justicedao/ipfs_state_laws huggingface dataset:
411-200-0020 Definitions Unless the context indicates otherwise, the following definitions apply to the rules in OAR chapter 411, division 200. (1) "Brief Narrative" means a document that summarizes claimant treatment to date and current status, briefly addresses three to five specific topics posed by the Department, if any, and is usually one or two pages. (2) "Comprehensive Narrative" means a document that describes an extended claimant history, addresses six or more specific topics, and is usually three or more pages. (3) "Consultant" means an individual whose professional credentials per the policy of the Social Security Administration identify the individual either as an acceptable medical source or qualified medical source. (4) "Department" means the Oregon Department of Human Services. (5) "DDS" means the Disability Determination Services program within the Department funded by, and subject to, the disability rating rules of the Social Security Administration. (6) "Fee Schedule" means a complete listing of fees used by the United States Department of Health and Human Services to pay for goods and services. The fee schedule is maintained at: https://www.cms.gov/apps/physician-fee-schedule/license-agreement.aspx. Printed copies may be obtained by contacting the Centers for Medicare & Medicaid Services, 7500 Security Blvd., Baltimore, MD 21244. (7) "HHS" means the United States Department of Health and Human Services. (8) "These Rules" mean the rules in OAR chapter 411, division 200. (9) "Vendor" means an individual or entity (such as hospitals, clinics, private practices) that provide medical evidence of record or other services at the Department's request and may, at the Department’s request and with the Department’s prior authorization, provide a brief or comprehensive narrative of medical treatment for the Department’s review. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: APD 18-2022, amend filed 03/29/2022, effective 04/01/2022 APD 43-2021, temporary amend filed 10/13/2021, effective 10/15/2021 through 04/12/2022 APD 1-2014, f. 1-27-14, cert. ef. 2-1-14 SPD 9-2011, f. 4-29-11, cert. ef. 5-1-11 SPD 12-2006, f. 3-23-06, cert. ef. 4-1-06 SPD 12-2005, f. & cert. ef. 9-26-05 SDSD 4-2002, f. & cert. ef. 6-12-02
411-200-0030 Medical Evidence of Record (MER) and Narrative Charges for Vendors (1) Except as provided by section (4) of this rule, the Department pays the lesser of the following fees for existing medical records requested by the Department: (a) The lowest fee for the records that the vendor charges the general public or other state or federal agencies for the records; or (b) When the invoice itemizes the number of pages provided: (A) For 10 or fewer pages, $18.00; (B) For 11–20 pages, $18.00 for the first 10 pages plus $0.25 per page for each additional page; (C) For 21–40 pages, $20.50 for the first 20 pages plus $0.10 per page for each additional page; and (D) For more than 40 pages, a maximum payment of $22.50. (c) If the invoice does not itemize the number of pages provided, the Department pays a total maximum payment of $18.00. (2) Additional payment is not made to a vendor for second or subsequent requests when the information to be provided was available at the time the original request was processed. (3) Records provided by a vendor, whether held in multiple locations or by multiple sources, are paid as a single record request regardless of whether the records are electronic or paper form, or both. (4) The Department pays a vendor an additional $5.00 when the Department receives the requested records within seven days from the date of the Department's record request. Time is measured from the date indicated on the Department's written request until the date that the Department receipts the copies. (5) The Department pays the vendor the amount billed up to a maximum payment of $35.00 for a brief narrative summarizing the medical treatment when requested by the Department. (6) The Department pays the vendor the amount billed up to a maximum payment of $75.00 for a comprehensive narrative summarizing the medical treatment when requested by the Department. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: APD 1-2014, f. 1-27-14, cert. ef. 2-1-14 SPD 9-2011, f. 4-29-11, cert. ef. 5-1-11 SPD 12-2006, f. 3-23-06, cert. ef. 4-1-06 SPD 12-2005, f. & cert. ef. 9-26-05 SDSD 4-2002, f. & cert. ef. 6-12-02
411-200-0035 Consultative Examination (CE) and Related Charges for Consultants (1) Except as provided in section (2) of this rule, the Department pays the lesser of the following fees for examinations and lab work when requested and pre-authorized by the Department: (a) The lowest fee for services that the consultant charges the general public or other state or federal agencies; or (b) The rate prescribed by HHS in the fee schedule. (2) With prior written approval by a DDS manager, the Department may exceed the fee described in section (1) of this rule when financial or human considerations outweigh the difference in cost. Such considerations may include examinations in a remote geographic area or logistical concerns. (3) No additional fees are reimbursed for certain scheduled services (e.g., blood work only, x-rays, lab tests, PFT’s, treadmill tests) where no preparation time is required. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: APD 18-2022, amend filed 03/29/2022, effective 04/01/2022 APD 43-2021, temporary amend filed 10/13/2021, effective 10/15/2021 through 04/12/2022 APD 1-2014, f. 1-27-14, cert. ef. 2-1-14 SPD 9-2011, f. 4-29-11, cert. ef. 5-1-11
411-200-0040 Limitations of Payments (1) A vendor or consultant who has entered into a price agreement or contract with one part of the Department to provide identified services must provide the same services at the same price to the Department if requested. (2) The vendor must accept the fees prescribed by these rules as payment in full. If a vendor's usual and customary fee for a service exceeds the fee prescribed by these rules, a client or the client's family may not be liable to the vendor for any portion of a vendor's usual and customary fee unless the client or the client's family agrees in writing to assume the additional charges. Without such explicit agreement, the vendor must accept the Department's payment as payment in full. (3) A consultant may be reimbursed a fee of $56.46 for a missed appointment, or those cancelled by the DDS with less than 48 hours/two (2) business days’ notice. A consultant may consider an appointment missed if a claimant is more than 15 minutes late following the appointed time and, consequently, the examination cannot be performed. (4) A consultant is not reimbursed for the time to travel to or from an authorized consultative examination. Statutory/Other Authority: ORS 410.070 Statutes/Other Implemented: ORS 410.070 History: APD 18-2022, amend filed 03/29/2022, effective 04/01/2022 APD 43-2021, temporary amend filed 10/13/2021, effective 10/15/2021 through 04/12/2022 APD 1-2014, f. 1-27-14, cert. ef. 2-1-14 SPD 9-2011, f. 4-29-11, cert. ef. 5-1-11 SPD 12-2006, f. 3-23-06, cert. ef. 4-1-06 SPD 12-2005, f. & cert. ef. 9-26-05 SDSD 4-2002, f. & cert. ef. 6-12-02
411-300-0100 Statement of Purpose (1) The rules in OAR chapter 411, division 300 prescribe standards, responsibilities, and procedures for the Department to partner with families and community partners in the delivery of specialized in-home services through a combination of Community First Choice state plan services and one of three Children’s Intensive In-Home Services (CIIS) Programs. (2) CIIS programs are comprised of three 1915(c) Home and Community-Based Services (HCBS) Model Waivers: (a) Behavioral Model Waiver services are exclusively intended for a child with an intellectual or developmental disability with significant behaviors as indicated by the Behavior Criteria who require an ICF/ID level of care. (b) Medically Fragile Model Waiver services are exclusively intended for a child with significant medical needs as indicated by the Medically Fragile Clinical Criteria who require a hospital level of care. (c) Medically Involved Model Waiver services are exclusively intended for a child with significant medical needs as indicated by the Medically Involved Children's Waiver Criteria who require a nursing facility level of care. (3) The goals of CIIS are to: (a) Provide appropriate supports and services to ensure health and safety in the family home; (b) Maximize independence and increase the ability to engage in a life that is fully integrated into the community; and (c) Prevent out-of-home placement of the child. (4) CIIS complement and supplement the services that are available through the State Medicaid Plan and other federal, state, and local programs as well as the natural supports that families and communities provide. (5) CIIS are delivered in a setting that is in compliance with OAR 411-004-0020(1). Statutory/Other Authority: ORS 409.050 & 417.345 Statutes/Other Implemented: ORS 417.345, 427.005, 427.007 & 430.215 History: APD 19-2016, f. 6-28-16, cert. ef. 6-29-16 APD 4-2015, f. 2-13-15, cert. ef. 2-16-15 SPD 53-2013, f. 12-27-13, cert. ef. 12-28-13 SPD 11-2009, f. 7-31-09, cert. ef. 8-1-09 SPD 13-2004, f. & cert. ef. 6-1-04 SDSD 12-2002, f. 12-26-02, cert. ef. 12-28-02
411-300-0190 CIIS Provider Documentation and Records (1) Documentation of services provided must be consistent with the requirements described in: (a) OAR 411-450-0080 for community living supports. (b) OAR 411-375-0035 for independent providers. (2) Documentation of private duty nursing services must comply with OAR chapter 851 (Oregon State Board of Nursing) and must include all of the following: (a) The name of the child or young adult on each page of documentation. (b) The date of service. (c) Time of start and end of service delivery by each provider. (d) Anything unusual from the Nursing Service Plan expanded in the narrative. (e) Interventions. (f) Outcomes, including the response of the child or young adult to services delivered. (g) Nursing assessment of the status of the child or young adult and any changes in that status per each working shift. (h) Full signature of the provider. Statutory/Other Authority: ORS 409.050, 417.345 & 427.104 Statutes/Other Implemented: ORS 417.345, 427.007, 427.104 & 430.215 History: APD 4-2020, amend filed 02/25/2020, effective 03/01/2020 APD 19-2016, f. 6-28-16, cert. ef. 6-29-16 APD 4-2015, f. 2-13-15, cert. ef. 2-16-15 APD 31-2014(Temp), f. & cert. ef. 8-20-14 thru 2-16-15 SPD 53-2013, f. 12-27-13, cert. ef. 12-28-13 SPD 11-2009, f. 7-31-09, cert. ef. 8-1-09 SDSD 12-2002, f. 12-26-02, cert. ef. 12-28-02
411-300-0205 Rights, Complaints, Notification of Planned Action, and Hearings (1) INDIVIDUAL RIGHTS. (a) The rights of a child are described in OAR 411-318-0010. (b) Upon entry and request and annually thereafter, the individual rights described in OAR 411-318-0010 must be provided to the child as applicable, and parent or guardian of the child. (2) COMPLAINTS. (a) Complaints must be addressed according to OAR 411-318-0015. (b) Upon entry and request and annually thereafter, the policy and procedures for complaints as described in OAR 411-318-0015 must be explained and provided to the child as applicable, and the parent or guardian of the child. (3) NOTIFICATION OF PLANNED ACTION. In the event services are denied, reduced, suspended, or terminated, a written advance Notification of Planned Action (form 0947) must be provided as described in OAR 411-318-0020. (4) HEARINGS. (a) Hearings must be addressed according to ORS chapter 183 and OAR 411-318-0025. (b) A parent or guardian may request a hearing as provided in ORS chapter 183 and OAR 411-318-0025. (c) Upon entry and request and annually thereafter, a notice of hearing rights and the policy and procedures for hearings as described in OAR chapter 411, division 318 must be explained and provided to the child as applicable, and the parent or guardian of the child. Statutory/Other Authority: ORS 409.050, 417.345 & 427.104 Statutes/Other Implemented: ORS 417.345, 427.007, 427.104 & 430.215 History: APD 4-2020, amend filed 02/25/2020, effective 03/01/2020 APD 19-2016, f. 6-28-16, cert. ef. 6-29-16 APD 4-2015, f. 2-13-15, cert. ef. 2-16-15 APD 31-2014(Temp), f. & cert. ef. 8-20-14 thru 2-16-15 SPD 53-2013, f. 12-27-13, cert. ef. 12-28-13 SPD 11-2009, f. 7-31-09, cert. ef. 8-1-09
411-303-0000 Statement of Purpose The rules in OAR chapter 411, division 303 prescribe standards, responsibilities, and procedures related to the ODDS-approved behavior intervention curriculum. Statutory/Other Authority: ORS 409.050, 418.529, 427.104 & 430.662 Statutes/Other Implemented: ORS 409.010, 418.529, 427.007, 427.104, 430.610 & 430.662 History: APD 32-2022, adopt filed 06/26/2022, effective 07/01/2022
411-303-0010 Definitions and Acronyms In addition to the following definitions, OAR 411-317-0000 includes general definitions for words and terms frequently used in OAR chapter 411, division 303. If a word or term is defined differently in OAR 411-317-0000, the definition in this rule applies. (1) "Authorized Entity" means an organization approved by ODDS to certify instructors in an ODDS-approved behavior intervention curriculum. (2) "Instructor" means a person certified by the authorized entity to teach an ODDS-approved behavior intervention curriculum to providers and designated persons supporting individuals with intellectual and developmental disabilities. (3) "ODDS" means "Office of Developmental Disabilities Services". (4) "These Rules" mean the rules in OAR chapter 411, division 303. Statutory/Other Authority: ORS 409.050, 418.529, 427.104 & 430.662 Statutes/Other Implemented: ORS 409.010, 418.529, 427.007, 427.104, 430.610 & 430.662 History: APD 32-2022, adopt filed 06/26/2022, effective 07/01/2022
411-303-0020 Authorized Entity Standards An authorized entity must have formal approval from ODDS to deliver an ODDS-approved behavior intervention curriculum to instructors, providers, and designated persons. Statutory/Other Authority: ORS 409.050, 418.529, 427.104 & 430.662 Statutes/Other Implemented: ORS 409.010, 418.529, 427.007, 427.104, 430.610 & 430.662 History: APD 32-2022, adopt filed 06/26/2022, effective 07/01/2022
411-303-0030 Curriculum Standards (1) An ODDS-approved behavior intervention curriculum must meet all of the following standards: (a) Be based in positive behavior support practices. (b) Require the teaching of techniques for nonviolent crisis intervention that do not require physical restraint. (c) Focus on de-escalation and trauma-informed behavioral support. (d) Offer options for certification in skills that do not include the use of restraint. (e) Ensure that any physical intervention skills taught are trauma-informed, culturally-responsive, age-appropriate, and developmentally appropriate. (f) Ensure that any physical intervention skills account for the individual’s size and the provider or designated person’s size. (g) Include training to reduce the risk of physical and emotional harm. (h) Be consistent with all state and federal laws. (i) Include training to identify the physical, psychological, and emotional risks related to the use of restraint. (j) Ensure fidelity of training through the publication of consistent, regularly-updated, training materials and resources for certified instructors, providers, and designated persons. (k) Include requirements for training and certification of instructors, providers, and designated persons. (l) Require regular, ongoing support to certified instructors, including quality control, monitoring of outcomes, and provision of information regarding networks for professional collaboration and support. (m) Ensure individual rights described in OAR chapter 411, division 318 are upheld. (2) An ODDS-approved behavior intervention curriculum must prohibit behavior intervention techniques that include the following characteristics: (a) Abusive. (b) Aversive. (c) Coercive. (d) For convenience. (e) Disciplinary. (f) Demeaning. (g) Pain compliance. (h) Punishment. (i) Retaliatory. Statutory/Other Authority: ORS 409.050, 418.529, 427.104 & 430.662 Statutes/Other Implemented: ORS 409.010, 418.529, 427.007, 427.104, 430.610 & 430.662 History: APD 32-2022, adopt filed 06/26/2022, effective 07/01/2022
411-303-0040 Behavior Intervention Instructor Standards (1) An instructor for an ODDS-approved behavior intervention curriculum must meet all of the following standards: (a) Be certified by the authorized entity to conduct the type of training the instructor is providing. (b) Be recertified by the authorized entity at least once every two years. (c) Demonstrate written and physical competency before receiving certification or recertification. (d) Complete a minimum of 26 hours of initial education with a focus on de-escalation, nonviolent intervention, and methods consistent with ODDS rules for the use of physical restraint. (e) Complete a minimum of eight hours of continuing education every two years. (2) An instructor who trains providers working in children’s 24-hour residential, host home, and foster care services must complete four hours of continuing education related to working with children every two years in addition to the requirements in section (1) of this rule. Statutory/Other Authority: ORS 409.050, 418.529, 427.104 & 430.662 Statutes/Other Implemented: ORS 409.010, 418.529, 427.007, 427.104, 430.610 & 430.662 History: APD 32-2022, adopt filed 06/26/2022, effective 07/01/2022
411-303-0050 Behavior Intervention Certification Standards (1) To be certified in an ODDS-approved behavior intervention curriculum, a provider or designated person must: (a) Complete an approved training program delivered by an instructor; and (b) Demonstrate physical and written competencies as appropriate to the settings and individuals supported. (2) Certifications issued by an ODDS-approved behavior intervention curriculum instructor: (a) Must be personal to the provider or designated person certified by the instructor; (b) Must be issued to the provider or designated person certified as described in section (1) of this rule; (c) May be valid for no more than two years without recertification; (d) Must require annual continuing education to maintain; (e) Must require additional training to renew the certification; (f) Must include certification levels that are portable between employers; and (g) Must include: (A) The dates during which the certification is current; (B) The types of restraint in which the person is certified, if any; (C) The types of training the person is certified to conduct, if any; (D) Any special endorsements; (E) The level of training; and (F) The name of the certified instructor who conducted the training and administered the assessment of proficiency. (3) A provider or designated person certified in an ODDS-approved behavior intervention curriculum under these rules must maintain the documentation of the certification and any records of annual continuing education and make that documentation available to ODDS upon request. Statutory/Other Authority: ORS 409.050, 418.529, 427.104 & 430.662 Statutes/Other Implemented: ORS 409.010, 418.529, 427.007, 427.104, 430.610 & 430.662 History: APD 32-2022, adopt filed 06/26/2022, effective 07/01/2022
411-304-0110 Statement of Purpose (1) The rules in OAR chapter 411, division 304 establish the standards for behavior professionals and the delivery of professional behavior services to individuals with intellectual or developmental disabilities receiving family support services or positive behavior support services under the Community First Choice state plan. (2) Professional behavior services are delivered by a behavior professional using a person-centered, problem-solving approach to address an individual's challenging behavior. A behavior professional also provides consultation and training to the individual's designated person on the least intrusive strategies to mitigate behaviors that may place the individual’s health and safety at risk. Statutory/Other Authority: ORS 409.050, 427.104 & 430.662 Statutes/Other Implemented: ORS 409.010, 427.007, 427.104, 430.610 & 430.662 History: APD 32-2022, amend filed 06/26/2022, effective 07/01/2022 APD 28-2017, adopt filed 11/30/2017, effective 12/01/2017
411-304-0130 Eligibility for Professional Behavior Services (1) An individual may not be denied professional behavior services or otherwise discriminated against on the basis of race, color, religion, sex, gender identity, sexual orientation, national origin, marital status, age, disability, source of income, duration of Oregon residence, or other protected classes under federal and Oregon Civil Rights laws. (2) To be eligible for professional behavior services, an individual must meet the following requirements: (a) Be determined eligible for developmental disabilities services by the Community Developmental Disabilities Program of the county of origin as described in OAR 411-320-0080, except for those enrolled in the Medically Involved Children's Waiver or the Medically Fragile Children's Program as described in OAR chapter 411, division 300. (A) A child enrolled in the Medically Involved Children's Waiver must be determined eligible for the waiver as described in OAR 411-300-0120(7). (B) A child enrolled in the Medically Fragile Children's Program must meet the eligibility requirements described in OAR 411-300-0120(5). (b) Be receiving one of the following: (A) Family support services as described in OAR chapter 411, division 305. (B) A Medicaid Title XIX benefit package through OSIPM or the HSD Medical Program. Individuals receiving Medicaid Title XIX under the HSD Medical Program for services in a nonstandard living arrangement as defined in OAR 461-001-0000 are subject to the requirements in the same manner as if they were requesting these services under OSIPM, including the rules regarding the following: (i) The transfer of assets as set forth in OAR 461-140-0210 through 461-140-0300. (ii) The equity value of a home which exceeds the limits as set forth in OAR 461-145-0220. (c) Be determined to meet the level of care as defined in OAR 411-317-0000 and enrolled in Community First Choice state plan services, except for individuals receiving family support services as described in OAR chapter 411, division 305. (d) For individuals with excess income, contribute to the cost of service pursuant to OAR 461-160-0610 and OAR 461-160-0620, except for individuals receiving family support services as described in OAR chapter 411, division 305. (e) A functional needs assessment, a similar assessment used for family support services, or an individual’s ISP team identifies a challenging behavior that may benefit from professional behavior services and the individual's ISP or Annual Plan indicates the individual may benefit from professional behavior services. (3) Additional service limitations are described in OAR 411-304-0140. Statutory/Other Authority: ORS 409.050, 427.104 & 430.662 Statutes/Other Implemented: ORS 409.010, 427.007, 427.104, 430.610 & 430.662 History: APD 53-2022, amend filed 12/14/2022, effective 12/15/2022 APD 34-2022, temporary amend filed 07/01/2022, effective 07/01/2022 through 12/27/2022 APD 32-2022, amend filed 06/26/2022, effective 07/01/2022 APD 28-2017, adopt filed 11/30/2017, effective 12/01/2017