411-325-0120 Medical Services in 24-Hour Residential Programs and Settings (1) A provider must have and implement written policies and procedures that maintain and protect individuals' physical health. The policies and procedures must address the following: (a) Individual health care; (b) Medication administration; (c) Medication storage; (d) Response to emergency medical situations; (e) Nursing services, if provided; (f) Disposal of medications; and (g) Early detection and prevention of infectious disease. (2) INDIVIDUAL HEALTH CARE. (a) A provider must ensure an individual receives care that promotes the health and well-being of the individual as follows: (A) The provider must ensure the individual has a primary physician or health care provider whom the individual has chosen from among qualified providers. Provisions must be made for a secondary physician or clinic in the event of an emergency. (B) The provider must ensure the individual receives a medical evaluation by a qualified health care provider no fewer than every two years or as recommended by a physician. (C) The provider must monitor the health status and physical conditions of the individual and take action in a timely manner in response to identified changes or conditions that may lead to deterioration or harm. (b) A written, signed order from a physician or qualified health care provider is required prior to the usage or implementation of all of the following: (A) Prescription medications; (B) Non-prescription medications except over the counter topical; (C) Treatments other than basic first aid; (D) Modified or special diets; (E) Adaptive equipment; and (F) Aids to physical functioning. (c) A provider must implement the order of a physician or qualified health care provider if the individual is willing. (d) A provider must maintain records on each individual to aid physicians, licensed health professionals, and the provider in understanding the medical history of the individual. The record must include: (A) A list of known health conditions, medical diagnoses, known allergies, and immunizations; (B) A record of visits to licensed health professionals that include documentation of the consultation and any therapy provided; and (C) A record of known hospitalizations and surgeries. (3) MEDICATION. (a) Except as described in subsection (e) of this section, all medications must be: (A) Kept in their original containers; (B) Labeled by the dispensing pharmacy, product manufacturer, or physician, as specified per the written order of a physician or qualified health care provider; and (C) Kept in a secured locked container and stored as indicated by the product manufacturer. (b) All medications and treatments must be recorded on an individualized medication administration record (MAR). The MAR must include: (A) The name of the individual; (B) A transcription of the written order of a physician or qualified health care provider, including the brand or generic name of the medication, prescribed dosage, frequency, and method of administration; (C) For topical medications and treatments without the order of a physician or qualified health care provider, a transcription of the printed instructions from the package; (D) Times and dates of administration or self-administration of the medication; (E) Signature of the person administering the medication or the person monitoring the self-administration of the medication; (F) Method of administration; (G) An explanation of why a PRN (as needed) medication was administered; (H) Documented effectiveness of any PRN (as needed) medication administration; (I) An explanation of any medication administration irregularity; and (J) Documentation of any known allergy or adverse drug reaction. (c) Self-administration of medication. (A) The ISP for individuals who independently self-administer medications must include a plan for the periodic monitoring and review of the self-administration of medications. (B) A provider must ensure that individuals able to self-administer medications keep the medications in a secure locked container unavailable to other individuals residing in the same home and store the medications as recommended by the product manufacturer. (d) PRN (as needed) orders are not allowed for psychotropic medication except while an individual is receiving hospice care. (e) Medications that must travel with an individual or be available for immediate use, such as rescue medications, are not required to be locked. These medications must: (A) Be labeled with the individual’s name, name of the medication, dosage, and instructions for administration. (B) Stored in accordance with the manufacturer’s recommendations and in a manner that prevents tampering or unintended access. (f) Safeguards to prevent adverse effects or medication reactions must be utilized and include: (A) Whenever possible, obtaining all prescription medication for an individual, except samples provided by a health care provider, from a single pharmacy which maintains a medication profile for the individual; (B) Maintaining information about the desired effects and side effects of each medication; (C) Ensuring that medications prescribed for one individual are not administered to, or self-administered by, another individual or staff member; and (D) Documentation in the record for an individual of the reason all medications are not provided through a single pharmacy. (g) All expired, discontinued, recalled, or contaminated medications, including over-the-counter medications, may not be kept in a home and must be disposed of within 10 calendar days of expiration, discontinuation, or a provider's knowledge of a recall or contamination. A provider must dispose of the prescription medications for an individual who has died within 10 calendar days of the individual's death. (A) A provider must dispose of medications according to the provider's policy. The provider's policy must reflect the medication disposal guidelines issued by the Department of Environmental Quality. (B) A provider must maintain a written record of the disposal of a medication. The record must include documentation of the following: (i) Date of disposal; (ii) Description of the medication, including dosage, strength, and amount being disposed of; (iii) Name of the individual for whom the medication was prescribed; (iv) Reason for disposal; (v) Method of disposal; (vi) Signature of the person disposing of the medication; and (vii) For controlled medications, the signature of a witness to the disposal. (4) NURSING SERVICES. When nursing services are provided to an individual, a provider must: (a) Coordinate with a registered nurse and the individual's ISP team to ensure the nursing services being provided are sufficient to meet the health needs of the individual; and (b) Implement the Nursing Service Plan, or appropriate portions therein, as agreed upon by the individual's ISP team and the registered nurse. (5) DELEGATION AND SUPERVISION OF NURSING TASKS. Nursing tasks must be delegated by a registered nurse to a provider in accordance with the rules of the Oregon State Board of Nursing in OAR chapter 851, division 047. (6) DIRECT NURSING SERVICES. Upon official approval from the Centers for Medicare and Medicaid Services, direct nursing services may be provided to individuals 21 years of age and older in accordance with OAR chapter 411, division 380. (a) A provider of a 24-hour residential setting may deliver direct nursing services to an individual in the 24-hour residential setting under the following conditions: (A) The provider must be endorsed to OAR chapter 411, division 380 in accordance with OAR chapter 411, division 323, and the staff delivering the direct nursing services must meet the qualifications described in OAR 411-380-0060; (B) More than one individual who receives Department-funded services must reside in the 24-hour residential setting; (C) The provider must be the individual's, or as applicable the individual's legal representative's, provider of choice for direct nursing services; (D) Direct nursing services are not delivered at the 24-hour residential setting for the convenience of the provider or 24-hour residential program; and (E) The provider meets the requirements as an enrolled Medicaid Provider as described in OAR 411-380-0060 and has a separate and distinct Medicaid provider number for the provision of direct nursing services. (b) A Nursing Service Plan must be present when Department funds are used for direct nursing services. The provision of direct nursing services must be authorized by a case manager as identified in an ISP. (c) When direct nursing services are provided to an eligible individual by a provider, the provider must: (A) Coordinate with the registered nurse and the individual's ISP team to ensure the direct nursing services being provided are sufficient to meet the individual's health needs; (B) Implement the Nursing Service Plan, or appropriate portions therein, as agreed upon by the individual's ISP team and the registered nurse; and (C) While delivering direct nursing services exclusively to the individual, assure the needs of other individuals in the home are met. (7) A provider must immediately notify an individual's case manager, and document the notification, when the individual's medical, behavioral, or physical needs change to a point that they may not be met by the provider. Statutory/Other Authority: ORS 409.050, 427.104, 430.662, 441.715, 443.450 & 443.455 Statutes/Other Implemented: ORS 409.010, 427.007, 427.101, 427.104, 430.215, 430.610, 430.662, 441.705-441.720, 441.740, 441.745, 443.384, 443.392, 443.400-443.445, 443.450, 443.455, 443.880, 443.881 & 443.991 History: APD 1-2026, amend filed 01/12/2026, effective 01/15/2026 APD 11-2025, temporary amend filed 07/17/2025, effective 07/21/2025 through 01/16/2026 APD 13-2019, amend filed 02/14/2019, effective 02/15/2019 APD 42-2014, f. 12-26-14, cert. ef. 12-28-14 APD 24-2014(Temp), f. & cert. ef. 7-1-14 thru 12-28-14 SPD 58-2013, f. 12-27-13, cert. ef. 12-28-13 SPD 25-2004, f. 7-30-04, cert. ef. 8-1-04 SPD 25-2003, f. 12-29-03, cert. ef. 1-1-04