per week.

(6) Supplies of staple foods for a minimum of one week and of perishable foods for a minimum of a two-day period must be maintained on the premises.

(7) Food must be stored and served at proper temperature.

(8) All utensils, including dishes, glassware, and silverware used in the serving or preparation of drink or food for the patient must be effectively washed, rinsed, sanitized, and stored after each patient use to prevent contamination in accordance with Health Division standards.

(9) Raw milk and home-canned vegetables, meats, and fish must not be served or stored in a program.

History

Statutory/Other Authority: ORS 430.256
Statutes/Other Implemented: 430.345 - 430.375 & ORS 430.306
ADS 3-2023, amend filed 04/07/2023, effective 04/07/2023
ADS 1-2023, renumbered from 415-050-0090, filed 01/20/2023, effective 01/20/2023
ADS 6-2013, f. & cert. ef. 8-1-13
ADS 3-2013(Temp), f. & cert. ef. 2-4-13 thru 8-2-13
ADS 2-2008, f. & cert. ef. 11-13-08
ADAP 3-1993, f. & cert. ef. 12-6-93, Renumbered from 309-050-0090
MHD 15-1983, f. 7-27-83, cert. ef. 10-25-83, Renumbered from 309-052-0000(6)
MHD 45, f. & cert. ef. 7-20-77
MHD 15(Temp), f. 1-16-74, cert. ef. 2-1-74

Or. Admin. R. 415-050-0195 Variances

Requirements and standards for requesting and granting variances or exceptions are found in OAR 415-012-0090

History

Statutory/Other Authority: ORS 413.042 & 430.256
Statutes/Other Implemented: 430.345 - 430.375 & ORS 430.306
ADS 3-2023, amend filed 04/07/2023, effective 04/07/2023
ADS 1-2023, renumbered from 415-050-0095, filed 01/20/2023, effective 01/20/2023
ADS 6-2013, f. & cert. ef. 8-1-13
ADS 2-2008, f. & cert. ef. 11-13-08
ADAP 3-1993, f. & cert. ef. 12-6-93, Renumbered from 309-050-0095
MHD 15-1983, f. 7-27-83, cert. ef. 10-25-83, Renumbered from 309-052-0000(7)
MHD 45, f. & cert. ef. 7-20-77
MHD 15(Temp), f. 1-16-74, cert. ef. 2-1-74

Division 52 RECOVERY HOMES FOR PEOPLE IN RECOVERY FROM ALCOHOL AND DRUG ABUSE OR DEPENDENCY

Or. Admin. R. 415-052-0100 Purpose

These rules prescribe standards for providing financial assistance in the form of loans under 42 U.S.C. 300x-25 to support the establishment of recovery homes for people in recovery from alcohol and drug abuse or dependency.

History

Statutory/Other Authority: ORS 413.042 & 430.256
Statutes/Other Implemented: ORS 90.100 - 90.459, 105.105 - 105.168, 430.265 - 430.920 & 279B
ADS 2-2009, f. & cert. ef. 12-3-09

Or. Admin. R. 415-052-0105 Definitions

(1) "Alcohol or drug abuse" means repetitive, excessive use of alcohol, a drug or controlled substance short of dependence, without medical supervision, which may have a detrimental effect on the individual, the family, or society.

(2) "Alcohol or drug dependence" means the loss of a person’s ability to control the personal use of controlled substances or other substances with abuse potential, including alcohol, or use of such substances or controlled substances to the extent that the health of the person or that of others is substantially impaired or endangered or the social or economic functioning of the person is substantially disrupted. A drug-dependent person may be physically dependent, a condition in which the body requires a continuing supply of a drug or controlled substance to avoid characteristic withdrawal symptoms, or psychologically dependent, a condition characterized by an overwhelming mental desire for continued use of a drug or controlled substance.

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

(4) “In recovery” means an individual who is recovering from alcohol or drug abuse or dependency.

(5) “Nonprofit Entity” means a charitable organization that has been approved for tax exemption by the Internal Revenue Code under Section 501(c)(3) or an affiliate of such charitable organization.

(6) “Recovery home” means a group home for individuals in recovery, as described in 42 U.S.C. 300x-25, that is developed by a nonprofit entity and prohibits the use of alcohol or any illegal drug on the premises. Recovery homes operate consistent with the following provisions:

(a) The use of alcohol or any illegal drugs in the housing is prohibited;

(b) Any resident of the housing who violates this prohibition is immediately expelled;

(c) The costs of the housing, including fees for rent and utilities, and repayment of the loan, are paid by the residents; and

(d) The residents of the housing will, through a majority vote, otherwise establish policies governing residence in the housing, including the manner in which applications for residence in the housing are approved.

(7) “Revolving Loan Fund” or "loan" means a fund established under 42 U.S.C. 300x-25 for the purpose of making loans to cover the cost of establishing a recovery home for 6 or more persons in recovery.

History

Statutory/Other Authority: ORS 413.042 & 430.256
Statutes/Other Implemented: ORS 90.100 - 90.459, 105.105 - 105.168, 430.265 - 430.920 & 279B
ADS 2-2009, f. & cert. ef. 12-3-09

Or. Admin. R. 415-052-0110 Revolving Loan Fund

(1) Establishment of the Revolving Loan Fund. The Division will establish and administer a revolving loan fund to assist the establishment of recovery homes. This fund shall be known as the “Oregon Recovery Homes Revolving Loan Fund”. The revolving loan fund will be established with federal funds allocated for this purpose under 42 U.S.C. 300x-25 and may be supplemented with state funds designated for this purpose.

(2) Administration of the Revolving Loan Fund. The Division may contract with a private, nonprofit entity to administer the revolving loan fund The private, nonprofit entity will be selected through a competitive process consistent with state contracting practices under ORS 279B. The selection of the contractor shall be based upon a review of qualifications, expertise, experience and documented capabilities relating to the administration of a revolving loan fund. The revolving loan fund will be administered consistent with all federal, state and local laws and the following requirements:

(a) The revolving loan fund will be maintained in an account that is separate and distinct from all other accounts maintained by the contractor that is selected by the Division. The account will be interest-bearing, if such an account is available, and be kept in a depository approved by the State of Oregon;

(b) The contractor will adopt policies and procedures for the administration of the revolving loan fund consistent with 42 U.S.C. 300x-25, 45 CFR 96.129 and these rules. These policies and procedures will include criteria for approving loans, collecting payments, assessing penalties, and managing loans in default. These policies and procedures will be reviewed and approved by the Division;

(c) The contractor will use forms and other written materials to provide loans. These will include, but not be limited to, a loan application form, a loan approval letter indicated loan terms, and a past due notification letter;

(d) Loans will be limited to legitimate costs relating to the establishment or relocation of a recovery home. These costs will include, but not be limited to, first month’s rent, necessary furniture, facility modifications, and purchase of appliances and equipment necessary to the operation of the household

(e) Loans will not exceed $5,000. This amount will include no more than $4,000 from federal sources. No interest will be charged;

(f) The terms for the loan shall specify that repayment will occur within two years after the date on which the loan is made;

(g) The loan will be paid through monthly installments with funds collected from residents of the recovery home;

(h) A reasonable penalty will be assessed for each failure to pay the monthly installment by the due date;

(i) There will be procedures that outline liability and recourse in the case of default; and

(j) A record for each loan shall be maintained and include the application, approval documentation, payment history, correspondence, penalties, default remedies and documentation of pay-off.

(3) Reporting Requirements. The contractor shall provide a monthly report to the Division on the status of the revolving loan fund and assist the Division with supplying data for an annual report to the federal government on the status of the revolving loan fund.

(4) Non-performance. In the event of contractor non-performance, the Division may take actions necessary to remediate problems or terminate the contract for administration of the revolving loan fund. If contract termination results in a period of time when no contractor is available to administer the fund, the Division will administer the fund until such time another contractor may be selected.

History

Statutory/Other Authority: ORS 413.042 & 430.256
Statutes/Other Implemented: ORS 90.100 - 90.459, 105.105 - 105.168, 430.265 - 430.920 & 279B
ADS 2-2009, f. & cert. ef. 12-3-09

Division 54 DUII ALCOHOL/OTHER DRUG INFORMATION AND DUII ALCOHOL/OTHER DRUG REHABILITATION PROGRAMS; ALCOHOL AND DRUG EVALUATION AND SCREENING SPECIALIST

Or. Admin. R. 415-054-0461 Purpose

(1) These rules:

(a) Establish procedures for the application, initial certification, renewal of certification, review, and other actions on a certificate including revocation, denial, suspension, and placement of conditions for the types of services listed in section (2) of this rule; and

(b) 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) These procedural rules apply to Alcohol and Other Drug Screening Specialists (ADSS)and those seeking certification as an ADSS.

History

Statutory/Other Authority: 430.256, 413.042 & 430.357
Statutes/Other Implemented: 430.256
ADS 4-2017, adopt filed 12/28/2017, effective 01/01/2018

Or. Admin. R. 415-054-0462 Definitions

(1) “Alcohol and Other Drug Screening Specialist (ADSS)” means an individual who possesses a valid certificate issued by the Division of the Authority.

(2) "ASAM Criteria" means the most current edition of the American Society of Addiction Medicine (ASAM) for the Treatment of Addictive, Substance-related, and Co-Occurring Conditions, which is a clinical guide to develop patient-centered service plans and make objective decisions about patient admission, continuing care, and transfer or discharge for individuals and is incorporated by reference in these rules.”

(3) “Background Check” means the Oregon Criminal Records Check and the processes and procedures required by OAR 943-007-0001 through 0501.

(4) “Certificate” means a document issued to an individual by the Division that authorizes the individual to provide ADSS services.

(5) “CFR 42 Part 2” means the Code of Federal Regulations, Title 42, Volume 1, Chapter 1, Part 2 entitled Confidentiality of Alcohol and Drug Abuse Patient Records.

(6) “Chief Officer” means the Chief Health Systems Officer of the Division or designee.

(7) “Conflict of Interest” means use of a personal relationship to obtain financial gain or avoidance of financial detriment, making business decisions that create a pattern of biased or preferential treatment, or initiating a professional role with someone with whom there was a pre-existing personal relationship. The conflict of interest may be actual or potential.

(8) "Court" means the last convicting or ruling court unless specifically noted.

(9) “Diversion Agreement” means a petition approved by the court meeting the criteria established in ORS 813.200 through 813.260.

(10) “Division” means the Health Systems Division of the Oregon Health Authority.

(11) “DUII” means driving under the influence of intoxicants as defined in ORS Chapter 813.

(12) “DUII Education Program” means a short-term, didactic alcohol and other drug education program that meets the minimum curriculum and hourly standards established by the Division 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.

(13) “DUII 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.

(14) “DUII Services Provider” means a provider of a DUII education program or a DUII rehabilitation program.

(15) “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.

(16) "Grievance" means a formal complaint submitted verbally or in writing by an individual or the individual’s representative pertaining to the denial or delivery of services and supports.

(17) “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).

(18) “Individual” means any individual being considered for or receiving services and supports regulated by these rules.

(19) “Individual Record” means documentation, written or electronic, regarding an individual including information relating to entry, screening, orientation, services and supports planning, services and supports provided, and transfer.

(20) “Negative Report” means a report of tampering with an ignition interlock device, unauthorized removal of an ignition interlock device, lockout or a test violation recorded by an ignition interlock device.

(21) “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.

(22) "Screening" means the process of administering a Division approved screening tool to determine whether the individual exhibits risk factors for a substance use disorder and resulting in a referral to a Division approved DUII services provider.

(23) "Single Agency or Organization" means any one individual or business entity; combination of persons or business entities acting together as a program; or agency or other arrangement that provides or has a financial interest in providing Division approved DUII Education or DUII Rehabilitation services.

(24) “Substance Use Disorder (SUD)" means a disorder related to the taking of a drug of abuse including alcohol to the side effects of a medication and to a toxin exposure. The disorders include substance use disorders such as substance dependence and substance abuse and substance-induced disorders, including substance intoxication, withdrawal, delirium, and dementia, and includes but is not limited to substance induced psychotic disorder, mood disorder, as defined in DSM criteria.

(25) “Variance” means an exception from a requirement in these rules, granted in writing by the Division on a case by case basis.

History

Statutory/Other Authority: 413.042 & 430.256
Statutes/Other Implemented: 430.256
ADS 4-2017, adopt filed 12/28/2017, effective 01/01/2018

Or. Admin. R. 415-054-0463 Minimum Qualifications

(1) Minimum experience requirements for ADSS certification include:

(a) A Bachelor Degree in a behavioral health field; or

(b) Four years of full-time supervised experience in the behavioral health services field with a minimum of two years of experience providing substance use disorder evaluation or treatment; or

(c) A combination of an Associate Degree in a behavioral health field and two years of full-time supervised experience providing substance use disorder evaluation or treatment.

(2) Applicants or ADSS recovering from substance use disorders must be able to document continuous abstinence under independent living conditions or recovery housing for the immediate past two years.

History

Statutory/Other Authority: 413.042 & 430.256
Statutes/Other Implemented: ORS 430.256
ADS 4-2017, adopt filed 12/28/2017, effective 01/01/2018

Or. Admin. R. 415-054-0464 Background Check Requirements

(1) For all new or renewal applications for ADSS certification, the Authority shall conduct a background check in accordance with OAR 943-007-0010 through OAR 943-007-0501. New or renewal certificates may not be issued prior to a background check being completed.

(2) New or renewal ADSS applicants may be denied certification or renewal of certification based on a fitness determination that applies a weighing test for potentially disqualifying convictions or conditions.

History

Statutory/Other Authority: 413.042 & 430.256
Statutes/Other Implemented: 430.256
ADS 4-2017, adopt filed 12/28/2017, effective 01/01/2018

Or. Admin. R. 415-054-0465 Terms of Certification

(1) Each applicant and ADSS agrees as a term of certification:

(a) To permit Division staff to inspect the service delivery location when the applicant or ADSS intends to provide or currently provides ADSS services:

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

(B) For immediate entry and inspection, extending to any premises the Division has reason to believe ADSS services are provided.

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

(A) Financial records;

(B) Individual service records;

(D) Employee records including but not limited to:

(i) Academic degrees;

(ii) Professional licenses;

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

(iv) Criminal background checks;

(v) All documentation required by applicable service 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) That the ADSS is certified to provide only those services that are specified in the scope of services and conditions listed on the certificate;

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

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

(f) That the certificate is not transferable to any other person or provider without Division approval; and

(g) To abide by the federal drug-free workplace requirements outlined in 45 CFR Part 76.

(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 ADSS;

(b) Upon the listed expiration date of the certificate if the ADSS fails to submit timely a complete application for certification renewal pursuant to these rules;

(4) Discontinuation of services:

(a) An ADSS discontinuing services voluntarily must:

(A) Notify the Division and appropriate court jurisdictions at least 60 days prior to the date of voluntary closure and provide a written plan to comply with record retention standards as applicable; and

(B) Make reasonable and timely efforts to obtain alternative services for individuals currently being served.

(b) An ADSS 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, the ADSS must notify individuals regarding the discontinuation of services as soon as possible.

History

Statutory/Other Authority: 413.042 & 430.256
Statutes/Other Implemented: 430.256
ADS 4-2017, adopt filed 12/28/2017, effective 01/01/2018

Or. Admin. R. 415-054-0466 The Application Process

(1) An applicant seeking initial certification or certification renewal must submit a completed application to the Division that demonstrates the following:

(a) Minimum education or experience as required in OAR 415-054-0463;

(b) Three signed letters of reference from individuals in the behavioral health services field with personal knowledge of the applicant who attests to the applicant’s character, work habits, and qualifications;

(c) A written statement signed by the Presiding Judge or Court Administrator for the court or courts designating the applicant to perform ADSS services.

(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; and

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

(3) 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) 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 rules; and

(b) Written attestation by the applicant of no potential or actual conflict of interest with any DUII services provider including financial gain or avoidance of financial detriment to self or a relative or business with which the applicant or ADSS is associated, except as provided for in OAR 415-054-0545 through 415-054-0570.

(4) 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 their certificate must:

(A) Request a renewal application from the Division; and

(B) Submit a complete application for recertification, which includes current court designations, at least six months prior to the expiration of the existing certificate.

History

Statutory/Other Authority: 413.042 & 430.256
Statutes/Other Implemented: 430.256
ADS 4-2017, adopt filed 12/28/2017, effective 01/01/2018

Or. Admin. R. 415-054-0467 Response to Application

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

(a) Within 60 days of the Division’s receipt of a complete application compliant with these rules, the Division shall notify the applicant that the application has been accepted as complete;

(b) Within 60 days of the Division’s receipt of an incomplete application, the Division shall provide written feedback describing any necessary amendment to the application prior to resubmission. To resubmit, the applicant must submit an amended application to the Division for review within 21 calendar days of receipt of the Division’s written feedback.

(2) When an application is denied, the Division shall issue a written notice of denial within 14 days of the determination.

(3) Applications for certification shall be denied when:

(a) The applicant does not meet the minimum qualifications in OAR 415-054-0463;

(b) The applicant is found to have disqualifying convictions or conditions by the Background Check Unit;

(c) The applicant fails to demonstrate substantial compliance with applicable statutes, administrative rules, or other applicable regulations;

(d) The applicant fails to re-submit complete application materials within 21 calendar days of receipt of the Division’s written feedback;

(e) The applicant timely re-submits the application, but the Division finds the re-submitted application remains incomplete or fails to demonstrate substantial compliance with applicable statutes, administrative rules, or other applicable regulations;

(f) 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 elect to deny an application prior to review 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 has been denied certification due to failure to submit complete application materials two or more times within the previous three calendar years;

(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.

History

Statutory/Other Authority: 413.042 & 430.256
Statutes/Other Implemented: 430.256
ADS 4-2017, adopt filed 12/28/2017, effective 01/01/2018

Or. Admin. R. 415-054-0468 Appealing Denial of Application for Certification

(1) When the Division has denied an application, an applicant may request, in writing, an appeal review by the Chief Officer:

(a) To obtain review, the applicant must submit a written request for the appeal review to the Division within 14 calendar days of receipt of the notice of denial;

(b) The Chief Officer, whose decision is final, must conduct an appeal review meeting within 30 days of receipt of the applicant’s written request;

(c) If the Chief Officer overturns the denial, the Division shall issue written notice to the applicant within 14 calendar days of the appeal review meeting. The notice shall inform the applicant of the outcome and shall either:

(A) Include an approved certification; or

(B) Include written notice of required amendment to application materials and a timeframe for re-submission.

(2) If the Chief Officer affirms the denial, the notice of denial shall become final, the application closed, and a notice of the appeal review outcome mailed to the applicant within 14 days of the appeal review meeting.

History

Statutory/Other Authority: 413.042 & 430.256
Statutes/Other Implemented: 430.256
ADS 4-2017, adopt filed 12/28/2017, effective 01/01/2018

Or. Admin. R. 415-054-0469 Types of Reviews

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

(a) Within six months of initial certification as an ADSS, Division staff shall complete a comprehensive audit of the required application documentation and a comprehensive audit of the service delivery locations to ensure compliance with applicable statute, administrative rules, other applicable regulations, and contractual obligations;

(b) Certification renewal reviews must occur prior to the expiration of the existing certificate and at least once every three years;

(A) With reasonable notice to ensure compliance with applicable statute, administrative rules, other applicable regulations, and contractual obligations;

(B) With or without notice for the following reasons:

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

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

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

(2) If Division staff may not access 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) At the sole discretion of the Division, Division staff may complete a certification review partially or fully via a desk review process. A desk review process is where Division staff conduct a certification review based on the ADSS or applicant’s submission of required documentation and telephonic interviews where Division staff do 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 ADSS;

(b) The applicant or ADSS 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 ADSS.

History

Statutory/Other Authority: 413.042 & 430.256
Statutes/Other Implemented: 430.256
ADS 4-2017, adopt filed 12/28/2017, effective 01/01/2018

Or. Admin. R. 415-054-0471 Conduct of Certification Reviews

(1) The Division shall employ review procedures deemed adequate to determine applicant or ADSS 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) Review of documents; and

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

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

(3) Within 30 days following the completion of each discretionary review, the Division may, at their discretion, issue a report and require a Plan of Correction 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:

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

(A) The ADSS 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 ADSS or applicant to complete the plan of correction process;

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

(i) The planned action already 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 plan of correction.

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

(d) The ADSS 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, suspend, or revoke an applicant or ADSS’ certification if the ADSS fails to submit an adequate POC within the established timeframes.

History

Statutory/Other Authority: 413.042 & 430.256
Statutes/Other Implemented: 430.256
ADS 4-2017, adopt filed 12/28/2017, effective 01/01/2018

Or. Admin. R. 415-054-0472 Issuing Certificates

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

(a) Be signed by the DUII Coordinator and Chief Officer;

(b) List the courts that have designated the ADSS;

(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) The courts that have designated the ADSS; and

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

(2) The Division shall issue initial certificates to new applicants whose applications demonstrate substantial compliance with applicable administrative rules and statutes:

(a) For up to six calendar months from the date of approval; 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: 413.042 & 430.256
Statutes/Other Implemented: 430.256
ADS 4-2017, adopt filed 12/28/2017, effective 01/01/2018

Or. Admin. R. 415-054-0473 Conditions

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

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

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

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

(f) The applicant or ADSS fails to fully implement a Plan of Correction or adequately maintain a corrective action;

(g) The Division has issued the applicant or ADSS 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 ADSS; or

(i) The applicant or ADSS 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 ADSS 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 ADSS to address any service needs that would be unmet if the applicant or ADSS is not issued a certificate with conditions as an alternative to revocation or refusal to award a certificate; or

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

(3) Conditions to the certificate may include:

(a) Requiring corrective actions with associated timeframes for completion necessary for the applicant or ADSS to correct areas of non-compliance or concern 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 ADSS 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 impose conditions on a certificate With Notice or Without Notice. In both processes, an ADSS 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 an ADSS 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 an ADSS advance notice. The Division may impose the conditions without notice by issuing an Order to an ADSS 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 ADSS. If the Notice is provided orally, it may be provided by telephone or in person to the applicant, ADSS, 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 ADSS by registered or certified mail. The Notice shall:

(a) Generally describe the acts or omissions of the applicant or ADSS 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 an individual within the Division who the applicant or ADSS 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 ADSS may request an informal conference prior to the issuance of the Order Imposing Certificate Condition, or if the ADSS 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 ADSS 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 is issued without a prior Notice, the applicant or ADSS 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;

(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 ADSS shall have waived the right to a hearing;

(h) Findings of specific acts or omissions of the applicant or ADSS 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, the applicant or ADSS is entitled to a contested case hearing pursuant to ORS Chapter 183;

(c) The applicant or ADSS 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 ADSS to admit or serve new individuals for whom the Division determines that alternate placement or ADSS 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 ADSS 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 ADSS 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 ADSS in writing, and the applicant or ADSS 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, suspend, and refuse to renew or revoke the certificate when the ADSS or applicant fails to comply timely with the condition.

(14) When the Division orders a condition be placed on a certificate under the provisions of this rule, the applicant or ADSS is entitled to request a hearing in accordance with ORS Chapter 183.

History

Statutory/Other Authority: 413.042 & 430.256
Statutes/Other Implemented: 430.256
ADS 4-2017, adopt filed 12/28/2017, effective 01/01/2018

Or. Admin. R. 415-054-0474 Modification to Certification

(1) An ADSS with a current certificate seeking to be designated by additional courts 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 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) When an emergency requires an ADSS to be designated by additional courts prior to Division approval:

(a) The ADSS must submit a request to the Division within 15 calendar days of the new designation and include copies of designation documentation as required in OAR 415-054-04669; and

(b) The Division shall make every reasonable effort to expediently review the ADSS’s request for the designation and make a final determination. The Division shall provide written notice of its determination.

History

Statutory/Other Authority: 413.042 & 430.256
Statutes/Other Implemented: 430.256
ADS 4-2017, adopt filed 12/28/2017, effective 01/01/2018

Or. Admin. R. 415-054-0475 Nonrenewal, Suspension, and Revocation of Certification

(1) Immediate revocation or suspension of a certificate may occur when:

(a) The Division finds there is substantial failure to comply with applicable statutes, administrative rules, service delivery rules, or other applicable regulations, such that the Division finds there is a serious danger to the public health or safety;

(b) The ADSS demonstrates substantial failure to comply with these administrative rules and other applicable regulations such that the health or safety of individuals is jeopardized to the degree that immediate cessation of services by the ADSS is considered necessary to prevent harm to the individual.

(2) The Division may revoke, suspend, or refuse to renew a certificate when the Division determines that there is substantiated evidence of abuse, neglect, or mistreatment or determines that an ADSS:

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

(b) Demonstrates a substantial failure to comply with applicable rules and regulations such that the health or safety of individuals is found to be jeopardized during two certification reviews within a six-year period;

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

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

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

(g) 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; or

(h) Fails to comply with staff qualification requirements.

(3) When the Division determines the need to revoke, suspend, 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 ADSS.

History

Statutory/Other Authority: 413.042 & 430.256
Statutes/Other Implemented: 430.256
ADS 4-2017, adopt filed 12/28/2017, effective 01/01/2018

Or. Admin. R. 415-054-0476 Informal Conference

(1) Within ten calendar days of the Division issuance of an Order of Suspension, a notice of intent to revoke or notice of intent to nonrenew (refusal to renew) the certificate to an applicant or ADSS, the Division shall offer the applicant or ADSS an opportunity for an informal conference. The applicant or ADSS shall make its request for an informal conference in writing within seven days of the issuance of notice. Upon receipt of a timely written request, the Division shall select a location and time for such a conference, provided that the conference occurs within 14 days of the Division’s receipt of the request.

(2) Following the conference, the Division may:

(a) Approve the application or renewal or initiate the process of imposing conditions to certification as described and allowed by these rules as an alternative to denying or revoking certification;

(b) Continue to proceed with action on the ADSS’ certificate up to and including suspension, revocation, or refusal to renew the certificate; or

(c) Withdraw or amend the order of suspension, notice of intent to revoke, or notice of intent to nonrenew the certificate.

(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 set forth in OAR 309-008-0905.

History

Statutory/Other Authority: 413.042 & 430.256
Statutes/Other Implemented: 430.256
ADS 4-2017, adopt filed 12/28/2017, effective 01/01/2018

Or. Admin. R. 415-054-0477 Hearings

(1) An applicant or ADSS who is issued a notice of intent to revoke, suspend, 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 ADSS shall be entitled to request a hearing.

History

Statutory/Other Authority: 413.042 & 430.256
Statutes/Other Implemented: 430.256
ADS 4-2017, adopt filed 12/28/2017, effective 01/01/2018

Or. Admin. R. 415-054-0478 Complaints

(1) Any individual may file a complaint with the Division concerning an ADSS holding a certificate. The Division may require the complainant to exhaust grievance procedures available through the ADSS prior to initiating an investigation.

(2) The Division shall only investigate a complaint concerning an ADSS 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 an ADSS 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 refusal to renew an applicant or ADSS’s application or certificate.

History

Statutory/Other Authority: 413.042 & 430.256
Statutes/Other Implemented: 430.256
ADS 4-2017, adopt filed 12/28/2017, effective 01/01/2018

Or. Admin. R. 415-054-0479 Policies

(1) All ADSS must develop and implement written personnel policies and specific procedures compliant with these rules including:

(a) Mandatory abuse reporting compliant with ORS 430.735 - 430.768 and OAR 943-045-0250 through 943-045-0370;

(b) Criminal Records Checks compliant with ORS 181.533 through 181.575 and 943-007-0001 through 0501; and

(2) All ADSS must develop and implement written service delivery policies and specific procedures compliant with these rules:

(a) Service delivery policies must be available to individuals and family members upon request; and

(b) Service delivery policies and procedures must include at a minimum:

(A) Fee agreements;

(B) 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;

(D) Grievances and appeals;

(E) Individual rights;

(F) Quality assessment and performance improvement;

(G) Trauma informed service delivery consistent with the Division Trauma Informed Services Policy;

(H) Provision of culturally and linguistically appropriate services;

(I) Crisis prevention and response, including suicide risk assessment and appropriate referral; and

(J) Incident reporting.

History

Statutory/Other Authority: 413.042 & 430.256
Statutes/Other Implemented: 430.256
ADS 4-2017, adopt filed 12/28/2017, effective 01/01/2018

Or. Admin. R. 415-054-0481 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 that are 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 referred to a Division approved DUII services provider of the individual’s choice and be free from undue influence or coercion when choosing a provider.

(c) Have the role of the court, DUII services provider, and ADSS monitoring process explained where the DUII system is concerned;

(d) Be treated with dignity and respect;

(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) Inspect their service record in accordance with ORS 179.505;

(g) Refuse participation in experimentation;

(h) Receive prior notice of transfer, unless the circumstances necessitating transfer pose a threat to health and safety;

(i) Be free from abuse or neglect and to report any incident of abuse or neglect without being subject to retaliation;

(j) Have religious freedom;

(k) Be free from seclusion and restraint;

(L) Be informed at the start of services of the rights guaranteed by this rule;

(m) 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;

(n) Have family and guardian involvement in service planning and delivery;

(o) File grievances, including appealing decisions resulting from the grievance;

(p) Exercise all rights set forth in ORS 109.610 through 109.697 if the individual is a child, as defined by these rules;

(q) Exercise all rights set forth in ORS 426.385 if the individual is committed to the Authority; and

(r) Exercise all rights described in this rule without any form of reprisal or punishment.

(2) The ADSS must 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 must 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 must be explained to the individual and if applicable the guardian; and

History

Statutory/Other Authority: 413.042 & 430.256
Statutes/Other Implemented: 430.256, 430.205-430.210, 430.254-430.640, 430.850-430.955, 461.549 & 743A.168
ADS 4-2017, adopt filed 12/28/2017, effective 01/01/2018

Or. Admin. R. 415-054-0485 Screening

(1) The ADSS shall perform a screening interview using documents and procedures designated by the Division for individuals under a DUII Diversion Agreement or convicted of a DUII within the preceding 15 years to determine whether to recommend an individual to a DUII education program or a DUII rehabilitation program.

(2) The ADSS must utilize a screening procedure that at a minimum shall ensure the provision and documentation of 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) Individuals must receive services in the most timely manner feasible consistent with the presenting circumstances;

(c) Development and maintenance of adequate records and other documentation for each individual served that demonstrates the specific services for which payment has been requested, including documentation of a suicide risk assessment and appropriate referral;

(d) An authorization for the release of information obtained for any confidential information concerning the individual being considered for or receiving services in accordance with ORS 179.505, Federal Confidentiality Regulations (42 CFR, Part 2), and HIPAA; and

(e) Reasonable effort is made to attain appropriate collateral information including but not limited to the individual’s DUII arrest record.

(3) At the time of screening, the program must offer to the individual and guardian, if applicable, written program orientation information. The information must be written or, upon request, in an alternative format or language appropriate to the individual’s need and must include:

(a) A description of individual rights;

(b) Policy concerning grievances and appeals consistent with these rules to include an example grievance form; and

(4) Screening interviews shall be conducted in a face-to-face interview unless:

(a) The individual provides documentation from a health care professional indicating that a face-to-face interview would jeopardize their health or safety;

(b) The individual is a resident of another state or county and lives more than 75 miles from the ADSS service site;

(d) Approved by the Division in writing prior to the screening interview.

(5) The ADSS shall clearly document the reason for the absence of a face-to-face interview in the individual record.

(6) Individuals who exhibit risk factors for a substance use disorder as indicated in the Division approved screening tool shall be referred to DUII Rehabilitation Services.

(7) Individuals who do not exhibit risk factors for a substance use disorder as indicated in the Division approved screening tool shall be referred to DUII Education Services.

History

Statutory/Other Authority: 413.042 & 430.256
Statutes/Other Implemented: 430.256
ADS 4-2017, adopt filed 12/28/2017, effective 01/01/2018

Or. Admin. R. 415-054-0490 Referrals

(1) After completion of a screening interview, the ADSS shall initiate a referral to the Division approved DUII services provider of the individual’s choice using forms and procedures designated by the Division.

(2) The ADSS shall provide the individual with a list of all Division approved DUII services providers:

(a) Within the geographic area preferred by the individual; and

(b) In any other geographic area capable of responding to a specific need including but not limited to:

(A) Ability to pay or seek reimbursement through insurance;

(B) Primary language;

(D) Hours of operation.

(3) The individual record shall include documentation of which Division approved DUII services providers were offered for referral that has been signed and dated by the individual.

(4) The ADSS may not deny a referral to any Division approved DUII services provider except in cases where the referral would constitute an imminent health or safety risk to the individual. Denials shall be clearly documented in the individual record and include the reason for the denial including the specific health or safety risk posed.

(5) Within three calendar days of a denial being made, the ADSS shall report to the Division using Division approved forms and procedures.

(6) Within five calendar days of the screening, the ADSS shall forward a copy of the Division approved referral form and completed screening instrument to:

(a) The selected DUII services provider; and

(b) The individual.

(7) When the individual is a resident of a state other than Oregon, the ADSS may refer the individual to a program licensed by and located in the individual’s state of residency.

(8) Referrals to out-of-state substance use disorder service providers shall also include a copy of applicable Oregon Administrative Rules for issuance of a DUII Treatment Completion Certificate.

History

Statutory/Other Authority: ORS 430.256 & 413.042
Statutes/Other Implemented: ORS 430.256
ADS 4-2017, amend filed 12/28/2017, effective 01/01/2018
ADS 2-2011, f. 3-8-11, cert. ef. 3-9-11
ADS 4-2010(Temp), f. & cert. ef. 9-20-10 thru 3-9-11

Or. Admin. R. 415-054-0500 Transfers

(1) An individual may request a transfer to a different Division approved DUII services provider by submitting a request in writing to the ADSS.

(2) The ADSS shall initiate a referral to the requested Division approved DUII services provider as described in OAR 415-054-0490(3) within five calendar days from the receipt of the individual’s written request.

(3) The ADSS may not deny a transfer request to any Division approved DUII services provider except in cases where the referral would constitute an imminent health or safety risk to the individual. Denials shall be clearly documented in the individual record and include the reason for the denial including the specific health or safety risk posed.

(4) Within three calendar days of a denial being made, the ADSS shall report to the Division using Division approved forms and procedures.

History

Statutory/Other Authority: ORS 430.256 & 413.042
Statutes/Other Implemented: ORS 430.256
ADS 4-2017, amend filed 12/28/2017, effective 01/01/2018
ADS 2-2011, f. 3-8-11, cert. ef. 3-9-11
ADS 4-2010(Temp), f. & cert. ef. 9-20-10 thru 3-9-11

Or. Admin. R. 415-054-0510 Monitoring

(1) The ADSS shall monitor the progress of individuals under a DUII Diversion Agreement or convicted of a DUII by documenting:

(a) Enrollment or failure to enroll in the DUII services program; and

(b) Successful completion of the DUII services program.

(2) Failure to complete all or any part of the screening interview or DUII services program.

History

Statutory/Other Authority: ORS 430.256 & 413.042
Statutes/Other Implemented: ORS 430.256
ADS 4-2017, amend filed 12/28/2017, effective 01/01/2018
ADS 2-2011, f. 3-8-11, cert. ef. 3-9-11
ADS 4-2010(Temp), f. & cert. ef. 9-20-10 thru 3-9-11

Or. Admin. R. 415-054-0520 Individual Records and Fees

(1) An individual record shall be maintained for each individual who receives ADSS services. The record shall contain at a minimum:

(a) Screening information;

(b) Documentation of referrals, re-referrals, or transfers to DUII services programs;

(d) Documentation of successful completion or failure to complete the DUII services programs referred to; and

(e) Documentation of each contact with or related to the individual.

(2) Any errors in the individual record shall be corrected by drawing a single ink line through the error and adding the correction date and ADSS’s initials. The use of correction fluid or tape or any other attempt to make the error illegible is unacceptable.

(3) Individual records shall be kept for a minimum of seven years.

(4) Documentation of the individual’s successful completion or failure to complete the screening interview or DUII services program referred to shall be kept for a minimum of 15 years.

(5) Client records shall be kept confidential in accordance with HIPAA, ORS 179.505, 45 CFR 205.50 and 42 CFR Part 2, and any Division administrative rule pertaining to client records.

(6) Pursuant to ORS 813.021 and ORS 813.240, the screening fee shall be $150.00.

(7) Additional fees may only be charged if ordered by the court in which the individual was adjudicated. The ADSS shall be responsible to provide the Division with a copy of any such fee court orders.

(8) A schedule of all fees shall be provided to each individual screened and posted in writing in a common area.

History

Statutory/Other Authority: ORS 430.256 & 413.042
Statutes/Other Implemented: ORS 430.256
ADS 4-2017, amend filed 12/28/2017, effective 01/01/2018
ADS 2-2011, f. 3-8-11, cert. ef. 3-9-11
ADS 4-2010(Temp), f. & cert. ef. 9-20-10 thru 3-9-11

Or. Admin. R. 415-054-0530 Reporting Requirements

(1) ADSS shall report to the adjudicating court the individual’s successful completion or failure to complete all or any part of the DUII services program determined by the screening interview within 14 calendar days of receipt of notification from the DUII services provider unless an alternate reporting schedule is agreed to in writing between the ADSS and the designating court.

(2) The form of the report shall be determined by agreement between the court and ADSS.

(3) For individuals enrolled in a DUII education or DUII rehabilitation program, the ADSS shall notify the DUII services provider within 72 hours of receipt of a negative report from the individual’s Ignition Interlock Device installer.

(4) ADSS shall submit monthly screening reports no later than the 10th of each month using forms and procedures designated by the Division.

History

Statutory/Other Authority: ORS 430.256 & 413.042
Statutes/Other Implemented: ORS 430.256
ADS 4-2017, amend filed 12/28/2017, effective 01/01/2018
ADS 2-2011, f. 3-8-11, cert. ef. 3-9-11

Or. Admin. R. 415-054-0535 Variance

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

(2) The applicant or ADSS must submit the variance request directly to the Division along with relevant 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 Chief Officer, 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 ADSS’ current certificate.

(4) A variance granted by the Division becomes part of the certificate. Continuance of the variance may not be automatic and shall be re-considered 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 ADSS.

(6) Failure by the ADSS 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 ADSS 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 ADSS is considered necessary to prevent harm to the individual may result in the Division taking action on the certificate pursuant to OAR 415-054-0475.

History

Statutory/Other Authority: 413.042 & 430.256
Statutes/Other Implemented: 430.256
ADS 4-2017, adopt filed 12/28/2017, effective 01/01/2018

Or. Admin. R. 415-054-0545 Sole Service Provider Designation Approval Process

(1) A single agency or organization with a valid letter of approval as a Division approved DUII services provider may request designation as a sole service provider if it is able to demonstrate that:

(a) It is the only Division approved DUII services provider in the county;

(b) ADSS records are kept separate from clinical records;

(d) The individual providing ADSS services does not provide DUII education or rehabilitation services.

(2) Requests for designation under these rules must be submitted in writing using Division approved forms and procedures.

(3) Sole service providers shall comply with all applicable ADSS, DUII education and DUII rehabilitation, and recommendations for restricted license requirements.

History

Statutory/Other Authority: 413.042 & 430.256
Statutes/Other Implemented: 430.256
ADS 4-2017, adopt filed 12/28/2017, effective 01/01/2018

Or. Admin. R. 415-054-0546 Revocation or Denial of Approval of Sole Service Provider Designation

(1) Approval of a request for designation as a sole service provider is at the Chief Officer’s discretion.

(2) The Chief Officer may deny, revoke, or refuse to renew designation for any of the reasons set forth in OAR 415-054-0475 or due to a finding that the county has more than one Division approved DUII services provider.

History

Statutory/Other Authority: 413.042 & 430.256
Statutes/Other Implemented: 430.256
ADS 4-2017, adopt filed 12/28/2017, effective 01/01/2018

Or. Admin. R. 415-054-0550 Demonstration Project Approval Process

(1) Only an ADSS with a valid certificate and a single agency or organization with a valid letter of approval to provide treatment services may be approved as a demonstration project.

(2) Requests for designation under these rules must be submitted in writing using Division approved forms and procedures.

(3) Requests must also include:

(a) Letters of endorsement from courts and other relevant persons or agencies;

(b) Written assurances of participation by each proposed participant;

(A) The Community Mental Health Program director of the proposed geographic area;

(B) The Local Alcohol and Drug Planning Committee; and

(d) Any additional information requested by the Division.

(4) Approval of a demonstration project is at the discretion of the Chief Officer. The Division shall review requests and shall notify the requestor of the approval or denial within 60 days of the date the request is received by the Division.

History

Statutory/Other Authority: 430.256 & 413.042
Statutes/Other Implemented: 430.256
ADS 4-2017, amend filed 12/28/2017, effective 01/01/2018
ADS 2-2011, f. 3-8-11, cert. ef. 3-9-11

Or. Admin. R. 415-054-0560 Demonstration Project General Requirements

(1) The approved demonstration project must comply with all applicable ADSS, DUII education and DUII rehabilitation, and recommendations for restricted license requirements.

(2) The effectiveness of the approved demonstration project must be evaluated as agreed upon between the applicant and the Division.

(3) Results of the program evaluation must be submitted to the Division within timelines approved by the Chief Officer.

History

Statutory/Other Authority: 430.256 & 413.042
Statutes/Other Implemented: 430.256
ADS 4-2017, amend filed 12/28/2017, effective 01/01/2018
ADS 2-2011, f. 3-8-11, cert. ef. 3-9-11

Or. Admin. R. 415-054-0570 Revocation or Denial of Approval for Demonstration Projects

(1) Approval of an application for a demonstration project is at the Chief Officer’s discretion.

(2) The Chief Officer may deny, revoke, or refuse to renew approval for any of the reasons detailed in OAR chapter 415, division 054 or due to a finding that the demonstration project is not resolving the problems explained in the original application.

(3) The Chief Officer may refuse to renew approval if the program evaluation required under these rules fails to demonstrate the effectiveness of combining the diagnostic assessment and the treatment functions within a single agency or organization.

(4) When a request for approval to operate a demonstration project is denied, a current approval is suspended or revoked, or renewal is denied, notice of the action shall be sent by certified mail and shall include information about contested case hearings.

History

Statutory/Other Authority: 430.256 & 413.042
Statutes/Other Implemented: ORS 430.256
ADS 4-2017, amend filed 12/28/2017, effective 01/01/2018
ADS 2-2011, f. 3-8-11, cert. ef. 3-9-11

Division 56 SUBSTANCE ABUSE PREVENTION PROGRAM

Or. Admin. R. 415-056-0030 Purpose and Scope

These rules prescribe standards and procedures for substance abuse providers approved by the Division. These rules establish standards for community substance abuse prevention and provide that a full continuum of services be available to Oregonians either directly or through written agreements or contracts.

History

Statutory/Other Authority: ORS 430.256 & 413.042
Statutes/Other Implemented: ORS 430.256 - 430.415
ADS 1-2018, amend filed 03/01/2018, effective 03/01/2018
ADS 1-2012, f. & cert. ef. 2-9-12

Or. Admin. R. 415-056-0035 Definitions

(1) "Approval" means the Letter of Approval issued by the Division to indicate that the substance abuse prevention program has been found in compliance with all relevant federal and Oregon laws and Oregon Administrative Rules.

(2) "Community Mental Health Program (CMHP)" means the entity 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.

(3) “Coordinator” means the designated county or tribal program coordinator hired to oversee prevention services.

(4) "Cultural Competence" means the process by which individuals and systems respond respectfully and effectively to people of all cultures, languages, classes, races, ethnic backgrounds, disabilities, religions, genders, sexual orientation, 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.

(5) “Director” means the Division Director or designee.

(6) "Division" means Division of the Oregon Health Authority.

(7) "Evidenced-Based Practices" (EBP) means practices for which there is consistent scientific evidence that produce positive outcomes. An EBP must meet the criteria set forth by the Division.

(8) "Gender-Specific Services" means services that comprehensively address the needs of a gender group and foster positive gender identity development.

(9) “Letter of Approval” means the “Approval" as defined in OAR 415-056-0035.

(10) "Institute of Medicine Model" means the framework that defines the target groups and activities addressed by various prevention efforts and includes the following:

(a) Promotion: Strategies that typically address the entire population. Strategies are aimed to enhance individuals’ ability to achieve developmentally appropriate tasks (competence) and a positive sense of self-esteem, mastery, well-being, and social inclusion and strengthen their ability to cope with adversity;

(b) Universal Prevention: Universal strategies address the entire population with messages and programs aimed at preventing or delaying the substance abuse.

(c) Selective Prevention: Selective prevention strategies target subsets of the total population that are deemed to be at-risk for substance abuse by virtue of the membership in a particular population segment; and

(d) Indicated Prevention: Indicated prevention strategies are designed to prevent the onset of substance abuse in individuals who do not meet criteria for addiction but who are showing early danger signs.

(11) "Local Alcohol and Drug Planning Committee" (LADPC) means a committee appointed or designated by a board of county commissioners. The committee identifies needs and establishes priorities for substance abuse prevention, treatment, and recovery services in the county. Members of the committee must be representative of the geographic area and include a number of minority members to reasonably reflect the proportion of need for minority services in the community.

(12) "Minority" means a participant who’s cultural, ethnic, or racial characteristics constitute a distinct demographic population, including but not limited to members of differing cultures, languages, classes, races, ethnic backgrounds, disabilities, religions, genders, or sexual orientations.

(13) "Minority Program" means a program that is designed to meet the unique prevention needs of a minority group and that provides services to individuals belonging to a minority population as defined in these rules.

(14) "Participant" means an individual who receives services under these rules.

(15) "Prevention Provider" means a governmental entity, an organization or federally recognized tribe that undertakes to establish, operate, or contract for prevention services.

(16) "Prevention Service" means an integrated combination of strategies designed to prevent substance abuse and associated effects regardless of the age of participants.

(17) "Strategy" means activities targeted to a specific population or the larger community that are designed to be implemented before the onset of problems as a means to prevent substance abuse or detrimental effects from occurring. The Center for Substance Abuse Prevention's strategies are defined below:

(a) Information Dissemination: This strategy provides knowledge and increases awareness of the nature and extent of alcohol and other drug use, abuse and addiction, as well as their effects on individuals, families, and communities. It also provides knowledge and increases awareness of available prevention and treatment programs and services. It is characterized by one-way communication from the source to the audience with limited contact between the two;

(b) Education: This strategy builds skills through structured learning processes. Critical life and social skills include decision making, peer resistance, coping with stress, problem solving, interpersonal communication and systematic and judgmental abilities. There is more interaction between facilitators and participants than in the information dissemination strategy;

(c) Alternatives: This strategy provides participation in activities that exclude alcohol and other drugs. The purpose is to identify and offer healthy activities and to discourage the use of alcohol and drugs through these activities;

(d) Problem Identification and Referral: This strategy aims at identification of individuals who have indulged in illegal or age-inappropriate use of tobacco or alcohol and those individuals who have indulged in the first use of illicit drugs in order to assess if the individual's behavior can be reversed through education;

(e) Community Based Processes: This strategy provides ongoing networking activities and technical assistance to community groups or agencies. It encompasses neighborhood-based or industry led, grassroots, empowerment models using action planning and collaborative systems planning; and

(f) Environmental: This strategy establishes or changes written and unwritten community standards, codes, and attitudes, thereby influencing alcohol and other drug use by the general population.

(18) “Tribal Authority” means an individual or group identified by the tribe that approves the prevention plan. Examples include a Tribal Council, Health Director, or Prevention Supervisor.

History

Statutory/Other Authority: ORS 430.256 & 413.042
Statutes/Other Implemented: ORS 430.256 - 430.415
ADS 1-2018, amend filed 03/01/2018, effective 03/01/2018
ADS 1-2012, f. & cert. ef. 2-9-12

Or. Admin. R. 415-056-0040 Administrative Requirements

(1) A prevention provider that contracts directly or indirectly with the Division must comply with all related administrative rules.

(2) Subcontracted agencies must be administered by staff in accordance with standards set forth in OAR 309-014-0000 through 0025 and OAR 309-014-0030(3) through 0040.

(3) A fee schedule may be established that approximates actual cost of service delivery. The fee schedule must assess the cost to the participant for the service in accordance with the participant's ability to pay.

(4) A prevention provider must establish comprehensive written policies and procedures that describe program operations and compliance with these rules and shall at minimum address the following:

(a) A mission, vision, and values statement;

(b) An organizational management chart;

(d) An anti-discrimination policy;

(e) A cultural competency plan;

(f) Gender specific services;

(g) The use of substances by program participants and staff during program activities;

(h) The protection and safety of service recipients; and

(i) A process for referring individuals who are not appropriate for prevention services to more applicable resources such as emergency and crisis services, detoxification, mental health treatment, and other services within the continuum of care.

(5) A request for certification shall be considered by the Division after the CMHP or tribal authority and the LADPC or other applicable committee have reviewed and commented on the request.

(6) Prevention providers must provide services that incorporate evidence based practices as defined in OAR 415-056-0035.

(7) Printed materials utilized by the program must be:

(a) Written with consideration to the demographic make-up of the program and in cultural competent language;

(b) In the participant’s native language; and

(8) The provider must report to the Division on approved standardized forms. All reporting must be done in accordance with Federal Confidentiality Regulations (42 CFR Part 2).

(9) The provider must ensure the privacy and safety of participants where appropriate and necessary.

(10) Providers must document coordination of activities with related community partners.

History

Statutory/Other Authority: ORS 430.256 & 413.042
Statutes/Other Implemented: ORS 430.256 - 430.415
ADS 1-2018, amend filed 03/01/2018, effective 03/01/2018
ADS 1-2012, f. & cert. ef. 2-9-12

Or. Admin. R. 415-056-0045 Staff Requirements

(1) The substance abuse prevention program must be administered by staff in accordance with standards set forth in these rules.

(2) The coordinator is qualified by virtue of knowledge, training, experience, and skills. The coordinator must be certified by the Addiction Counselor Certification Board of Oregon (ACCBO) as a Certified Prevention Specialist (CPS) or must acquire certification within two years from the date of hire.

(3) The coordinator shall be employed greater than .50 FTE to carry out their responsibilities.

(4) Roles and authorities of the coordinator include:

(a) Development, monitoring, and oversight of the Prevention Implementation Plan, which shall be in compliance with the requirements set forth by the Division;

(b) Implementation of the defined strategies;

(d) Administration of funds;

(e) Accountability for the oversight and quality of prevention services; and

(f) Supervision of other staff related to their skill level with the goal of achieving the objectives of the prevention program and assisting staff to increase their knowledge, skills, and abilities.

(5) Program staff providing more than .5 FTE hours of direct prevention services must:

(a) Have a CPS certification or must acquire the certification within two years of hire;

(b) Have a workforce development plan utilized to assure compliance with these rules and to ensure each staff has opportunities to advance their prevention knowledge and skills; and

(c) Be culturally competent to serve the identified populations. Agencies who contract for the delivery of direct prevention services must ensure that the contractors meet the requirements for prevention staff described in these rules.

(6) The number and responsibilities of the prevention staff must be sufficient to provide the services required under these rules for the number of participants the program intends to serve.

History

Statutory/Other Authority: ORS 430.256 & 413.042
Statutes/Other Implemented: ORS 430.256 - 430.415
ADS 1-2018, amend filed 03/01/2018, effective 03/01/2018
ADS 1-2012, f. & cert. ef. 2-9-12

Or. Admin. R. 415-056-0050 Variances

Requirements and standards for requesting and granting variances or exceptions are found in OAR 415-012-0090.

History

Statutory/Other Authority: ORS 430.256 & 413.042
Statutes/Other Implemented: ORS 430.256 - 430.415
ADS 1-2012, f. & cert. ef. 2-9-12

Division 57 STANDARDS FOR DEPARTMENT OF CORRECTIONS-BASED ALCOHOL AND OTHER DRUGS TREATMENT PROGRAMS

Or. Admin. R. 415-057-0000 Purpose

These rules prescribe standards for the development and operation of adult prison-based Alcohol and other drugs Treatment Programs for the Department of Corrections (DOC) approved by the Addictions and Mental Health Division.

History

Statutory/Other Authority: ORS 409.050, 409.410 & ORS 409.420
Statutes/Other Implemented: ORS 430.240 - 430.640, 430.850 - 430.955, 813.010 - 813.052 & 813.200 - 813.270
ADS 2-2010, f. & cert. ef. 5-6-10

Or. Admin. R. 415-057-0010 Definitions

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

(2) "ASAM PPC-2R" means the American Society of Addiction Medicine Patient Placement Criteria for the Treatment of Substance-related Disorders, Second Edition Revised, April 2001, which is a clinical guide used in matching individuals to appropriate levels of care, and incorporated by reference in these rules.

(3) “Care Coordination” means a process-oriented activity to facilitate ongoing communication and collaboration to meet multiple needs. Care coordination includes facilitating communication between the Doc institution transition representatives, 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 the program and the community.

(4) "Client" means a person receiving services in an Oregon prison-based Alcohol and Other Drugs treatment program under these rules and who has signed a written consent that complies with Section 2.35 of the federal confidentiality regulations (42 CFR Part 2).

(5) “Co-occurring Disorders" or “COD” means co-occurring substance use and mental health disorders.

(6) “Comprehensive Diagnostic Assessment" means the process for obtaining all pertinent information, ancillary and causal factors, as identified by the individual, family and collateral sources used to determine a diagnosis and develop the individualized treatment plan.

(7) “Criminal Risk Factor Assessment” of the Oregon Accountability Model (OAM) means the assessment process implemented by the Oregon DOC. The outcome is a corrections plan for every inmate that is tracked throughout an inmate’s incarceration and supervision in the community.

(8) “Criminal Risk Factors” means factors that predict criminal behavior. The risk factors are assessed at DOC central intake and integrated in the corrections plan for each inmate.

(9) “Department of Corrections Prison-Based Alcohol and Other Drugs Treatment Program” means a treatment program for adult inmates of state correctional institutions who are within the last six to twelve months of release from incarceration. The program provides Alcohol and Other Drugs treatment and recovery services and collaborates with partners to ensure a seamless re-entry into the community.

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

(11) “DOC” means the Oregon Department of Corrections.

(12) "DSM" means the "Diagnostic and Statistical Manual of Mental Disorders", published by the American Psychiatric Association.

(13) “DSM Five-axis Diagnosis” means the multi-axial diagnosis, consistent with the Diagnostic and Statistical Manual of Mental Disorders, resulting from the assessment.

(14) “Evidence Based Practice (EBP)” means clinical Alcohol and Other Drugs treatment practices that are based on generally accepted scientific research. Treatment programs document efforts to assure fidelity to a practice and measure the impact of a practice on the clients, participants and communities.

(15) "Intern or student" means an individual who is supervised by a qualified supervisor defined in section 415-057-0120 of this rule, provides a clinical or non-clinical program service, and who is enrolled in a credentialed or accredited educational program.

(16) “Oregon Accountability Model (OAM)” means the simultaneous, coordinated and efficient implementation of DOC initiatives and projects that provide a foundation for inmates to lead productive lives upon re-entry into the community.

(17) “Oregon Corrections Plan” means the specific activities the inmate performs to learn skills in order to mitigate the risk factors identified through the assessment process.

(18) “Permanent client record" means the official clinical written file for each client containing all information required by these rules. The permanent client record is maintained to demonstrate compliance with these rules.

(19) "Primary Counselor" means a program staff person who is assigned to the client and follows the case throughout the treatment process.

(20) “Program” means the Alcohol and Other Drugs Prison-Based Treatment Program.

(21) "Quality assurance" means the process of objectively and systematically monitoring and evaluating the appropriateness of client care to identify and resolve identified problems.

(22) "Qualified Mental Health Associate (QMHA)” means a person delivering services under the direct supervision of a Qualified Mental Health Professional (QMHP) and meeting the following minimum qualifications as documented by the Local Mental Health Authority (LMHA) or designee:

(a) A bachelor's degree in a behavioral sciences field or a combination of at least three years relevant work, education, training or experience; and

(b) Who has the competencies necessary to:

(A) Communicate effectively;

(B) Understand mental health assessment, treatment and service terminology and to apply these concepts; and

(C) Provide psychosocial skills development and the ability to implement interventions prescribed in a treatment plan within the scope of his or her practice.

(23) "Qualified Mental Health Professional (QMHP)" means a Licensed Medical Practitioner (LMP) or any other person meeting the following minimum qualifications as documented by the LMHA or designee:

(a) A graduate degree in social work, psychology, a behavioral science field or recreational, art or music therapy; or

(b) A bachelor's degree in nursing and licensed by the State of Oregon; or Bachelor’s degree in occupational therapy and licensed by the State of Oregon; and

(c) Education and experience demonstrating the competencies to identify precipitating events; gather histories of mental and physical disabilities, recognizing and understanding alcohol and drug use, past mental health services and criminal justice contacts; assessing family, social and work relationships; conducting a mental status examination; documenting a multiaxial DSM diagnosis; writing and supervising a treatment plan; conducting a Comprehensive Mental Health Assessment; and providing individual, family, and group therapy within the scope of his or her practice.

(24) “Responsivity factors” means individual factors that facilitate or interfere with learning and are focused on personal characteristics that regulate an individual's ability and motivation to learn and change behavior.

(25) "Substance related disorders" are defined in DSM criteria as disorders related to taking a drug, including alcohol, to the side effects of a medication, and to a toxin exposure. The disorders include substance dependency and substance abuse, alcohol dependence and alcohol abuse, and substance induced disorders and alcohol induced disorders.

(26) “Supportive Persons” means any person approved by the DOC that the client identifies as being supportive to the recovery process of the client, including but not limited to a spouse, domestic partner, parent, child, relative, mentor, recovery coach, elder, or representative from a faith-based organization or self-help community organization.

(27) “Unusual Incidents” means an incident or circumstance involving any DOC inmate participating in the program that constitutes an immediate threat to the life or health of self, staff, another inmate, private citizen, or to the property of the DOC.

(28) "Treatment" means the specific medical and non-medical therapeutic techniques employed to assist the client in recovering from substance related disorders.

(29) "Volunteer" means an individual who provides an Alcohol and Other Drugs treatment program service or who takes part in an Alcohol and Other Drugs treatment program service and who is not an employee of the program and is not paid for services.

History

Statutory/Other Authority: ORS 413.042, 409.410 & 409.420
Statutes/Other Implemented: ORS 430.240 - 430.640, 430.850 - 430.955, 813.010 - 813.052 & 813.200 - 813.270
ADS 2-2010, f. & cert. ef. 5-6-10

Or. Admin. R. 415-057-0020 Program Approval and Variances

(1) In order to receive a Letter of Approval or license from the Division, a program will meet the standards of OAR 415-012-0000 to 415-012-0090 and any other administrative rules applicable to the program.

(2) Requirements and standards for requesting and granting variances or exceptions to these rules for programs are found in OAR 415-012-0090.

(3) The denial, revocation, or suspension of a letter of approval or license for the program may be based on any of the grounds set forth in OAR 415-012-0060.

(4) In addition to the grounds set forth in OAR 415-012-0060, the Assistant Director may deny, revoke, refuse to renew, or suspend a letter of approval or license when he or she determines that the issuance or continuation of the letter of approval or license would be inconsistent with the public interest. In determining the public interest, the assistant Director will consider the following factors, or any one of them, which apply to the applicant, licensee, or any person holding a 5 percent or greater financial interest in the program or which apply to the medical director, program manager, clinical supervisor, or program staff:

(a) Any convictions under any federal or state law relating to any controlled substance or related to such person’s involvement in the administration of a state-or federally-funded public assistance or treatment program;

(b) Furnishing of false or fraudulent material in any application for a letter of approval; or

History

Statutory/Other Authority: ORS 413.042, 409.410 & 409.420
Statutes/Other Implemented: ORS 430.240 - 430.640, 430.850 - 430.955, 813.010 - 813.052 & 813.200 - 813.270
Reverted to ADS 2-2010, f. & cert. ef. 5-6-10
ADS 4-2016(Temp), f. & cert. ef. 8-10-16 thru 2-5-17
ADS 2-2010, f. & cert. ef. 5-6-10

Or. Admin. R. 415-057-0030 Administrative Requirements for Treatment Programs

(1) The program will implement written policies and procedures to ensure compliance with these administrative rules, including program operations, quality assurance and reporting procedures. The policies and procedures will describe how the program will deliver treatment that ensures desired outcomes. The Quality Assurance Plan must:

(a) Include a measurement of the proportion of full-time equivalent program staff who are licensed and or certified as defined in this rule;

(b) Have and follow a supervision plan for program staff; and

(A) Monitoring treatment groups and program activities to evaluate fidelity and effectiveness;

(B) Reviewing clinical charts to ensure permanent records are accurate, legible and meet documentation requirements set forth in these rules;

(C) Providing a formal mechanism for clients to give input into the delivery of treatment services and program structure that at a minimum includes client satisfaction surveys; and

(D) Providing a written policy and procedure for reporting unusual incidents to the designated DOC administrator and AMH that includes a detailed description of the event, the persons involved and the final resolution of the incident.

(2) The program will have and implement the following written personnel policies and procedures, which are applicable to all program staff, volunteers, and interns or students:

(a) Rules of conduct and standards for ethical practices of program staff, including written procedures to report misconduct to the appropriate authority;

(b) Managing incidents of alcohol and drug use by program staff that, at a minimum, comply with Drug Free Workplace Standards; and

(c) Compliance with the federal and state personnel regulations including the Civil Rights Act of 1964 as amended in 1972, Equal Pay Act of 1963, the Age Discrimination in Employment Act of 1967, Title I of the Americans with Disabilities Act, Oregon civil rights laws related to employment practices, and any subsequent amendments to these laws effective on or before the effective date of these rules. The program will give individualized consideration to all applicants who, with or without reasonable accommodation, can perform the essential functions of the job position.

(3) The program will maintain a personnel record for each program staff documenting applicable qualification standards as described in OAR 415-057-0110 to 0130 and 415-057-0150. The program will maintain the record for a period of three years following the departure of a program staff.

(4) The program receiving public funds must comply with Title 2 of the Americans with Disabilities Act of 1990, 42 USC § 1231 et seq. after July 26, 1992.

(5) The program will maintain malpractice and liability insurance and be able to demonstrate evidence of current compliance with this requirement. Programs operated by a public body will demonstrate evidence of insurance or a self-insurance fund pursuant to ORS 30.282.

(6) The program will:

(a) Comply with federal regulations (42 CFR § 2 and 45 CFR § 205.50) and state statutes including ORS 179.505 and 430.399 pertaining to confidentiality of permanent client records;

(b) Accurately record all information about the client as required by these rules in the permanent client record and unless specified otherwise, within seven days of delivering the service or obtaining the information;

(c) Maintain each permanent client record to assure identification, permanency, accessibility, uniform organization, and completeness of all components required by these rules and in a manner to protect against damage or separation from the permanent client or program record;

(d) Keep all documentation legible and current;

(e) Include the date that the service was provided;

(f) Include the signature and credentials of the person providing the service and include the date of the signature;

(g) Not falsify, alter, or destroy any client information required by these rules to be maintained in the permanent client record or program records;

(h) Require that errors in the permanent client record be corrected by lining out the incorrect information with a single line in ink, adding the correct information, dating, and initialing the correction. Errors may not be corrected by removal or obliteration through the use of correction fluid or tape;

(i) Provide written description in the permanent client record of any injury, accident or unusual incident involving any client occurring during program services or on program grounds; and

(j) Permit inspection of permanent client records upon request by the Division to determine compliance with these rules.

(7) Permanent client records will be kept for a minimum of seven years. If a program is acquired by another program, the original program is responsible for assuring compliance with the requirements of 42 CFR § 2.19(a)(1) or (b), whichever is applicable.

(8) If a program discontinues operations, the program is responsible for: Transferring permanent client records to the DOC records administrator; and

(9) When a program discontinues operations, the identified DOC records administrator is responsible for:

(a) Assuring compliance with the requirement of 42 CFR §2.19(a)(1) or (b), whichever is applicable for transferred permanent client records;

(b) Keeping all transferred permanent client records for a minimum of seven years; or

History

Statutory/Other Authority: ORS 413.042, 409.410 & 409.420
Statutes/Other Implemented: ORS 430.240 - 430.640, 430.850 - 430.955, 813.010 - 813.052 & 813.200 - 813.270
ADS 2-2010, f. & cert. ef. 5-6-10

Or. Admin. R. 415-057-0040 Client Rights

(1) Participation in the program will be voluntary. Clients will have their rights, responsibilities, and services explained, including expected outcomes and possible risks. The program will document informed consent in writing, assure the document is signed and dated by the client, and placed in the permanent client record prior to the start of services.

(2) The client will have the right to refuse services, including any specific procedure. Any consequence that may result from refusing the service, such as termination from the program or referral to a person having supervisory authority over the client, will be explained verbally and in writing to the client. The document will be signed and dated by both the client and the program representative, and placed in the client’s permanent record.

(3) No person will be denied services or discriminated against on the basis of age, ethnicity, gender identity, sexual orientation, religion, disability or diagnostic category unless restricted by predetermined program criteria.

(4) Each client will be assured civil rights as defined by laws that govern DOC and be assured the same human rights as other persons. The program will develop, implement and inform clients of written policies and procedures which protect clients' rights, including:

(a) Protecting client's privacy and dignity;

(b) Assuring confidentiality of records consistent with federal and state laws;

(d) Protecting clients from sexual activity, sexual assault, sexual coercion, sexual solicitation and sexual harassment; and

(e) Providing adequate treatment or care.

(5) Any client labor performed as part of the client's treatment plan or standard program expectations will be agreed to, in writing, by the client, documented in the client permanent record and must comply with regulations of other agencies sharing oversight of the program.

(6) The client has the right to obtain a copy of the permanent client record defined in OAR 415-057-0010(19) within thirty calendar days of a documented request. The program will have a written procedure for client requests to review the permanent client record. Payment for cost of duplication may be required. The client will have the right to access his or her own permanent record except:

(a) When the clinical supervisor determines that disclosure of permanent client records would be detrimental to the client's treatment;

(b) If confidential information has been provided to the program on the basis that the information not be re-disclosed; or

(c) When collateral records in the permanent client record originated outside the program, the client will make the request for those records directly to the originating source.

(7) The client has the right to include any DOC-approved client-identified supportive persons in the treatment planning process.

(8) The program will develop, implement, and inform clients of policies and procedures regarding grievances specific to the program that provide for:

(a) Specific steps for clients to follow the grievance to conclusion;

(b) An opportunity for discussion of the grievance with their primary counselor;

(d) Investigation of the facts supporting or disproving the written grievance;

(e) Initiating action to resolve substantiated grievances within five working days of documented receipt of grievance for clients currently in the treatment program;

(f) Initiating action to resolve substantiated grievances within thirty calendar days of documented receipt of grievance, for clients released from the DOC;

(g) Documentation in the permanent client record of the receipt, investigation, and any action taken regarding the written grievance; and

(h) Specifying contact information for the Division for further investigation if a satisfactory conclusion is not reached.

(9) Where there are barriers to services due to culture, language, gender, illiteracy, or disability, the program will develop a holistic treatment approach including support services available to address or overcome those barriers including:

(a) Making reasonable modifications in policies, practices, and procedures to avoid discrimination, unless the program can demonstrate that doing so would fundamentally alter the nature of the program, service, or activity, such as:

(A) Providing individuals to assist the program in minimizing barriers, such as interpreters;

(B) Translating of written materials to appropriate language or method of communication;

(D) Acknowledging cultural and other values which are important to the client.

(b) Not charging clients for costs of any measure, such as the provision of interpreters, that are required to provide nondiscriminatory treatment to the client; and

(c) Referring the client to the DOC program liaison for re-consideration of treatment placement should the program have a barrier providing appropriate treatment services.

History

Statutory/Other Authority: ORS 413.042, 409.410 & 409.420
Statutes/Other Implemented: ORS 430.240 - 430.640, 430.850 - 430.955, 813.010 - 813.052 & 813.200 - 813.270
ADS 2-2010, f. & cert. ef. 5-6-10

Or. Admin. R. 415-057-0050 Admission Policies and Procedures

(1) The program will have a written policy and procedure that describes criteria to admit clients to the program. The policy and procedure will be made available to clients, program staff, and the community. The written procedure will include:

(a) Criteria for accepting or refusing admission based on the DOC individual Oregon Corrections Plan and DSM-IV criteria;

(b) Documentation that all admissions have been found appropriate for services according to the DOC individual Oregon Corrections Plan and DSM-IV criteria; and

(2) The program will give orientation materials to the client upon arrival to the program and document client receipt of orientation materials in the permanent client record. Written program orientation materials include:

(a) The program's philosophical approach to treatment;

(b) A description of the treatment services;

(d) Information on the rules governing clients' behavior and those infractions that may result in removal from the program or other actions. At a minimum, the rules will state the consequence of using Alcohol and Other Drugs, absences from appointments, and failure to participate in the planned treatment activities.

History

Statutory/Other Authority: ORS 413.042, 409.410 & 409.420
Statutes/Other Implemented: ORS 430.240 - 430.640, 430.850 - 430.955, 813.010 - 813.052 & 813.200 - 813.270
ADS 2-2010, f. & cert. ef. 5-6-10

Or. Admin. R. 415-057-0060 Comprehensive Diagnostic Assessment

(1) Written Procedure: The program will develop and implement a written procedure for assessing each client’s treatment needs that includes collection and assessing data obtained through interview, observation, testing, and review of previous treatment or other written records.

(2) Assessment: The diagnostic assessment will be documented in the permanent client record. The assessment will include:

(a) Clinical formulation of presenting problems; the six dimensions of the ASAM PPC 2-R; important biological, psychological and social factors; medical and trauma history; clinical events and course of substance use or mental illness including onset, duration and severity of presenting concerns; consumer or family expectations for recovery; justification for treatment services and prognosis; current medication regime; and data to support a DSM Five-axis Diagnosis;

(b) A Criminal Risk Factor Assessment and the individual Oregon Corrections Plan;

(c) Documentation of the client’s self-identified cultural background, including level of acculturation, knowledge of own culture, primary language, spiritual or religious interests, and cultural attitude about Alcohol and Other Drugs use;

(d) The date of the assessment;

(e) The signature, signature date, and credentials of the program staff member completing the assessment; and

(f) If Alcohol and Other Drugs treatment is not appropriate or contraindicated, include a written statement justifying the determination.

History

Statutory/Other Authority: ORS 413.042, 409.410 & 409.420
Statutes/Other Implemented: ORS 430.240 - 430.640, 430.850 - 430.955, 813.010 - 813.052 & 813.200 - 813.270
ADS 2-2010, f. & cert. ef. 5-6-10

Or. Admin. R. 415-057-0070 Treatment Planning and Documentation of Treatment Progress

(1) An individualized treatment plan will be developed and placed in the client record no later than 14 days from placement in the program. The treatment plan will include:

(a) The primary client-centered problems and strengths as determined by the client, the DOC individual Oregon Corrections Plan and the comprehensive diagnostic assessment;

(b) Individualized treatment objectives that were developed in collaboration with the client;

(d) Documentation of participation of any supportive person involved in the development of the treatment plan or client’s refusal to include any supportive person;

(e) The date and signature of the client; and

(f) The signature of the program staff with credentials and date of the signature.

(2) At a minimum of once every seven days, program staff will document in the permanent record a comprehensive summary of the client’s progress toward achieving the individualized treatment objectives in the client’s treatment plan and any current obstacles to recovery and include documentation of any participation of the supportive person in treatment services or activities, and their input of client’s progress toward individualized treatment objectives.

(3) The individual treatment plan will be reviewed and modified with the client, assigned program staff and any supportive person every 30 days, or more often as clinically appropriate.

History

Statutory/Other Authority: ORS 413.042, 409.410 & 409.420
Statutes/Other Implemented: ORS 430.240 - 430.640, 430.850 - 430.955, 813.010 - 813.052 & 813.200 - 813.270
ADS 2-2010, f. & cert. ef. 5-6-10

Or. Admin. R. 415-057-0080 Continuing Care Planning

(1) Continuing care planning will begin no less than 45 days prior to the client’s anticipated discharge from the program. Continuing care planning will include:

(a) At least one continuing care staffing, in person or by telephone, between the client, treatment program representatives, DOC institution transition representatives, a post-prison community corrections representative, community-based continuing care representatives, and any supportive person (s);

(b) Referrals to continuing care community-based Alcohol and Other Drugs and mental health treatment providers; and

(c) Documentation that contact was made with the community continuing care services provider to schedule an appointment within seven days of the client’s anticipated release from the program.

(2) No less than 14 days prior to the client’s anticipated discharge from the program, a comprehensive treatment summary will be written and placed in the permanent client record. Copies of the document will be sent to the DOC institution transition staff, continuing care provider and to the community corrections representative. The summary will include:

(a) A copy of a valid Consent To Release Information form;

(b) A copy of the comprehensive diagnostic assessment and latest treatment plan;

(c) A summary of the client’s treatment history, progress in meeting individualized treatment objectives and any unresolved problem areas client is continuing to address from the treatment plan;

(d) A current level of care assessment that is consistent with the six dimensions of the ASAM PPC 2-R adult level of care index and includes documentation of any co-occurring substance related and mental health disorders (COD);

(e) The criminogenic risk level as indicated in the DOC individual Oregon Corrections Plan;

(f) The legal status of the client;

(g) The client’s current stage of change and recommendations on how best to engage the client;

(h) Any client responsivity factors that should be considered in treatment planning and community-based continuing care provider staff assignments;

(i) A relapse prevention plan; and

(j) Recommendations for an initial community-based treatment plan.

History

Statutory/Other Authority: ORS 413.042, 409.410 & 409.420
Statutes/Other Implemented: ORS 430.240 - 430.640, 430.850 - 430.955, 813.010 - 813.052 & 813.200 - 813.270
ADS 2-2010, f. & cert. ef. 5-6-10

Or. Admin. R. 415-057-0090 Treatment Services

(1) The program will provide to each client clinically appropriate services based on best practices for prison-based Alcohol and Other Drugs programs that facilitate desired service outcomes as identified by the individual, and family, when applicable, and address the objectives identified in the treatment plan.

(2) Treatment services provided for clients in prison-based Alcohol and Other Drugs treatment programs will be evidence-based and at a minimum include:

(a) Cognitive behavioral interventions;

(b) Motivational interventions;

(d) Gender specific services;

(e) Cultural relevance;

(f) Healthy relationship education related to parenting, family, significant others, employers, and the community;

(g) Services that address special needs such as trauma, domestic violence, sexual or physical abuse, and self sufficiency; and

(h) Therapeutic community model for residential programs.

(3) Each client admitted to the program will be assigned a primary counselor.

History

Statutory/Other Authority: ORS 413.042, 409.410 & 409.420
Statutes/Other Implemented: ORS 430.240 - 430.640, 430.850 - 430.955, 813.010 - 813.052 & 813.200 - 813.270
ADS 2-2010, f. & cert. ef. 5-6-10

Or. Admin. R. 415-057-0100 Clinical Supervision

Persons providing services to program clients in accordance with this rule will receive supervision by a qualified Clinical Supervisor, as defined in these rules, related to the development, implementation and outcome of services.

(1) The objective of clinical supervision is to assist staff, interns, students and volunteers to increase their skills, improve quality of services to individuals, and supervise program staff, interns, students and volunteers’ compliance with program policies and procedures.

(2) Clinical Supervision will be specified through a current written agreement, job description, or similar type of binding arrangement between the Clinical Supervisor and the program staff, intern, student or volunteer which describes the Clinical Supervisor's oversight responsibility, including documentation of supervision no less than two hours per month. The two hours will include one hour of face-to-face contact for each person supervised, or a proportional level of supervision for part-time staff.

History

Statutory/Other Authority: ORS 413.042, 409.410 & 409.420
Statutes/Other Implemented: ORS 430.240 - 430.640, 430.850 - 430.955, 813.010 - 813.052 & 813.200 - 813.270
ADS 2-2010, f. & cert. ef. 5-6-10

Or. Admin. R. 415-057-0110 Program Staff

(1)(a) Program staff will at the time of hire:

(b) Have documented competence in the following essential job functions in an Alcohol and Other Drugs program including:

(A) Conducting comprehensive diagnostic Alcohol and Other Drugs assessment, developing treatment plans, providing care coordination, providing individual and group counseling, and following documentation policy and procedures set forth in these rules; and

(B) Except as provided in section (4) of this rule, hold a current certification or license in Alcohol and Other Drugs counseling or hold a current license as a health or allied provider issued by a state licensing body.

(2) For program staff holding a certification or license in Alcohol and Other Drugs counseling, qualifications for the certificate or license must have included at least:

(a) 750 hours of supervised experience in Alcohol and Other Drugs counseling;

(b) 150 hours of alcohol and drug education and training; and

(3) For program staff holding a health or allied provider license, such license or registration will have been issued by one of the following state bodies and the program staff person will possess documentation of at least 60 contact hours of academic or continuing professional education in the treatment of substance related disorders:

(a) The Board of Medical Examiners;

(b) The Board of Psychologist Examiners;

(d) The Board of Licensed Professional Counselors and Therapists; or

(e) The Board of Nursing.

(4) Program staff who do not hold a certificate or license that meets the standards identified in sections (2) or (3) of this rule will apply to a qualified credentialing organization or state licensing board within three months of the date of hire and achieve certification or licensure meeting the standards of sections (2) or (3) of this rule within 24 months of the application date.

(5) Additional Training Requirements:

(a) Within the first six months of hire, program staff will receive training on evidenced-based practices for clients with criminal behavior; and

(b) At least 10 hours of professional development toward recertification credits every two years specific to offenders with substance related disorders.

(6) Recovering program staff: Any program staff, clinical supervisor, program manager, student, intern or volunteer applying or hired to provide services who are recovering from substance related disorders must be able to demonstrate continuous sobriety under nonresidential, independent living conditions for the immediate past two years.

History

Statutory/Other Authority: ORS 413.042, 409.410 & 409.420
Statutes/Other Implemented: ORS 430.240 - 430.640, 430.850 - 430.955, 813.010 - 813.052 & 813.200 - 813.270
ADS 2-2010, f. & cert. ef. 5-6-10

Or. Admin. R. 415-057-0120 Clinical Supervisor

(1) The program will have an identified clinical supervisor who has:

(a) A Bachelor's degree in social services and four years of paid full-time experience in direct Alcohol and Other Drugs counseling; or

(b) A Master's degree in social services and two years of paid full-time experience in direct Alcohol and Other Drugs counseling; or

(d) Holds a current license as a health or allied provider issued by a state licensing body; and

(e) Has documented training or education in evidence-based treatment interventions for clients with criminal behavior.

(2) For clinical supervisors holding a certification or license in Alcohol and Other Drugs counseling, qualifications for the certificate or license must have included at least:

(a) 300 alcohol and drug education and training hours;

(b) 4,000 hours of supervised experience in Alcohol and Other Drugs counseling; and

(3) For clinical supervisors holding a health or allied provider license, such license or registration will have been issued by one of the following state bodies and the supervisor will possess documentation of at least 120 contact hours of academic or continuing professional education in the treatment of substance related disorders:

(a) The Board of Medical Examiners;

(b) The Board of Psychologist Examiners;

(d) The Board of Licensed Professional Counselors and Therapists; or

(e) The Board of Nursing.

(4) Any clinical supervisor will have knowledge and experience demonstrating competence in the performance of the following essential job functions for clients with criminal behavior including:

(a) The process to accept clients into the program;

(b) Conducting comprehensive diagnostic assessments in coordination with the DOC individual inmate Corrections Plan;

(d) Providing regular observation and monitoring of program staff and giving feedback to improve service delivery quality and program staff performance;

(e) Coordinating development opportunities for program staff who conduct the comprehensive diagnostic assessment, developing the treatment plans, providing care coordination, and collaborating with community resources including self-help groups; and

(f) Assuring the clinical integrity of all permanent client records assigned to program staff under their supervision, including timely entry of documentation, correctness of information, assuring appropriate clinical rationale for assessment, treatment plans, progress notes, and continuing care planning consistent with policies and procedures in these rules.

(5) If the program's manager meets the qualifications of the Clinical Supervisor, the manager may be the clinical supervisor.

History

Statutory/Other Authority: ORS 413.042, 409.410 & 409.420
Statutes/Other Implemented: ORS 430.240 - 430.640, 430.850 - 430.955, 813.010 - 813.052 & 813.200 - 813.270
ADS 2-2010, f. & cert. ef. 5-6-10

Or. Admin. R. 415-057-0130 Program Manager

(1) The program will have a program manager who:

(a) Oversees the day to day program operations;

(b) Is responsible for compliance with the requirements of these rules; and

(2) The program manager will have knowledge and paid full-time experience demonstrating competence in the performance or oversight of the following essential job functions:

(a) For contracted programs, planning, budgeting, and fiscal management;

(b) Supervision of program staff;

(d) Data collection, program evaluation and quality assurance; and

(e) Meeting reporting requirements.

(3) The program manager will have paid full-time experience working with offenders for a minimum of three years that includes implementing evidence-based practices for clients with criminal behavior.

History

Statutory/Other Authority: ORS 413.042, 409.410 & 409.420
Statutes/Other Implemented: ORS 430.240 - 430.640, 430.850 - 430.955, 813.010 - 813.052 & 813.200 - 813.270
ADS 2-2010, f. & cert. ef. 5-6-10

Or. Admin. R. 415-057-0140 Use of Volunteers

Volunteers may provide only non-clinical services unless the individual has the required credentials to provide a clinical service. A Program utilizing volunteers will have the following:

(1) A written policy regarding volunteers that includes:

(a) Specific responsibilities and tasks of volunteers, based on their credentials;

(b) Procedures and criteria used in selecting volunteers, including sobriety requirements for individuals recovering from substance related disorders consistent with DOC policy;

(d) Specific procedure for reviewing the performance of volunteers and providing direct feedback to them by a supervisor.

(2) Volunteers will complete an orientation and training program specific to their responsibilities before they participate in program assignments. The orientation and training for volunteers will:

(a) Include a thorough review of the program's philosophical approach to treatment;

(b) Include information on clients’ rights including confidentiality regulations;

(d) Explain procedure for discontinuing a volunteer's participation; and

(e) Document each volunteer’s completion of orientation in program records.

History

Statutory/Other Authority: ORS 413.042, 409.410 & 409.420
Statutes/Other Implemented: ORS 430.240 - 430.640, 430.850 - 430.955, 813.010 - 813.052 & 813.200 - 813.270
ADS 2-2010, f. & cert. ef. 5-6-10

Or. Admin. R. 415-057-0150 Co-occurring Substance Related and Mental Health Disorders (COD)

(1)(a) In addition to the general standards for prison-based Alcohol and Other Drugs treatment programs under OAR 415-057-0000 through 415-057-0140, programs approved and designated to primarily provide treatment services for people with COD will meet the following standards:

(b) The program will develop written policies and procedures that include program philosophy, acceptance criteria, program content, and providing concurrent substance related treatment and mental health interventions documented in one integrated client record.

(2) COD Program Content: The program for people with COD will include at a minimum an array of treatment options including:

(a) Individual medication evaluation and treatment;

(b) Motivational strategies;

(d) Care coordination;

(e) Wellness management; and

(f) Relapse prevention.

(3) COD Program Staffing Patterns: The program that provides services and activities to persons with COD will have at a minimum, one full-time QMHP on staff. Caseloads will average 12 clients for each program staff member. Additional masters level practitioners and QMHAs will be scheduled with the consideration of client mental health needs.

(4) COD Program Staffing Qualifications: Staff demonstrate competency in the treatment of co-occurring mental health and substance related disorders. Competencies will include ability to evaluate:

(a) If there is a chronic condition that creates risk or complicates treatment;

(b) If there is cognitive, emotional or behavioral condition severe enough to warrant specific mental health treatment;

(d) Ability of the client to cope with emotional, behavioral and cognitive problems.

(5) Additional Training Requirements: Of the 10 hours required in section 415-057-0130(4)(b), at least 8 hours of professional development toward recertification credits every two years specific to COD.

(6) Program Clinical Supervision Staff Qualifications: Clinical Supervision and case consultation is provided on-site by individuals with both CADC and QMHP credentials.

History

Statutory/Other Authority: ORS 413.042, 409.410 & 409.420
Statutes/Other Implemented: ORS 430.240 - 430.640, 430.850 - 430.955, 813.010 - 813.052 & 813.200 - 813.270
ADS 2-2010, f. & cert. ef. 5-6-10

Division 65 HEALTH PROFESSIONALS' SERVICES PROGRAM

Or. Admin. R. 415-065-0005 Purpose, Intent and Scope

(1) These rules establish a consolidated, statewide health professionals’ services program for licensees of participating health licensing boards, as required by ORS 676.190, who are unable to practice with professional skill and safety due to substance use disorders, mental disorders, or both types of disorders. The program shall enroll licensees in the program, monitor enrolled licensees for compliance with monitoring agreements, report non-compliance to a licensee’s board, and perform other duties as required by 676.190 to 676.200.

(2) The program may be operated by the Division or by a private contractor.

History

Statutory/Other Authority: ORS 413.042 & ORS 676.190
Statutes/Other Implemented: ORS 676.185 - 676.200
ADS 2-2014, f. & cert. ef. 4-24-14
ADS 3-2010, f. & cert. ef. 7-1-10

Or. Admin. R. 415-065-0010 Definitions

(1) “Assessment” or “Evaluation” means the process an independent third-party evaluator uses to diagnose the licensee and to recommend treatment options for the licensee.

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

(3) “Board” means a health professional board as defined in ORS 676.160 or the Health Licensing Office for a board, council or program listed in 676.606.

(4) “Business Day” means Monday through Friday, 8:00 a.m. to 5:00 p.m. Pacific Time, except legal holidays as defined in ORS 187.010 or 187.020.

(5) “Comply Continuously” means to have been:

(a) Enrolled in the program for at least two uninterrupted years without any reports of substantial noncompliance that a board deems were significant violations of the monitoring agreement; and

(b) Deemed by the program if self-referred, or by the licensee’s board if board referred, to have otherwise successfully complied with all terms of the monitoring agreement.

(6) “Course of Employment” means all circumstances which may occur in the performance of a licensee’s job, whether or not the licensee is self-employed.

(7) "Diagnosis" means the principal mental or substance use diagnosis listed in the DSM. The diagnosis is determined through the assessment and any examinations, tests, or consultations suggested by the assessment, and is the medically appropriate reason for services.

(8) “Direct Supervisor” means the individual who is responsible for:

(a) Supervising a licensee enrolled in the impaired health professional program;

(b) Monitoring the licensee’s compliance with the requirements of the program; and

(9) "Division" means the Oregon Health Authority, Addictions and Mental Health Division.

(10) "DSM" means the Diagnostic and Statistical Manual of Mental Disorders-5, published by the American Psychiatric Association on May 18, 2013.

(11) “Independent Third-Party Evaluator” means an individual who is approved by a licensee’s board to evaluate, diagnose, and offer treatment options for substance use disorders, mental disorders, or co-occurring disorders.

(12) “Licensee” means a health professional who is licensed or certified by or registered with a board and the professional is receiving services in the program under these rules.

(13) “Mental Disorder” means a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress or disability or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom that is identified in the DSM. “Mental Disorder” includes gambling disorders.

(14) “Monitoring Agreement” means an individualized agreement, including amendments, between a licensee and the program that meets the requirements of OAR 415-065-XXXX and is the same as the term diversion agreement as that is used in ORS 676.190.

(15) “Positive Toxicology Test” for the purposes of ORS 676.185(5)(d) means that a test result meets or exceeds the cutoff concentrations listed in 49 CFR § 40.87 as in effect on [insert effective date of rules] for the substances listed in that federal regulation.

(16) “Program” means the Health Professionals’ Services Program established by the Division to monitor enrolled licensees of participating health profession licensing boards who have been diagnosed with a substance use or a mental disorder, for compliance with his or her monitoring agreement. If the program is operated by a contractor “program” may refer to the contractor, or the Division and the contractor, depending on the context.

(17) “Provisional Enrollment” means temporary enrollment, pending verification that a self-referred licensee meets all program eligibility criteria.

(18) “Random Drug or Alcohol Testing” for the purposes of ORS 676.190(5)(g) means enrolled licensees are selected for drug or alcohol testing in accordance with 49 CFR § 199.105(c)(5) and 49 CFR §199.105(c)(7) as in effect on [insert effective date of rules].

(19) “Self-Referred Licensee” means a licensee who seeks to participate in the program without a referral from the board.

(20) "Substance Use Disorder" means a disorder related to the taking of a drug of abuse including alcohol, to the side effects of a medication, and to a toxin exposure. Disorders include substance dependence and substance abuse, and substance-induced disorders, including substance intoxication, withdrawal, delirium, and dementia, as well as substance induced psychotic disorder, mood disorder and other disorders, as defined in DSM criteria.

(21) “Substantial Non-Compliance” means but is not limited to the following when they occur after a licensee entered into a monitoring agreement.

(a) Criminal behavior;

(b) Conduct that causes injury, death or harm to the public, or a patient, including sexual impropriety with a patient;

(d) A positive toxicology test result as determined by federal regulations pertaining to drug testing;

(e) Violation of a restriction on a licensee’s practice imposed by the program or the licensee’s health profession licensing board

(f) Civil commitment for mental illness;

(g) Failure to participate in the program after entering into a monitoring agreement under ORS 676.190;

(h) Failure to enroll in the program after being referred to the program;

(i) Violation of a provision of a licensee’s monitoring agreement that gives rise to concerns about the licensee’s ability or willingness to participate in the program; or

(j) Violation of a Board’s rules establishing additional requirements for licensees referred to the program in accordance with ORS 676.200(1)(c).

(22) “Successful Completion” means that for the period of service deemed necessary by the program or by the licensee’s board by rule, the licensee has complied with the licensee’s monitoring agreement to the satisfaction of the program, and has met the terms of the fee agreement between the program and the licensee.

(23) “Toxicology Testing” means urine testing or alternative chemical monitoring including but not limited to blood, saliva, hair or breath.

(24) "Treatment" means the planned, specific, individualized health and behavioral-health procedures, activities, services and supports that a treatment provider uses to remediate symptoms of a substance use disorder, mental disorder or both types of disorders.

(25) “Workplace Monitor” includes but is not limited to a direct supervisor and any other individual who has signed a workplace monitoring agreement with the program that requires the individual to observe and report to the program a licensee’s:

(a) Compliance with his or her monitoring agreement; or

(b) Any other concerns regarding the licensee’s participation in the program.

History

Statutory/Other Authority: ORS 413.042 & 676.190
Statutes/Other Implemented: ORS 676.185 - 676.200
ADS 2-2014, f. & cert. ef. 4-24-14
ADS 3-2012, f. 6-27-12, cert. ef. 7-1-12
ADS 2-2012, f. & cert. ef. 2-9-12
ADS 3-2011, f. & cert. ef. 8-16-11
ADS 3-2010, f. & cert. ef. 7-1-10

Or. Admin. R. 415-065-0020 Audits

(1) The Division shall arrange for an independent third-party to audit the program and to ensure compliance with the program guidelines.

(2) The Division shall report the results of the audit to the Legislative Assembly, the Governor, and the boards.

(3) The Division’s report may not contain individually identifiable information about the licensees.

History

Statutory/Other Authority: ORS 413.042 & 676.190
Statutes/Other Implemented: ORS 676.185 - 676.200
Reverted to ADS 3-2012, f. 6-27-12, cert. ef. 7-1-12
ADS 7-2013(Temp), f. & cert. ef. 11-8-13 thru 5-7-14
ADS 3-2012, f. 6-27-12, cert. ef. 7-1-12
ADS 3-2010, f. & cert. ef. 7-1-10

Or. Admin. R. 415-065-0030 Administration Fee

(1) Each board that participates in the program shall pay the Division a fee for participating in the program.

(2) The Division shall calculate the total fee based on all the program costs, including but not limited to, Division personnel costs and ancillary expenses, funds paid to a contractor for operating the program, if any and the costs of an auditor.

History

Statutory/Other Authority: ORS 413.042 & 676.190
Statutes/Other Implemented: ORS 676.185 - 676.200
ADS 2-2014, f. & cert. ef. 4-24-14
ADS 3-2012, f. 6-27-12, cert. ef. 7-1-12
ADS 2-2012, f. & cert. ef. 2-9-12
ADS 3-2010, f. & cert. ef. 7-1-10

Or. Admin. R. 415-065-0035 Board Referrals

(1) A board that refers a licensee to the program must make the referral in writing. The referral must include:

(a) A copy of a report from an independent third-party evaluator who diagnosed the licensee with a substance use disorder, a mental disorder or both types of disorder, stating the diagnosis and the applicable diagnostic code from the DSM;

(b) The recommended treatment plan;

(c) A statement that the board has investigated the licensee’s professional practice and has determined whether the licensee’s professional practice, while impaired, presents or has presented a danger to the public;

(d) A description of any restrictions imposed by the board or recommended by the board on the licensee’s professional practice;

(e) A statement that the licensee has agreed to report any arrest for or conviction of a misdemeanor or felony crime to the board within three business days after the licensee is arrested or convicted; and

(f) A written statement from the licensee agreeing to enter the program and agreeing to abide by all terms and conditions established by the program.

(2) A board-referred licensee is enrolled in the program effective on the date the program receives the licensee’s signed consents and the signed monitoring agreement including payment of fees as required by ORS 676.190.

History

Statutory/Other Authority: ORS 413.042 & 676.190
Statutes/Other Implemented: ORS 676.185 - 676.200
ADS 2-2014, f. & cert. ef. 4-24-14
ADS 3-2012, f. 6-27-12, cert. ef. 7-1-12
ADS 2-2012, f. & cert. ef. 2-9-12
ADS 3-2010, f. & cert. ef. 7-1-10

Or. Admin. R. 415-065-0040 Self-Referrals

(1) A licensee may only self-refer to the program if the licensee’s board has adopted a rule permitting self-referrals.

(2) Provisional Enrollment. To be provisionally enrolled in the program, a self-referred licensee must:

(a) Sign a written consent allowing disclosure and exchange of information between the program or the program’s contractor, as applicable, the licensee’s employer, independent third-party evaluators, and treatment providers;

(b) Sign a written consent allowing disclosure and exchange of information between the program or the programs’ contractor, as applicable, the board, the licensee’s employer, independent third-party evaluators and treatment providers in the event the program determines the licensee to be in substantial noncompliance with his or her provisional monitoring agreement.;

(c) Sign a written statement that the licensee has agreed to report any arrest for or conviction of a misdemeanor or felony crime to the program within three business days after the licensee is arrested or convicted;

(d) Attest that the licensee is not, to the best of the licensee’s knowledge, under investigation by his or her board; and

(e) Agree to and sign a monitoring agreement.

(3) Enrollment: To move from provisional enrollment to enrollment in the program, a self-referred the licensee must:

(a) Obtain at the licensee’s own expense and provide to the program, an independent third-party evaluator’s written evaluation containing a DSM diagnosis and diagnostic code, treatment recommendations, and practice restrictions, if any;

(b) Agree to cooperate with the program’s investigation to determine whether the licensee’s practice while impaired presents or has presented a danger to the public; and

(c) Enter into an amended monitoring agreement to reflect the treatment recommendations of the independent third-party evaluator and the program’s practice investigation.

(4) Once the program provisionally enrolls a self-referred licensee in the program failure to complete enrollment constitutes substantial non-compliance and must be reported to the board.

(5) The program may not report a self-referred licensee’s enrollment in or successful completion of the program to the licensee’s board.

History

Statutory/Other Authority: ORS 413.042 & 676.190
Statutes/Other Implemented: ORS 676.185 - 676.200
ADS 2-2014, f. & cert. ef. 4-24-14
ADS 3-2012, f. 6-27-12, cert. ef. 7-1-12
ADS 2-2012, f. & cert. ef. 2-9-12
ADS 3-2010, f. & cert. ef. 7-1-10

Or. Admin. R. 415-065-0045 Licensee Responsibilities

(1) Board-referred licensees must:

(a) Comply continuously with his or her monitoring agreement, including any amendments to the agreement required by the licensee’s board or the program, for at least two years or longer, as specified by the board by rule or order; and

(b) Be responsible for the cost of evaluations, toxicology testing and treatment.

(2) Self-referred licensees must:

(a) Provide to the program a copy of a report of the licensee’s criminal history periodically, at the program’s discretion;

(b) Comply continuously with his or her monitoring agreement, including any amendments to the agreement required by the program, for at least two years or longer, as specified by the board by rule or order; and

History

Statutory/Other Authority: ORS 413.042 & 676.190
Statutes/Other Implemented: ORS 676.185 - 676.200
ADS 2-2014, f. & cert. ef. 4-24-14
ADS 2-2012, f. & cert. ef. 2-9-12
ADS 3-2010, f. & cert. ef. 7-1-10

Or. Admin. R. 415-065-0050 Unique Identification Number

(1) The program shall assign a unique licensee identification number to each licensee enrolled in the program:

(a) If the program is operated by a contractor, the contractor and the Division shall use the same number and shall include the number in any communications or data exchanges involving the licensee;

(b) Once a unique identification is used the program may not use it again for any other licensee enrolled in the program and it shall be retired when the licensee is no longer enrolled in the program; and

(c) If a licensee reenrolls in the the program the program must use the same unique identification number that was previously assigned to the licensee.

(2) The program may not use all or a portion of a licensee’s social security number as the unique identification number.

History

Statutory/Other Authority: ORS 413.042 & 676.190
Statutes/Other Implemented: ORS 676.185 - 676.200
ADS 2-2014, f. 4-24-14, cert. ef. 4-1-14
ADS 3-2012, f. 6-27-12, cert. ef. 7-1-12
ADS 2-2012, f. & cert. ef. 2-9-122
ADS 3-2010, f. & cert. ef. 7-1-10

Or. Admin. R. 415-065-0055 Program Requirements

The contractor shall:

(1) Inform the licensee about the program services, requirements, benefits, risks, and confidentiality limitations and ensure that the licensee has signed a consent for services. The consent for services explains:

(a) Information the contractor will give to the board and under what circumstances;

(b) That the board may take action to suspend, restrict, modify, or revoke the licensee’s license or end the licensee’s participation in the program based on information from the contractor.

(2) Enter into a monitoring agreement with the licensee;

(3) Assess the licensee’s compliance with his or her monitoring agreement;

(4) Assess the ability of the licensee’s employer, when an employer exists to supervise the licensee, and require the employer to establish minimum training requirements for the licensee’s supervisor;

(5) Report the licensee’s substantial noncompliance with his or her monitoring agreement to a noncompliant licensee’s board within one business day after the contractor learns of any substantial noncompliance; and

(6) At least weekly, submit to licensees’ boards:

(a) A list of licensees who were referred to the program by the health profession licensing board and who are enrolled in the program; and

(b) A list of licensees who were referred to the program by the health profession licensing board and who successfully completed the program.

(7) The lists submitted under section 6 (a) (b) are exempt from disclosure as a pubic record under ORS 192.140 to 192.505.

(8) Seek a court order authorizing the contractor to release identifying information to a licensee’s board, including a report of substantial noncompliance as is described in OAR 415-065-0060, if a self-referred licensee enrolled in the program, or a provisionally enrolled licensee with a qualifying diagnosis, revokes his or her consent to report substantial noncompliance to the licensee’s board.

(a) The contractor shall file documents with the court seeking a court order as soon as possible but no later than three business days from the date it was notified that the licensee revoked consent to report substantial noncompliance.

(b) The contractor shall comply with 42 USC & 290dd-2(b)(2); 42 CFR Part 2; the Health Insurance Portability and Accountability Act (HIPAA), Public Law 104-191, 45 CFR Parts 160, 162 and 164 and ORS 179.505, ORS 192.518–192.524 in seeking such a court order.

(c) The contractor shall disclose to the licensee’s board, within one (1) business day, any information the court authorizes it to disclose.

History

Statutory/Other Authority: ORS 413.042 & 676.190
Statutes/Other Implemented: ORS 676.185 - 676.200
ADS 2-2014, f. & cert. ef. 4-24-14
ADS 7-2013(Temp), f. & cert. ef. 11-8-13 thru 5-7-14
ADS 3-2012, f. 6-27-12, cert. ef. 7-1-12
ADS 2-2012, f. & cert. ef. 2-9-122
ADS 3-2011, f. & cert. ef. 8-16-11
ADS 1-2011(Temp), f. & cert. ef. 2-11-11 thru 8-5-11
ADS 3-2010, f. & cert. ef. 7-1-10

Or. Admin. R. 415-065-0060 Reports of Substantial Noncompliance

Unless otherwise prohibited by law, a report of substantial noncompliance to a licensee’s board must include:

(1) A description of the noncompliance;

(2) A copy of the report from the independent third-party evaluator who diagnosed the licensee stating the licensee’s diagnosis

(3) A copy of the licensee’s monitoring agreement; and

(4) The licensee’s practice or employment status.

History

Statutory/Other Authority: ORS 413.042 & 676.190
Statutes/Other Implemented: ORS 676.185 - 676.200
ADS 2-2014, f. & cert. ef. 4-24-14
ADS 3-2012, f. 6-27-12, cert. ef. 7-1-12
ADS 2-2012, f. & cert. ef. 2-9-12
ADS 3-2010, f. & cert. ef. 7-1-10

Or. Admin. R. 415-065-0070 Monitoring Agreements

Each monitoring agreement developed by the program and entered into by a licensee must require the licensee to:

(1) Participate in the program for at least two years or longer, as specified by board rule or order;

(2) Participate in the recommended treatment plan;

(3) Comply with any practice restrictions required by the board or if the licensee is a self-referred licensee, any practice restrictions recommended by the third-party evalator;

(4) Comply with any applicable workplace monitoring requirements;

(5) Abstain from all mind-altering or intoxicating substances or potentially addictive drugs, unless the drug is:

(a) Prescribed for a documented medical condition by a person authorized by law to prescribe the drug to the licensee; and

(b) Approved by the program if the licensee’s board has granted the program that authority;

(6) Report to the program the licensee’s:

(a) Use of mind-altering or intoxicating substances or potentially addictive drugs within 24 hours of the licensee’s use of the substances or drugs;

(b) Arrest for or conviction of a misdemeanor or felony crime within three business days of the arrest or conviction; and

(c) Application for licensure in another state, change in employment, change in practice setting, or change in residence;

(7) Submit to random toxicology testing in accordance with an individualized schedule, unless the licensee is diagnosed with solely a mental disorder and the licensee’s board does not otherwise require the licensee to submit to random drug or alcohol testing;

(8) Comply with other toxicology testing in accordance with OAR 415-065-0075;

(9) Submit periodic reports to the program regarding the licensee’s compliance with the monitoring agreement at a frequency determined by program;

(10) Comply with any other requirement established by the licensee’s board in accordance with ORS 676.200(1)(c);

(11) Comply with any amendments to the monitoring agreement deemed necessary by the licensee’s board or the program because of a change in the licensee’s situation; and

(12) Pay any required fees.

History

Statutory/Other Authority: ORS 413.042 & 676.190
Statutes/Other Implemented: ORS 676.185 - 676.200
ADS 2-2014, f. & cert. ef. 4-24-14

Or. Admin. R. 415-065-0075 Toxicology Testing

(1) Unless a licensee is diagnosed solely with a mental disorder and an independent third-party evaluator has not recommended toxicology testing, the program must ensure that a licensee receives:

(a) A baseline toxicology test within fifteen business days of the date the licensee is enrolled in the program; and

(b) A final toxicology test before the licensee is deemed to successfully complete the program;

(2) The program may require a licensee to submit to a non-random toxicology test.

(3) Urinalysis specimens.

(a) The program must ensure that urine specimens are collected in a way that preserves the integrity of the specimen and unless otherwise provided by the licensee's board by rule, that the person collecting the sample is able to directly observe the urine leaving the licensee’s body and enter the collection cup.

(b) If the program suspects that the licensee has used alcohol or other drugs in violation of the licensee's monitoring agreement or suspects that the licensee has attempted to provide a false or dilute urine sample, the program may require a licensee to provide a directly observed urine specimen under the procedures described in 49 CFR § 40.67(g) through (k), in effect on 4-24-14, including having an individual the same gender as the licensee:

(A) Ask the licensee to raise his or her shirt, blouse, or dress/skirt, as appropriate, above the waist, and lower clothing and underpants to demonstrate, by turning around, that the licensee does not have a prosthetic device to dispense urine; and

(B) Watch the urine go from the licensee's body into the specimen collection container.

(4) Toxicology testing must be done by a laboratory:

(a) Certified by the Substance Abuse and Mental Health Services Administration and accredited through the College of American Pathologists Forensic Drug Testing Accreditation Program; and

(b) That performs testing in compliance with OAR 333-024-0305 through 333-024-0350.

History

Statutory/Other Authority: ORS 413.042 & 676.190
Statutes/Other Implemented: ORS 676.185 - 676.200
ADS 2-2014, f. & cert. ef. 4-24-14

Or. Admin. R. 415-065-0080 Confidentiality

The program may not use or disclose any information that individually identifies a licensee except in accordance with 42 CFR § Part 2 and any other applicable federal or state laws

History

Statutory/Other Authority: ORS 413.042 & 676.190
Statutes/Other Implemented: ORS 676.185 - 676.200
ADS 2-2014, f. & cert. ef. 4-24-14