Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 35 - RESIDENTIAL TREATMENT FACILITIES AND RESIDENTIAL TREATMENT HOMES FOR ADULTS WITH MENTAL HEALTH DISORDERS › Section 309-035-0190 - Person-Centered Service Plan

Current through Register Vol. 63, No. 7, July 1, 2024
This rule becomes effective July 1, 2016, and enforceable as
				described in OAR 309-035-0115(17).
(1) When developed as described in sections
			 (2) and (3), a person-centered service plan shall be developed through a
			 person-centered service planning process. The person-centered service planning
			 process:
(a) Is driven by the
			 individual;
(b) Includes people
			 chosen by the individual;
(c)
			 Provides necessary information and supports to ensure the individual directs
			 the process to the maximum extent possible and is enabled to make informed
			 choices and decisions, except as limited or required by a court order, an
			 administrative order, the supervisory entity or the individual's legal
			 representative;
(d) Is timely,
			 responsive to changing needs, occurs at times and locations convenient to the
			 individual, and is reviewed at least annually;
(e) Reflects the cultural considerations of
			 the individual;
(f) Uses language,
			 format, and presentation methods appropriate for effective communication
			 according to the needs and abilities of the individual and the individual's
			 legal representative;
(g) Includes
			 strategies for resolving disagreement within the process including clear
			 conflict of interest guidelines for all planning participants such as:
(A) Discussing the concerns of the individual
			 and determining acceptable solutions;
(B) Supporting the individual in arranging
			 and conducting a person-centered service planning meeting;
(C) Utilizing any available greater community
			 conflict resolution resources;
(D)
			 Referring concerns to the Office of the Long-Term Care Ombudsman; or
(E) For Medicaid recipients, following
			 existing, program-specific grievance processes.
(h) Offers choices to the individual
			 regarding the services and supports the individual receives and from whom and
			 records the alternative HCB settings considered by the individual, except as
			 limited by a court, OHA, CMHP, or PSRB order;
(i) Provides a method for the individual, or
			 the individual's legal representative to request updates to the person-centered
			 service plan;
(j) Is conducted to
			 reflect what is important to the individual to ensure delivery of services in a
			 manner reflecting personal preferences and ensuring health and
			 welfare;
(k) Identifies the
			 strengths and preferences, service and support needs, goals, and desired
			 outcomes of the individual;
(l)
			 Includes any services that are self-directed, if applicable;
(m) Includes but is not limited to
			 individually identified goals and preferences related to relationships, greater
			 community participation, employment, income and savings, healthcare and
			 wellness, and education;
(n)
			 Includes risk factors and plans to minimize any identified risk factors;
			 and
(o) Results in a
			 person-centered service plan documented by the person-centered services plan
			 coordinator, signed by the individual or the individual's legal representative,
			 the individual's case manager, and all persons responsible for the
			 implementation of the person-centered service plan. The person-centered service
			 plan is distributed to the individual, the individual's legal representative,
			 the supervisory entity if applicable, and other people involved in the
			 person-centered service plan.