Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 18 - RESIDENTIAL SUBSTANCE USE DISORDERS AND PROBLEM GAMBLING TREATMENT AND RECOVERY SERVICES › Section 309-018-0105 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
(1) "Abuse of an
			 Adult" means the circumstances defined in ORS
			 430.735 and OAR Chapter 407,
			 Division 45 for abuse of an adult with mental illness or who is receiving
			 residential substance use disorder treatment or withdrawal management
			 services.
(2) "Abuse of a Child"
			 means the circumstances defined in ORS
			 419B.005 and ORS
			 418.257
(3) "Active Supervision" means a designated
			 supervisor is physically present who provides direct or indirect observation of
			 the program staff, to determine if the service or task is being completed
			 properly and providing intervention and consultation as needed.
(4) "Activities of Daily Living or
			 Instrumental Activities of Daily Living (IADL)" means those personal functional
			 activities required by an individual for continued well-being, which are
			 essential for health and safety. Activities include eating, dressing, and
			 grooming, bathing and personal hygiene, mobility, elimination, and
			 cognition.
(5) "Admission" means
			 the act or process of enrollment into services as regulated by Chapter 309
			 Division 18 rules.
(6) "Adolescent"
			 means an individual from 12 through 21 years of age or those individuals who
			 are determined to be developmentally appropriate for such services.
(7) "Adult" means an individual 18 years of
			 age or older or an emancipated minor. An individual with Medicaid eligibility,
			 who is in need of services specific to children, adolescents, or young adults
			 in transition, shall be considered a child until age 21 for the purposes of
			 these rules. Adults who are between the ages of 18 and 21, who are considered
			 children for purposes of these rules, shall have all rights afforded to adults
			 as specified in these rules.
(8)
			 "The ASAM Criteria " means the criteria in the Third edition of The American
			 Society of Addiction Medicine (ASAM) for the assessment, level of care
			 placement and treatment of addictive, substance-related, and co-occurring
			 conditions. The ASAM Criteria is a clinical guide to developing
			 patient-centered service plans and making objective decisions about admission,
			 continuing care, and transfer or discharge for individuals. The ASAM Criteria
			 is incorporated by reference in these rules.
(9) "ASAM Dimensional Admission Criteria"
			 means the specifications described in the ASAM Criteria for determining that an
			 individual is appropriately admitted to a program based on six ASAM assessment
			 dimensions. The criteria, dimensions and number of dimensions indicated differs
			 per level of care and is described within The ASAM Criteria, Third
			 Edition.
(10) "ASAM Level of Care"
			 means one of several discrete intensities of services and supports, as
			 described within The ASAM Criteria, Third Edition, within a substance use
			 disorders program that are delivered in a structured, programmatic fashion, by
			 a Division certified outpatient or licensed residential provider.
(11) "ASAM Level of Care 3.1" Clinically
			 Managed Low-Intensity Residential Substance Use Disorder Services means a
			 licensed residential setting as described in The ASAM Criteria, Third Edition
			 with 24-hour structure and support that offers at least 5 hours per week of
			 low-intensity substance use treatment services. Services and supports are
			 designed to facilitate the uptake of recovery skills, relapse prevention, and
			 emotional coping skills. Services and the milieu support individuals in
			 addressing reintegration into family, work, education and other pro-social
			 activities and communities. Programs facilitate reintegration and transition to
			 lower levels of care.
(12) "ASAM
			 Level of Care 3.3" Clinically Managed Population-Specific High-Intensity
			 Substance Use Disorder Residential Services means a licensed residential
			 setting as described in The ASAM Criteria, Third Edition with a 24-hour,
			 structured recovery environment and high-intensity substance use treatment
			 services and supports that meet the functional limitations of the individuals.
			 The functional limitations appropriate for placement in this level of care are
			 primarily cognitive and can be either temporary or permanent. When nursing
			 supervision adequate to the identified needs is available, individuals who also
			 have medical conditions may be placed in this level of care.
(13) "ASAM Level of Care 3.5" Clinically
			 Managed High-Intensity Substance Use Disorder Residential Services means a
			 24-hour supportive living environment with a habilitative focus with a reliance
			 on the treatment community. Severe substance use and social or emotional
			 limitation(s) are treated in this level of care, where an emphasis on targeted
			 interventions reduces the risk of relapse, reinforces prosocial behaviors,
			 assists with integration into a health community, and offers basic life skills
			 training. Duration at this level of care is marked by the acquisition of coping
			 and relapse prevention skills so that relapse is no longer imminently
			 dangerous. Individuals admitted to this level of care meet the DSM-5-TR
			 criteria for moderate or severe substance use disorder(s) and may have
			 co-occurring mental health disorder(s) meeting DSM-5-TR criteria or experience
			 difficulties with mood, behavior or cognition that are problematic but do not
			 meet diagnostic criteria.
(14)
			 "ASAM Level of Care 3.7" Medically Monitored Intensive Substance Use Disorder
			 Inpatient Services, means a planned and structured program of 24-hour,
			 professionally directed evaluation, observation, medical monitoring and
			 substance use treatment. Individuals admitted to this level of care have
			 subacute biomedical and emotional or cognitive conditions that are severe
			 enough to need a residential setting but not need medically managed inpatient
			 services. This level of care addresses the needs of individuals who have
			 functional limitations in Dimensions 1, 2 and 3. Services are delivered by an
			 interdisciplinary staff that are appropriately credentialed. See also,
			 "Bio-medical Enhanced ASAM Level of Care 3.7" and "Co-Occurring Enhanced ASAM
			 Level of Care 3.7"
(15) "ASAM Level
			 of Care Determination" means documentation in the service record that justifies
			 the change in a Level of Care placement, whether the placement is more
			 intensive or less intensive, completed in a multidimensional format that
			 captures what has changed for the individual and resulted in the change in
			 placement. It is the result of an evaluation of the level of care rating for
			 each dimension, the interactions of each dimension, and the individual's
			 preferred level of care. These are used together to inform the determination of
			 overall level of care assessment and placement decisions, with a rationale for
			 any discrepancy.
(16) "Assessment"
			 means the process of obtaining sufficient information through a face-to-face
			 interview to determine a diagnosis and to plan individualized services and
			 supports. For residential substance use disorder treatment programs, the
			 assessment is multidimensional and consistent with The ASAM Criteria third
			 edition
(17) "Authority" means the
			 Oregon Health Authority.
(18)
			 "Baseline evaluation" means an identification of the current status that an
			 individual expresses a desire to change in order to identify the starting
			 point(s) for measuring progress by using pre-determined benchmarks, such as a
			 Likert Scale. Progress can then be determined by using the same benchmarks to
			 obtain additional ratings of the identified status, and using the additional
			 ratings to make comparisons between the starting rating and subsequent ratings,
			 from which a measure of change can be assessed.
(19) "Behavioral Health Clinician" means a
			 practitioner of behavioral health services whose authorized scope of practice
			 includes substance use and mental health diagnosis and treatment.
(20) "Behavioral Health Treatment" means
			 treatment for mental health, substance use disorders, and problem
			 gambling.
(21) "Bio-medical
			 Enhanced ASAM Level of Care 3.1" means ASAM Level of Care 3.1 Clinically
			 Managed Low-Intensity Residential Substance Use Disorder Services programs that
			 also offers onsite or closely facilitates off-site the medical services needed
			 to assess and treat co-occurring bio-medical conditions, and the intensity of
			 on-site nursing care meets each individual's identified needs.
(22) "Bio-medical Enhanced ASAM Level of Care
			 3.3" means, in addition to the definition of ASAM Level of Care 3.3 Clinically
			 Managed Population-Specific High-Intensity Substance Use Disorder Residential
			 Services, medical services are rendered by medical staff working within their
			 scope and staffed in a manner that meets the identified needs.
(23) "Bio-medical Enhanced ASAM Level of Care
			 3.5" means, in addition to the definition of ASAM Level of Care 3.5 Clinically
			 Managed High-Intensity Substance Use Disorder Residential Services these
			 programs offer medical services that are rendered by medical staff working
			 within their scope, and the medical services are staffed in a manner such that
			 the medical oversight and treatment meet the identified needs.
(24) "Bio-medical Enhanced ASAM Level of Care
			 3.7" means in addition to the definition of ASAM Level of Care these programs
			 offer medical services that are rendered by medical staff working within their
			 scope, and the medical services are staffed in a manner such that the medical
			 oversight and treatment meet the identified needs.
(25) "Brief Intervention" means an early
			 intervention for individuals using substances, by utilizing tribal-based,
			 evidence-based, or culturally based practice designed to engage and motivate
			 individuals at risk of substance use disorder and related health problems to
			 seek services and/or support. Brief interventions can also be used to encourage
			 those with more serious dependence or disorders to accept more intensive
			 treatment. Brief interventions are intended to address problematic or risky
			 substance use that presents with or without a previous diagnosis.
(26) "Care Coordination" means a
			 process-oriented activity to facilitate ongoing communication and collaboration
			 to meet multiple needs. Care coordination includes facilitating communication
			 between the person or family served, natural supports, community resources, and
			 involved providers and agencies; organizing, facilitating, and participating in
			 team meetings; and providing for continuity of care by creating linkages to and
			 managing transitions between levels of care and transitions for young adults in
			 transition to adult services.
(27)
			 "Case Management" or "Targeted Case Management" means the services provided to
			 assist individuals who reside in a community setting or are transitioning to a
			 community setting in gaining access to desired medical, social, educational,
			 entitlement, and other applicable services.
(28) "Certificate" means the document or
			 documents issued by the Division, which identifies and declares certification
			 of a provider pursuant to OAR
			 309-008-0100 to
			 309-008-1600. A letter
			 accompanying issuance of the certificate shall detail the scope and approved
			 service delivery locations of the certificate.
(29) "Child" means an individual under the
			 age of 18. An individual with Medicaid eligibility, who is in need of services
			 specific to children, adolescents, or young adults in transition, shall be
			 considered a child until age 21 for purposes of these rules.
(30) "Clinical Supervision" means oversight
			 by a qualified clinical supervisor of the rendering of physical health,
			 substance use, problem gambling, and mental health services and supports,
			 according to these rules, including ongoing evaluation and improvement of the
			 effectiveness of those services and supports.
(31) "Clinical Supervisor" means program
			 staff qualified to oversee and evaluate the rendering of physical health,
			 substance use, problem gambling, or mental health services and
			 supports.
(32) "Community Mental
			 Health Program (CMHP)" means the organization of various services for
			 individuals with a mental health diagnosis or addictive disorders operated by
			 or contractually affiliated with a local mental health authority and operated
			 in a specific geographic area of the state under an agreement with the Division
			 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 a local mental health authority and pursuant to
			 OAR 309-014.
(33) "Cognition"
			 refers to how the individual is able to use information, make decisions, and
			 ensure their daily needs are met. There are four components to cognition:
			 self-preservation, decision-making, ability to make one's self understood, and
			 unsafe behaviors.
(34) "Cognitive
			 Ability" means a general mental capability involving reasoning, problem
			 solving, planning, abstract thinking, complex idea comprehension and learning
			 from experience.
(35) "Cognitive
			 Impairment" means a behavioral health condition or disability which impacts the
			 individual's cognitive abilities to perform Activities of Daily Living (ADL) or
			 Instrumental Activities of Daily Living (IADL), regardless of whether the
			 individual may be physically capable of performing ADLs or IADLs. For example,
			 a cognitive impairment could prevent an individual from knowing when or how to
			 carry out the task.
(36)
			 Collaborative Educational Agreement" means an individualized written
			 arrangement between an accredited college or university and a
			 Division-certified provider pertaining to a student's internship or field
			 placement experience.
(37)
			 "Consistent with ASAM Criteria" means containing information that demonstrates
			 use of and adherence to the description of components contained within The ASAM
			 Criteria, Third Edition.
(38)
			 "Co-Occurring Enhanced ASAM Level of Care 3.1" means ASAM Level of Care 3.1
			 Clinically Managed Low-Intensity Residential Substance Use Disorder Services
			 programs that also offer onsite or closely facilitate off-site psychiatric
			 services that meet the individual's identified needs, including medication
			 evaluation and laboratory services. Individuals admitted to this care have
			 documented mental health disorder(s) that may or may not meet criteria for a
			 DSM-5-TR diagnosis.
(39)
			 "Co-Occurring Enhanced ASAM Level of Care 3.3" means in addition to the
			 definition of ASAM Level of Care 3.3 Clinically Managed Population-Specific
			 High-Intensity Substance Use Disorder Residential Services, psychiatric
			 services are rendered by psychiatrists and other qualified behavioral health
			 clinicians trained in the interactions between psychotropic medications and
			 substance use.
(40) "Co-Occurring
			 Enhanced ASAM Level of Care 3.5" means in addition to the definition of ASAM
			 Level of Care 3.5 Clinically Managed High-Intensity Substance Use Disorder
			 Residential Services, these programs offer onsite or closely facilitate
			 off-site psychiatric, medication evaluation and laboratory services that meets
			 the individual's identified needs within 24 hours, as indicated by the severity
			 and urgency of the condition. These programs are staffed by psychiatrists and
			 other qualified behavioral health clinician trained in the interactions between
			 psychotropic medications and substance use. Individuals admitted to this level
			 of care meet the diagnostic criteria for a mental health disorder as well as a
			 substance use disorder, as defined by the DSM-5-TR.
(41) "Co-Occurring Enhanced ASAM Level of
			 Care 3.7" means in addition to the definition of ASAM Level of Care these
			 programs offer onsite psychiatric and medication evaluation, and nursing
			 observation and care that meets the individual's identified needs, as indicated
			 by the severity and urgency of the condition. These programs are staffed by
			 psychiatrists and other qualified medical and behavioral health clinicians
			 trained in the interactions between psychotropic medications and substance use.
			 Individuals admitted to this level of care meet the diagnostic criteria for a
			 mental health disorder as well as a substance use disorder, as defined by the
			 DSM-5-TR.
(42) "Co-occurring
			 Enhanced Substance Use Disorder Programs" means, consistent with The ASAM
			 Criteria, Third Edition, a setting where integrated services address
			 concurrently unstable mental health and substance use disorder conditions.
			 There is a focus on the integration of mental health and substance use
			 disorders throughout the staffing, services, and program content, as well as
			 the use of Motivational Enhancement therapies throughout services.
(43) "Co-occurring Substance Use, Problem
			 Gambling, and Mental Health Disorders (COD)" means the existence of a diagnosis
			 for a substance use disorder, problem gambling disorder, and/or a mental health
			 disorder.
(44) "Community Health
			 Worker (CHW)" means personnel who meets qualification criteria adopted by the
			 authority under ORS 414.665 and who is certified
			 pursuant to the requirements in OAR
			 410-180-0310.
(45) "Court" means a criminal court, drug
			 court, circuit court, juvenile court or last convicting or ruling court in this
			 state with jurisdiction over the individual.
(46) "Criminal Records Check" means
			 documenting the criminal background check results for all employees, contracted
			 staff, interns and volunteers considered to be program staff that render
			 medical or behavioral health services and supports or have access to protected
			 health information such as service records or billing information.
(47) "Crisis" means either an actual or
			 perceived urgent or emergent situation that occurs when an individual's
			 stability or functioning is disrupted and there is an immediate need to resolve
			 the situation to prevent a serious deterioration in the individual's mental or
			 physical health or to prevent referral to a significantly higher level of care
			 or death.
(48) "Crisis Plan" means
			 an individualized document designed in collaboration with the individual served
			 to help anticipate and prevent future crisis episodes and to direct
			 interventions in the instance of a crisis.
(49) "Crisis Stabilization Services" means
			 providing evaluation and treatment to individuals experiencing a crisis. Crisis
			 Services may be provided prior to completion of an intake. These services are
			 intended to stabilize the individual in crisis, prevent further deterioration
			 and provide immediate treatment and intervention in a location best suited to
			 meet the needs of the individual and in the least restrictive environment
			 available.
(50) "Cultural
			 Competence" means the process by which people and systems respond respectfully
			 and effectively to people of all cultures, languages, classes, races, ethnic
			 backgrounds, disabilities, religions, genders, sexual orientations, and other
			 diversity factors in a manner that recognizes, affirms, and values the worth of
			 individuals, families, and communities and protects and preserves the dignity
			 of each.
(51) "Culturally
			 Responsive" means services that are respectful of and relevant to the beliefs,
			 practices, culture and linguistic needs of diverse populations and communities
			 whose members identify as having particular cultural or linguistic
			 affiliations. Cultural responsiveness describes the capacity to respond to the
			 issues of diverse communities and requires knowledge and capacity at different
			 levels of intervention: systemic, organizational, professional, and
			 individual.
(52) "Culturally
			 Specific Program" means a program that is designed to meet the unique service
			 needs of a specific culture and that provides services to a majority of
			 individuals representing that culture.
(53) "Diagnosis" means the principal mental
			 health, substance use or problem gambling diagnosis listed in the Diagnostic
			 and Statistical Manual of Mental Disorders, fifth edition (DSM-5-TR). The
			 diagnosis is determined through the assessment and any examinations, tests, or
			 consultations suggested by the assessment and are the medically necessary
			 reason for services.
(54)
			 "Division" means the Health Systems Division of the Oregon Health Authority, or
			 its designee.
(55) "Diagnostic and
			 Statistical Manual of Mental Disorders, DSM-5-TRFifth Edition, (DSM-5-TR)"
			 means the textbook used to diagnose and classify mental disorders that is
			 published by the American Psychiatric Association.
(56) "Emergent" means the onset of symptoms
			 requiring attention within 24 hours to prevent serious deterioration in mental
			 or physical health or threat to safety.
(57) "Employment Support Services" means
			 services approved by the division, determined to be necessary and provided to
			 an individual to obtain and maintain employment in the community as they are
			 transitioning from an inpatient or residential facility that provides substance
			 use disorder treatment.
(58)
			 "Entry" means the act or process of acceptance and enrollment into services
			 regulated by this rule.
(59)
			 "Episode of Care" means care that begins at treatment admission and ends at
			 discharge.
(60) "Face-to-Face"
			 means a personal interaction where both words can be heard and facial
			 expressions can be seen in person or through telehealth services where there is
			 a live streaming audio and video, if clinically appropriate.
(61) "Family" means the biological or legal
			 parents, siblings, other relatives, foster parents, legal guardians, spouse,
			 domestic partner, caregivers, and other primary relations to the individual
			 whether by blood, adoption, legal, or social relationships. Family also means
			 any natural, formal, or informal support persons identified as important by the
			 individual.
(62) "Gender Identity"
			 means an individual's self-identification of gender without regard to legal or
			 biological identification, including but not limited to an individual
			 identifying themselves as male, female, transgender, and transsexual.
(63) "Gender Expression" means the external
			 characteristics and behaviors that are socially defined as either masculine or
			 feminine, such as dress, mannerisms, speech patterns, and social
			 interactions.
(64) "Grievance"
			 means a formal complaint submitted to a provider verbally or in writing by an
			 individual or the individual's chosen representative.
(65) "Guardian" means an individual appointed
			 by a court of law to act as guardian of a minor or a legally incapacitated
			 person.
(66) "Habilitation or
			 Habilitative" means medically necessary for the maintenance, learning or
			 improving skills and function for daily living. Services are designed to help
			 an individual improve their level of independence and includes, but is not
			 limited to, services provided in order to help an individual acquire, retain,
			 or improve skills in Activities of Daily Living (ADL) and Instrumental
			 Activities of Daily Living (IADL), community survival skills, communication,
			 self-help, socialization, and adaptive skills necessary to reside successfully
			 in an individual's home or a community-based setting.
(67) "Health Insurance Portability and
			 Accountability Act (HIPAA)" means the federal[MSM1] Health Insurance
			 Portability and Accountability Act of 1996 and the regulations published in
			 Title 45, parts 160 and 164, of the Code of Federal Regulations
			 (CFR).
(68) "Health Systems
			 Services and Supports" means all services and supports including but not
			 limited to Outpatient Community Mental Health Services and Supports for
			 Children and Adults, Intensive Treatment Services for Children, Outpatient and
			 Residential Substance Use Disorders Treatment Services, and Outpatient and
			 Residential Problem Gambling Treatment Services.
(69) "Housing Support Services" means
			 services approved by the division, provided to an individual to obtain and
			 reside in an independent community setting and are tailored to the goal of
			 maintaining an individual's personal health and welfare in a home and
			 community-based setting as they are transitioning from an inpatient or
			 residential facility that provides substance use disorder treatment.
(70) "Immediate Need Profile" means the
			 portion of an assessment that includes the identification of the most severe
			 and destabilizing or life-threatening conditions, in order to inform the
			 determination of the level of risk, the level of care placement and need for
			 immediate intervention(s).
(71)
			 "Institutions of Mental Disease (IMD)" means a hospital, nursing facility, or
			 other institution of more than 16 beds that is primarily engaged in providing
			 diagnosis, treatment, or care of persons with mental diseases, which includes
			 substance use disorders (SUDs).
(72) "Incident" means any event involving an
			 individual or the child of an individual receiving services occurring on the
			 premises of the program or involving program staff or any individual, occurring
			 on the premises of the program, or during a service plan activity and
			 including, but not limited to death, injury, major illness or medical event,
			 accident, act of physical aggression, medication error, suspected abuse or
			 neglect, or any other type of unusual or critical event that presents a risk to
			 the health and/ or safety of any person. Critical incidents are reported to the
			 Division.
(73) "Incident Report"
			 means a written description of any incident.
(74) "Individual" means any individual being
			 considered for or receiving services and supports regulated by these
			 rules.
(75) "Informed Consent for
			 Services" means that the service options, risks and benefits have been
			 explained to the individual and guardian, if applicable, in a manner that they
			 comprehend, and the individual and guardian, if applicable, have consented to
			 the services on, or prior to, the first date of service.
(76) "Intensive Case Management" means the
			 management of an array of services and supports that assist the individual in
			 meeting service plan objectives, includes an evaluation of needs and offers to
			 meet those needs through skill building, outreach, advocation, and arranging
			 support services through the provider or external community
			 providers.
(77) "Interim Referral
			 and Information Services" means services provided by a substance use disorders
			 treatment provider to individuals on a waiting list and whose services are
			 funded by the Substance Use Prevention Treatment Recovery (SUPTR) Block Grant
			 to reduce the adverse health effects of substance use, promote the health of
			 the individual, and reduce the risk of disease transmission.
(78) "Institution" means an establishment
			 that furnishes (in single or multiple facilities) food, shelter, and some
			 treatment or services to four or more persons unrelated to the
			 proprietor.
(79) "Institutions of
			 Mental Disease (IMD)" means a hospital, nursing facility, or other institution
			 of more than 16 beds that is primarily engaged in providing diagnosis,
			 treatment, or care of individuals with mental diseases, which includes
			 substance use disorders (SUDs).
(80) "Level of Care" means the type,
			 frequency, and duration of medically necessary services provided from the most
			 integrated setting to the most restrictive and intensive inpatient
			 setting.
(81) "Level of Care
			 Determination" means documentation in the service record that justifies the
			 change in a Level of Care placement, whether the placement is more intensive or
			 less intensive, completed in a 6-Dimensional format that captures what has
			 changed for the individual and resulted in the change in placement. The Level
			 of Care Determination shall include the assessed level of care, the placed
			 level of care, the individual's preferred level of care, and a rationale if
			 there is a difference between the assessed and placed levels of care.
(82) "Licensed Health Care Professional"
			 means a practitioner of the healing arts acting within the scope of their
			 practice under State law who is licensed by a recognized governing board in
			 Oregon.
(83) "Licensed Medical
			 Practitioner (LMP)" means aperson who meets the following minimum
			 qualifications as documented by the Local Mental Health Authority (LMHA) or
			 designee:
(a) Physician licensed to practice
			 in the State of Oregon; or
(b)
			 Nurse practitioner licensed to practice in the State of Oregon; or
(c) Physician's Assistant licensed to
			 practice in the State of Oregon; and
(d) Whose training, experience, and
			 competence demonstrates the ability to conduct a medical exam, a mental health
			 assessment and provide medication management.