justicedao/ipfs_state_laws huggingface dataset:
411-065-0000 Purpose The purpose of these rules is to establish standards for specialized living service contracts. The standards provide an enhanced continuum of quality care in a home-like environment for specific target groups who are eligible for a live-in attendant, but because of special needs, are unable to live independently or receive services in other community-based care facilities and who would otherwise require nursing facility care. Services provided to residents in the Specialized Living Services Program are Medicaid home and community-based services, which may include specific services required because of physical, intellectual, or behavioral limitations in meeting self-care needs. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: 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 SSD 19-1991, f. & cert. ef. 10-10-91 SSD 5-1982, f. 5-12-82, ef. 5-15-82
411-065-0020 Compliance and Documentation (1) Providers must document appropriate qualifications and training or supervisors and staff to provide care and services for the target group. (2) Providers must maintain documentation that the approved services are in fact being provided to each client consistent with the care management plan of each client as recorded in each client's record. (3) Authorized Department and AAA representatives must have immediate access to clients and records. "Access" to client records means the right to personally read charts and records in order to document continuing eligibility for payment, quality of care or alleged abuse. Authorized Department and AAA representatives must be able to make and remove copies of charts and records from the program's premises as required to carry out the above responsibilities. (4) Authorized Department and AAA representatives must have the right to privately interview any client and any program supervisor or staff in carrying out the above responsibilities. (5) Authorized Department and AAA representatives may, upon proper identification enter and inspect a facility which has a specialized living services approval and contract at any time to secure compliance with, or prevent a violation of provision of these rules. (6) If authorized Department and AAA representatives are not permitted access consistent with the requirements of the rule, a search warrant may be obtained. (7) Completed reports in inspections and evaluations except for confidential information, will be available to the public upon request, during business hours. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: SPD 26-2006, f. 8-22-06, cert. ef. 9-1-06 SSD 19-1991, f. & cert. ef. 10-10-91 SSD 5-1982, f. 5-12-82, ef. 5-15-82
411-065-0025 Staffing Requirements (1) The provider must have staff of sufficient number and qualifications to meet the specialized needs of the target group. (2) The number and quality of staff will be specified by the Department contract at the time of approval of the contract. At least one staff person must be in attendance at all times when a resident is on the premises. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: SPD 26-2006, f. 8-22-06, cert. ef. 9-1-06 SSD 19-1991, f. & cert. ef. 10-10-91 SSD 5-1982, f. 5-12-82, ef. 5-15-82
411-065-0030 Admission Criteria (1) Each provider will develop admission criteria specific to the target group to be served. (2) Each person must be stabilized in their physical and emotional adjustments to their disability and be able to participate in planning for services to meet their needs. (3) Each Title XIX eligible person must be screened through the Department's Pre-Admission Screening process to determine suitability for placement based on specific admission criteria. (4) First priority for any individual needing placement in a specialized living services setting will be a resident of a nursing facility or an acute hospital. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: SPD 26-2006, f. 8-22-06, cert. ef. 9-1-06 SSD 19-1991, f. & cert. ef. 10-10-91 SSD 5-1982, f. 5-12-82, ef. 5-15-82
411-065-0035 Exit Criteria (1) A resident may choose to leave a specialized living services program whenever the program is no longer of benefit. A resident may also be moved if his or her condition deteriorates either mentally or physically to the point that his or her needs can no longer be met by the specialized living services program. (2) At the time of termination, the resident will be given assistance in securing other placement and resources as needed. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: SPD 26-2006, f. 8-22-06, cert. ef. 9-1-06 SSD 19-1991, f. & cert. ef. 10-10-91 SSD 5-1982, f. 5-12-82, ef. 5-15-82
411-065-0040 Records (1) The provider must maintain confidential records for each resident that contains the client's service plan, a copy of written client right rules and documentation that the rules have been discussed with the client, and all pertinent medical, social and financial information. Narrative entries describing the client's progress must be made no less often than every 30 days. Disclosure of information from any records must be in accordance with applicable laws and rules. (2) The provider will keep records, books and documents as may be required by contract by the Department that will be made available for inspection to authorized state or federal personnel or persons authorized on their behalf. (3) If the provider manages a client's money, a separate account record must be maintained in the client's name. The provider must not commingle, borrow from, or pledge any funds of a client. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: SPD 26-2006, f. 8-22-06, cert. ef. 9-1-06 SSD 19-1991, f. & cert. ef. 10-10-91 SSD 5-1982, f. 5-12-82, ef. 5-15-82
411-065-0045 Facility Standards (1) Specialized living services that are provided in a community based setting must meet applicable zoning, building, housing, water, sewer and fire safety codes, rules, and regulations. If an exception or waiver is granted by a regulatory agency, the Department may accept the waiver or exception as long as it does not jeopardize the health, safety or welfare of the residents. (2) The facility must be constructed in such a way as to be adaptable to meet the physical needs of the resident. (3) The facility must maintain in good repair and operable conditions all structures, installed equipment, grounds and living units so as to maintain health and safety. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: SPD 26-2006, f. 8-22-06, cert. ef. 9-1-06 SSD 19-1991, f. & cert. ef. 10-10-91 SSD 5-1982, f. 5-12-82, ef. 5-15-82
411-065-0046 Client Rights (1) Each client receiving specialized living services must be assured the same civil and human rights accorded to other citizens. (2) The provider must document in writing, implement and fully inform each client of policies and procedures that protect clients' rights, including: (a) Adequate food, housing, clothing, medical and health care and personal services; (b) Visits to and from family members, friends, advocates, legal and medical professionals; (c) Confidential communications; (d) Personal property; (e) Privacy; (f) Freedom from involuntary training, treatment, participation in activities and chemical or mechanical restraints; (g) Religious practices as personally preferred; (h) Voting; (i) Access to community resources, including recreation, agency services. (3) Providers shall not inflict or tolerate to be inflicted, physical, sexual or emotional abuse or punishment, intimidation, threats, exploitation, or neglect of clients. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: SPD 26-2006, f. 8-22-06, cert. ef. 9-1-06 SSD 19-1991, f. & cert. ef. 10-10-91
411-065-0047 Denial, Termination, Nonrenewal or Suspension of Approval (1) Failure to Comply. The Department may deny, terminate, or refuse to renew provider approvals with providers who fail to comply with OAR 411-065-0000 through 411-065-0050 relating to specialized living services contracts. (2) Emergency Suspension. When the Department has reason to believe that imminent danger to clients exists, the Department may immediately suspend the provider's approval and take action necessary to protect the health and safety of clients. (3) Suspension or Termination of Payments. Since valid approval is a condition precedent to payment under a contract for specialized living services, the denial, termination, nonrenewal or suspension of approval provides grounds for suspending or termination payments under a specialized living services contract. (4) Any denial, termination, nonrenewal or suspension shall be done in accordance with the rules of the division and ORS chapter 183. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: SPD 26-2006, f. 8-22-06, cert. ef. 9-1-06 SSD 19-1991, f. & cert. ef. 10-10-91
411-065-0048 Conditions for Payment (1) No payment will be made to any person or organization from the Department for specialized living services without first obtaining approval from the Department as prescribed in these rules. (2) Where specialized living services are provided in a residential care facility, or an adult foster home or independent living unit, the following requirements apply: (a) Facilities that meet the definition of residential care facility in ORS 443.400 to 443.455 must be licensed and certified pursuant to OAR 411-054-0000 et seq.; (b) Facilities that meet the definition of an adult foster home in ORS 443.705 to 443.825 must be licensed and certified pursuant to OAR 411-050-0400 et seq.; and (c) Facilities that meet the definition of independent living units must meet the requirements of OAR chapter 411, division 030. (3) The provider must sign a written contract with the Department as described in OAR 411-065-0050. (4) The provider must bill the Department in accordance with established rules and guidelines. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: SPD 26-2006, f. 8-22-06, cert. ef. 9-1-06 SSD 19-1991, f. & cert. ef. 10-10-91
411-065-0049 Reimbursement (1) The total monthly rate for specialized living services must not exceed the amount approved for each resident in accordance with the terms of the contract signed by the Department. (2) Any add-on costs for nursing services must not exceed the RN Contract fee rate. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: SPD 26-2006, f. 8-22-06, cert. ef. 9-1-06 SSD 19-1991, f. & cert. ef. 10-10-91
411-065-0050 Contract (1) Each specialized living services provider will have a contractual agreement with the Department specifying: type of administrative and direct care staff; terms of payment and procedures; roles and responsibilities of each party; and general provisions. The contract does not guarantee the number of Department clients who will be referred to or maintained in a program. (2) Specialized living services contracts are effective for one year. In conjunction with the annual program evaluation, the Department will consider the results of the program evaluation prior to making its determination to renew the contract. (3) The terms of the contract will establish the conditions upon which the contract may be terminated. A provider has no right to continuation of a specialized living services contract beyond the specific year in which a written contract has been executed. Approval of a provider's specialized living services program pursuant to OAR 411-065-0015 does not create an express or implied contract in the absence of a fully executed written contract with the Department. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: SPD 26-2006, f. 8-22-06, cert. ef. 9-1-06 SSD 19-1991, f. & cert. ef. 10-10-91 SSD 5-1982, f. 5-12-82, ef. 5-15-82
411-066-0000 Statement of Purpose (1) Adult day services are community-based group programs designed to meet the service needs of aging and people with physical disabilities in a structured non-residential setting. (2) These rules: (a) Create a registry of adult day services programs and describe the process and criteria for listing on the registry. (b) Allow state certification for programs enrolled as a provider with the State of Oregon to provide Medicaid-funded adult day services to Medicaid-eligible individuals in home and community-based settings. Certification by the Department of Human Services (DHS), Aging and People with Disabilities (APD) is intended to fulfill the Centers for Medicare and Medicaid Services (CMS) requirements of "state certified" adult day service programs with the purpose of continuing eligibility criteria for Medicare beneficiaries. (c) Define the criteria for state certification. Statutory/Other Authority: ORS 409.050, 410.070, 410.490, 410.495, 413.085 Statutes/Other Implemented: ORS 410.485 - 410.495 History: APD 10-2019, amend filed 02/13/2019, effective 02/15/2019 SPD 19-2007, f. & cert. ef. 11-7-07 SPD 6-2007(Temp), f. & cert. ef. 5-15-07 thru 11-11-07 SDSD 4-1999, f. & cert. ef. 3-15-99 SSD 12-1992, f. & cert. ef. 12-1-92
411-066-0010 Registration (1) All ADS programs that voluntarily provide APD with the information described in section (2) of this rule shall be placed on APD's ADS registry. (2) Information on the registry must include, but is not limited to: (a) The name and address of the ADS program. (b) A checklist to determine the extent the ADS program is voluntarily complying with the standards set forth in OAR 411-066-0020. Statutory/Other Authority: ORS 409.050, 410.070, 410.490, 410.495, 413.085 Statutes/Other Implemented: ORS 410.485 - 410.495 History: APD 10-2019, amend filed 02/13/2019, effective 02/15/2019 SPD 19-2007, f. & cert. ef. 11-7-07 SPD 6-2007(Temp), f. & cert. ef. 5-15-07 thru 11-11-07 SDSD 4-1999, f. & cert. ef. 3-15-99 SSD 12-1992, f. & cert. ef. 12-1-92
411-067-0010 Registration Required (1) Providers who operate a CCRC must register with the Division. (2) If a provider operates more than one CCRC facility, each facility must be registered with the Division and separately listed on the disclosure statement. (3) No entity shall claim to be a CCRC in Oregon without being registered pursuant to these rules. (4) A new CCRC provider must register with the Division before: (a) Entering into a residency agreement with a nonresident; (b) Soliciting either a prospective resident or nonresident to pay an application fee or execute a residency agreement; or (c) Collecting an entrance fee. (5) The provider must apply for registration with the Division on forms prescribed by the Division as described in OAR 411-067-0020. The application must include a disclosure statement as described in OAR 411-067-0050. (6) The Division shall issue a notice of filing to the applicant within 10 business days after receipt of the completed application for registration of a new CCRC and the initial registration fee. (7) The Division shall enter an order registering the provider or rejecting the registration within 60 days of the notice of filing. If no order of rejection is entered within 60 days from the date of notice of filing, the provider shall be considered registered unless the provider and the Division agree in writing to an extension of time. If no order of rejection is entered within the time period as so extended, the provider shall be considered registered. (8) The Division shall enter an order registering the provider if the Division determines that the requirements of these rules and ORS Chapter 101 have been met. (9) The Division shall notify the applicant that the application for registration must be corrected within 30 days if the Division determines that any of the requirements of these rules and ORS Chapter 101 have not been met. (a) The Division may enter an order rejecting the registration if the applicant does not meet the requirements within 30 days. The order shall include the findings of fact upon which the order is based and which may not become effective until 20 days after the end of the foregoing 30-day period. (b) During the 20-day period, the applicant may petition for reconsideration and request a contested case hearing pursuant to ORS Chapter 183. (c) If a contested case hearing has been requested, an order of rejection may not take effect, in any event, until a decision is rendered by the administrative law judge that sustains the Division's decision to reject the registration. Statutory/Other Authority: ORS 101.150 & 410.090 Statutes/Other Implemented: ORS 101.030 History: SPD 8-2011, f. 3-31-11, cert. ef. 4-1-11 SDSD 5-1999, f. 4-30-99, cert. ef. 5-1-99 SSD 9-1990, f. & cert. ef. 3-26-90
411-067-0020 Registration (1) APPLICATION FOR REGISTRATION: (a) Application for registration must be made to the Division on forms prescribed by the Division. The application must include: (A) The registration fee as described in section (2) of this rule; (B) The annual disclosure statement as described in OAR 411-067-0050; and (C) The reserve requirement statement as described in OAR 411-067-0060. (b) The application is not considered to be complete until the Division receives all required information and the registration fee. (c) The application for registration must be signed and notarized by the provider or an authorized individual. (d) Application for registration must be made annually to the Division as described in this section. (2) REGISTRATION FEE: (a) The initial application for registration must be accompanied by a fee of $500. (b) After the initial registration, the subsequent annual registration fee shall be $250 per facility. (3) ISSUANCE OF REGISTRATION: (a) The Division shall issue a certificate of registration to the provider once the provider has: (A) Submitted a completed application, disclosure statement, registration fee, and other required information; (B) Met the reserve requirement as described in OAR 411-067-0060; and (C) Met all other requirements as described in ORS chapter 101 and these rules. (b) The certificate of registration shall identify the provider as a CCRC and include: (A) The name and address of the provider; (B) The names and addresses of all facilities owned and operated by the provider; (C) The effective date of the registration; and (D) The following statement in a prominent location and typeface: "A certificate of registration does not constitute approval, recommendation or endorsement of the community by the Seniors and People with Disabilities, and this registration does not evidence the accuracy or completeness of the information set forth in the disclosure statement." (c) The provider must use a copy of the certificate of registration as the cover page for the disclosure statement as described in OAR 411-067-0050. Statutory/Other Authority: ORS 101.150 & 410.090 Statutes/Other Implemented: ORS 101.030 & 101.040 History: SPD 8-2011, f. 3-31-11, cert. ef. 4-1-11 SDSD 5-1999, f. 4-30-99, cert. ef. 5-1-99 SSD 9-1990, f. & cert. ef. 3-26-90
411-067-0055 Residency Agreement (1) The provider and the prospective resident must sign and date a residency agreement before CCRC services begin. (2) A copy of the agreement must be provided to the resident. (3) The residency agreement must list in boldface type the percentage of the entrance fee to be refunded and the manner in which the percentage of the entrance fee is calculated. Statutory/Other Authority: ORS 101.150 & 410.090 Statutes/Other Implemented: ORS 101.030, 101.050 & 101.080 History: SPD 8-2011, f. 3-31-11, cert. ef. 4-1-11 SDSD 5-1999, f. 4-30-99, cert. ef. 5-1-99
411-067-0060 Reserve Requirements (1) A provider must establish and maintain at all times: (a) A debt service liquid reserve in an amount equal to or exceeding the total of all principal and interest payments due during the next 12 months on account of a mortgage loan or other long term financing of the CCRC taking into consideration any anticipated refinancing; and (b) An operating liquid reserve in an amount equal to or exceeding the total of the CCRC's projected operating expenses for three months. For the purpose of calculating the amount required for the operating liquid reserve, projected operating expenses include any anticipated expenses associated with providing housing or health related services included under all the residency agreements. (2) If the provider does not meet the reserve requirements, the Division may require the provider to place the reserves in an escrow account. (3) The division may allow withdrawal or borrowing from the reserves in an amount not greater than 20 percent of the provider's total required reserves. (a) The Division shall only approve the borrowing or withdrawal if required: (A) For making an emergency repair or replacement of equipment; (B) To cover catastrophic loss that is not able to be covered by insurance; or (C) For debt service in a potential default situation. (b) No withdrawal or borrowing may be made from the reserves without the approval of the Division except upon a court order. (c) All funds borrowed from the reserves must be repaid to the reserves within 18 months in accordance with a payment plan approved by the Division. (4) The reserve requirement statement must identify: (a) The total of all principal and interest payments due during the provider's previous fiscal year including any mortgage loans or other long-term financing; (b) Any anticipated refinancing and any change in principal and interest payments expected during the next 12 months; (c) The amount of liquid reserves maintained by the provider; and (d) Three months projected operating expenses. A provider must determine the three months projected operating expenses by taking the provider's previous year's audited financial statement and adding any projected increases or decreases in expenses for the next year, excluding depreciation and payments on long-term financing. (5) New providers must determine their three months projected operating expenses by estimating their start-up, marketing, and personnel costs for the year of operation and divide the total costs by four. The projected budget must be provided to the Division. New providers must also submit an audited financial statement to the Division. (6) Registered providers who build, purchase, or operate a new facility must immediately meet the full reserve requirements for that facility. Statutory/Other Authority: ORS 101.150 & 410.090 Statutes/Other Implemented: ORS 101.060 History: SPD 8-2011, f. 3-31-11, cert. ef. 4-1-11 SDSD 5-1999, f. 4-30-99, cert. ef. 5-1-99 SSD 9-1990, f. & cert. ef. 3-26-90
411-067-0065 Provider Liquidation If the provider is liquidated, the claims of the residents arising under residency agreements must be preferred claims that have priority over other unperfected claims against the provider's assets. Statutory/Other Authority: ORS 101.150 & 410.090 Statutes/Other Implemented: ORS 101.065 History: SPD 8-2011, f. 3-31-11, cert. ef. 4-1-11
411-067-0080 Transfer of Ownership (1) A certificate of registration is not transferable. (2) A registered provider who wishes to sell, transfer ownership, or lease any CCRC or CCRC facility must obtain approval from the Division. The Division shall grant approval when the requirements of sections (3) and (4) of this rule have been met. (3) Prior to taking over ownership or operation of the CCRC or CCRC facility, the purchasing provider must obtain a certificate of registration as described in OAR 411-067-0020. (4) If the purchasing provider already has a certificate of registration, then the purchasing provider's certificate of registration must be amended to include the newly purchased CCRC or CCRC facility prior to taking over ownership or operation of the newly purchased CCRC or CCRC facility. Statutory/Other Authority: ORS 101.150 & 410.090 Statutes/Other Implemented: ORS 101.100 History: SPD 8-2011, f. 3-31-11, cert. ef. 4-1-11 SSD 9-1990, f. & cert. ef. 3-26-90