justicedao/ipfs_state_laws huggingface dataset:
333-006-0000 Purpose (1) The purpose of these rules is to establish requirements for a voluntary statewide program for providing newborn nurse home visiting services to all families with newborns residing in the state to support healthy child development and strengthen families. (2) Newborn nurse home visiting services provided under these rules must be reimbursed by health benefit plans as specified in ORS 743A.078. Statutory/Other Authority: ORS 413.042 & ORS 433.301 Statutes/Other Implemented: ORS 433.301 History: PH 165-2022, amend filed 07/29/2022, effective 07/29/2022 PH 75-2020, adopt filed 10/27/2020, effective 10/27/2020
333-006-0010 Definitions (1) "Authority" means the Oregon Health Authority. (2) "Carrier" has the meaning given to that term under ORS 743B.005. (3) "Community" means a geographic region, county, Tribe or other group of individuals living in proximity. (4) "Community lead" means an organization designated by the Authority to provide community coordination and quality assurance services in accordance with OAR 333-006-0050 for the newborn nurse home visiting program in a specified community. (5) "Comprehensive newborn nurse home visit" means a home visit where a comprehensive, defined set of assessments and activities must be completed as described in OAR 333-006-0120. (6) "Early learning hub" means any entity designated by regional partners to coordinate early learning services, as determined by rules adopted by the Early Learning Council under ORS 417.827. (7) "Families with newborns" or "families" means all families caring for newborns up to the age of six months, including foster and adoptive newborns. (8) "Health benefit plan" has the meaning given to that term under ORS 743B.005. (9) "Home visitor" means an individual who provides newborn nurse home visits on behalf of a newborn nurse home visiting provider. (10) "Identified community" means the community that the community lead is designated to coordinate the newborn nurse home visiting services for. (11) "Local public health authority" or "LPHA" has the meaning given that term in ORS 431.003. (12) "Newborn nurse home visiting program" or "program" means the statewide program that families with newborns may voluntarily participate in to receive newborn nurse home visiting services. Newborn nurse home visiting providers provide home visiting services through the program and community leads provide community coordination and quality assurance services in the identified community. (13) "Newborn nurse home visiting provider" or "certified provider" means an organization certified by the Authority to provide newborn nurse home visits in accordance with OAR 333-006-0070 and OAR 333-006-0120. (14) "Newborn nurse home visiting services" means the services required by the newborn nurse home visiting program. These services include but are not limited to requirements of the community lead and newborn nurse home visiting providers as described in these rules. (15) “Organization” includes but is not limited to, a local public health authority, early learning hub, Tribe, hospital, or non-profit. (16) "Other home visiting provider" means a provider of any home visiting services serving pregnant people and families with young children and may include newborn nurse home visiting providers. (17) "Support newborn home visit" means a home visit to complete defined set of assessments and activities or address a specific nurse or family-identified need. (18) "These rules" means OAR 333-006-0000 to 333-006-0190. Statutory/Other Authority: ORS 413.042 & ORS 433.301 Statutes/Other Implemented: ORS 433.301 History: PH 116-2024, amend filed 12/13/2024, effective 01/01/2025 PH 165-2022, amend filed 07/29/2022, effective 07/29/2022 PH 75-2020, adopt filed 10/27/2020, effective 10/27/2020
333-006-0020 Community Lead Designation (1) The Oregon Health Authority (Authority) shall designate one community lead per community. (a) Communities based on geographic areas, including counties, shall have one community lead; (b) Communities may be based on Tribal membership and coexist with a community lead designated for the geographic area where the Tribal member lives. (2) The designation of a community lead is effective for up to three years unless withdrawn earlier. (3) To apply for community lead designation, an organization must submit to the Authority: (a) A complete application in the format provided by the Authority; and (b) Documentation demonstrating that the applicant shall comply with the requirements in OAR 333-006-0050, including but not limited to: (A) Identification of staff available to implement community lead activities; and (B) Evidence of established partnerships with other home visiting providers in the community, including but not limited to memorandums of agreement and letters of support as outlined in the application; and (C) Evidence demonstrating that the applicant has initiated planning and implementation activities for a universally offered newborn nurse home visiting services model that has been reviewed by the Administration for Children and Families to meet the U.S. Health and Human Services (HHS) criteria for an evidence-based early childhood home visiting service delivery model. (4) The application shall describe the identified community that the applicant proposes to serve. (5) The Authority may designate as the community lead an organization for Oregon’s Universally Offered Home Visiting Initiative without an application being submitted. Statutory/Other Authority: ORS 413.042 & ORS 433.301 Statutes/Other Implemented: ORS 433.301 History: PH 116-2024, amend filed 12/13/2024, effective 01/01/2025 PH 165-2022, amend filed 07/29/2022, effective 07/29/2022 PH 75-2020, adopt filed 10/27/2020, effective 10/27/2020
333-006-0030 Community Lead Application Review (1) If a community lead applicant satisfies these rules, the Authority may designate the applicant as the community lead. The Authority shall notify the applicant in writing of the designation. (2) The Authority may deny designation to an applicant as the community lead if: (a) A community lead for the identified community is already designated; (b) The applicant fails to submit a complete application or required documentation; (c) The applicant fails to demonstrate that it shall comply with the requirements of these rules or has a history of noncompliance with the requirements of these rules; or (d) The applicant submits false or misleading information. (3) The Authority shall notify the applicant of a denial of the community lead designation in writing. Statutory/Other Authority: ORS 413.042 & ORS 433.301 Statutes/Other Implemented: ORS 433.301 History: PH 75-2020, adopt filed 10/27/2020, effective 10/27/2020
333-006-0040 Community Lead Renewal and Review (1) A community lead may apply to renew its designation by submitting a complete renewal application to the Authority in the format provided by the Authority at least 60 days prior to the expiration of its current designation. (2) The Authority may deny renewal of a designation if: (a) The applicant fails to timely submit a complete application or required documentation; (b) A letter of support is required and is withdrawn; or (c) The applicant fails to comply with the requirements of these rules or has a history of noncompliance with the requirements of these rules. (3) The Authority may withdraw the designation of a community lead if: (a) A letter of support is required and is withdrawn; or (b) The community lead fails to comply with the requirements of these rules. Statutory/Other Authority: ORS 413.042 & ORS 433.301 Statutes/Other Implemented: ORS 433.301 History: PH 75-2020, adopt filed 10/27/2020, effective 10/27/2020
333-006-0060 Community Lead Training Requirements (1) Community leads must ensure staff members working with the newborn nurse home visiting program receive an orientation within six weeks of beginning work in the program that includes, but is not limited to: (a) Overview of the home visiting model implemented by the community lead described in OAR 333-006-0050(1)(a); and (b) Training in early childhood systems coordination that includes partner engagement, working with community advisory boards, identification of community resources and using data. (2) Community leads must ensure staff working with the program receive within six weeks of beginning work in the program and annually, training in the following: (a) Health equity; and (b) Other training specified by the Oregon Health Authority. Statutory/Other Authority: ORS 413.042 & ORS 433.301 Statutes/Other Implemented: ORS 433.301 History: PH 116-2024, amend filed 12/13/2024, effective 01/01/2025 PH 75-2020, adopt filed 10/27/2020, effective 10/27/2020
333-006-0070 Newborn Nurse Home Visiting Provider Certification (1) To apply for certification as a newborn nurse home visiting provider, an applicant must: (a) Submit a complete application, in a format prescribed by the Oregon Health Authority (Authority); (b) Submit documentation demonstrating that the applicant meets the requirements of these rules, including but not limited to providing the following: (A) Letter of support from the currently designated community lead for the applicant’s identified community; and (B) Copies of the policies and procedures required in OAR 333-006-0110. (2) The application shall: (a) Describe the identified community that the applicant proposes to serve; (b) Describe how the applicant shall coordinate with certified providers and other home visiting providers serving the same identified community so that all families with newborns are offered newborn nurse home visiting. (c) Describe how the applicant shall coordinate with primary care providers of care to the families receiving services. (d) Include a staffing plan that describes staff positions including required qualifications. (e) Describe how the applicant will collect and maintain newborn nurse home visiting services data. (f) Include any other information or forms required by the Authority. (3) A certified provider must ensure it meets and continues to meet during its certification, the requirements in these rules. (4) A certificate for a newborn nurse home visiting provider is awarded for up to three years. (5) A certified provider is only certified to provide home visiting services in the identified community or communities listed on its certificate. (6) The Authority shall maintain a current list of all certified providers and make the list publicly available. Statutory/Other Authority: ORS 413.042 & ORS 433.301 Statutes/Other Implemented: ORS 433.301 History: PH 116-2024, amend filed 12/13/2024, effective 01/01/2025 PH 165-2022, amend filed 07/29/2022, effective 07/29/2022 PH 75-2020, adopt filed 10/27/2020, effective 10/27/2020
333-006-0080 Newborn Nurse Home Visiting Provider Application Review (1) The Authority shall review the application to determine if it is complete. If the applicant does not provide all of the documentation and information required in OAR 333-006-0070, the Authority shall reject the application as incomplete. (2) If the applicant meets all of the certification requirements, the Authority may: (a) Issue the applicant a written certificate that includes the identified community(ies); and (b) Schedule an on-site review in accordance with OAR 333-006-0140. (3) The Authority may deny an applicant if: (a) The applicant does not meet all of the requirements of these rules; (b) The applicant submitted false, misleading, or incorrect information; (c) The applicant does not comply or has a history of past noncompliance with these rules; or (d) The applicant poses a danger to public health or safety. (4) If the Authority denies the applicant, the Authority shall notify the applicant of the denial in accordance with ORS chapter 183. Statutory/Other Authority: ORS 413.042 & ORS 433.301 Statutes/Other Implemented: ORS 433.301 History: PH 165-2022, amend filed 07/29/2022, effective 07/29/2022 PH 75-2020, adopt filed 10/27/2020, effective 10/27/2020
333-006-0090 Newborn Nurse Home Visiting Provider Certification Renewal (1) A certified provider may apply to renew its certification by submitting a complete renewal application to the Authority in the format provided by the Authority. (2) A renewal application shall include the following: (a) Attestation that the certified provider continues to implement the home visiting model described in OAR 333-006-0050(1)(a); and (b) Attestation that the community lead’s letter of support for the certified provider has not been withdrawn. (3) A complete renewal application must be received by the Authority at least 30 days prior to the expiration of the certified provider’s current certificate. (4) The Authority may require an on-site review or that the certified provider submit additional information during its review of the renewal application. (5) The Authority shall review a renewal application in accordance with OAR 333-006-0080. Statutory/Other Authority: ORS 413.042 & ORS 433.301 Statutes/Other Implemented: ORS 433.301 History: PH 165-2022, amend filed 07/29/2022, effective 07/29/2022 PH 75-2020, adopt filed 10/27/2020, effective 10/27/2020
333-006-0100 Newborn Nurse Home Visiting Provider Coordination (1) Certified providers must coordinate with the community lead(s) designated in the communities that the certified provider serves, or the Oregon Health Authority (Authority) if no community lead has been designated. Coordination includes, but is not limited to: (a) Actively communicating and working with community leads to ensure that the services are offered to all families with newborns residing in the community lead’s identified community. (b) Participating in community lead’s community advisory board. (c) Actively communicating and collaborating with other home visiting providers in the identified communities to promote continuity of care. (2) Certified providers must coordinate with the certified providers in the same identified communities to coordinate the offering of services to families. (3) Certified providers must actively communicate with primary care providers of care to the families receiving services. (4) A certified provider discontinuing services voluntarily must notify the community lead(s) and the Authority at least 90 days prior to ceasing program enrollment and provide a written plan to ensure continuity of care for families and appropriately maintain records. Statutory/Other Authority: ORS 413.042 & ORS 433.301 Statutes/Other Implemented: ORS 433.301 History: PH 116-2024, amend filed 12/13/2024, effective 01/01/2025 PH 165-2022, amend filed 07/29/2022, effective 07/29/2022 PH 75-2020, adopt filed 10/27/2020, effective 10/27/2020
333-006-0130 Newborn Nurse Home Visitor Provider Training Requirements (1) Certified providers shall ensure that staff working in the program timely receive the training in this rule. (2) All staff working in the program must receive training that includes an overview of the universally offered newborn nurse home visiting model implemented by the community lead in the certified provider’s identified community prior to providing services. (3) All staff working in the program must receive the following training prior to providing services and annually thereafter: (a) Health equity; (b) Child abuse and vulnerable adult mandatory reporting; and (c) Other training as required by the Oregon Health Authority. (4) All home visitors and supervisors providing services must, prior to providing services, receive an orientation that includes: (a) Overview of the newborn nurse home visiting services home visit protocol; (b) Documentation of services; (c) Observational training that includes services delivery, documentation and fidelity assessment; (d) Foundations of infant mental health; (e) Motivational interviewing; (f) Caregiver and newborn physical assessments; (g) Lactation; (h) Adverse childhood experiences and resilience; and (i) Home visitor safety. Statutory/Other Authority: ORS 413.042 & ORS 433.301 Statutes/Other Implemented: ORS 433.301 History: PH 116-2024, amend filed 12/13/2024, effective 01/01/2025 PH 165-2022, amend filed 07/29/2022, effective 07/29/2022 PH 75-2020, adopt filed 10/27/2020, effective 10/27/2020
333-006-0140 Newborn Nurse Home Visiting Provider Review (1) The Oregon Health Authority (Authority), or its designee, may conduct a review of each certified newborn nurse home visiting provider within one year of initial certification to determine compliance with these rules. The Authority may conduct additional reviews at its discretion. (2) The certified provider must permit the Authority, or its designee, access to the certified provider’s place of business during a review. The provider must permit the Authority, or its designee, access to provider records and cooperate with the Authority during a review. A review may include, but is not limited to: (a) Review of documents, policies and procedures, and records; (b) Review of electronic health records systems, and review of practice management systems; (c) Review of data reports from electronic systems or other tracking systems; and (d) Interviews with management, clinical and administrative staff. (3) The Authority, or its designee, shall provide the certified provider with a written report of the findings from the on-site review. (4) If the Authority finds violations by the certified provider, the Authority may: (a) Require corrective actions to be completed within a specified timeline; or (b) Revoke or suspend the certification in accordance with ORS chapter 183. (5) The Authority may conduct a review of a certified provider without prior notice at any time. (6) A certified provider must provide the Authority with provider records upon request. Statutory/Other Authority: ORS 413.042 & ORS 433.301 Statutes/Other Implemented: ORS 433.301 History: PH 116-2024, amend filed 12/13/2024, effective 01/01/2025 PH 165-2022, amend filed 07/29/2022, effective 07/29/2022 PH 75-2020, adopt filed 10/27/2020, effective 10/27/2020
333-006-0150 Newborn Nurse Home Visiting Provider Compliance (1) A certified provider must notify the community lead(s) and the Oregon Health Authority (Authority) within 20 calendar days of any change that brings the provider out of compliance with these rules. (2) The Authority may revoke, deny renewal, or suspend a certificate for a certified provider if: (a) The certified provider submits false, misleading, or incorrect information; (b) The certified provider violates ORS 433.301 or these rules; (c) The certified provider fails to cooperate with a review or request for documentation; (d) The certified provider fails to timely complete corrective actions; (e) The community lead withdraws its letter of support for the certified provider; or (f) The certified provider poses a danger to public health or safety. Statutory/Other Authority: ORS 413.042 & ORS 433.301 Statutes/Other Implemented: ORS 433.301 History: PH 116-2024, amend filed 12/13/2024, effective 01/01/2025 PH 165-2022, amend filed 07/29/2022, effective 07/29/2022 PH 75-2020, adopt filed 10/27/2020, effective 10/27/2020
333-006-0160 Health Benefit Plans Reporting Requirements For each calendar year, carriers shall report the following de-identified information to the Authority on an annual basis: (1) Number of enrollees who added a newborn to coverage under the carrier’s health benefit plans; (2) Number of enrollees reported under section (1) who, at the time the newborn was added to coverage, resided in an identified community where a certified provider was authorized to provide services; (3) Number of enrollees for whom the carrier paid claims for services from a certified provider; (4) Number of enrollees for whom the carrier paid claims for services from a certified provider on multiple dates of service; and (5) Any other claims data for services from a certified provider requested by the Authority. Statutory/Other Authority: ORS 413.042, ORS 433.301 & ORS 743A.078 Statutes/Other Implemented: ORS 433.301 & ORS 743A.078 History: PH 75-2020, adopt filed 10/27/2020, effective 10/27/2020
333-006-0190 Reimbursement Methodology The health benefit plan reimbursement methodology for newborn nurse home visiting services is a claim invoicing process. (1) If a health benefit plan requires credentialing as a prerequisite to claim submission, health benefit plans must credential Oregon Health Authority (Authority)-certified newborn nurse home visiting providers. Newborn nurse home visiting providers must be credentialed as an organization. The organization also serves as the rendering provider. (2) A bundled claim submitted for the newborn nurse home visiting services case rate must include, at a minimum, a comprehensive newborn nurse home visit, meeting the requirements of OAR 333-006-0120(5) and (6). The bundled claim may include one to two support visits that occur after the comprehensive visit and may include one support visit that occurs prior to a comprehensive visit. (a) If a support visit is completed prior to a comprehensive newborn nurse home visit and the comprehensive newborn nurse home visit is subsequently not completed, the newborn nurse home visiting provider must submit a claim for the single support visit rate. (b) Claims must follow the Authority’s billing guidance for newborn nurse home visiting services and generally accepted medical services billing standards. (3) All services provided as part of the newborn nurse home visiting program shall be documented in the client's medical record by the home visitor who provides newborn nurse home visiting services on behalf of a certified newborn nurse home visiting services provider. (4) Claims for newborn nurse home visiting services to health benefit plans with no contract in place with newborn nurse home visiting providers must be submitted as an out of network claim by the provider. (5) Single case out of network claims must be reimbursed by health benefit plans in the amount of the case rate and per the billing procedures described in OAR 333-006-0180 through 333-006-0190. (6) Health benefit plans must reimburse at the case rate for newborn nurse home visiting services conducted via telemedicine pursuant to OAR 333-006-0120 and ORS 743A.058. Statutory/Other Authority: ORS 413.042, ORS 433.301 & ORS 743A.078 Statutes/Other Implemented: ORS 433.301 & ORS 743A.078 History: PH 116-2024, amend filed 12/13/2024, effective 01/01/2025 PH 201-2022, adopt filed 10/13/2022, effective 01/01/2023