justicedao/ipfs_state_laws huggingface dataset:
411-046-0190 Disenrollment or Termination (1) Medicaid providers of Behavior Support Services, their behavior consultant employees, or subcontractors may be terminated or prohibited from providing services for any of the following: (a) Violation of any part of these rules; (b) Violation of the protective service and abuse rules in OAR chapter 411, division 20 and chapter 407, division 45; (c) A demonstrated pattern of repeated unsubstantiated complaints of neglect and abuse per OAR chapter 411, division 020 and chapter 407, division 045; (d) Failure to meet behavior consultant qualifications or continuing education requirements; (e) Failure to provide copies of records to designated Department or Oregon Health Authority entities; (f) Repeated failure to participate in Behavior Support Plan review or service planning meetings when requested by an individual's case manager; (g) Failure to provide the services noted in these rules; or (h) Fraud or misrepresentation in the provision of services under these rules. (2) Medicaid providers have rights to appeal a termination based on OAR 407-120-0360(8)(g) and, as applicable, OAR chapter 410, division 120. (3) Medicaid providers of these services must provide 30 day written notice, or more if specified in contract, to the Department of the decision to cease services. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: APD 17-2014, f. & cert. ef. 6-23-14
411-046-0200 Compensation and Billing (1) All billing and claims must comply with OAR 407-120-0330; OAR 407-120-0340; and chapter 410, division 120, as applicable. (2) Compensation for Behavior Support Services in supplemental or specific needs setting contracts shall be defined through the Department contract. (3) The Department may adjust rates in underserved areas to ensure individuals have access to services. (4) Failure to comply with standards in this rule may result in determination of overpayment for which restitution may be sought. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: APD 17-2014, f. & cert. ef. 6-23-14
411-046-0210 Continuing Education Requirements (1) Behavior consultants must maintain a record verifying completion of at least 12 hours of continuing education per year in person-centered care or behavior support training that is provided by a Department approved trainer or training organization noted on the Department website. (2) Requests for documentation verifying compliance with this requirement must be provided upon request to the Department. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: APD 17-2014, f. & cert. ef. 6-23-14
411-046-0220 Exceptions to Rules (1) Exceptions to these rules may be made by the Department central office and must be granted by the Department in writing. Implementation of an exception may not occur without written approval. (2) On a case specific basis, the following exceptions may be granted by local office managers: (a) Changing the timeframes for service activation, (b) Initiating the person-centered evaluation, (c) Completing the Behavior Plan; or (d) Initiating coaching. (3) Requests for exceptions to the rules must include, but are not limited to, a written request provided to central office management for prior approval. Documentation must include: (a) Local office management support for the exception request; (b) Description of the benefit to the individual or program served by the Department as result of the exception; (c) Details regarding the specific rule for which: (A) The exception will be granted; (B) Rationale for why the exception is needed; (C) Proposed duration of the exception; (D) Identification of alternatives (including rule compliance); and (E) Costs, if any, of the exception. (4) Exceptions will not impact compliance, and will not result in non-compliance, with any OAR other than chapter 411, division 46. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: APD 17-2014, f. & cert. ef. 6-23-14
411-048-0150 Purpose (1) The rules in OAR chapter 411, division 048 establish standards and procedures for Medicaid enrolled providers who provide long term care community nursing services. Long term care community nursing services provide ongoing registered nurse (RN) services to eligible individuals who are receiving services in a Medicaid-funded home and community-based setting. (2) Long term care community nursing services provide the following: (a) Evaluation and identification of supports that help an individual maintain maximum functioning and minimize health risks, while promoting the individual's autonomy and self-management of healthcare. (b) Teaching an individual, or the individual's caregiver or family, what is necessary to assure the individual's health and safety in a Medicaid-funded home and community-based setting as described in OAR 411-048-0180. (c) Delegation of nursing tasks to an individual’s caregiver as described in OAR 411-048-0180. (d) Providing case managers and healthcare providers with the information needed to maintain an individual’s health, safety, and community living situation while honoring the individual's autonomy and choices. Statutory/Other Authority: ORS 409.050 & 410.070 Statutes/Other Implemented: ORS 409.010 & 410.070 History: APD 30-2021, amend filed 08/25/2021, effective 08/25/2021 APD 10-2021, temporary amend filed 02/24/2021, effective 03/01/2021 through 08/27/2021 SPD 44-2013, f. 12-13-13, cert. ef. 12-15-13 SPD 14-2013(Temp), f. & cert. ef. 7-1-13 thru 12-28-13 SPD 8-2013, f. & cert. ef. 4-15-13
411-048-0190 Communication and Notification Practices (1) MANDATORY REPORTING. The RN must report suspected or known neglect or abuse of all older adults, adults, and children as required by ORS 124.050 to 095, ORS 418, ORS 430.735 to 765, ORS 441, ORS 419B.005 to 045, ORS 676.150 and OSBN’s ORS 678.135. (2) The RN or agency must notify the Department in writing of material changes in any status or condition that relates to their qualifications or eligibility to provide medical assistance services. (3) CONFIDENTIALITY. (a) The RN must protect client confidential information in a manner consistent with current laws, standards as described in OAR chapter 851 as well as the federal regulations adopted to implement the Health Insurance Portability and Accountability Act. (b) The RN must provide all written, verbal, digital, video, and electronic information regarding an individual in accordance with the Department's confidentiality parameters as described in OAR chapter 407, division 014 and the federal regulations adopted to implement the Health Insurance Portability and Accountability Act. (4) NOTIFICATION. (a) The RN must communicate any potential or actual life-threatening health and safety concerns immediately to: (A) 911, police, or physician as appropriate to address emergent or urgent safety concerns; and (B) The local office protective service worker, worker of the day, or case manager. (b) If while performing long term care community nursing services under these rules the RN determines that an individual's health condition is unstable or a significant change of condition is noted, the RN must either notify the individual's physician or primary care provider directly or ensure that the individual's UAP has reported this information to the physician or primary care provider. (c) The RN must notify the individual's case manager or local office management within one business day the individual’s non-life threatening but high-risk concerns including: (A) Changes in condition as described in subsection (b) of this section, (B) Concerns about, or changes in, the client’s current place of residence, or (C) Concerns about a UAP’s performance. (d) The RN must notify the individual's case manager if the RN becomes aware that an individual has recently received a significant healthcare intervention such as an emergency room visit, hospitalization, a change in physician, referral to a specialist, home health, or hospice. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: APD 18-2023, amend filed 10/13/2023, effective 11/01/2023 SPD 8-2013, f. & cert. ef. 4-15-13
411-048-0220 Medicaid Provider Disenrollment / Termination (1) Enrolled Medicaid providers of long term care community nursing services, or RN employees of an agency enrolled as a Medicaid provider delivering long term care community nursing services may be denied enrollment, terminated, or prohibited from providing long term care community nursing services for, but not limited to, any of the following: (a) Violation of any part of these rules at any time. (b) Violation of the protective service and abuse rules in OAR chapter 411, division 020 and OAR chapter 407, division 045. (c) Violation of the applicable service rules in OAR chapter 410, division 120 or 173, or the provider rules in OAR chapter 333, division 027 or 536. (d) Any sanction or action as a result of an OSBN investigation. (e) Failure to keep required licensure or certifications current. (f) Failure to provide copies of the records described in these rules to designated Department or Oregon Health Authority entities. (g) Failure to participate in Nursing Service Plan review or care coordination meetings when requested by an individual's case manager. (h) Failure to obtain a pass score on the Department's test on OSBN’s OAR division 006, 045, and 047 as requested by the Department. (i) Failure to provide services. (j) Fraud or misrepresentation in the application for enrollment or for the provision of long-term care community nursing services. (k) Evidence of conduct derogatory to the standards of nursing as described in OAR 851-045-0070 that results in referral to OSBN. (l) A demonstrated pattern of repeated unsubstantiated complaints of neglect or abuse per OAR chapter 411, division 020 or OAR chapter 407, division 045. (m) Exclusion by the Office of Inspector General from participating in publicly funded programs. Agencies listed in section (3)(b) and (c) of this rule are prohibited from employing or paying any excluded person or entity and must promptly notify the Authority Health Systems Division's Provider Enrollment Unit or the Office of Inspector General in writing of any violation. (2) Enrolled Medicaid providers may appeal a termination of their Medicaid provider number based on OAR 407-120-0360(8)(g) and OAR chapter 410, division 120 as applicable. (3) Enrolled Medicaid providers of long term care community nursing services must provide advance written notice to the Department at least 30 days prior to no longer providing long term care community nursing services. (4) An RN ending long term care community nursing services must comply with the OSBN's standards regarding transition of care and transfer or rescinding of delegations per OAR chapter 851, division 047. Statutory/Other Authority: ORS 409.050 & 410.070 Statutes/Other Implemented: ORS 409.010 & 410.070 History: APD 18-2023, amend filed 10/13/2023, effective 11/01/2023 APD 30-2021, amend filed 08/25/2021, effective 08/25/2021 SPD 8-2013, f. & cert. ef. 4-15-13
411-048-0230 Compensation and Billing (1) All long term care community nursing services must be authorized by an individual's case manager using Department approved forms provided by the Department prior to the delivery of long term care community nursing services. (2) All billing and claims must comply with: (a) OAR 407-120-0330 and 407-120-0340; (b) OAR chapter 410, divisions 120 and 173 as applicable; and (c) The Long Term Care Nursing Procedure Codes and Payment Authorization Guidelines posted at https://www.oregon.gov/odhs/providers-partners/ltccn/Pages/resources.aspx#billing (3) Compensation for long term care community nursing services in OAR 411-048-0180 shall be defined in the Department's rate schedule. The Department may adjust rates in underserved areas to assure that individuals have access to long term care community nursing services. (4) Payment for non-Medicaid covered services must be prior authorized by the Department and billed on Department approved invoices. (a) Rates for non-Medicaid services shall be determined by the Department but may not exceed the rate noted on the Department's rate schedule. (b) The Department makes payment for non-Medicaid covered services within 45 days of receipt of the completed invoice. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: APD 18-2023, amend filed 10/13/2023, effective 11/01/2023 SPD 8-2013, f. & cert. ef. 4-15-13
411-048-0240 Orientation Requirements (1) A self-employed RN or agency administrator as described in OAR 411-048-0210 must complete an orientation with the Local Office for the area they intend to provide services. The orientation must be completed prior to accepting Referrals as described under OAR 411-048-0180. (2) Local office management and RN or agency administrator shall review at a minimum the following: (a) Local area practices that the RN should be aware of, schedules or best access times for case managers. (b) Local CCO resources and practices that the RN or agency may need to know about. (c) Communication, documentation and problem-solving activities that occur between the RN or agency and case managers. (d) Develop expectation regarding when the RN or agency should contact management for concerns regarding the program, a client, a case manager or other providers. (e) Review any questions the RN or agency may have from the program material and connect with LTCCN Contract Administrator for any additional guidance. (f) Other procedures as required by ODHS offices or designee. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: APD 18-2023, amend filed 10/13/2023, effective 11/01/2023 SPD 8-2013, f. & cert. ef. 4-15-13
411-048-0250 Variances (1) The Department may grant a variance to these rules. Implementation of a variance may not occur without the Department's written approval. (2) A request for a variance to these rules must include but not be limited to the following standards: (a) A written request must be provided to central office Department management for prior approval. The variance request must include; (A) Local office management support for the variance request; (B) A description of the benefit to the individual served by the Department that may occur as result of the variance; and (C) Details regarding the specific rule for which the variance may be granted, the rationale for why the variance is needed, the proposed duration of the variance, identification of alternatives (including rule compliance), and costs of the variance if any. (b) The variance may not impact compliance with any rules other than these rules for long term care community nursing services in OAR chapter 411, division 048. (c) The variance may not result in noncompliance with the Department's provider enrollment standards. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: APD 18-2023, amend filed 10/13/2023, effective 11/01/2023 SPD 8-2013, f. & cert. ef. 4-15-13
411-049-0100 Purpose (1) The purpose of the rules in OAR chapter 411, division 049, 050, 051, and 052 is to establish the minimum standards and procedures for Adult Foster Homes (AFH) that provide care and services for adults who are older or adults with physical disabilities in a homelike environment that is safe and secure. (2) Adult foster homes: (a) Provide necessary care and services that emphasize the resident's independence through a cooperative relationship between the resident (or court-appointed guardian) and the resident's care providers. (b) Care and services are provided in a setting that protects and encourages resident dignity, choice, and decision-making while addressing the needs of the resident in a manner that supports and enables the residents to maximize their ability to function at the highest level of independence possible. Statutory/Other Authority: ORS 409.050, 410.070, 413.085, 443.001, 443.004, 443.725, 443.730 & 443.735, 443.738, 443.742, 443.760, 443.767, 443.775, 443.790 Statutes/Other Implemented: ORS 409.050, 410.070, 413.085, 443.001 - 443.004, 443.705 - 443.825 & 443.875, 443.991 History: APD 19-2019, adopt filed 06/20/2019, effective 07/01/2019
411-049-0110 Adult Day Services (1) An AFH licensee may request authorization to provide adult day services to a specific number of individuals. The licensee may not provide adult day services without first receiving written authorization from the LLA. (2) The care needs of adult day services individuals must be within the classification of the license and any conditions imposed. (3) A copy of the current house policies, as identified in the current Residency Agreement, and the current Resident's Bill of Rights and Freedoms, signed and dated by the resident or the resident's representative. (4) The licensee or administrator must have arrangements for adult day services individuals to sleep in areas other than a resident's bed, a resident's room, or space designated as common use, in accordance with OAR 411-050-0715. (a) Adult day services individuals may use a cot or rollaway bed if bedroom space is available that meets the requirements of OAR 411-50-0715(9)(c). (b) A resident's bed may not be used by an adult day services individual. (5) Licensees that provide adult day services to individuals must remain in compliance with OAR 411-049-0105(6) in addition to the other requirements in these rules including, but not limited to, facility standards addressing: (a) Common use areas, OAR 411-050-0715(7). (b) Bathrooms, OAR 411-050-0715(8). (c) Evacuations, OAR 411-050-0725. (6) Before the admission of each adult day services individual, the licensee or administrator must: (a) Conduct and document a screening as described in OAR 411-051-0110. (b) Obtain current medical professional orders as described in OAR 411-051-0130(2), if medications are to be administered and the necessary delegations, as applicable. (c) Develop and maintain a current, written medication administration record (MAR) as described in OAR 411-051-0130(6), if medications are to be administered. Statutory/Other Authority: ORS 409.050, 410.070, 413.085, 443.001, 443.004, 443.725, 443.730 & 443.735, 443.738, 443.742, 443.760, 443.767, 443.775, 443.790 Statutes/Other Implemented: ORS 409.050, 410.070, 413.085, 443.001 - 443.004, 443.705 - 443.825 & 443.875, 443.991 History: APD 19-2019, adopt filed 06/20/2019, effective 07/01/2019
411-049-0115 Room and Board (1) Licensee may request authorization to provide room and board services to a specific number of tenants according to these rules prior to admission. If room and board tenants are in the home, the licensee must ensure each tenant has: (a) An approved background check in accordance with OAR 411-049-0120. (b) A tenancy agreement. (c) A copy of the current tenancy agreement signed and dated by the tenant. (d) A resident may choose to have a room and board tenant, such as the resident's spouse, as a roommate if the bedroom is approved for shared occupancy. In addition: (A) Verification of sufficient square footage and written authorization from the LLA is required in advance of the tenant's admission. (B) If the tenant placement would take an approved resident's bed, the licensee must also submit a request to change the home's license capacity according to OAR 411-049-0105(6). (2) AFH licensees that provide room and board services to individuals must remain in compliance with OAR 411-050-0715 in addition to the other requirements in these rules including, but not limited to: (a) Common use areas, OAR 411-050-0715(7). (b) Bathrooms, OAR 411-050-0715(8). (c) Bedrooms, OAR 411-050-0715(9). (d) Evacuations, OAR 411-050-0725. Statutory/Other Authority: ORS 409.050, 410.070, 413.085, 443.001, 443.004, 443.725, 443.730 & 443.735, 443.738, 443.742, 443.760, 443.767, 443.775, 443.790 Statutes/Other Implemented: ORS 409.050, 410.070, 413.085, 443.001 - 443.004, 443.705 - 443.825 & 443.875, 443.991 History: APD 19-2019, adopt filed 06/20/2019, effective 07/01/2019
411-050-0710 Refunds (1) If a resident dies, the licensee may not retain or require payment for more than 15 calendar days after the date of the resident's death, or the time specified in the licensee's Agreement, whichever is less. (2) If a resident leaves an AFH for medical reasons and the resident or the resident's representative indicates the resident's intent to not return, the licensee may not retain or require payment for more than 15 calendar days after the date the licensee or administrator receives notification from the resident, the resident's representative, or the time specified in the licensee's Agreement, whichever is less. (3) If a resident who has paid with private funds becomes eligible for Medicaid services, the licensee must accept payment from the Department from the date of eligibility forward as payment in full. The licensee must reimburse the resident or the resident's representative within 30 calendar days after the licensee receives payment from the Department for any private payment received after the resident became eligible for Medicaid services. (4) The licensee must act in good faith to reduce the charge to a resident who has left the home by seeking a new resident to fill the vacancy. (5) The licensee must refund any unused advance payment to the resident, or the resident's representative as appropriate, within 30 calendar days after the resident dies or leaves the home. (6) If the AFH closes or the licensee or administrator gives written notice for the resident to leave, the licensee waives the right to collect any fees beyond the date of closure or the resident's departure, whichever is sooner. (7) If a resident dies or leaves an AFH due to neglect or abuse at the AFH that is substantiated by a Department investigator, or due to conditions of imminent danger of life, health, or safety, the licensee may not charge the resident beyond the resident's last day in the home. (8) The refund policies in these rules also apply to refunds for resident moves and transfers as described in OAR 411-050-0760. Statutory/Other Authority: ORS 409.050, 410.070, 413.085, 443.001, 443.004, 443.725, 443.730 & 443.735, 443.738, 443.742, 443.760, 443.767, 443.775, 443.880, 443.790 Statutes/Other Implemented: ORS 409.050, 410.070, 413.085, 443.001 - 443.004, 443.705 - 443.825, 443.875, 443.991 History: APD 19-2019, adopt filed 06/20/2019, effective 07/01/2019