reglab/statecodes huggingface dataset:
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 380 - DIRECT NURSING SERVICES FOR ADULTS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-380-0040 - Complaints, Notifications of Planned Actions, and Hearings

Current through Register Vol. 63, No. 7, July 1, 2024
(1) INDIVIDUAL
			 COMPLAINTS. Complaints by or on behalf of individuals must be addressed in
			 accordance with OAR 411-318-0015.
(2) NOTIFICATION OF PLANNED ACTION. In the
			 event that direct nursing services are denied, reduced, suspended, or
			 terminated or voluntarily reduced, suspended, or terminated, a written advance
			 Notification of Planned Action (form 0947) must be provided as described in OAR
			 411-318-0020.
(3) HEARINGS.
(a) Hearings must be addressed in accordance
			 with ORS chapter 183 and OAR
			 411-318-0025.
(b) An individual may request a hearing as
			 provided in ORS chapter 183 and OAR
			 411-318-0025 for a denial,
			 reduction, suspension, or termination of direct nursing services.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 380 - DIRECT NURSING SERVICES FOR ADULTS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-380-0050 - Direct Nursing Service Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) DIRECT NURSING SERVICES CRITERIA. The
			 Department uses the Direct Nursing Services Criteria at the following times:
(a) For initial eligibility of direct nursing
			 services.
(b) As part of annual ISP
			 planning, but no longer than 12 months from the last assessment.
(c) After any significant change of
			 condition, such as hospitalization, emergency visits, or significant changes in
			 the health status of the individual, reported by the case management entity or
			 provider.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 380 - DIRECT NURSING SERVICES FOR ADULTS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-380-0065 - Standards for Direct Nursing Services Agencies

Current through Register Vol. 63, No. 7, July 1, 2024
(1) CERTIFICATION, ENDORSEMENT, AND
			 ENROLLMENT. In addition to completing the provider enrollment requirements in
			 OAR 411-380-0060, a direct nursing
			 services agency must also have the following:
(a) A certificate and endorsement to deliver
			 direct nursing services according to OAR chapter 411, division 323.
(b) A Medicaid Agency Identification Number
			 assigned by the Department as described in OAR chapter 411, division
			 370.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 380 - DIRECT NURSING SERVICES FOR ADULTS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-380-0060 - Qualifications for Providers of Direct Nursing Services

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Direct nursing services may be delivered
			 by the following enrolled Medicaid providers:
(a) A self-employed LPN or RN licensed under
			 ORS 678.021 that may also be an
			 adult foster home provider or family member.
(A) An adult foster home provider must also
			 be licensed under OAR
			 411-360-0040.
(B) The decision to have an adult foster home
			 provider or family member deliver direct nursing services must:
(i) Be made by the individual and the ISP
			 team;
(ii) Be documented;
			 and
(iii) Not be for the
			 convenience of the adult foster home provider or family member.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 380 - DIRECT NURSING SERVICES FOR ADULTS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-380-0070 - Provider Disenrollment and Termination

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Enrolled Medicaid providers may be denied
			 enrollment, terminated, or prohibited from providing direct nursing services
			 for any of the following:
(a) Violation of
			 any part of these rules.
(b) A
			 founded report of child abuse or substantiation of a violation of the
			 protective service and abuse rules in OAR chapter 411, division 020 or OAR
			 chapter 407, division 045.
(c) Any
			 sanction or action as a result of an investigation of the Oregon State Board of
			 Nursing.
(d) Failure to keep
			 required licensure or certifications current.
(e) Failure to provide copies of the records
			 described in these rules to OHA, the Department, or case management
			 entity.
(f) Failure to participate
			 in the review of the Nursing Service Plan or care coordination meetings when
			 requested by the case management entity.
(g) Failure to provide services.
(h) Fraud or misrepresentation in the
			 provision of direct nursing services.
(i) Evidence of conduct derogatory to the
			 standards of nursing as described in OAR
			 851-045-0070 that results in
			 referral to the Oregon State Board of Nursing.
(j) A demonstrated pattern of repeated
			 unsubstantiated complaints of neglect or abuse per OAR chapter 411, division
			 020 or OAR chapter 407, division 045.
(k) The provider is listed in the exclusions
			 database of the Office of the Inspector General.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 380 - DIRECT NURSING SERVICES FOR ADULTS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-380-0080 - Provider Documentation and Records

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Documentation of direct nursing services
			 must be written in an accurate, timely, thorough, and clear manner.
(2) Documentation must comply with OAR
			 chapter 851 and must include all of the following:
(a) The name of the individual on each page
			 of documentation.
(b) The date of
			 service.
(c) Time of start and end
			 of service delivery by each provider.
(d) Anything unusual from the standard plan
			 of care expanded in the narrative.
(e) Interventions.
(f) Outcomes, including the response of the
			 individual to services delivered.
(g) Nursing assessment of the status of the
			 individual and any changes in that status per each working shift.
(h) Full signature of the provider.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 380 - DIRECT NURSING SERVICES FOR ADULTS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-380-0090 - Provider Billing and Payment

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 AUTHORIZATION OF HOURS. Authorization for direct nursing service hours are:
(a) Based on acuity levels from the Direct
			 Nursing Services Criteria and documented on an individual's Direct Nursing
			 Service Criteria Memo.
(b)
			 Authorized in the ISP by the case management entity.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 390 - HEALTH CARE ADVOCATES FOR ADULTS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-390-0100 - Statement of Purpose

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The rules in
			 OAR chapter 411, division 390 prescribe standards by which a health care
			 advocate may be appointed for an adult with an intellectual or developmental
			 disability.
(2) The Department
			 recognizes the individual rights described in OAR
			 411-318-0010 and supports the
			 rights of adult individuals to make informed choices including refusal of, and
			 consent to, health care. The intent of these rules is to maximize access to
			 health care by prescribing standards for the appointment of a health care
			 advocate when an adult individual is incapable of making a health care
			 decision.
(3) These rules encourage
			 and provide for the appointment of a health care advocate in situations not
			 covered by ORS 127.505 through
			 127.660 and when there is no
			 legally appointed guardian with authority over health care decisions. ORS
			 127.635 provides for appointment
			 of a health care representative to decide whether life-sustaining procedures
			 may be withheld or withdrawn for an incapable individual.
Statutory/Other Authority: ORS
				  127.765 &
				  409.050
Statutes/Other Implemented: ORS
				  127.765
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 390 - HEALTH CARE ADVOCATES FOR ADULTS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-390-0140 - Limits on Rule

Current through Register Vol. 63, No. 7, July 1, 2024
(1) These rules do
			 not impair or supersede Oregon's existing laws relating to any of the
			 following:
(a) Any requirement of notice to
			 others of proposed health care.
(b)
			 The standard of care required of a health care provider in the administration
			 of health care.
(c) Whether consent
			 is required for health care.
(d)
			 The elements of informed consent for health care according to ORS
			 677.097 or other law.
(e) The provision of health care in an
			 emergency.
(f) Any right a capable
			 person may have to consent or withhold consent to health care administered in
			 good faith pursuant to religious tenets of the person requiring health
			 care.
(g) Delegation of health care
			 decision-making to, or by, a health care representative.
(h) Any legal right or responsibility any
			 person may have to affect the providing, withholding, or withdrawal of
			 life-sustaining procedures including artificially administered nutrition and
			 hydration in any lawful manner.
(i)
			 Guardianship or conservatorship proceedings or appointments.
(j) Any right a person may otherwise have to
			 make their own health care decisions, or to make a health care decision for
			 another.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 390 - HEALTH CARE ADVOCATES FOR ADULTS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-390-0180 - Authority and Responsibility of a Health Care Advocate

Current through Register Vol. 63, No. 7, July 1, 2024
(1) When making a health care decision for an
			 individual, a health care advocate must first consider any preference indicated
			 by the individual by any means of communication (verbal or nonverbal) and
			 attempt to make the decision that the individual may have made if capable. If
			 this is not possible, the health care decision must be made in what the health
			 care advocate believes to be in the individual's best interest.
(2) A health care advocate must inform an
			 individual and the individual's case manager of all health care decisions made,
			 or considered by, the health care advocate.
(3) A health care advocate must consult with
			 any other available surrogate decision-maker and an individual's attending
			 physician to provide information with regards to the health care decision being
			 made.
(4) A health care advocate
			 shall have all the authority over an individual's health care that the
			 individual may have if not incapable, subject to the limitations of the health
			 care advocate's appointment, these rules, and ORS
			 127.765.
(5) A health care advocate is authorized to
			 access the medical records necessary to make a health care decision.
(6) A health care advocate may not disclose
			 the contents of, and must maintain the confidentiality of, an individual's
			 health information, as required by state and federal laws.
Statutory/Other Authority: ORS
				  127.765 &
				  409.050
Statutes/Other Implemented: ORS
				  127.765 &
				  409.010
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 390 - HEALTH CARE ADVOCATES FOR ADULTS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-390-0200 - Limits on Authority

Current through Register Vol. 63, No. 7, July 1, 2024
(1) A
			 health care advocate may not make a health care decision related to any of the
			 following:
(a) Convulsive
			 treatment.
(b)
			 Psychosurgery.
(c)
			 Sterilization.
(d)
			 Abortion.
(e) Withholding or
			 withdrawing of a life-sustaining treatment.
(f) Withholding or withdrawing artificially
			 administered nutrition and hydration other than hyperalimentation.
(g) Testing for HIV, unless testing is
			 necessary for obtaining treatment or care for an individual.
(h) A request for medication for the purpose
			 of ending an individual's life according to ORS
			 127.805 or other form of
			 assisted suicide.
(i) An
			 experimental procedure, unless the procedure has been approved by an
			 institutional review board and is determined by the attending physician to be
			 in the best interest of an individual.
(j) An experimental drug that has not been
			 approved for use by the United States Food and Drug Administration, unless the
			 drug is part of an approved clinical trial and an individual's attending
			 physician has determined that it is in the best interest of the
			 individual.
(k) The use of
			 seclusion or physical or chemical restraints, unless an imminent risk of harm
			 to the individual or others exists but only for as long as the imminent risk
			 continues except in the case of an emergency.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 390 - HEALTH CARE ADVOCATES FOR ADULTS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-390-0220 - Safeguards

Current through Register Vol. 63, No. 7, July 1, 2024
(1) When an
			 individualized written service plan team is discussing the appointment of a
			 health care advocate for an individual, or discussing an individual's
			 significant medical treatment or procedure, the individual and any advocate
			 named to the individualized written service plan team by the individual must be
			 included in the individualized written service plan team and may not be
			 excluded.
(a) The individualized written
			 service plan team must be composed of at least three members other than the
			 individual.
(b) The individualized
			 written service plan team may include, but is not limited to, family,
			 advocates, and staff with a vested interest in the individual.
(c) An individual is not required to
			 participate in the discussion if the individual declines to participate or is
			 unable to participate due to the individual's medical condition.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 415 - CASE MANAGEMENT SERVICES FOR INDIVIDUALS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-415-0010 - Statement of Purpose

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The rules in
			 OAR chapter 411, division 415 prescribe standards, responsibilities, and
			 procedures for the delivery of case management services to individuals with
			 intellectual or developmental disabilities.
(2) Providers of case management services are
			 limited to employees of:
(a) A Community
			 Developmental Disabilities Program (CDDP);
(b) A Support Services Brokerage (Brokerage);
(c) Other public or private
			 agencies contracted by a local community mental health authority; or
(d) The Department of Human Services, Office
			 of Developmental Disabilities Services.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 415 - CASE MANAGEMENT SERVICES FOR INDIVIDUALS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-415-0020 - Definitions and Acronyms

Current through Register Vol. 63, No. 7, July 1, 2024
In addition to the following definitions and acronyms, OAR
				411-317-0000 includes general
				definitions for words and terms frequently used in OAR chapter 411, division
				415. If a word or term is defined differently in OAR
				411-317-0000, the definition in
				this rule applies.
(1) "ADL" means
			 "Activities of Daily Living" as defined in OAR
			 411-317-0000.
(2) "Affiliated Entity" means an individual,
			 a trust or estate, a partnership, a corporation (including associations, joint
			 stock companies, and insurance companies), or a political subdivision or
			 instrumentality (including a municipal corporation of a state), that has an
			 incident of ownership in the CME.
(3) "Case Management Contact" means a
			 reciprocal interaction between a case manager and an individual or the
			 individual's legal or designated representative (as applicable).
(4) "Case Management Services" mean the
			 functions performed by a case manager that are funded by the Department. Case
			 management services include, but are not limited to, the following:
(a) Assessment of support needs.
(b) Developing an ISP or Annual Plan that may
			 include authorized services.
(c)
			 Information and referral for services.
(d) Monitoring the effectiveness of services
			 and supports.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 415 - CASE MANAGEMENT SERVICES FOR INDIVIDUALS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-415-0020 - Definitions and Acronyms

Current through Register Vol. 63, No. 7, July 1, 2024
In addition to the following definitions, OAR
				411-317-0000 includes general
				definitions for words and terms frequently used in OAR chapter 411, division
				415. If a word or term is defined differently in OAR
				411-317-0000, the definition in
				this rule applies.
(1) "ADL" means
			 "Activities of Daily Living" as defined in OAR
			 411-317-0000.
(2) "Affiliated Entity" means an individual,
			 a trust or estate, a partnership, a corporation (including associations, joint
			 stock companies, and insurance companies), or a political subdivision or
			 instrumentality (including a municipal corporation of a state), that has an
			 incident of ownership in the CME.
(3) "Case Management Contact" means a
			 reciprocal interaction between a case manager and an individual or the
			 individual's legal or designated representative (as applicable).
(4) "Case Management Services" mean the
			 functions performed by a case manager that are funded by the Department. Case
			 management services include, but are not limited to, the following:
(a) Assessment of support needs.
(b) Developing an ISP or Annual Plan that may
			 include authorized services.
(c)
			 Information and referral for services.
(d) Monitoring the effectiveness of services
			 and supports.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 415 - CASE MANAGEMENT SERVICES FOR INDIVIDUALS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-415-0030 - Eligibility for Case Management Services - Entry, Exit, Transfers

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An individual
			 may not be denied case management services or otherwise discriminated against
			 on the basis of race, color, religion, sex, gender identity, sexual
			 orientation, national origin, marital status, age, disability, source of
			 income, duration of Oregon residence, or other protected classes under federal
			 and Oregon Civil Rights laws.
(2)
			 To be eligible for case management services, an individual must be determined
			 eligible for developmental disabilities services by the CDDP of the county of
			 origin as described in OAR
			 411-320-0080.
(a) An adult who is eligible for case
			 management services who lives in their own or family home may select to have
			 case management services provided by a CDDP or a Brokerage, when the Brokerage
			 has the capacity to provide the service according to OAR
			 411-340-0110. When a local
			 Brokerage is selected, but the local Brokerage does not have the capacity to
			 provide case management, case management must be delivered by the local CDDP
			 until the local Brokerage has capacity.
(b) A child or adult selecting services from
			 a residential program may only have case management services delivered by a
			 CDDP or the Department.
(c) A child
			 who is eligible for and receives family support services, as described in OAR
			 chapter 411, division 305, may only have case management services delivered by
			 a CDDP.
(d) A child who is eligible
			 for and enrolled in a CIIS program, as described in OAR chapter 411, division
			 300, may only have case management services delivered by the Department, and by
			 the CDDP with respective roles identified in the child's ISP.
(e) A child enrolled to the CEN Program, as
			 described in OAR chapter 411, division 440, who meets ICF/IID Level of Care,
			 must be enrolled to a CDDP for case management services.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 415 - CASE MANAGEMENT SERVICES FOR INDIVIDUALS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-415-0030 - Eligibility for Case Management Services - Entry, Exit, Transfers

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An individual
			 may not be denied case management services or otherwise discriminated against
			 on the basis of race, color, religion, sex, gender identity, sexual
			 orientation, national origin, marital status, age, disability, source of
			 income, duration of Oregon residence, or other protected classes under federal
			 and Oregon Civil Rights laws.
(2)
			 To be eligible for case management services, an individual must be determined
			 eligible for developmental disabilities services by the CDDP of the county of
			 origin as described in OAR
			 411-320-0080.
(a) An adult who is eligible for case
			 management services who lives in their own or family home may select to have
			 case management services provided by a CDDP or a Brokerage, when the Brokerage
			 has the capacity to provide the service according to OAR
			 411-340-0110. When a local
			 Brokerage is selected, but the local Brokerage does not have the capacity to
			 provide case management, case management must be delivered by the local CDDP
			 until the local Brokerage has capacity.
(b) A child or adult selecting services from
			 a residential program may only have case management services delivered by a
			 CDDP or the Department.
(c) A child
			 who is eligible for and receives family support services as described in OAR
			 chapter 411, division 305 may only have case management services delivered by a
			 CDDP.
(d) A child who is eligible
			 for and enrolled in a CIIS program as described in OAR chapter 411, division
			 300 may only have case management services delivered by the Department, and by
			 the CDDP with respective roles identified in the ISP.
(e) In order to receive case management
			 services, an individual, or as applicable the legal representative of the
			 individual, must accept the following supports:
(A) Assistance from a CME with the design and
			 management of Department-funded services and supports;
(B) Abuse investigations;
(C) The presence of a case manager at
			 required entry or exit meetings;
(D) Monitoring of services (when applicable)
			 in accordance with OAR
			 411-415-0090;
(E) Case management contacts as described in
			 OAR 411-415-0090; and
(F) Case manager access to the service
			 record.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 415 - CASE MANAGEMENT SERVICES FOR INDIVIDUALS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-415-0040 - Case Manager Staff Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) A case manager
			 must have knowledge of the public service system for developmental disabilities
			 services in Oregon and at least one of the following:
(a) A bachelor's degree in behavioral
			 science, social science, or a closely related field.
(b) A bachelor's degree in any field and one
			 year of human services related experience, such as work providing assistance to
			 people and groups with economical disadvantages, employment, abuse and neglect,
			 substance abuse, aging, disabilities, prevention, health, cultural
			 competencies, or housing.
(c) An
			 associate's degree in a behavioral science, social science, or a closely
			 related field and two years of human services related experience, such as work
			 providing assistance to people and groups with economical disadvantages,
			 employment, abuse and neglect, substance abuse, aging, disabilities,
			 prevention, health, cultural competencies, or housing.
(d) Three years of human services related
			 experience, such as work providing assistance to people and groups with
			 economical disadvantages, employment, abuse and neglect, substance abuse,
			 aging, disabilities, prevention, health, cultural competencies, or
			 housing.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 415 - CASE MANAGEMENT SERVICES FOR INDIVIDUALS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-415-0040 - Case Manager Staff Requirements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) CASE MANAGER. A
			 case manager must have knowledge of the public service system for developmental
			 disabilities services in Oregon and at least one of the following:
(a) A bachelor's degree in behavioral
			 science, social science, or a closely related field.
(b) A bachelor's degree in any field and one
			 year of human services related experience, such as work providing assistance to
			 people and groups with economical disadvantages, employment, abuse and neglect,
			 substance abuse, aging, disabilities, prevention, health, cultural
			 competencies, or housing.
(c) An
			 associate's degree in a behavioral science, social science, or a closely
			 related field and two years of human services related experience, such as work
			 providing assistance to people and groups with economical disadvantages,
			 employment, abuse and neglect, substance abuse, aging, disabilities,
			 prevention, health, cultural competencies, or housing.
(d) Three years of human services related
			 experience, such as work providing assistance to people and groups with
			 economical disadvantages, employment, abuse and neglect, substance abuse,
			 aging, disabilities, prevention, health, cultural competencies, or
			 housing.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 415 - CASE MANAGEMENT SERVICES FOR INDIVIDUALS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-415-0050 - Standards for Case Management Services

Current through Register Vol. 63, No. 7, July 1, 2024
(1) A Case Management Entity (CME) must apply
			 the principles of self-determination, person-centered practices, diversity,
			 equity, and inclusion to the provision of case management services.
(2) A CME must ensure that a case manager is
			 available to provide case management services and other supports to an
			 individual.
(a) Case management services
			 include the activities related to:
(A)
			 Assessment and periodic reassessment of an eligible individual to determine
			 service needs, including activities that focus on needs identification, to
			 determine the need for any medical, educational, social, or other services
			 including those assessments described in OAR
			 411-415-0060.
(B) Development and periodic revision of an
			 ISP or Annual Plan based on the information collected through an assessment or
			 reassessment that specifies the desired outcomes, goals, and actions to address
			 the medical, employment, social, educational, and other services needed by an
			 eligible individual as described in OAR
			 411-415-0070.
(C) Support to access available services,
			 including referral and related activities to help an individual obtain needed
			 services as described in OAR
			 411-415-0080.
(D) Monitoring and follow-up activities,
			 including activities and contacts that are necessary to ensure an ISP or Annual
			 Plan is effectively implemented and adequately addresses the needs of an
			 eligible individual as described in OAR
			 411-415-0090.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 415 - CASE MANAGEMENT SERVICES FOR INDIVIDUALS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-415-0055 - Abuse and Serious Incident Management

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Once certified by the Department to be a
			 CAM user, a CME must ensure that all serious incidents related to an individual
			 enrolled in developmental disabilities services are recorded using the CAM
			 system.
(a) All reports of abuse and serious
			 incidents must be entered into CAM regardless of the date of the
			 incident.
(b) A serious incident
			 must be entered into CAM within seven calendar days of the CME becoming aware
			 that a serious incident has occurred.
(c) A complaint of abuse may only be entered
			 into CAM by an abuse investigator.
(d) Every serious incident entered into CAM
			 must be closed in CAM no more than 30 calendar days from the date the incident
			 was entered into CAM.
(e) The CME
			 must form an incident management team to review serious incidents for evidence
			 of trends. The CME must submit findings to the Department quarterly on a format
			 determined by the Department.
(A) The incident
			 management team at a CDDP must include at a minimum three people, including an
			 abuse investigator and a management level staff member.
(B) The incident management team at a
			 Brokerage must include at a minimum three people, including a personal agent
			 and a management level staff member.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 415 - CASE MANAGEMENT SERVICES FOR INDIVIDUALS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-415-0060 - Assessment Activities

Current through Register Vol. 63, No. 7, July 1, 2024
For the purpose of this rule, "supervisor" means an employee of
				a CME who provides management level oversight of an assessor and is trained and
				qualified to conduct an Oregon Needs Assessment (ONA) according to OAR chapter
				411, division 425.
(1) An ONA must be
			 conducted according to the standards described in OAR chapter 411, division
			 425.
(2) A Case Management Entity
			 (CME) must assure an individual has an initial ONA from an assessor or
			 supervisor prior to receiving Community First Choice state plan or waiver
			 services.
(3) The Department may
			 require an ONA to be completed by an assessor employed or identified by the
			 Department.
(4) For each individual
			 who has an authorized Individual Support Plan (ISP), a CME must assure an ONA
			 is conducted by:
(a) An assessor or
			 supervisor:
(A) For each individual who has
			 not had a functional needs assessment using the ONA when a functional needs
			 assessment or Intermediate Care Facility for Individuals with Intellectual
			 Disabilities (ICF/IID) Level of Care determination is required.
(B) Any time there may be a significant
			 change in an individual's support needs.
(C) At a frequency or at specific ages as
			 determined by the Department.
(D)
			 Upon a request for reassessment by an individual or the individual's legal or
			 designated representative.
(E) When
			 a child who has been determined to be eligible for developmental disabilities
			 services according to OAR
			 411-320-0080 and is enrolled to
			 the Medically Involved Children's Program or Medically Fragile Children's
			 Program and will be turning 18 in the next year and expects to receive
			 Community First Choice state plan or waiver services as an adult.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 415 - CASE MANAGEMENT SERVICES FOR INDIVIDUALS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-415-0070 - Service Planning

Current through Register Vol. 63, No. 7, July 1, 2024
This rule prescribes standards for the development and
				implementation of an Individual Support Plan (ISP) or Annual Plan.
(1) An ISP must meet the following
			 requirements:
(a) Be developed using a
			 person-centered planning process consistent with OAR
			 411-004-0030 and in a manner
			 that addresses issues of independence, integration, and provides opportunities
			 to seek employment and work in competitive integrated employment settings, in
			 order to assist with establishing outcomes, planning for supports, and
			 reviewing and redesigning support strategies.
(b) Be designed to enhance an individual's
			 quality of life.
(c) Be consistent
			 with the following principles:
(A) Adult
			 individuals have the right to make informed choices about the level of family
			 member participation.
(B) The
			 preferences of an individual, and when applicable a child's legal
			 representative or family, must serve to guide the ISP team. A case manager must
			 facilitate active participation of an individual throughout the planning
			 process.
(C) The planning process
			 is designed to identify the types of services and supports necessary to achieve
			 an individual's preferences, and when applicable a child's legal representative
			 or family, identify the barriers to providing those preferred services, and
			 develop strategies for reducing the barriers.
(D) Specify cost-effective arrangements for
			 obtaining the required supports and applying public, private, formal, and
			 alternative resources available to an eligible individual.
(E) When planning for a child in a 24-hour
			 residential program, foster home, or host home, the following must apply:
(i) Unless contraindicated, there must be a
			 goal for family reunification.
(ii)
			 The number of moves or transfers must be kept to a minimum.
(iii) Unless contraindicated, if the
			 placement of a child is distant from their family, the child's case manager
			 must continue to seek a placement that brings the child closer to their
			 family.
(d)
			 Be developed based on assessed need.
(e) For community living supports, the ISP
			 must include an hour allocation that is within:
(A) The maximum service level for the
			 individual as described in OAR
			 411-450-0060(7)(f) or
			 (h); or
(B) Within the amount approved by an
			 exception as described in OAR
			 411-450-0065.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 415 - CASE MANAGEMENT SERVICES FOR INDIVIDUALS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-415-0070 - Service Planning

Current through Register Vol. 63, No. 7, July 1, 2024
This rule prescribes standards for the development and
				implementation of an Individual Support Plan (ISP) or Annual Plan.
(1) An ISP must meet the following
			 requirements:
(a) Be developed using a
			 person-centered planning process consistent with OAR
			 411-004-0030 and in a manner
			 that addresses issues of independence, integration, and provides opportunities
			 to seek employment and work in competitive integrated employment settings, in
			 order to assist with establishing outcomes, planning for supports, and
			 reviewing and redesigning support strategies.
(b) Be designed to enhance an individual's
			 quality of life.
(c) Be consistent
			 with the following principles:
(A) Adult
			 individuals have the right to make informed choices about the level of family
			 member participation.
(B) The
			 preferences of an individual, and when applicable a child's legal
			 representative or family, must serve to guide the ISP team. A case manager must
			 facilitate active participation of an individual throughout the planning
			 process.
(C) The planning process
			 is designed to identify the types of services and supports necessary to achieve
			 an individual's preferences, and when applicable a child's legal representative
			 or family, identify the barriers to providing those preferred services, and
			 develop strategies for reducing the barriers.
(D) Specify cost-effective arrangements for
			 obtaining the required supports and applying public, private, formal, and
			 alternative resources available to an eligible individual.
(E) When planning for a child in a 24-hour
			 residential program, foster home, or host home, the following must apply:
(i) Unless contraindicated, there must be a
			 goal for family reunification.
(ii)
			 The number of moves or transfers must be kept to a minimum.
(iii) Unless contraindicated, if the
			 placement of a child is distant from their family, the child's case manager
			 must continue to seek a placement that brings the child closer to their
			 family.
(d)
			 Be developed based on assessed need.
(e) For community living supports, the ISP
			 must include an hour allocation that is within the maximum service level for
			 the individual as described in OAR
			 411-450-0060(7)(f) or
			 (h) or within the amount approved by an
			 exception as described in OAR
			 411-450-0065.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 415 - CASE MANAGEMENT SERVICES FOR INDIVIDUALS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-415-0080 - Accessing Developmental Disabilities Services

Current through Register Vol. 63, No. 7, July 1, 2024
(1) A CME is
			 required to:
(a) Provide assistance in
			 finding and arranging resources, services, and supports. When an individual or
			 the individual's legal or designated representative chooses to receive supports
			 delivered by a personal support worker, a CME must not limit their choice of
			 qualified providers, including all those available on the Home Care Commission
			 Registry.
(b) Provide information
			 and technical assistance to an individual, and as applicable the legal or
			 designated representative of the individual, in order to make informed
			 decisions. This may include, but is not limited to, information about support
			 needs, settings, programs, and types of providers.
(c) Provide a brief description of the
			 services available from the CME, including typical timelines for activities,
			 required assessments, monitoring and other activities required for
			 participation in a Medicaid program, and the planning process.
(d) Inform an individual, or as applicable
			 the legal or designated representative of the individual, of any potential
			 conflicts of interest between the CME and providers available to the
			 individual.
(e) Inform a provider
			 of the responsibility:
(A) To carry out their
			 duty as a mandatory reporter of suspected abuse; and
(B) To immediately notify anyone specified by
			 an individual of any incident that occurs when the provider is delivering
			 services when the incident may have a serious effect on the individual's
			 health, safety, physical, or emotional well-being, or level of services
			 required.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 415 - CASE MANAGEMENT SERVICES FOR INDIVIDUALS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-415-0090 - Case Management Contact and Monitoring of Services

Current through Register Vol. 63, No. 7, July 1, 2024
(1) CASE MANAGEMENT
			 CONTACT.
(a) Every individual who has an ISP
			 must have a case management contact no less than once every three months.
(A) The purpose of a case management contact
			 must be to assure one of the following:
(i)
			 Known health and safety risks are adequately addressed.
(ii) The support needs of an individual have
			 not significantly changed.
(iii) An
			 individual and the individual's designated representative are satisfied with
			 the current services and supports.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 415 - CASE MANAGEMENT SERVICES FOR INDIVIDUALS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-415-0100 - Specialized Services in a Nursing Facility

Current through Register Vol. 63, No. 7, July 1, 2024
An individual residing in a nursing facility determined to
				require specialized services, as described in OAR
				411-070-0043, must have an
				annual plan for specialized services incorporated with a plan of care by the
				nursing facility.
(1) A case manager
			 must coordinate with the individual, the legal representative of the
			 individual, the staff of the nursing facility, and other service providers, as
			 appropriate, to provide or arrange the specialized services. The plan for
			 specialized services must include:
(a) The
			 name of the service provider.
(b) A
			 description of the specialized services to be provided.
(c) The number of hours of service per
			 month.
(d) A description of how the
			 services must be tracked.
(e) A
			 description of the process of communication between the specialized service
			 provider and the nursing facility in the event of serious incidents, serious
			 illness, absence, and emergencies.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 415 - CASE MANAGEMENT SERVICES FOR INDIVIDUALS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-415-0120 - Reimbursement for Case Management Services

Current through Register Vol. 63, No. 7, July 1, 2024
A CME is reimbursed for case management activities.
				Reimbursement may only be made when:
(1) The claim for reimbursement is for a
			 service provided to an individual determined eligible for case management
			 services.
(2) The person providing
			 the service is a qualified case manager as described in OAR
			 411-415-0040 or an assessor as
			 defined in OAR 411-317-0000.
(3) An individual is properly enrolled into
			 the Department's electronic payment and reporting system.
(4) A claim has been made in the Department's
			 electronic payment and reporting system.
(5) Case management has been authorized in an
			 ISP or as part of an Annual Plan.
(6) The claim is for a qualifying case
			 management service.
(7) A progress
			 note is in the individual file supporting the delivery of a case management
			 service.
Statutory/Other Authority: ORS
				  409.050,
				  427.104,
				  427.105,
				  427.115,
				  427.154 &
				  430.662
Statutes/Other Implemented: ORS
				  427.007,
				  427.104,
				  427.105,
				  427.115,
				  427.121,
				  427.154,
				  427.160,
				  430.212,
				  430.215,
				  430.610,
				  430.620,
				  430.662&
				  430.664
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 425 - FUNCTIONAL NEEDS ASSESSMENTS FOR INDIVIDUALS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-425-0005 - Statement of Purpose

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The
			 rules in OAR chapter 411, division 425 prescribe standards, responsibilities,
			 and procedures for conducting an Oregon Needs Assessment (ONA).
(2) The purpose of conducting an ONA is to
			 assist the Department in addressing the following:
(a) Assuring an individual's strengths,
			 preferences, risks, and support needs are identified to inform the development
			 of an ISP.
(b) Providing access to
			 services paid by the Department to eligible individuals who have an assessed
			 need.
(c) Providing services to
			 eligible individuals at an appropriate service level based on the Department's
			 assessment of the individual's functional support needs.
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 425 - FUNCTIONAL NEEDS ASSESSMENTS FOR INDIVIDUALS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-425-0015 - Definitions and Acronyms

Current through Register Vol. 63, No. 7, July 1, 2024
In addition to the following definitions, OAR
				411-317-0000 includes general
				definitions for words and terms frequently used in OAR chapter 411, division
				425. If a word or term is defined differently in OAR
				411-317-0000, the definition in
				this rule applies.
(1) "ADL" means
			 "Activities of Daily Living".
(2)
			 "CME" means "Case Management Entity".
(3) "IADL" means "Instrumental Activities of
			 Daily Living".
(4) "ONA" means
			 "Oregon Needs Assessment".
(5)
			 "Submission date" means the date an ONA is uploaded to the Department's
			 electronic payment and reporting system, indicating a completed ONA.
(6) "Supervisor" means an employee of a CME
			 who provides management level oversight of an assessor and is trained and
			 qualified to conduct an ONA according to these rules.
(7) "These Rules" mean the rules in OAR
			 chapter 411, division 425.
Statutory/Other Authority: ORS
				  409.050,
				  427.104,
				  427.105,
				  427.115 &
				  430.662
Statutes/Other Implemented: ORS
				  427.104,
				  427.105,
				  427.115 &
				  430.662
Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 425 - FUNCTIONAL NEEDS ASSESSMENTS FOR INDIVIDUALS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-425-0025 - Policies and Procedures

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Each
			 CME must have adequate policies and procedures to assure adherence to these
			 rules no later than June 30, 2019.
(2) CONFLICTS OF INTEREST. A CME must assure
			 that an ONA is free from conflicts of interest to the greatest extent possible.
(a) ASSESSOR.
(A) At a minimum, an assessor may not conduct
			 an assessment for an individual for whom the assessor:
(i) Acted in the role of the individual's
			 case manager within the previous six months prior to the start of the
			 assessment.
(ii) Is related by
			 blood or marriage to the individual, or to any paid provider of the
			 individual.
(iii) Is financially
			 responsible for the individual.
(iv) Is empowered to make financial or
			 health-related decisions on behalf of the individual.