309-045-0310 Temporary rule language in effect until 04/06/2026. Definitions (1) “Abuse” means abuse as defined in ORS 430.735 and ORS 419B.005 . (2) “Activities of Daily Living (ADLs)” means those functional activities required by an individual for continued well-being that are essential for health and safety. ADLs including eating, dressing/grooming, bathing/personal hygiene, mobility (ambulation and transferring), and elimination/toileting bowel, and maintaining continence as defined in OAR 410-173-0005 . (3) “Administrator” means the person designated by the licensee through an employment agreement to be responsible for the daily operations and maintenance of the Agency with Choice. (4) “Agency with Choice (AWC)” means an organization licensed by the Oregon Health Authority that provides self-directed Agency with Choice Services for compensation to individuals primarily at the individual’s home and their community. (5) “Agency with Choice Services” means services provided to individuals by an Agency with Choice operating within a self-directed service delivery model and include the services specified in these rules. Agency with Choice services do not include nursing procedures or tasks that require nursing delegation or teaching as defined in OAR Chapter 851, Division 047 . (6) “Applicant” means the person, entity, or governmental organization applies for an Agency with Choice license. (7) “Assessment” means a comprehensive and holistic determination of an individual’s physical, mental, and social functioning including identification of risk factors, individual choices and preferences, and the status of service needs, established by a medical or behavioral health professional. (8) “Assistance” means developmentally appropriate help from another person to complete Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) as described in OAR 410-173-0005 . (9) “Authority” means the Oregon Health Authority. (10) “Authorized Representative” for the purpose of these rules means: (a) A person designated by court order to make financial or health care decisions on behalf of another individual. The legal representative only has authority to act within the scope and limits of their authority as designated by the court or other agreement; or (b) A legal representative as defined in these rules; or (c) A person designated by an individual or the individual’s legal representative to act on behalf of the individual in making decisions on matters pertaining to the planning and implementation of an in-home person-centered service plan; and (d) An authorized representative cannot be a Direct Support Worker or other provider type offering home and community-based services (HCBS) and supports to an individual for whom they provide services. (11) “Background Check” means a criminal records check and abuse check as defined in OAR 407-007 , as adopted and incorporated by OAR 943-007 , that includes a final fitness determination that the subject individual is fit to hold a position and have direct access to or otherwise provide care and services necessary for the health, welfare, maintenance, or protection of an individual. (12) “Back-up Plan” means a plan developed by the individual or the individual’s authorized representative in coordination with the Agency with Choice to ensure uninterrupted services and supports in the event of planned or unplanned absences of the direct support work or in case of an emergency. The back-up plan should include the name and contact information and the specific ways in which the back-up direct support worker will support the individual. (13) “Behavioral Health” means mental health, mental illness, addiction disorders, and substance use disorders. (14) “Behavioral Health Assessment” means a qualified mental health professional’s determination of an individual’s need for behavioral health services. (15) “Behavioral Health Division (Division)” means the section within the Oregon Health Authority responsible for program and policy development and oversight of behavioral health facilities and services. (16) “Behavioral Health Services” means medically appropriate and medically necessary services rendered or made available to a recipient for treatment of a behavioral health diagnosis. (17) “Behavioral Interventions” mean those interventions that modify an individual’s behavior or environment. (18) “Care” means the provision of services including, but not limited to, assistance with activities of daily living, instrumental activities of daily living, and supervision to promote maximum independence and enhance quality of life. (19) "Change of Ownership " means adding or removing one or more owners or a change of more than five percent interest in Agency with Choice ownership. (20) “Community Mental Health Program (CMHP)” means an entity that is responsible for planning and delivery of safety net services for persons with mental or emotional disturbances, drug abuse problems, and alcoholism and alcohol abuse in a specific geographic area of the state under a contract with the Division or Local Mental Health Authority pursuant to OAR chapter 309 division 014 . (21) “Complaint” means an allegation of abuse, a violation of these rules, or an expression of dissatisfaction relating to an Agency with Choice. (22) “Critical Incident” means an actual or alleged event that creates a risk of serious harm to the health or welfare of an individual receiving services and may endanger or negatively impact the mental or physical well-being of an individual. Critical incidents include: (a) Verbal abuse; (b) Physical abuse; (c) Sexual abuse; (d) Psychological or emotional abuse; (e) Neglect; (f) Exploitation, including financial exploitation or theft of money or property; (g) Misuse or unauthorized use of seclusion or restraint; (h) A medication error resulting in: (A) A telephone call to or a consultation with a poison control center or emergency department; (B) A visit to an urgent care, emergency room or hospital; or (C) Death. (i) Missing person; (j) Criminal activity; (k) Unsafe living conditions or inability to respond to an alarm or emergent situation without additional cues and reach a point of safety without assistance; (l) Self-injurious behaviors, substance abuse, or suicidal ideation; (m) An injury or illness leading to a non-routine visit to a health care provider (n) An unexplained injury; or (o) An unexplained or unanticipated death, including, but not limited to, suicide or death caused by abuse or neglect. (23) “Critical Incident Report” means a formal written document detailing key information of the events related to the critical incident that occurred, the interventions used or attempted, and the outcome to those involved. (24) “Cultural Competence” means the ability to interact effectively with people, including those with limited English proficiency, diverse cultural and ethnic backgrounds, carceral histories, disabilities and regardless of gender, sexual orientation or gender identify. (25) “Direct Support Worker” means a person employed by an Agency with Choice, to assist individuals with activities of daily living, instrumental activities of daily living and health related tasks identified in the individual’s person-centered service plan. Direct support worker does not mean a homecare worker or personal support worker as defined in ORS 410.600 , or personal care attendant as defined in OAR 410-172-0776 . (26) “Division” means the Behavioral Health Division of the Oregon Health Authority (OHA). (27) “Drug-Free Workplace” means the Agency with Choice ensures direct support workers: (a) Are prohibited from using or being under the influence of alcohol, inhalants, prescription drugs, over-the-counter medications, or other substances that prevents duties from being performed; and (b) Are prohibited from manufacturing, possessing, selling, using or offering to make, sell, trade, or use illegal drugs while providing services to an individual or while in the individual’s home. (28) “Electronic Visit Verification (EVV)” means a system under which visits conducted as part of the person-centered service plan are electronically verified at the time of service and meets the requirements specified in 42 U.S.C. 1396b(l) . (29) “Grievance” means a written dissatisfaction submitted by and individual or authorized representative regarding the failure of an Agency with Choice to provide services in alignment with the person-centered service plan or the agencies policies, or to follow these rules. (30) “Home and Community-Based Services (HCBS)” means services and supports that assist eligible individuals to remain in their home and community in accordance with the Code of Federal Regulations, approved Medicaid State Plan authorities, and Oregon Administrative Rules. (31) “Incident” means an actual or alleged event that creates a risk of harm to the health or welfare of an individual receiving care and services and may negatively impact the mental and/or physical well-being of an individual and does not meet the definition of critical incident. Incident includes but is not limited to: (a) Injury or illness requiring first aid or medical attention; (b) Missing or damaged property; or (c) A medication error that does not result in consultation with a poison control center, visit to urgent care, emergency room or hospital, or death. (32) “Incident Report” means a formal written document detailing the events of any incident that occurred, the interventions used or attempted, and the outcome to those involved. (33) “Independent Qualified Agent (IQA)” means an entity meeting the qualification requirements identified in 42 CFR §441.730 and under contract with the Authority. (34) “Individual” means a person who receives Agency with Choice services and supports and who has a behavioral health disability. (35) “Instrumental Activities of Daily Living (IADLs)” means those self-management activities performed by an individual on a day-to-day basis that are essential to basic self-care and independent living. IADLs include, but are not limited to, housekeeping, laundry, shopping, transportation, medication management, and meal preparation. (36) "Investigative Authority" means the Office of Training, Investigations, and Safety (OTIS), or local Community Mental Health Programs that contracts with the Authority to receive and investigate alleged abuse and assess protective services under OAR Chapter 943, Division 45 . (37) “Legal Representative” means a person who has been legally designated by court order to make financial or health care decisions on behalf of another individual. The legal representative only has authority to act within the scope and limits of their authority as designated by the court or other agreement. For the purpose of these rules, authorized presentative and legal representative are synonymous. (38) “Licensed Medical Professional (LMP)” means program staff who meet the following minimum qualifications: (a) Physician licensed to practice in the State or Oregon; or (b) Nurse Practitioner licensed to practice in the State of Oregon; or (c) Physician’s assistant licensed to practice in the State or Oregon; and (d) Whose training, experience, and competence demonstrate the ability to conduct a mental health assessment and provide medication management. (39) “Licensee” means the person or entity who has been issue an Agency with Choice license. (40) “Management experience”, means verifiable experience in the administration, supervision, or management in a health-related or long-term services, and supports fields including at a minimum, hiring, assigning, evaluating, promoting and responsibility for implementing disciplinary actions. (41) “Mandatory Reporter” means any public or private official who is required by Oregon Revised Statute (ORS) to report suspected abuse to the Authority or law enforcement agency as it applies to a: (a) "Child" defined in ORS 419B.005 ; (b) "Child in care" as defined in ORS 418.257 ; or (c) "Adult" with developmental disabilities or mental illness as defined in ORS 430.735 . (42) "Medication" means a drug as defined in ORS 689.005 . (43) “Medication Administration” means the direct application of a medication, whether by injection, inhalation, ingestion, or other means, by a Direct Support Worker to the body of an individual receiving Agency with Choice Services from an Agency with Choice licensed under these rules. Medication administration includes but is not limited to taking the individual’s medications from the original containers and putting the medications into closed secondary containers designed and manufactured for this purpose. (44) “Medication Assistance” means assistance with self-administration of medication rendered by a Direct Support Worker to an individual receiving Agency with Choice Services from an Agency with Choice licensed under these rules when the individual is able to self-direct through documented demonstration of understanding: (a) The reason why each medication is taken; (b) The amount or dose of each medication that needs to be taken; (c) The route the medication needs to be taken; and (d) The time of day each mediation needs to be taken. (45) "Medication Management" means the ability to order, organize and administer prescribed medications. Administering prescribed medications includes pills, drops, ointments, creams, injections, inhalers, and suppositories unrelated to bowel care. Administering as a paid service means set-up, reminding, cueing, checking for effect and monitoring for choking while taking medications. Oxygen management is included in medication management. Oxygen management means assisting with the administration of oxygen, monitoring the equipment, and assuring adequate oxygen supply. (46) "Medication Reminding" means providing an individual with an audio, visual or oral reminder to take medication when an individual is able to self-direct. (47) "Medication Services" means medication assistance, medication administration and medication management . (48) “Oregon Administrative Rules (OAR)” means any agency directive, standard, regulation, or statement of general applicability that implements, interprets, or prescribes law or policy, or describes the procedure or practice requirements of any agency. (49) “Person-Centered Service Plan (PCSP)” means the written document prepared by the IQA service coordinator that details the supports, desired outcomes, activities, and resources required for an individual to achieve and maintain personal goals, health, and safety as described in OAR 410-173-0025 . The PCSP must be completed and signed prior to the individual receiving HCBS. The PCSP is not satisfied by a document primarily prepared by a provider. (50) “Personal Care Services” means a range of assistance provided to individuals with a physical behavioral health disability to enable them to accomplish activities of daily living and instrumental activities of daily living that are essential for self-care, safety, and independent living. (51) "Professional Experience" means having verifiable work experience as a licensed or certified nurse, nursing assistant, medication aide, physician, or physical or occupational therapist. The license or certificate must be current and in good standing. (52) "Provider Enrollment Agreement" refers to the agreement between the Medicaid Division of the Oregon Health Authority and a qualified Medicaid provider to receive a provider number and deliver services for compensation. (53) "Qualified Trainer" means a person who: (a) Has professional experience providing training to direct support workers, homecare workers, certified nursing assistants or other relevant caregivers with the necessary skills, knowledge and information to deliver competent, quality care, and is approved by the Authority; (b) Is designated by an Agency with Choice to conduct direct support worker training on behalf of the Agency with Choice , including, but not limited to, orientation, mandatory reporter training and continuing education training required by these rules. ( 54 ) "Self-directed C are" means the ability of an adult who is prevented by a functional or behavioral health disability from independently completing an ADL or IADL, chooses to direct and supervise a direct support worker to perform those tasks as authorized in the person-centered service plan. (55) “Self-directed Plan” means the personalized plan created by the Agency with Choice in partnership with the individual or the authorized representative. The plan documents details of the supports, preferences, desired outcomes, activities, and backup resources needed for the individual to achieve and maintain personal goals, health, and safety aligned with the “person-centered service plan.” (56) “Self-directed Service Delivery Model” for the purpose of these rules means a model in which an individual is supported by an Agency with Choice that functions as the employer of direct support workers recruited by the individual or the Agency with Choice and provides financial management services and tasks in place of the individual. The individual directs the direct support workers and is considered a co-employer with the Agency with Choice. (57) “Service Coordinator” means an employee of the IQA with whom the Authority contracts, who assesses the service needs of individuals, determines eligibility, and offers service choices to eligible individuals. The Service Coordinator authorizes and implements an individual's person-centered service plan and monitors the personal care services delivered. (58) “Services and Supports” means those services defined as habilitation services and psychosocial rehabilitation services under OAR Chapter 410, Division 173 or personal care services under OAR 410-172-0776 . (59) "Stable and Predictable" means a situation where the individual’s physical and behavioral state is known, not characterized by rapid changes, and does not require continuous reassessment and evaluation. Stable and predictable must include individuals with intermittent needs that are a predictable symptom or component of their underlying health condition. (60) "Subject Individual (SI)” means a person for whom an agency must conduct a background check and BCU may conduct a criminal records check, an abuse check or both, and from whom BCU may require fingerprints for the purpose of conducting a national criminal records check. An SI includes all staff and volunteers working for or with an Agency with Choice. (61) "Survey" means an inspection, investigation or monitoring visit of an applicant for an Agency with Choice license or a licensed Agency with Choice to determine the extent to which the applicant or Agency with Choice is in compliance with state statutes and Agency with Choice rules. Statutory/Other Authority: Oregon Law 2024, Chapter 37, ORS 413.042 & HB 4129 (2024) Statutes/Other Implemented: Oregon Law 2024, Chapter 37 History: BHS 23-2025, temporary adopt filed 10/09/2025, effective 10/09/2025 through 04/06/2026