justicedao/ipfs_state_laws huggingface dataset:
309-014-0025 Management of Community Mental Health Program Areas Each CMHP contractor providing a community mental health program area under a contract with the Division is required to meet the following standards for management: (1) Organizations: (a) Each CMHP area contractor shall have an up-to-date organization chart showing the line of authority and responsibility from the local mental health authority to the CMHP area director and to each of the components of the CMHP area contractor; (b) For all components of the community mental health program area contractor operated by agencies other than the local mental health authority, there shall be a contract between the local mental health authority and the subcontract agency specifying the authorities and responsibilities of each party and conforming to the requirements of any Division rule pertaining to contracts. (2) Needs Assessment and Planning: When the Division contracts for a CMHP program area, the contractor shall assess local needs for services to persons within that program area, and shall plan to effectively and efficiently meet those needs within the constraints of available resources. The local mental health authority shall review and approve the plan before it is submitted to the Division. (3) Monitoring: The local mental health authority shall monitor all community mental health service elements within the program area to assure that: (a) Service elements are provided as specified in the contract with the Division; and (b) Service elements are in compliance with these rules and other applicable Division administrative rules. Statutory/Other Authority: ORS 413.042 & 430.640 Statutes/Other Implemented: ORS 430.610 – 430.640 History: MHS 23-2016, f. & cert. ef. 12-1-16 MHD 13-2000, f. 9-15-00, cert. ef. 9-16-00 MHD 14-1982, f. & cert. ef. 7-7-82, Renumbered from 309-014-0000(5) & (6) MHD 39, f. 5-20-76, cert. ef. 6-11-76
309-014-0036 Records (1) Service Records. A record shall be maintained for each client who receives direct treatment training and/or care services. The record shall contain client identification, problem assessment, treatment, training and/or care plan, medical information when appropriate; and progress notes. (2) Retention of Records. Records shall be retained in accordance with OAR 166-005-0000 through 166-040-0010 (State Archivist). Financial records, supporting documents, statistical records, and all other records (except client records) shall be retained for a minimum of three years after the close of the contract period, or until audited. Client records shall be kept for a minimum of seven years. (3) Confidentiality of Client Records. Client records shall be kept confidential in accordance with ORS 179.505, 45 CFR 205.50 and 42 CFR Part 2, any Division administrative rule pertaining to client records, and the most current edition of the Division Handbook on Confidentiality. (4) Client Rights. Each agency providing any community mental health service shall have written procedures to assure: (a) Protection of client privacy and dignity; (b) Confidentiality of records consistent with state statutes and federal statutes and regulations; (c) Involvement of the client in planning the service through the provision of information, presented in general terms, which explains the following: (A) The treatment to be undertaken; (B) Alternative treatment methods available, if any; and (C) Risks that may be involved in the training or treatment, if any. (d) Client's right to refuse service unless otherwise ordered by a court; and (e) Client is provided with information, presented in general terms, concerning the agency fee policies. Statutory/Other Authority: ORS 413.042 & 430.640 Statutes/Other Implemented: ORS 430.610 – 430.640 History: MHS 23-2016, f. & cert. ef. 12-1-16
309-014-0037 Dispute Resolution (1) The CMHP shall adopt a dispute resolution policy that pertains to disputes that may arise from contracts with service providers that deliver services funded by the Division for the CMHP. Procedures implementing this policy shall be included in the contract with any such service provider. (2) When a dispute exists between a county or a CMHP and a service provider regarding the terms of their contract or the interpretation of an administrative rule of the Division relating to Division programs under ORS Chapter 430, and local dispute resolution efforts have been unsuccessful, either party may request assistance from the Division in mediating the dispute. (a) Procedure. The parties shall demonstrate a spirit of cooperation, mutual respect, and good faith in all aspects of the mediation process. Mediation shall be conducted as follows: (A) Request. The party requesting mediation shall send a written request to the Division Chief Officer, the CMHP director, and the provider agency director, unless other persons are named as official contact persons in the specific rule or contract under dispute. The request shall describe the nature of the dispute and identify the specific rule or contract provisions that are central to the dispute. (B) Arrangements. The Chief Officer or designee, shall arrange the first meeting of the parties at the earliest possible date. The agenda for the first meeting should include: (i) Consideration of the need for services of an outside mediator. If such services are desired, agreement should be made on arrangements for obtaining these services. (ii) Development of rules and procedures that will be followed by all parties during the mediation; (iii) Agreement on a date by which mediation will be completed, unless extended by mutual agreement. (C) Cost. Unless otherwise agreed to by all parties: (i) Each party shall be responsible for the compensation and expenses of their own employees and representatives; and (ii) Costs that benefit the group, such as services of a mediator, rental of meeting space, purchase of snack food and beverage, etc. shall be shared equally by all parties. (b) Final Report. A written statement documenting the outcome of the mediation shall be prepared. This statement shall consist of a brief written statement signed by all parties or separate statements from each party declaring their position on the dispute at the conclusion of the mediation process. In the absence of written statements from other parties, the Division representative shall prepare the final report. The final report on each mediation shall be retained on file at the Division. The Division will, from time to time, or as requested by the legislature or others, prepare summary reports that describe the success of mediation in resolving disputes. Statutory/Other Authority: ORS 413.042 & 430.640 Statutes/Other Implemented: ORS 430.610 – 430.640 History: MHS 23-2016, f. & cert. ef. 12-1-16 MHD 13-2000, f. 9-15-00, cert. ef. 9-16-00 MHD 8-2000(Temp), f. 3-20-00, cert. ef. 3-21-00 thru 9-16-00
309-014-0040 Variances (1) Requirements and standards for requesting and granting variances or exceptions are found in OAR 309-008-1600. (2) Division Review and Notification: The Division must approve or deny the request for a variance to these rules within the scope and authority The Division must be made in writing using the Division approved variance request form and following the variance request procedure compliant with OAR 309-008-1600. (3) Granting a variance for one request does not set a precedent that must be followed by the Division when evaluating subsequent requests for variance. (4) A variance granted by the Division shall be attached to, and become part, of the contract for that year. Statutory/Other Authority: ORS 413.042 & 430.640 Statutes/Other Implemented: ORS 430.610 – 430.640 History: MHS 23-2016, f. & cert. ef. 12-1-16 MHD 13-2000, f. 9-15-00, cert. ef. 9-16-00 MHD 14-1982, f. & cert. ef. 7-7-82, Renumbered from 309-014-0000(13) MHD 39, f. 5-20-76, cert. ef. 6-11-76
309-014-0300 Purpose and Scope These rules relate to the implementation of Chapter 418, Oregon Laws 2011 sections 13 through 20. The scope is limited to the creation of the Central Health Council and the implementation of the Central Oregon Health Improvement Plan. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: 2011 OL Ch. 418 & Sec. 13-19 History: MHS 3-2012, f. & cert. ef. 2-23-12 MHS 6-2011(Temp), f. 8-26-11, cert. ef. 9-1-11 thru 2-28-12
309-014-0310 Definitions (1) “Authority” means the Oregon Health Authority (OHA). (2) “Central Oregon Health Council” (COHC) means a council which shall, as a minimum, conduct a regional health assessment and adopt a regional health improvement plan to serve as a strategic population health and health care system service plan for the region served by the council. (3) “Commission” means the Commission on Children and Families. (4) “Council” means the Central Oregon Health Council (COHC). (5) “Plan” means the Regional Health Improvement Plan. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: 2011 OL Ch. 418 & Sec. 13-19 History: MHS 3-2012, f. & cert. ef. 2-23-12 MHS 6-2011(Temp), f. 8-26-11, cert. ef. 9-1-11 thru 2-28-12
309-014-0320 Regional Health Improvement Plan (1) The Regional Health Improvement Plan (RHIP) submitted by the Central Oregon Health Council, defined in OAR 309-014-0300, must include, but need not be limited to the following: (a) Federally required components; (b) Health policy; (c) System design; (d) Outcome and quality improvement; (e) Integration of service delivery and (f) Workforce development. (2) Any additional requirements to the RHIP will be agreed upon in advance by the Council, the Authority and the Commission. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: 2011 OL Ch. 418 & Sec. 13-19 History: MHS 3-2012, f. & cert. ef. 2-23-12 MHS 6-2011(Temp), f. 8-26-11, cert. ef. 9-1-11 thru 2-28-12
309-014-0330 Central Oregon Health Council (1) The council may not convene until the governing body of each county adopts a resolution signifying the body’s intention to do so. (2) Subsequent to the formation of the council, a county that is adjacent to Crook, Deschutes or Jefferson County may join the council if: (a) The governing body of the county seeking to join the council adopts a resolution signifying the body’s intention to include a portion of that county in the region served by the council; (b) The portion of the county to be included in the region is part of a natural health care referral pattern with the other counties on the council; and (c) The authority and the council approve. (3) The COHC shall consist of no more than 11 members, including: (a) A formative council consisting of: (A) One member each from the governing bodies of Crook, Deschutes and Jefferson Counties, appointed by each body; (B) The chief executive officer, or a designee of the chief executive officer, of the health care system serving the region; and (C) The chief executive officer, or a designee of the chief executive officer, of the Medicaid contractor serving the region; and (b) At least three members appointed by the formative council established under paragraph (3)(a)(A) of this rule. Members appointed under this section shall be representatives of: (A) Consumers of physical and behavioral health services; (B) Health care professionals; (C) School districts or educational service districts; (D) The business community; or (E) A member from the governing body of each county that joins the council defined in (3)(a)(A) of this rule. (4) The term of office of the members of the council is four years. (5) A majority of the members of the council constitutes a quorum for the transaction of business. (6) The council shall elect a member of the council to serve as the chairperson. (7) If there is a vacancy for any cause, the appointing authority shall make an appointment to the vacated position to become effective immediately. (8) The council may enter into necessary contracts, apply for and receive grants, hold and dispose of property and take other actions necessary to carry out the activities, services and responsibilities assumed by the council. (9) The council may adopt rules necessary for the operation of the council. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: 2011 OL Ch. 418 & Sec. 13-19 History: MHS 3-2012, f. & cert. ef. 2-23-12 MHS 6-2011(Temp), f. 8-26-11, cert. ef. 9-1-11 thru 2-28-12
309-014-0340 Central Oregon Health Improvement Plan (COHIP) (1) The COHC shall develop a health improvement plan as detailed in OAR 309-017-0030. (2) The COHIP will replace all prior plans required by the Authority in ORS 430.630, 430.640, 431.385 and 624.510 and plans required by the State Commission on Children and Families under ORS 417.705 through 417.801. (3) The COHC will submit the plan no later than March 1, 2012 to the Authority. (4) The Authority shall have 45 days from the date the plan is submitted to review the plan and return it to the Council either approved or with suggested modifications. (a) If modifications are suggested the Council will have 45 days to respond to the suggestions and resubmit the plan. (b) The Authority will have a final 30 days to review the plan. (5) The plan is effective July 1, 2012. (6) New plans must be submitted every four years if the sunset in the enabling legislation is removed by the Legislative Assembly. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: 2011 OL Ch. 418 & Sec. 13-19 History: MHS 3-2012, f. & cert. ef. 2-23-12 MHS 6-2011(Temp), f. 8-26-11, cert. ef. 9-1-11 thru 2-28-12
309-015-0000 Purpose and Statutory Authority (1) Purpose. These rules prescribe the eligibility criteria, methods, and standards for payments to psychiatric hospitals through the Division of Medical Assistance Programs, Oregon Health Authority . The rules apply to provision of psychiatric hospital inpatient services for persons eligible for medical assistance under the Basic Health Program (Section 1331 of the Affordable Care Act), which the Authority calls OHP Bridge – Basic Health Program, and Medicaid (Title XIX of the Social Security Act). (2) Statutory Authority. These rules are authorized by ORS 413.042 and HB 4035 (2022) and carry out the provisions of ORS 414.025, 414.065, and 414.085 and Title XIX of the Social Security Act and 42 CFR 441, Subparts C and D and Section 1331 of the Affordable Care Act. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 414.025 & 414.065 & 414.241 History: BHS 12-2024, amend filed 05/29/2024, effective 06/01/2024 MHD 2-1994, f. & cert. ef. 2-24-94 MHD 12-1990, f. & cert. ef. 10-15-90 MHD 7-1987, f. & ef. 12-30-87 Reverted to MHD 21-1983, f. & ef. 12-5-83 MHD 12-1985(Temp), f. & ef. 7-1-85 MHD 21-1983, f. & ef. 12-5-83 MHD 17-1983(Temp), f. 9-30-83, ef. 10-1-83
309-015-0007 General Conditions of Eligibility and Treatment In order for payment to be made by the Division, the following conditions must be met: (1) Medicaid-eligible age. The patient must be eligible for Medicaid benefits, be aged 65 or over, aged 20 or under, or aged 21 and receiving services at the time of reaching age 21. (2) Written plan of care. A professionally developed written plan of care for each patient will describe treatment objectives and prescribe an integrated program of appropriate therapy activities and experiences designed to improve the patient’s condition to the extent that inpatient care is no longer necessary. (3) Unemancipated minor consultation. If the patient is under 18 years of age and not emancipated, the facility shall consult with the parent(s), legal guardian or others into whose care or custody the person will be released following discharge. The consultation shall be documented in the hospital records. (4) Conformance with these rules. The Division has determined that admission and care of the patient who is eligible for Medicaid benefits is in accordance with these rules and regulations as evidenced by the hospital record. (5) Service provider requirements. The service provider must meet all requirements for participation under OAR 309-015-0010. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 414.025 & 414.065 History: MHD 6-1989, f. & cert. ef. 11-17-89 MHD 7-1987, f. & ef. 12-30-87
309-015-0010 Conditions of Service Provider Participation (1) Medicaid certification. A service provider must be certified by the responsible state or federal authority as meeting federal Medicaid certification requirements for psychiatric hospital inpatient services. (2) Written agreement with the Division. A service provider must provide medically prescribed psychiatric hospital inpatient services to patients eligible for Medicaid benefits under terms of a written agreement with the Division. The agreement must assure that the psychiatric hospital and the services provided comply with all applicable state and federal requirements. No billing for Medicaid payment will be paid until a service provider has fully executed a written agreement with the Division. (3) Legislative compliance. A service provider must be in compliance with: (a) Title VI of the Civil Rights Act of 1964; (b) Section 504 of the Rehabilitation Act of 1973; (c) The Age Discrimination Act of 1975; (d) The Americans with Disabilities Act of 1990; and (e) Any other applicable federal and state laws. (4) Medicaid vendor number. A service provider must request a vendor number from the Division. No billing for Medicaid payment will be paid until a service provider has secured a Medicaid vendor number. (5) Patient admission. A service provider must obtain approval for the admission of patients to the psychiatric hospital as required by Addictions and Mental Health Division’s OARs 309-031-0200 through 309-031-0255 (Admission and Discharge of Mentally Ill Persons). (6) Clinical records. A service provider must maintain clinical records which are adequate to document the need for psychiatric hospital inpatient services, and the specific services provided, including mental health assessment, diagnosis, and treatment plans. (7) Fiscal records. A service provider must maintain fiscal records in accordance with generally accepted accounting principles. (8) Patient funds. A service provider must provide an accounting for any funds accepted from the patient for safekeeping. Such accounts will be available for inspection by personnel designated by the Division. (9) Records review. A service provider must maintain the availability of financial and treatment records for review without notice by authorized personnel of the Medicaid Intermediary and of the United States Department of Health and Human Services during normal business hours at the location of its licensed psychiatric hospital. (10) Reimbursement for services. A service provider must accept payment from the Division through the Division of Medical Assistance Programs as full and total reimbursement for the Medicaid services provided. (11) Annual cost reports. A service provider must submit annually to the Division a Medicaid cost report accompanied by a copy of the provider’s Medicare cost report. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 414.025 & 414.065 History: MHD 12-1990, f. & cert. ef. 10-15-90 MHD 6-1989, f. & cert. ef. 11-17-89 MHD 7-1987, f. & ef. 12-30-87 MHD 21-1983, f. & ef. 12-5-83 MHD 17-1983(Temp), f. 9-30-83, ef. 10-1-83
309-015-0020 Establishing the Base Year and the Initial Maximum Allowable Rate (1) Base year. In order to establish a base year rate, the Medicaid Intermediary used cost statements which overlapped the base period (July 1, 1981 through June 30, 1982) for all Oregon hospitals who were either: (a) Licensed as psychiatric hospitals on the effective date of these rules (10-1-83) and in operation during the base period; or (b) Were applicants for Joint Commission on Accreditation of Hospitals (JCAH) accreditation as a psychiatric hospital on the first effective date of these rules and had operated as a licensed hospital during the base period. (2) Reporting period adjustments. If a psychiatric hospital’s cost report was for a period either longer or shorter than 12 months, the Medicaid allowable costs were reduced or increased, as appropriate, by multiplying the total allowable costs by the ratio that 12 months bore to the number of months in the hospital’s report period. This procedure resulted in a prorated 12-month cost projection for use in establishing the statewide average per diem rate for the base period. (3) Inflation factor adjustments. If a psychiatric hospital had a fiscal period other than the base period, the hospital’s Medicaid allowable costs were adjusted by applying the relevant inflation factors from the Medicare market basket index so that the Medicaid costs corresponded to the base period. The inflation factors were applied to the interval between the mid-point of the hospital’s fiscal period and the mid-point of the base period. The number of Medicaid patient days in the hospital’s fiscal period were used as the number of days in the base period. (4) Rate calculation. The total Medicaid allowable costs from all hospitals included in the base period divided by the total number of Medicaid patient days from all hospitals included in the base period yielded the statewide average per diem cost (maximum allowable rate) for the base period. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 414.025 & 414.065 History: MHD 6-1989, f. & cert. ef. 11-17-89 MHD 21-1983, f. & ef. 12-5-83 MHD 17-1983(Temp), f. 9-30-83, ef. 10-1-83
309-015-0021 Establishing the Maximum Allowable Rate for Years Following the Base Period (1) Base rate usage. The statewide average per diem cost for the base period has been used as the fixed base for determining the maximum allowable reimbursement rate for all fiscal periods following the base period. (2) Subsequent period rate calculations. The maximum allowable reimbursement rate for each new fiscal period affected by these rules is now calculated by inflating the maximum allowable reimbursement rate for the previous period by the annual Health Care Financing Administration target percentages for PPS — excluded hospitals (as published in the Federal Register). This percentage increase is applied from the mid-point of the previous period to the mid-point of the 12-month period for which the rate is being established. (3) Hospitals with other fiscal periods. When a psychiatric hospital has a fiscal period other than that used by the State of Oregon, July 1 through June 30, the applicable maximum allowable rate for each month will be the same as the maximum allowable rate in effect that month for hospitals operating under the state fiscal period. Statutory/Other Authority: ORS 413.042 Statutes/Other Implemented: ORS 414.025 & 414.065 History: MHD 12-1990, f. & cert. ef. 10-15-90 MHD 6-1989, f. & cert. ef. 11-17-89