reglab/statecodes huggingface dataset:
Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 13 - ACCOUNTING AND BUSINESS PRACTICES › Section 309-013-0120 - Purpose and Statutory Authority

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Purpose. These rules establish a Division
			 procedure for audits of community mental health programs, mental health
			 organizations and their subcontractors and vendors and any service provider
			 agreeing to offer services through direct contract with the Division. These
			 rules also establish basic record keeping standards for programs subject to
			 audit under these rules, establish procedures for appealing audit findings, and
			 set out a process to implement the findings of the final audit
			 report.
(2) Statutory Authority.
			 These rules are authorized by ORS
			 179.040,
			 413.042 &
			 430.640 and are promulgated to
			 enable the Division to carry out its responsibilities under ORS
			 414.018 to
			 414.024 and
			 430.610 through
			 430.695.
Stat. Auth.: ORS
				  179.040 &
				  413.042 &
				  430.640
Stats. Implemented: ORS
				  414.018 &
				  430.610-430.695
Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 13 - ACCOUNTING AND BUSINESS PRACTICES › Section 309-013-0130 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
(1) "Audit" means
			 the examination of documents, records, reports, systems of internal control,
			 accounting and financial procedures, and other evidence for one or more of the
			 following purposes:
(a) To ascertain whether
			 the financial statements present fairly the financial position and the results
			 of financial operations of the fund types and/or account groups in accordance
			 with Generally Accepted Accounting Principles and federal and state rules and
			 regulations;
(b) To determine
			 compliance with applicable laws, rules, regulations and contract
			 provisions;
(c) To review the
			 efficiency and economy with which operations are carried out; and
(d) To review effectiveness in achieving
			 program results.
Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 13 - ACCOUNTING AND BUSINESS PRACTICES › Section 309-013-0140 - Scope and Application of the Rule

Current through Register Vol. 63, No. 7, July 1, 2024
Under these rules, the Division may audit any service provider
				that provides any part of the community mental health program including the
				community mental health program itself, Mental Health Organizations providing
				services under the Oregon Health Plan including subcontractors and vendors
				providing mental health services, or any direct contractor. The scope of the
				audit shall include only Division funds or related matching funds. However,
				Division may include other funds in its tests to the extent necessary to audit
				Division funds or matching funds. These rules shall be read and applied
				consistently with OAR
				309-014-0000 (Community Mental
				Health Contractors) or the Division of Medical Assistance Programs general
				rules (OAR 410-120-0000 through
				410-120-1980) when these are
				applicable.
Stat. Auth.: ORS
				  413.042 &
				  430.640
Stats. Implemented: ORS
				  430.610-430.695
Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 13 - ACCOUNTING AND BUSINESS PRACTICES › Section 309-013-0150 - Revenue

Current through Register Vol. 63, No. 7, July 1, 2024
(1) A service
			 provider shall maintain a revenue account for each income source which results
			 from the operation of the service or is used to support the service. For
			 example, separate revenue accounts shall be established for each service
			 element for which the provider receives payment from Division or the Division
			 of Medical Assistance Programs, direct federal payments, donations, fees,
			 interest earned, rentals collected from subleases and parking lots, sales of
			 capital equipment, training grants or any other source of income.
(2) Only cash revenue may be used to match
			 state funds unless the Division gives prior authorization in writing to use
			 contributed services or property to match state funds.
Stat. Auth.: ORS
				  179.040 &
				  413.042 &
				  430.640
Stats. Implemented: ORS
				  414.018 &
				  430.610-430.695
Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 13 - ACCOUNTING AND BUSINESS PRACTICES › Section 309-013-0170 - Audit Process and Reports

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 Any person, organization, or agency, including the Division, may request an
			 audit of a community mental health program or any service provider offering a
			 service thereunder or any direct contractor by submitting an audit request in
			 writing to the Division Internal Audit Unit Coordinator. The request shall
			 clearly identify the service provider to be audited, setting forth its name,
			 location, program director, the period for which the audit is requested and the
			 reason for the request.
(2) The
			 Internal Audit Unit Coordinator shall review the request and arrange for
			 scheduling if an audit is considered appropriate. The Internal Audit Unit
			 Coordinator shall notify appropriate Assistant Administrators of the audit
			 schedule.
(3) The Assistant
			 Administrator of the Division for the Office of Finance has the discretion to
			 notify the appropriate community mental health program director of the
			 scheduled audit in advance. The Division retains the right to perform an audit
			 without prior notice to the subject service provider.
(4) Upon completion of the audit, the
			 Internal Audit Unit Coordinator shall prepare a report setting forth the
			 findings, recommendations, and auditee responses where applicable. Audit work
			 papers shall be available showing the details of the audit findings.
Stat. Auth.: ORS
				  179.040 &
				  413.042 &
				  430.640
Stats. Implemented: ORS
				  414.018 &
				  430.610-430.695
Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 13 - ACCOUNTING AND BUSINESS PRACTICES › Section 309-013-0180 - Disposition of Audit Findings

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 To the extent an audit documents non-allowable expenditures in non-capitated
			 programs, the Division shall recover such funds.
(2) To the extent an audit report evidences
			 non-compliance with applicable program and/or licensing rules, the audit
			 findings may be referred to the Administrator of the Division to assess civil
			 penalties, where applicable, or for other corrective action deemed necessary by
			 the program office.
(3)
			 Notwithstanding any other provisions of these rules, to the extent an audit
			 report reveals non-compliance with Generally Accepted Accounting Principles or
			 these rules, the Division may require corrective action to bring the
			 deficiencies into compliance with state and federal rules and regulations.
			 Non-compliance which results in substantial misrepresentation of financial
			 activities may result in termination of the license and/or contract upon
			 consultation with Division program offices and/or the local mental health
			 authority.
Stat. Auth.: ORS
				  179.040 &
				  413.042 &
				  430.640
Stats. Implemented: ORS
				  414.018 &
				  430.610-430.695
Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 13 - ACCOUNTING AND BUSINESS PRACTICES › Section 309-013-0190 - Provider Appeals

Current through Register Vol. 63, No. 7, July 1, 2024
(1) A provider
			 may appeal certain decisions affecting the provider by making a written request
			 to the Division Assistant Administrator for the Office of Finance. The request
			 must state whether the provider wants an administrative review, and/or a
			 contested case hearing, as outlined in the OMAP General Rules OAR
			 410-120-1560, Provider Appeals,
			 through 410-120-1840, Provider Hearings-Role of Hearings Officer. If the
			 subject service provider decides to appeal the audit, it shall set forth in
			 writing the reasons for its appeal within 30 days of receipt of the
			 report.
(2) When the Division seeks
			 to recover funds under these rules, the Division shall negotiate the terms and
			 conditions of repayment with the audited service provider, after consultation
			 with the community mental health program director or the MHO director (if
			 applicable).
Stat. Auth.: ORS
				  179.040 &
				  413.042 &
				  430.640
Stats. Implemented: ORS
				  414.018 &
				  430.610-430.695
Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 13 - ACCOUNTING AND BUSINESS PRACTICES › Section 309-013-0200 - Basic Accounting Records

Current through Register Vol. 63, No. 7, July 1, 2024
A service provider subject to audit under these rules shall
				maintain a chart of accounts that defines all items included in determining the
				cost for each service element. The chart of accounts shall list all revenues
				and expense accounts. The organization shall have bank deposit records and
				documentation to verify the source of revenue. Revenue and expense accounts,
				with related asset, liability, and equity accounts, shall account for all
				expenditures related to delivery of the service. All basic accounting records
				shall be retained for at least three years following the expiration of the
				contract or from the finalization of an audit including any appeal, whichever
				is later.
Stat. Auth.: ORS
				  179.040 &
				  413.042 &
				  430.640
Stats. Implemented: ORS
				  414.018 &
				  430.610-430.695
Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 13 - ACCOUNTING AND BUSINESS PRACTICES › Section 309-013-0210 - Internal Controls

Current through Register Vol. 63, No. 7, July 1, 2024
Establishing and maintaining an internal control structure is
				the responsibility of the service provider. Effective internal controls are
				considered essential to achieving the proper conduct of business with full
				accountability for the resources made available. Internal controls shall be
				implemented and maintained to provide reasonable assurance that:
(1) The provider identifies, assembles,
			 classifies, records, analyzes, and reports its transactions in conformity with
			 Generally Accepted Accounting Principles or appropriate regulatory requirements
			 for preparing financial statements and other required financial
			 reports;
(2) Losses or
			 misappropriations of assets due to errors or irregularities in processing
			 transactions and handling the related assets are prevented or
			 detected;
(3) Noncompliance with
			 applicable federal and state laws and rules and regulations and terms of the
			 contract is prevented or detected;
(4) State and federal funds are reasonably,
			 prudently and economically spent; and
(5) All costs are appropriately allocated
			 among programs, departments, and other benefiting units.
Stat. Auth.: ORS
				  179.040 &
				  413.042 &
				  430.640
Stats. Implemented: ORS
				  414.018 &
				  430.610-430.695
Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 13 - ACCOUNTING AND BUSINESS PRACTICES › Section 309-013-0220 - Independent Audit Reports

Current through Register Vol. 63, No. 7, July 1, 2024
The Division may, in its discretion, accept an independent
				audit, in lieu of a Division audit, if it determines the workpapers and
				procedures of the independent auditor meet Government Auditing Standards (where
				applicable), Generally Accepted Auditing Standards and other audit standards
				which may be adopted by the Division.
Stat. Auth.: ORS
				  179.040 &
				  413.042 &
				  430.640
Stats. Implemented: ORS
				  414.018 &
				  430.610-430.695
Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 14 - COMMUNITY MENTAL HEALTH PROGRAMS › Section 309-014-0000 - Purpose and Statutory Authority

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Purpose. These rules prescribe general
			 administrative standards for Division community mental health programs.
(2) Certificate Required: To
			 receive a certificate for the provision of behavioral health treatment services
			 a Community Mental Health Program must meet the criteria under OAR
			 309-008-0100 to
			 309-008-1600; in addition, the
			 Opioid Treatment Program must:
(3)
			 Renewal: The renewal of a Certificate shall be governed by OAR
			 309-008-0100 to
			 309-008-1600.
(4) Denial, Revocation, Nonrenewal,
			 Suspension: The denial, revocation, nonrenewal, or suspension of a letter of
			 approval or license for an opioid treatment program may be based on any of the
			 grounds set forth in OAR
			 309-008-1100.
Stat. Auth.: ORS
				  413.042 &
				  430.640
Stats. Implemented: ORS
				  430.610 -
				  430.695
Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 14 - COMMUNITY MENTAL HEALTH PROGRAMS › Section 309-014-0010 - Purpose of a Community Mental Health Program

Current through Register Vol. 63, No. 7, July 1, 2024
The purpose of a CMHP is to provide a system of appropriate,
				accessible, coordinated, effective, efficient safety net services to meet the
				mental health needs of the citizens of the community.
Stat. Auth.: ORS
				  413.042 &
				  430.640
Stats. Implemented: ORS
				  430.610 -
				  430.640
Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 14 - COMMUNITY MENTAL HEALTH PROGRAMS › Section 309-014-0015 - Division Responsibility for Community Addictions and Mental Health

Current through Register Vol. 63, No. 7, July 1, 2024
The Division shall assist the local mental health authority in
				establishing and operating community mental health services and shall integrate
				such services with other mental health system components in the state by:
(1) Assessing needs for community
			 mental health services in the state.
(2) Identifying priorities among needs and
			 preparing state plans for community mental health disability services.
(3) Conducting the Division's
			 activities in the least costly and most efficient manner so that delivery of
			 services to the mentally or emotionally disturbed, alcohol abuser, alcoholic,
			 drug abuser and drug-dependent persons shall be effective, coordinated and
			 integrated with other services within the Oregon Health Authority.
(4) Obtaining resources and contracting with
			 local mental health authorities for the operation of community mental health
			 safety net service.
(5) Subject to
			 the availability of funds, providing public information, program consultation,
			 technical assistance, and training concerning community mental health
			 services.
Stat. Auth.: ORS
				  413.042 &
				  430.640
Stats. Implemented: ORS
				  430.610 -
				  430.640
Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 14 - COMMUNITY MENTAL HEALTH PROGRAMS › Section 309-014-0020 - Program Director Qualifications

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The CMHP Director shall be a full time
			 employee of the local mental health authority or the public or private
			 corporation operating the community mental health program;
(2) The CMHP Director shall meet the
			 following requirements:
(a) Hold at least a
			 master's degree in a behavioral, social, health science, special education,
			 public administration, or human service administration; and
(b) Have a minimum of five years of
			 experience in human services programs, two of which are in community mental
			 health and two of which are program managerial experience in human services;
			 and
(c) Present references
			 documenting experience, training, and ability to manage a community mental
			 health program.
Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 14 - COMMUNITY MENTAL HEALTH PROGRAMS › Section 309-014-0021 - Management Functions

Current through Register Vol. 63, No. 7, July 1, 2024
(1) In
			 addition to other duties as may be assigned in the area of developmental
			 disability services, the CMHP shall, at a minimum, assure the following duties
			 are performed:
(a) Develop plans as may be
			 needed to provide a coordinated and efficient use of resources available to
			 serve people with developmental disabilities;
(b) Develop positive and cooperative working
			 relationships with families, advocates, service providers, the Division, and
			 other state and local agencies with an interest in developmental disability
			 services;
(c) Assure collection
			 and timely reporting of information as may be needed to conduct business with
			 the Division, including but not limited to information needed to license foster
			 homes, to collect federal funds supporting services, and to investigate
			 complaints related to services or suspected individual abuse; and
Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 14 - COMMUNITY MENTAL HEALTH PROGRAMS › Section 309-014-0022 - Contracts

Current through Register Vol. 63, No. 7, July 1, 2024
(1) In keeping with
			 the principles of family support expressed in ORS
			 417.342, and notwithstanding
			 430.670(2) or 291.047(3), an entity operating a CMHP may purchase services for
			 an individual from a service provider without first providing an opportunity
			 for competition among other service providers if the service provider is
			 selected by the individual, the individual's family or the individual's
			 guardian, as long as the service provider has been approved by the Division to
			 provide such service.
(2) Limit on
			 contract requirements. When a CMHP contracts with a public agency or private
			 corporation for delivery of developmental disability services, the CMHP shall
			 include in the contract only terms that are substantially similar to model
			 contract terms established by the Division. The CMHP may not add contractual
			 requirements, including qualifications for contractor selection, which are
			 nonessential to the service element(s) being provided under the contract. The
			 CMHP shall specify in contracts with service providers that disputes, which
			 arise from these limitations, shall be resolved according to procedures
			 contained in these rules. For purposes of this section, the following
			 definitions apply:
(a) "Model contract terms
			 established by the Division" means all applicable material terms and conditions
			 of the omnibus contract, as modified to appropriately reflect a contractual
			 relationship between the service provider and the CMHP, and any other
			 requirements approved by the Division as local options under procedures
			 established in these rules.
(b)
			 "Substantially similar to model contract terms" means that the terms developed
			 by the CMHP and the model contract terms require the service provider to engage
			 in approximately the same type activity and expend approximately the same
			 resources to achieve compliance.
(c) "Nonessential to the service element(s)
			 being provided" means requirements that are not substantially similar to model
			 contract terms developed by the Division.
Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 14 - COMMUNITY MENTAL HEALTH PROGRAMS › Section 309-014-0023 - The Appeal Process

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Notice of
			 Appeal.
(a) If a service provider believes
			 that the contract offered by the CMHP contains terms or conditions that are not
			 substantially similar to those established by the Division in the model
			 contract, the service provider may appeal imposition of the disputed terms or
			 conditions by sending a written notice of appeal to the Division's Chief
			 Officer within 30 calendar days after the effective date of the contract
			 requirement. The notice of appeal shall include:
(A) A copy of the contract and any pertinent
			 contract amendments;
(B)
			 Identification of the specific term(s) that are in dispute; and
(C) A complete written explanation of the
			 dissimilarity between terms.
(D)
			 The service provider shall send a copy of its notice of appeal to the CMHP.
			 Upon receipt of this notice, the CMHP shall suspend enforcement of compliance
			 with any contract requirement under appeal by the contractor until the appeal
			 process is concluded.
Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 14 - COMMUNITY MENTAL HEALTH PROGRAMS › Section 309-014-0025 - Management of Community Mental Health Program Areas

Current through Register Vol. 63, No. 7, July 1, 2024
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.
Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 14 - COMMUNITY MENTAL HEALTH PROGRAMS › Section 309-014-0030 - Management of All Service Elements

Current through Register Vol. 63, No. 7, July 1, 2024
All contractors providing community mental health service
				elements under a contract with the Division are required to meet the following
				standards for management:
(1) Fee
			 Policy. For all community mental health service elements, except local
			 administration and those provided by a public education district, the agency
			 providing the service element shall:
(a)
			 Determine the cost of each type of service element provided;
(b) Establish a schedule of fees for service
			 elements based on the costs of the service elements, adjusted on the basis of
			 the client's ability to pay;
(c)
			 At the time the service elements is initiated, inform the client of the agency
			 fee policy, the agency fee schedules, and the fee rate to be collected from the
			 client in the event that third party payments do not cover the cost of the
			 client's service elements;
(d)
			 Billings for Title XIX funds shall in no case exceed the customary charges to
			 private clients for any like item or service charged by the service element;
			 and
(e) Charge fees for service
			 elements as follows:
(A) Except where
			 expressly prohibited by federal law or regulation, when third party payments do
			 not cover the full fee for the service elements provided, charge the client or
			 those legally responsible for the cost of the client's care, in an amount which
			 is the lesser of:
(i) The balance of the fee
			 charged to but not paid by the third party payor(s); or
(ii) A fee adjusted on the basis of the
			 client's ability to pay.
(B) Charge any third party payor in the
			 amount of the full fees for the service elements provided. Should the sum of
			 any third party payments and client payments exceed the fee, a refund of the
			 excess payment shall be given to the client.
Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 14 - COMMUNITY MENTAL HEALTH PROGRAMS › Section 309-014-0035 - Delivery of CMHP Service Elements

Current through Register Vol. 63, No. 7, July 1, 2024
All community mental health contractors providing community
				mental health service elements under a contract with the Division are required
				to meet the following general standards for delivery of community mental health
				service elements:
(1) Eligibility for
			 Service:
(a) In accordance with the Civil
			 Rights Act of 1964, community mental health services shall not be denied any
			 person on the basis of race, color, creed, sex, national origin or duration of
			 residence. Community mental health contractors shall also comply with Section
			 504 of the Rehabilitation Act of 1973 as implemented by
			 45 CFR
			 84.4, which states in part, "No qualified
			 person shall, on the basis of handicap, be excluded from participation in, be
			 denied benefits of, or otherwise be subjected to discrimination under any
			 program or activity which receives or benefits from federal financial
			 assistance";
(b) No person shall
			 be denied services or be discriminated against on the basis of age or
			 diagnostic or disability category unless predetermined clinical or program
			 criteria for service restrict the service to specific age or diagnostic groups
			 or disability category;
(c) No
			 person shall be denied community mental health services based on ability to
			 pay;
(d) Any person eligible for
			 community mental health services provided by one agency shall also be eligible
			 for other CMHP services provided by any other agency, unless admission to the
			 service is subject to diagnostic or disability category or age restrictions
			 based on predetermined criteria.
Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 14 - COMMUNITY MENTAL HEALTH PROGRAMS › Section 309-014-0036 - Records

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 14 - COMMUNITY MENTAL HEALTH PROGRAMS › Section 309-014-0037 - Dispute Resolution

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 14 - COMMUNITY MENTAL HEALTH PROGRAMS › Section 309-014-0040 - Variances

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Stat. Auth.: ORS
				  413.042 &
				  430.640
Stats. Implemented: ORS
				  430.610 -
				  430.640
Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 14 - COMMUNITY MENTAL HEALTH PROGRAMS › Section 309-014-0300 - Purpose and Scope

Current through Register Vol. 63, No. 7, July 1, 2024
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.
Stat. Auth.: ORS
				  413.042
Stats. Implemented: 2011 OL SB 204, Sec.
				  13-20
Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 14 - COMMUNITY MENTAL HEALTH PROGRAMS › Section 309-014-0310 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Stat. Auth.: ORS
				  413.042
Stats. Implemented: 2011 OL SB 204, Sec.
				  13-20
Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 14 - COMMUNITY MENTAL HEALTH PROGRAMS › Section 309-014-0320 - Regional Health Improvement Plan

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 14 - COMMUNITY MENTAL HEALTH PROGRAMS › Section 309-014-0330 - Central Oregon Health Council

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 14 - COMMUNITY MENTAL HEALTH PROGRAMS › Section 309-014-0340 - Central Oregon Health Improvement Plan (COHIP)

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 15 - MEDICAID PAYMENT FOR PSYCHIATRIC HOSPITAL INPATIENT SERVICES › Section 309-015-0000 - Purpose and Statutory Authority

Current through Register Vol. 63, No. 7, July 1, 2024
(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
Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 15 - MEDICAID PAYMENT FOR PSYCHIATRIC HOSPITAL INPATIENT SERVICES › Section 309-015-0007 - General Conditions of Eligibility and Treatment

Current through Register Vol. 63, No. 7, July 1, 2024
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.
Stat. Auth.: ORS
				  413.042
Stats. Implemented: ORS
				  414.025 &
				  414.065
Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 15 - MEDICAID PAYMENT FOR PSYCHIATRIC HOSPITAL INPATIENT SERVICES › Section 309-015-0010 - Conditions of Service Provider Participation

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 15 - MEDICAID PAYMENT FOR PSYCHIATRIC HOSPITAL INPATIENT SERVICES › Section 309-015-0020 - Establishing the Base Year and the Initial Maximum Allowable Rate

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 15 - MEDICAID PAYMENT FOR PSYCHIATRIC HOSPITAL INPATIENT SERVICES › Section 309-015-0021 - Establishing the Maximum Allowable Rate for Years Following the Base Period

Current through Register Vol. 63, No. 7, July 1, 2024
(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.
Stat. Auth.: ORS
				  413.042
Stats. Implemented: ORS
				  414.025 &
				  414.065
Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 15 - MEDICAID PAYMENT FOR PSYCHIATRIC HOSPITAL INPATIENT SERVICES › Section 309-015-0030 - Billing Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Bill
			 submission time limits. Bills shall be submitted to the Division through the
			 Division of Medical Assistance Programs, on forms designated by the Medicaid
			 Intermediary, as soon as possible after the date service is rendered. Payment
			 shall not be made for services which were provided more than 12 months prior to
			 presentation of the claim unless the hospital shows that the delay was caused
			 by factors outside its control.
(2)
			 Billing charge limits. Billings to the Division shall in no case exceed the
			 customary charges to private patients for any like item or service charged by
			 the hospital.
(3) Customary charge
			 criteria. In determining the customary charges to a private patient for use in
			 billings or calculating interim or settlement rates, the following criteria
			 will be applied:
(a) The private patient
			 billing rate must be for items and services comparable to the items and
			 services included in the rate for Medicaid services;
(b) When private patient rates are based on
			 the number of beds in a room, the Medicaid intermediary considers the lowest
			 room charge as the usual and customary charge for services;
(c) When ancillary charges are made to
			 private patients in addition to a basic charge, the Medicaid Intermediary
			 considers the usual and customary charge to be the lowest basic room charge
			 plus the average ancillary charge for those items included in the Medicaid
			 rate. The average ancillary charge is determined by dividing the ancillary
			 costs by the number of patient days; or
(d) Where charges are based on the
			 classification of the patient (i.e., Medicare, Medicaid and Private), the
			 Medicaid Intermediary considers the usual and customary charge to be the rate
			 for private patients exclusive of ancillary charges.
Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 15 - MEDICAID PAYMENT FOR PSYCHIATRIC HOSPITAL INPATIENT SERVICES › Section 309-015-0040 - Accounting and Record Keeping

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 Records retention. The provider shall maintain, for a period of not less than
			 three years following the date of submission of the annual Medicaid cost report
			 to the Medicaid Intermediary, financial and statistical records of the period
			 covered by such statement which are accurate and in sufficient detail to
			 substantiate the cost data reported. If there are audit issues, the records
			 shall be maintained for three years after the final audit settlement. The
			 records shall be maintained in a condition that can be audited for compliance
			 with generally accepted accounting principles and provisions of these rules.
			 Failure to maintain records in such condition shall result in disallowance of
			 costs.
(2) Documentation of
			 allowable costs. Expenses reported as allowable costs must be adequately
			 documented in the financial records of the provider or they shall be
			 disallowed.
Stat. Auth.: ORS
				  413.042
Stats. Implemented: ORS
				  414.025 &
				  414.065
Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 15 - MEDICAID PAYMENT FOR PSYCHIATRIC HOSPITAL INPATIENT SERVICES › Section 309-015-0050 - Auditing

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Desk review of
			 annual Medicaid cost report. The Medicaid intermediary will analyze by desk
			 review each annual Medicaid cost report after it has been properly completed
			 and filed.
(2) Scope of desk
			 review. The scope of the desk review will verify, to the extent possible:
(a) That the provider has properly included
			 its allowable costs on the annual Medicaid cost report on the basis of
			 generally accepted accounting principles and the provisions of these
			 rules;
(b) That the provider has
			 properly applied the cost finding method specified by the Medicaid Intermediary
			 to its allowable costs determined in subsection (a) of this section;
			 and
(c) Whether or not the analysis
			 indicates that further auditing of the provider's financial and statistical
			 records is needed.