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Oregon Bulletin

June 1, 2012

Oregon Health Authority, Addictions and Mental Health Division: Mental Health Services, Chapter 309

Rule Caption: Adult Foster Homes.

Adm. Order No.: MHS 4-2012

Filed with Sec. of State: 5-3-2012

Certified to be Effective: 5-4-12

Notice Publication Date: 4-1-2012

Rules Amended: 309-040-0300, 309-040-0305

Rules Repealed: 309-040-0300(T), 309-040-0305(T)

Subject: These rules prescribe standards and procedures for the provision of care and services to residents with mental illness in the Addictions and Mental Health Division of the Oregon Health Authority adult foster homes, as a condition for licensure and payment.

Rules Coordinator: Nola Russell—(503) 945-7652

309-040-0300

Purpose and Scope

(1) Purpose. These rules prescribe the standards and procedures for the provision of care and services to residents with mental illness in the Addictions and Mental Health Division of the Oregon Health Authority (Authority) adult foster homes as a condition for licensure and payment. The care and services are designed to promote the resident’s right to independence, choice and decision making while providing a safe, secure, homelike environment. The resident’s needs shall be addressed in a manner, which enables the resident to function at the highest level of independence possible.

(2) Scope. These rules apply to adult foster homes for five or fewer residents.

Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 443.705 - 443.825
Hist.: MHD 19-1985(Temp), f. & ef. 12-27-85; MHD 6-1986, f. & ef. 7-2-86; MHD 1-1992, f. & cert. ef. 1-7-92 (and corrected 1-31-92); MHD 6-1999, f. 8-24-99, cert. ef. 8-26-99; Renumbered from 309-040-0000, MHD 3-2005, f. & cert. ef. 4-1-05; MHS 11-2011(Temp), f. & cert. ef. 12-5-11 thru 5-31-12; MHS 4-2012, f. 5-3-12, cert. ef. 5-4-12

309-040-0305

Definitions

As used in these rules the following definitions apply:

(1) “Abuse” includes but is not limited to:

(a) Any death caused by other than accidental or natural means or occurring in unusual circumstances;

(b) Any physical injury caused by other than accidental means, or that appears to be at variance with the explanation given of the injury;

(c) Willful infliction of physical pain or injury;

(d) Sexual harassment or exploitation including, but not limited to, any sexual contact between an employee of a community facility or community program, or provider, or other caregiver and the adult. For situations other than those involving an employee, provider, or other caregiver and an adult, sexual harassment or exploitation means unwelcome verbal or physical sexual contact including requests for sexual favors and other verbal or physical conduct directed toward the adult;

(e) Neglect that leads to physical harm through withholding of services necessary to maintain health and well being;

(f) Abuse does not include spiritual treatments by a duly accredited practitioner of a recognized church or religious denomination when voluntarily consented to by the adult.

(2) “Abuse Investigation and Protective Services” means an investigation and any subsequent services or supports necessary to prevent further abuse as required by ORS 430.745 to 430.765 and OAR 407-045-0000 through 407-045-0980, or any other rules established by the Authority applicable to allegations of abuse of residents of an Adult Foster Home licensed by the Division.

(3) “Activities of Daily Living (ADL)” are those individual skills necessary for a resident’s continued well being including eating and nutrition, dressing, personal hygiene, mobility, and toileting.

(4) “Administration of Medication” means administration of medicine or a medical treatment to a resident as prescribed by a Licensed Medical Practitioner.

(5) “Adult Foster Home (AFH)” means any home licensed by the Addictions and Mental Health Division of the Oregon Health Authority in which residential care is provided to five or fewer adults who are not related to the provider by blood or marriage as described in ORS 443.705 through 443.825. For the purpose of these rules, if an adult family member receives care, he or she must be included as one of the residents within the total license capacity of the home. A home or person that advertises, including word-of-mouth advertising, to provide room, board, and care and services for adults, is deemed to be an Adult Foster Home. For the purpose of these rules, an Adult Foster Home does not include facilities referenced in 443.715(1)(2)(3)(4).

(6) “Applicant” means any person or entity that makes an application for a license that is also the owner of the business.

(7) “Assessment” means an evaluation of a resident and the resident’s level of function completed by a case manager and provides the basis for the development of the resident’s Personal Care Plan.

(8) “Authority” means the Oregon Health Authority.

(9) “Authorized Department Representative” means an employee of the Addictions and Mental Health Division or the designee of the local Community Mental Health Program.

(10) “Behavioral Interventions” means those interventions that will modify the resident’s behavior or the resident’s environment.

(11) “Bill of Rights” means civil, legal or human rights afforded to Adult Foster Home residents, which are in accord with those rights afforded to all other U.S. citizens, including but not limited to those rights delineated in the Adult Foster Home Bill of Rights as described in OAR 309-040-0390(7).

(12) “Board of Nursing Rules” means the standards for Registered Nurse Teaching and Delegation and assignments to Unlicensed Persons according to the statutes and rule of the Oregon State Board of Nursing, chapter 851, division 47, ORS 678.010 to 678.445.

(13) “Care” means the provision of but is not limited to services of room, board, services and assistance with activities of daily living, such as assistance with bathing, dressing, grooming, eating, money management, recreational activities, and medication management. Care also means services that promote maximum resident independence and enhance quality of life.

(14) “Case Management” means identified services provided by qualified persons to residents by local, regional or state allied agencies or other service providers. Case management includes advocating for the resident’s treatment needs, providing assistance in obtaining entitlements based on mental or emotional disability, accessing housing or residential programs, coordinating services including mental health treatment, educational or vocational activities, and arranging alternatives to inpatient hospital services.

(15) “Case Manager” means a person employed by a local, regional, or state allied agency approved by the Division to provide case management services. In accordance with OAR 309-032-0545(2)(g)–(j), Standards for Adult Mental Health Services, when a resident resides in a Adult Foster Home, the case manager shall assist in development of the Personal Care Plan. Additionally, the case manager must evaluate the appropriateness of services in relation to the consumer’s assessed need and review the Personal Care Plan every 180 days.

(16) “Community Mental Health Program (CMHP)” means the organization of all services for persons with mental or emotional disturbances, drug abuse problems, and alcoholism and alcohol abuse problems, operated by, or contractually affiliated with, a local mental health authority, operated in a specific geographic area of the state under an intergovernmental agreement or direct contract with the Division.

(17) “Compensation” means payments made by or on behalf of a resident to a provider in exchange for room and board, care and services, including services described in the resident’s Personal Care Plan.

(18) “Complaint Investigation” means an investigation of any allegation that a provider has taken action, which is perceived as contrary to law, rule, or policy but does not meet the criteria for an abuse investigation.

(19) “Condition” means a provision attached to a new or existing license, which limits or restricts the scope of the license or imposes additional requirements on the licensee.

(20) “Contested Case Hearing” means an arbitrated hearing resulting in a directed or recommended action. The hearing is held at the request of the provider or the Division in response to an action, sanction, or notice of finding issued by the Division that would result in the loss of license of the provider or other sanctions that would adversely affect the license of the provider. The hearing group is composed of:

(a) The provider and if the provider chooses, the provider’s attorney;

(b) The Division as represented by the Attorney General’s Office; and

(c) The Office of Administration Hearings Administrative Law Judge.

(21) “Contract” means a written agreement between a provider and the Division to provide room and board, care and services for compensation for residents of a licensed Adult Foster Home.

(22) “Controlled Substance” means any drug classified as schedules one through five under the Federal Controlled Substance Act.

(23) “Criminal History Check (CHC)” means the Oregon Criminal History Check and when required, a National Criminal History check and or a State-Specific Criminal History check, and the processes and procedures required by the rules OAR 943-007-0000 through 943-007-0500 Criminal History Check.

(24) “Day Care” means care and services in an Adult Foster Home for a person who is not a resident of the Adult Foster Home. Children under the age of five living in the Adult Foster Home are included in the licensed capacity of the home.

(25) “Declaration for Mental Health Treatment” means a document that states the resident’s preferences or instructions regarding mental health treatment as defined by ORS 127.700 through 127.737.

(26) “Director” means the Director of the Oregon Health Authority or that person’s designee.

(27) “Discharge Summary” means a document that describes the conclusion of the planned course of services described in the resident’s individualized personal care plan, regardless of outcome or attainment of goals described in the resident’s individualized personal care plan. In addition, the discharge summary addresses resident’s monies, financial assets and monies, medication and personal belongings at time of discharge.

(28) “Division” means the Addictions and Mental Health Division of the Oregon Health Authority.

(29) “Employee” means a person who is employed by a licensed Adult Foster Home (AFH), who receives wages, a salary, or is otherwise paid by the AFH for providing the service. The term also includes employees of other providers delivering direct services to clients of AFHs.

(30) “Exempt Area” means a county agency that provides similar programs for licensing and inspection of Adult Foster Homes which the Director finds equal to or superior to the requirements of ORS 443.705 to 443.825 and which has entered into an agreement with the Authority to license, inspect, and collect fees according to the provisions of 443.705 to 443.825.

(31) “Family Member” for the purposes of these rules, means a husband or wife, natural parent, child, sibling, adopted child, domestic partner, adopted parent, stepparent, stepchild, stepbrother, stepsister, father-in-law, mother-in-law, son-in-law, brother-in-law, sister-in-law, grandparent, grandchild, aunt, uncle, niece, nephew, or first cousin.

(32) “Home” means the Adult Foster Home (AFH).

(33) “Homelike Environment” means an Adult Foster Home setting, which promotes the dignity, safety, independence, security, health and comfort of residents through the provision of personalized care and services to encourage independence, choice, and decision making of the residents.

(34) “House Rules” means those written standards governing house activities developed by the provider and approved by the Authority or designee. These standards must not conflict with the Adult Foster Home Bill of Rights.

(35) “Incident Report” means a written description and account of any occurrence including but not limited to, any injury, accident, acts of physical aggression, use of physical restraints, medication error, any unusual incident involving a resident or the home and/or providers.

(36) “Informed Consent for Services” means that the services to be provided by the Adult Foster Home provider to the person have been explained to the person and guardian, if applicable, and explained in a manner that they may comprehend.

(37) “Initial Personal Care Plan (IPCP)” means a written document developed for a resident within 24 hours of admission to the home. The document must address the care and services to be provided for the resident during the first 30 days or less until the Personal Care Plan can be developed. At a minimum the IPCP must contain goals that address the following: Immediate health care support needs, medication management issues, safety and supervision needs, activities of daily living that the resident needs assistance with completing as well as any pertinent information as required by the case manager or their designee at the time of the admission. The provider must develop an Initial Personal Care Plan (IPCP) within 24 hours of admission to the Adult Foster Home.

(38) “Level One Adult Foster Home” means an Adult Foster Home licensed by the Division to provide care and services to individuals with severe and persistent mental illness, who may also have limited medical conditions.

(39) “License” means a document issued by the Authority to applicants who are determined by the Authority or designee to be in substantial compliance with these rules.

(40) “Licensed Medical Practitioner (LMP)” means any person who meets the following minimum qualifications as documented by the CMHP or designee and holds at least one of the following educational degrees and a valid license:

(a) Physician licensed to practice in the State of Oregon; or

(b) Nurse practitioner licensed to practice in the State of Oregon.

(41) “Licensee” means the person or entity to whom a license is issued and whose name(s) is on the license.

(42) “Local Mental Health Authority (LMHA)” means the county court or board of county commissioners of one or more counties who choose to operate a community mental health program, or in the case of a Native American reservation, the tribal council, or if the county declines to operate or contract for all or part of a community mental health program, the board of directors of a public or private corporation which directly contracts with the Authority to operate a CMHP for that county.

(43) “Mandatory Reporter” means any public or private official who, while acting in an official capacity, comes in contact with and has reasonable cause to believe that the adult has suffered abuse, or that any person with whom the official contact while acting in an official capacity, has abused the adult. Pursuant to ORS 430.765(2) psychiatrists, psychologists, clergy, and attorneys are not mandatory reporters with regard to information received through communications that are privileged under 40.225 to 40.295.

(44) “Medication” means any drug, chemical, compound, suspension or preparation in suitable form for use as a curative or remedial substance taken either internally or externally by any person.

(45) “Mental or Emotional Disturbances (MED)” means a disorder of emotional reactions, thought processes, or behavior that results in substantial subjective distress or impaired perceptions of reality or impaired ability to control or appreciate the consequences of the person’s behavior and constitutes a substantial impairment of the person’s social, educational, or economic functioning. Medical diagnosis and classification must be consistent with the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association (DSM-IV). As used in these rules, this term is functionally equivalent to “serious and persistent mental illness.”

(46) “Mistreatment” means the following behaviors, displayed by an employee, program staff, provider or volunteer of an AFH when directed toward an individual:

(a) “Abandonment” means desertion or willful forsaking when the desertion or forsaking results in harm or places the individual at a risk of serious harm.

(b) “Financial Exploitation” means:

(A) Wrongfully taking the assets, funds, or property belonging to or intended for the use of an individual.

(B) Alarming an individual by conveying a threat to wrongfully take or appropriate money or property of the individual if the individual would reasonably believe that the threat conveyed would be carried out.

(C) Misappropriating, misusing, or transferring without authorization any money from any account held jointly or singly by an individual.

(D) Failing to use the income or assets of an individual effectively for the support and maintenance of the individual. “Effectively” means use of income or assets for the benefit of the individual.

(c) “Involuntary Restriction” means the involuntary restriction of an individual for the convenience of a caregiver or to discipline the individual. Involuntary restriction may include but is not limited to placing restrictions on an individual’s freedom of movement by restriction to his or her room or a specific area, or restriction from access to ordinarily accessible areas of the facility, residence or program, unless agreed to by the treatment plan. Restriction may be permitted on an emergency or short term basis when an individual’s presence would pose a risk to health or safety to the individual or others.

(d) “Neglect” means active or passive failure to provide the care, supervision, or services necessary to maintain the physical and mental health of an individual that creates a significant risk of harm to an individual or results in significant mental injury to an individual. Services include but are not limited to the provision of food, clothing, medicine, housing, medical services, assistance with bathing or personal hygiene, or any other services essential to the well-being of the individual.

(e) “Verbal Mistreatment” means threatening significant physical harm or emotional harm to an individual through the use of:

(A) Derogatory or inappropriate names, insults, verbal assaults, profanity, or ridicule.

(B) Harassment, coercion, punishment, deprivation, threats, implied threats, intimidation, humiliation, mental cruelty, or inappropriate sexual comments.

(C) A threat to withhold services or supports, including an implied or direct threat of termination of services. “Services” include but are not limited to the provision of food, clothing, medicine, housing, medical services, assistance with bathing or personal hygiene, or any other services essential to the well-being of an individual.

(D) For purposes of this definition, verbal conduct includes but is not limited to the use of oral, written, or gestured communication that is directed to an individual or within their hearing distance or sight, regardless of their ability to comprehend. In this circumstance the assessment of the conduct is based on a reasonable person standard.

(E) The emotional harm that can result from verbal abuse may include but is not limited to anguish, distress, or fear.

(f) “Wrongful Restraint” means:

(A) A wrongful use of a physical or chemical restraint excluding an act of restraint prescribed by a licensed physician pursuant to OAR 309-033-0730.

(B) Wrongful restraint does not include physical emergency restraint to prevent immediate injury to an individual who is in danger of physically harming himself or herself or others. Provided that only the degree of force reasonably necessary for protection is used for the least amount of time necessary.

(47) “National Criminal History Check” means obtaining and reviewing criminal history outside Oregon’s borders. This information may be obtained from the Federal Bureau of Investigation through the use of fingerprint cards and from other criminal information resources in accordance with OAR 943-007-0000 through 943-007-0500 Criminal History Check Rules.

(48) “Neglect” means an action or inaction that leads to physical harm through withholding of services necessary to maintain health and well-being. For purposes of this paragraph, “neglect” does not included a failure of the state or a community program to provide services due to a lack of funding available to provide the services.

(49) “Nurse Practitioner” means a registered nurse who has been certified by the board as qualified to practice in an expanded specialty role within the practice of nursing.

(50) “Nursing Care” means the practice of nursing by a licensed nurse, including tasks and functions relating to the provision of nursing care that are delegated under specified conditions by a registered nurse to persons other than licensed nursing personnel, which is governed by ORS chapter 678 and rules adopted by the Oregon State Board of Nursing in OAR Chapter 851.

(51) “Nursing Delegation” means that a registered nurse authorizes an unlicensed person to perform special tasks of client/nursing care in selected situations and indicates that authorization in writing. The delegation process includes nursing assessment of a client in a specific situation, evaluation of the ability of the unlicensed person, teaching the task and ensuring supervision.

(52) “Personal Care Plan (PCP)” means a written plan outlining the care and services to be provided to a resident. The PCP is based upon the review of current assessment, referral, observations, resident preference, and input from members of the Personal Care Plan Team. The plan identifies the care, services, activities, and opportunities to be provided by the caregiver to promote the resident’s recovery and independence.

(53) “Personal Care Plan Team (PCP Team)” means a group composed of the resident, the case manager or other designated representative CMHP representative, the provider and or resident manager, and others needed including the resident’s legal guardian, representatives of all current service providers, advocates or others determined appropriate by the resident receiving services. If the resident is unable or does not express a preference, other appropriate team membership must be determined by the PCP team members.

(54) “Personal Care Services” means services prescribed by a physician or other designated person in accordance with the individual’s plan of treatment. The services are provided by a caregiver that is qualified to provide the service and is not a member of the individual’s immediate family. For those Adult Foster Home individuals who are Medicaid eligible, Personal Care services are funded under Medicaid.

(55) “Practice of Registered Nursing” means the application of knowledge drawn from broad in-depth education in the social and physical sciences in assessing, planning, ordering, giving, delegating, teaching and supervising care which promotes the person’s optimum health and independence.

(56) “Program Staff” means an employee or person who, by contract with an AFH provides a service and who has the applicable competencies, qualifications, and certification, required by the Integrated Services and Supports Rule (ISSR) (OAR 309-032-1500 through 309-032-1565) to provide the service.

(57) “Provider” means a qualified individual or an organizational entity operated by or contractually affiliated with a community mental health program, or contracted directly with the Division for the direct delivery of mental health services and supports to adults receiving residential and supportive services in an AFH.

(58) “Psychiatric Security Review Board (PSRB)” means the Board consisting of five members appointed by the Governor and subject to confirmation by the Senate under Section Four, Article 111 of the Oregon Constitution and described in ORS 161.295 through 161.400 and OAR 309-032-1540.

(59) “Registered Nurse” means an individual licensed and registered to practice nursing by the State of Oregon Board of Nursing in accordance with ORS Chapter 678 and OAR Chapter 851.

(60) “Related” means spouse, domestic partner, natural parent, child sibling, adopted child, adopted parent, stepparent, stepchild, stepbrother, stepsister, father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law, sister-in-law, grandparent, grandchild, aunt, uncle, niece, nephew or first cousin.

(61) “Relative” means any person identified as family members.

(62) “Resident” means any person age 18 or older who receives room, board, care, and services in an Adult Foster Home.

(63) “Resident Manager” means an employee of the provider who is approved by the Division to live in the Adult Foster Home and is responsible for the care and services of residents on a day-to-day basis.

(64) “Residential Care” means the provision of room, board, and services that assist the resident in activities of daily living, such as assistance with bathing, dressing, grooming, eating, medication management, money management or recreation. Residential care includes 24 hour supervision; being aware of the residents’ general whereabouts; monitoring the activities of the resident while on the premises of the Adult Foster Home to ensure their health, safety, and welfare; providing social and recreational activities; and assistance with money management as requested.

(65) “Residents’ Bill of Rights” means residents of the Adult Foster Home have the following rights as defined in ORS 443.739. Each resident has a right to:

(a) Be treated as an adult, with respect and dignity;

(b) Be informed of all resident rights and all house rules;

(c) Be encouraged and assisted to exercise legal rights, including the right to vote;

(d) Be informed of the resident’s medical condition and the right to consent to or refuse treatment;

(e) Receive appropriate care and services, and prompt medical care as needed;

(f) A safe and secure environment;

(g) Be free from mental and physical abuse;

(h) Be free from chemical or physical restraints except as ordered by a physician or other qualified practitioner;

(i) Complete privacy when receiving treatment or personal care;

(j) Associate and communicate privately with any person the resident chooses;

(k) Send and receive personal mail unopened;

(l) Participate in activities of social, religious and community groups;

(m) Have medical and personal information kept confidential;

(n) Keep and use a reasonable amount of personal clothing and belongings, and to have a reasonable amount of private, secure storage space;

(o) Manage the resident’s own money and financial affairs unless legally restricted;

(p) Be free from financial exploitation. The provider must not charge or ask for application fees or nonrefundable deposits and must not solicit, accept or receive money or property from a resident other than the amount agreed to for services;

(q) A written agreement regarding the services to be provided and the rate schedule to be charged. The provider must give 30 days’ written notice before any change in the rates or the ownership of the home;

(r) Not to be transferred or moved out of the adult foster home without 30 days’ advance written notice and an opportunity for a hearing. A provider may transfer or discharge a resident only for medical reasons including a medical emergency described in ORS 443.738(11)(a), or for the welfare of the resident or other residents, or for nonpayment;

(s) Be free of discrimination in regard to race, color, national origin, sexual orientation, disability, sex or religion;

(t) Make suggestions and complaints without fear of retaliation.

(66) “Respite Care” means the provision of room, board, care, and services in an Adult Foster Home for a period of up to 14 days. Respite care residents will be counted in the total licensed capacity of the home. Respite care is not crisis respite care.

(67) “Restraints” means any physical hold, device, or chemical substance, which restricts, or is meant to restrict, the movement or normal functioning of a resident.

(68) “Room and Board” means the provision of meals, a place to sleep, laundry and housekeeping.

(69) “Seclusion” means the involuntary confinement of an individual to a room or area where the person is physically prevented from leaving.

(70) “Self-Administration of Medication” means the act of a resident placing a medication in or on their own body. The resident identifies the medication and the times and manners of administration, and placed the medication internally or externally on their own body without assistance.

(71) “Self Preservation” in relation to fire and life safety means the ability of residents to respond to an alarm without additional cues and be able to reach a point of safety without assistance.

(72) “Services” means those activities which are intended to help the residents develop appropriate skills to increase or maintain their level of functioning and independence. Services include coordination and consultation with other service providers or entities to assure residents access to necessary medical care, treatment, and/or services identified in the resident’s personal care plan.

(73) “Substitute Caregiver” means any person meeting the qualifications of a caregiver who provides care and services in an Adult Foster Home under the jurisdiction of the Authority in the absence of the provider or resident manager. A resident may not be a substitute caregiver.

(74) “Unusual Incident” means those incidents involving acts of physical aggression, serious illnesses or accidents, any injury or illness of a resident requiring a non-routine visit to a health care practitioner, suicide attempts, death of a resident, a fire requiring the services of a fire Department, or any incident requiring an abuse investigation.

(75) “Variance” means an exception from a regulation or provision of these rules, granted in writing by the Authority, upon written application from the provider.

(76) “Volunteer” means a person who provides a service or who takes part in a service provided to individuals receiving supportive services in an AFH or other provider, and who is not a paid employee of the AFH or other provider. The services must be non-clinical unless the person has the required credentials to provide a clinical service.

[Publications: Publications referenced are available from the agency.]

Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 426.072 & 443.705 - 443.825
Hist.: MHD 19-1985(Temp), f. & ef. 12-27-85; MHD 6-1986, f. & ef. 7-2-86; MHD 1-1992, f. & cert. ef. 1-7-92 (and corrected 1-31-92); MHD 6-1999, f. 8-24-99, cert. ef. 8-26-99; Renumbered from 309-040-0005, MHD 3-2005, f. & cert. ef. 4-1-05; MHS 6-2007(Temp), f. & cert. ef. 5-25-07 thru 11-21-07; MHS 13-2007, f. & cert. ef. 8-31-07; MHS 11-2011(Temp), f. & cert. ef. 12-5-11 thru 5-31-12; MHS 4-2012, f. 5-3-12, cert. ef. 5-4-12


 

Rule Caption: Residential Treatment Facilities for Mentally or Emotionally Disturbed Persons.

Adm. Order No.: MHS 5-2012

Filed with Sec. of State: 5-3-2012

Certified to be Effective: 5-4-12

Notice Publication Date: 4-1-2012

Rules Amended: 309-035-0100, 309-035-0105, 309-035-0250, 309-035-0260

Rules Repealed: 309-035-0100(T), 309-035-0105(T), 309-035-0250(T), 309-035-0260(T)

Subject: These rules prescribe standards by which the Addictions and Mental Health Division of the Oregon Health Authority approves residential treatment homes and facilities for adults with mental or emotional disorders.

Rules Coordinator: Nola Russell—(503) 945-7652

309-035-0100

Purpose and Scope

(1) Purpose. These rules prescribe standards by which the Addictions and Mental Health Division of the Oregon Health Authority approves residential treatment facilities for adults with mental or emotional disorders. The standards promote the well-being, health and recovery of adults with mental or emotional disorders through the availability of a wide range of residential service options. They prescribe how services will be provided in safe, secure and homelike environments that recognize the dignity, individuality and right to self-determination of each resident.

(2) Scope. These rules apply to residential treatment facilities for six to 15 residents and to residential treatment facilities serving 16 or more residents. Where standards differ based on the number of residents in a facility, the rules prescribe different requirements.

Stat. Auth.: ORS 413.042 & 443.450
Stats. Implemented: ORS 443.400 - 443.465 & 443.991
Hist.: MHD 9-1984(Temp), f. & ef. 12-10-84; MHD 9-1985, f. & ef. 6-7-85; MHD 4-1998, f. 5-21-98, cert. ef. 6-1-98; MHD 4-2005, f. & cert. ef. 4-1-05; MHS 4-2008, f. & cert. ef. 6-12-08; MHS 10-2011(Temp), f. & cert. ef. 12-5-11 thru 5-31-12; MHS 5-2012, f. 5-3-12, cert. ef. 5-4-12

309-035-0105

Definitions

As used in these rules the following definitions apply:

(1) “Abuse” includes but is not limited to:

(a) Any death caused by other than accidental or natural means or occurring in unusual circumstances;

(b) Any physical injury caused by other than accidental means, or that appears to be at variance with the explanation given of the injury;

(c) Willful infliction of physical pain or injury;

(d) Sexual harassment or exploitation including, but not limited to, any sexual contact between an employee of a community facility or community program, or provider, or other caregiver and the adult. For situations other than those involving an employee, provider, or other caregiver and an adult, sexual harassment or exploitation means unwelcome verbal or physical sexual contact including requests for sexual favors and other verbal or physical conduct directed toward the adult;

(e) Neglect that leads to physical harm through withholding of services necessary to maintain health and well being;

(f) Abuse does not include spiritual treatments by a duly accredited practitioner of a recognized church or religious denomination when voluntarily consented to by the individual.

(2) “Administrator” means the person designated by the licensee as responsible for the daily operation and maintenance of the facility.

(3) “Adult” means an individual 18 years of age or older.

(4) “Aid to Physical Functioning” means any special equipment ordered for a resident by a Licensed Medical Professional (LMP) or other qualified health care professional which maintains or enhances the resident’s physical functioning.

(5) “Applicant” means the person(s) or entity, including the Division, who owns or maintains and operates the facility and is applying for the license.

(6) “Approved” means authorized or allowed by the Division.

(7) “Authority” means the Oregon Health Authority.

(8) “Building Code” means the Oregon Structural Specialty Code adopted by the Building Codes Division of the Oregon Department of Consumer and Business Services.

(9) “Care” means services such as supervision; protection; assistance with activities of daily living such as bathing, dressing, grooming or eating; management of money; transportation; recreation; and the providing of room and board.

(10) “Caregiver” means an employee, program staff, provider or volunteer of a licensed Residential Treatment Facility (RTF).

(11) “Community Mental Health Program (CMHP)” means the organization of all or a portion of services for persons with mental or emotional disorders, operated by, or contractually affiliated with, a local mental health authority, operated in a specific geographic area of the state under an intergovernmental agreement or direct contract with the Division.

(12) “Contract” means a formal written agreement between the community mental health program, Oregon Health Plan contractor or the Division and a Residential Treatment Facility (RTF) owner. (13) “Crisis-Respite Services” means the provision of services to individuals for up to 30 days. Individuals receiving crisis-respite services are RTF residents.

(14) “DSM” means the “Diagnostic and Statistical Manual of Mental Disorders (DSM-IV),” published by the American Psychiatric Association.

(15) “Deputy Director” means the Deputy Director of the Addictions and Mental Health Division of the Oregon Health Authority.

(16) “Division” means the Addictions and Mental Health Division of the Oregon Health Authority.

(17) “Direct Care Staff Person” means an employee responsible for providing services to residents.

(18) “Emergency Admission” means an admission to an RTF made on an urgent basis due to the pressing service needs of the individual.

(19) “Employee” means a person who is employed by a licensed Residential Treatment Facility (RTF), who receives wages, a salary, or is otherwise paid by the RTF for providing the service. The term also includes employees of other providers delivering direct services to clients of RTFs.

(20) “Evacuation Capability” means the ability of occupants, including residents and staff as a group, to either evacuate the building or relocate from a point of occupancy to a point of safety as defined in the Oregon Structural Specialty Code. The category of evacuation capability is determined by documented evacuation drill times or scores on National Fire Protective Association (NFPA) 101A 2000 edition worksheets. There are three categories of evacuation capability:

(a) Impractical (SR-2): A group, even with staff assistance, that cannot reliably move to a point of safety in a timely manner, determined by an evacuation capability score of five or greater or with evacuation drill times in excess of 13 minutes.

(b) Slow (SR-1): A group that can move to a point of safety in a timely manner, determined by an evacuation capability score greater than 1.5 and less than five or with evacuation drill times over three minutes but not in excess of 13 minutes.

(c) Prompt: A group with an evacuation capability score of 1.5 or less or equivalent to that of the general population or with evacuation drill times of three minutes or less. The Division is authorized to determine evacuation capability for RTFs in accordance with the NFPA 101A 2000 edition. Facilities that are determined to be “Prompt” may be used in Group R occupancies classified by the building official, in accordance with the building code.

(21) “Facility” means one or more buildings and adjacent grounds on contiguous properties that are used in the operation of a Residential Treatment Facility.

(22) “Fire Code” means the Oregon Fire Code as adopted by the State of Oregon Fire Marshal.

(23) “Individual” means any person being considered for or receiving residential and other services regulated by these rules.

(24) “Licensed Medical Professional (LMP)” means a person who meets the following minimum qualifications as documented by the Local Mental Health Authority (LMHA) or designee:

(a) Holds at least one of the following educational degrees and valid licensures:

(A) Physician licensed to practice in the State of Oregon;

(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

(b) Whose training, experience and competence demonstrate the ability to conduct a Comprehensive Mental Health Assessment and provide medication management.

(25) “Licensee” means the person(s) or entity legally responsible for the operation of the facility to which the Division has issued a license.

(26) “Local Mental Health Authority (LMHA)” means the county court or board of county commissioners of one or more counties who choose to operate a CMHP or MHO; or, if the county declines to operate or contract for all or part of a CMHP or MHO, the board of directors of a public or private corporation which contracts with the Division to operate a CMHP or MHO for that county.

(27) “Medication” means any drug, chemical, compound, suspension, or preparation in suitable form for use as a curative or remedial substance either internally or externally by any person.

(28) “Mental or Emotional Disorder” means a primary Axis I or Axis II DSM diagnosis, other than mental retardation or a substance abuse disorder that limits an individual’s ability to perform activities of daily living.

(29) “Mental Health Assessment” means a determination by a Qualified Mental Health Professional (QMHP) of the client’s need for mental health services. It involves collection and assessment of data pertinent to the client’s mental health history and current mental health status obtained through interview, observation, testing, and review of previous treatment records. It concludes with determination of a DSM diagnosis or other justification of priority for mental health services, or a written statement that the person is not in need of community mental health services.

(30) “Mental Health Organization (MHO)” means an approved organization that provides most mental health services through a capitated payment mechanism under the Oregon Health Plan. MHOs may be fully capitated health plans, community mental health programs, private mental health organizations or combinations thereof.

(31) “Mistreatment” means the following behaviors, displayed by an employee, program staff, provider or volunteer of an RTF when directed toward an individual:

(a) “Abandonment” means desertion or willful forsaking when the desertion or forsaking results in harm or places the individual at a risk of serious harm.

(b) “Financial Exploitation” means:

(A) Wrongfully taking the assets, funds, or property belonging to or intended for the use of an individual.

(B) Alarming an individual by conveying a threat to wrongfully take or appropriate money or property of the individual if the individual would reasonably believe that the threat conveyed would be carried out.

(C) Misappropriating, misusing, or transferring without authorization any money from any account held jointly or singly by an individual.

(D) Failing to use the income or assets of an individual effectively for the support and maintenance of the individual. “Effectively” means use of income or assets for the benefit of the individual.

(c) “Involuntary Restriction” means the involuntary restriction of an individual for the convenience of a caregiver or to discipline the individual. Involuntary restriction may include but is not limited to placing restrictions on an individual’s freedom of movement by restriction to his or her room or a specific area, or restriction from access to ordinarily accessible areas of the facility, residence or program, unless agreed to by the treatment plan. Restriction may be permitted on an emergency or short term basis when an individual’s presence would pose a risk to health or safety to the individual or others.

(d) “Neglect” means active or passive failure to provide the care, supervision, or services necessary to maintain the physical and mental health of an individual that creates a significant risk of harm to an individual or results in significant mental injury to an individual. Services include but are not limited to the provision of food, clothing, medicine, housing, medical services, assistance with bathing or personal hygiene, or any other services essential to the well-being of the individual.

(e) “Verbal Mistreatment” means threatening significant physical harm or emotional harm to an individual through the use of:

(A) Derogatory in inappropriate names, insults, verbal assaults, profanity or ridicule.

(B) Harassment, coercion, punishment, deprivation, threats, implied threats, intimidation, humiliation, mental cruelty, or inappropriate sexual comments.

(C) A threat to withhold services or supports, including an implied or direct threat of termination of services. “Services” include but are not limited to the provision of food, clothing, medicine, housing, medical services, assistance with bathing or personal hygiene, or any other services essential to the well-being of an individual.

(D) For purposes of this definition, verbal conduct includes but is not limited to the use of oral, written, or gestured communication that is directed to an individual or within their hearing distance of sight, regardless of their ability to comprehend. In this circumstance the assessment of the conduct is based on a reasonable person standard.

(E) The emotional harm that can result from verbal abuse may include but is not limited to anguish, distress or fear.

(f) “Wrongful Restraint” means:

(A) A wrongful use of a physical or chemical restraint excluding an act of restraint prescribed by a licensed physician pursuant to OAR 309-033-0730.

(B) Wrongful restraint does not include physical emergency restraint to prevent immediate injury to an individual who is in danger of physically harming himself or herself or others, provided that only the degree of force reasonably necessary for protection is used for the least amount of time necessary.

(32) “Nursing Care” means the practice of nursing by a licensed nurse, including tasks and functions that are delegated by a registered nurse to a person other than a licensed nurse, which are governed by ORS Chapter 678 and rules adopted by the Oregon State Board of Nursing in OAR Chapter 851.

(33) “Owner” means the person(s) or entity, including the Division, that is legally responsible for the operation of the facility.

(34) “P.R.N. (pro re nata) Medications and Treatments” means those medications and treatments which have been ordered to be given as needed.

(35) “Program” means the Residential Treatment Facility and may refer to the owner, staff and/or services as applicable to the context.

(36) “Program Staff” means an employee or person who, by contract with an RTF, provides a service and who has the applicable competencies, qualifications, and certification, required by the Integrated Services and Supports Rule (ISSR), OAR 309-032-1500 through 309-032-1565 to provide the service.

(37) “Progress Notes” means the notations in the resident record documenting significant information concerning the resident and summarizing progress made relevant to the objectives outlined in the residential service plan.

(38) “Protection” means the necessary actions taken by the program to prevent abuse, mistreatment, or exploitation of the residents, to prevent self-destructive acts, and to safeguard residents, property and funds.

(39) “Provider” means a qualified individual or an organizational entity operated by or contractually affiliated with a community mental health program, or contracted directly with the Division for the direct delivery of mental health services and supports to adults receiving residential and supportive services in an RTF.

(40) “Resident” means any adult residing in a facility who receives services on a 24-hour basis, except as excluded under ORS 443.400.

(41) “Residential Service Plan” means an individualized, written plan outlining the care and treatment to be provided to a resident in or through the facility based upon an individual assessment of care and treatment needs. The residential service plan may be a section or subcomponent of the individual’s overall mental health treatment plan when the RTF is operated by a mental health service agency that provides other services to the resident.

(42) “Residential Treatment Facility (RTF)” means a facility that is operated to provide services on a 24-hour basis for six or more residents.

(43) “Restraints” means any chemical or physical methods or devices that are intended to restrict or inhibit the movement, functioning, or behavior of a resident.

(45) “Seclusion” means placing an individual in a locked room. A locked room includes a room with any type of door locking device, such as a key lock, spring lock, bolt lock, foot pressure lock, or physically holding the door shut.

(46) “Secure Residential Treatment Facility (SRTF)” means any Residential Treatment Facility, or portion thereof, that restricts a resident’s exit from the facility or its grounds through the use of approved locking devices on resident exit doors, gates or other closures. Such locking locking devices will be installed in accordance with Building Code requirements.

(47) “Services” means the care and treatment provided to residents as part of the Residential Treatment Facility plan.

(48) “Supervision” means the daily observation, and monitoring of residents by direct care staff or oversight of staff by the administrator or administrator’s designee, as applicable to the context.

(49) “Termination of Residency” means the time at which the resident ceases to live in the RTF, and includes the transfer of the resident to another facility, but does not include absences from the facility for the purpose of taking a planned vacation, visiting family or friends, or receiving time-limited medical or psychiatric treatment.

(50) “Treatment” means a planned, individualized program of medical, psychological or rehabilitative procedures, experiences and activities consistent with ORS 443.400(12).

(51) “Volunteer” means a person who provides a service or who takes part in a service provided to individuals receiving supportive services in an RTF or other provider, and who is not a paid employee of the RTF or other provider. The services must be non-clinical unless the person has the required credentials to provide a clinical service.

Stat. Auth.: ORS 413.042 & 443.450
Stats. Implemented: ORS 443.400 - 443.465 & 443.991
Hist.: MHD 9-1984(Temp), f. & ef. 12-10-84; MHD 9-1985, f. & ef. 6-7-85; MHD 4-1998, f. 5-21-98, cert. ef. 6-1-98; MHD 4-2005, f. & cert. ef. 4-1-05; MHS 6-2007(Temp), f. & cert. ef. 5-25-07 thru 11-21-07; MHS 13-2007, f. & cert. ef. 8-31-07; MHS 4-2008, f. & cert. ef. 6-12-08; MHS 10-2011(Temp), f. & cert. ef. 12-5-11 thru 5-31-12; MHS 5-2012, f. 5-3-12, cert. ef. 5-4-12

309-035-0250

Purpose, Scope and Statutory Authority

(1) Purpose. These rules prescribe standards by which the Addictions and Mental Health Division of the Oregon Health Authority approves residential treatment homes for adults with mental or emotional disorders. The standards promote the well-being, health and recovery of adults with mental or emotional disorders through the availability of a wide range of residential service options. They prescribe how services will be provided in safe, secure and homelike environments that recognize the dignity, individuality and right to self-determination of each resident.

(2) Scope. These rules apply to residential treatment homes for five or fewer residents.

Stat. Auth.: ORS 413.042 & 443.450
Stats. Implemented: ORS 443.400 - 443.465 & 443.991
Hist.: MHD 7-1999, f. 11-15-99, cert. ef. 12-1-99; MHD 5-2005, f. & cert. ef. 4-1-05; MHS 10-2011(Temp), f. & cert. ef. 12-5-11 thru 5-31-12; MHS 5-2012, f. 5-3-12, cert. ef. 5-4-12

309-035-0260

Definitions

As used in these rules the following definitions apply:

(1) “Abuse” includes but is not limited to:

(a) Any death caused by other than accidental or natural means or occurring in unusual circumstances;

(b) Any physical injury caused by other than accidental means, or that appears to be at variance with the explanation given of the injury;

(c) Willful infliction of physical pain or injury;

(d) Sexual harassment or exploitation including, but not limited to, any sexual contact between an employee of a community facility or community program, or provider, or other caregiver and the adult. For situations other than those involving an employee, provider, or other caregiver and an adult, sexual harassment or exploitation means unwelcome verbal or physical sexual contact including requests for sexual favors and other verbal or physical conduct directed toward the adult;

(e) Neglect that leads to physical harm through withholding of services necessary to maintain health and well being;

(f) Abuse does not include spiritual treatments by a duly accredited practitioner of a recognized church or religious denomination when voluntarily consented to by the individual. (2) “Administrator” means the person designated by the licensee as responsible for the daily operation and maintenance of the Residential Treatment Home (RTH).

(3) “Adult” means an individual 18 years of age or older.

(4) “Aid to Physical Functioning” means any special equipment ordered for a resident by a Licensed Medical Professional or other qualified health care professional which maintains or enhances the resident’s physical functioning.

(5) “Applicant” means the person(s) or entity that owns the business and is applying for the license.

(6) “Approved” means authorized or allowed by the Department.

(7) “Authority” means the Oregon Health Authority.

(8) “Building Code” means the state building code as defined in ORS 455.010 and includes the Oregon Structural Specialty Code, One and Two Family Dwelling Code and other specialty codes adopted by the Building Codes Division of the Oregon Department of Consumer and Business Services.

(9) “Care” means services such as supervision; protection; assistance with activities of daily living such as bathing, dressing, grooming, or eating; management of money; transportation; recreation; and the providing of room and board.

(10) “Caregiver” means an employee, program staff, provider or volunteer of a licensed Residential Treatment Facility (RTF), Residential Treatment Home (RTH) or Adult Foster Home (AFH).

(11) “Community Mental Health Program (CMHP)” means the organization of all or a portion of services for persons with mental or emotional disorders, and operated by, or contractually affiliated with, a local mental health authority, operated in a specific geographic area of the state under an intergovernmental agreement or direct contract with the Division.

(12) “Contract” means a formal written agreement between the community mental health program, Mental Health Organization or the Addictions and Mental Health Division and a Residential Treatment Home (RTH) owner.

(13) “Crisis-Respite Services” means the provision of services to individuals for up to 30 days. Individuals receiving crisis-respite services are RTH residents.

(14) “DSM” means the “Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)” published by the American Psychiatric Association.

(15) “Direct Care Staff Person” means an employee responsible for providing services to residents.

(16) “Division” means the Addictions and Mental Health Division of the Oregon Health Authority.

(17) “Electrical Code” means the Uniform Building and Fire Codes adopted on October 1, 2004 by the Building Codes Division of the Oregon Department of Consumer and Business Services.

(18) “Emergency Admission” means an admission to an RTH made on an urgent basis due to the pressing service needs of the individual.

(19) “Employee” means a person who is employed by a licensed Residential Treatment Home (RTH) who receives wages, a salary, or is otherwise paid by the RTH for providing the service. The term also includes employees of other providers delivering direct services to clients of RTHs.

(20) “Evacuation Capability” means the ability of occupants, including residents and staff as a group, to either evacuate the building or relocate from a point of occupancy to a point of safety as defined in the Oregon Structural Specialty Code. The category of evacuation capability is determined by documented evacuation drill times or scores on National Fire Protective Association (NFPA) 101A 2000 edition worksheets. There are three categories of evacuation capability:

(a) Impractical (SR- 2): A group, even with staff assistance, that cannot reliably move to a point of safety in a timely manner, determined by an evacuation capability score of five or greater or with evacuation drill times in excess of 13 minutes.

(b) Slow (SR- 1) for more than 16 residents) and (SR-4 for 6 to 16 residents): A group that can move to a point of safety in a timely manner, determined by an evacuation capability score greater than 1.5 and less than five or with evacuation drill times over three minutes but not in excess of 13 minutes. SR-3 occupancies are those homes with five or fewer occupants having evacuation capabilities of impractical or slow with assistance.

(c) Prompt: A group with an evacuation capability score of 1.5 or less or equivalent to that of the general population or with evacuation drill times of three minutes or less. The Division shall determine evacuation capability for RTH’s in accordance with the National Fire Protection Association (NFPA) 101A 2000 edition. Facilities that are determined to be “Prompt” may be used in Group R occupancies classified by the building official, in accordance with the building code.

(21) “Fire Code” means the Oregon Fire Code as adopted by the Office of State Fire Marshal and as amended by local jurisdictions.

(22) “Home” means the building and grounds where the Residential Treatment Home program is operated.

(23) “Individual” means any person being considered for or receiving residential and other services regulated by these rules.

(24) “Licensed Medical Professional (LMP)” means a person who meets the following minimum qualifications as documented by the Local Mental Health Authority (LMHA) or designee:

(a) Holds at least one of the following educational degrees and valid licensures:

(A) Physician licensed to practice in the State of Oregon;

(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

(b) Whose training, experience, and competence demonstrate the ability to conduct a Comprehensive Mental Health Assessment and provide medication management.

(25) “Licensee” means the person or entity legally responsible for the operation of the RTH to which the Division has issued a license.

(26) “Local Mental Health Authority (LMHA)” means the county court or board of county commissioners of one or more counties who choose to operate a CMHP or MHO; or, if the county declines to operate or contract for all or part of a CMHP or MHO, the board of directors of a public or private corporation which contracts with the Division to operate a CMHP or MHO for that county.

(27) “Mechanical Code” means the Oregon Mechanical Specialty Code adopted by the Building Codes Division of the Oregon Department of Consumer and Business Services.

(28) “Medication” means any drug, chemical, compound, suspension, or preparation in suitable form for use as a curative or remedial substance either internally or externally by any person.

(29) “Mental or Emotional Disorder” means a primary Axis I or Axis II DSM diagnosis, other than mental retardation or a substance abuse disorder that limits an individual’s ability to perform activities of daily living.

(30) “Mental Health Assessment” means a determination by a Qualified Mental Health Professional of the client’s need for mental health services. It involves collection and assessment of data pertinent to the client’s mental health history and current mental health status obtained through interview, observation, testing, and review of previous treatment records. It concludes with determination of a DSM diagnosis or other justification of priority for mental health services, or a written statement that the person is not in need of community mental health services.

(31) “Mental Health Organization (MHO)” means an approved organization that provides most mental health services through a capitated payment mechanism under the Oregon Health Plan. MHOs may be fully capitated health plans, community mental health programs, private mental health organizations or combinations thereof.

(32) “Mistreatment” means the following behaviors, displayed by an employee, program staff, provider or volunteer of an RTH when directed toward an individual:

(a) “Abandonment” means desertion or willful forsaking when the desertion or forsaking results in harm or places the individual at a risk of serious harm.

(b) “Financial exploitation” means:

(A) Wrongfully taking the assets, funds, or property belonging to or intended for the use of an individual.

(BI) Alarming an individual by conveying a threat to wrongfully take or appropriate money or property of the individual if the individual would reasonably believe that the threat conveyed would be carried out.

(C) Misappropriating, misusing, or transferring without authorization any money from any account held jointly or singly by an individual.

(D) Failing to use the income or assets of an individual effectively for the support and maintenance of the individual. “Effectively” means use of income or assets for the benefit of the individual.

(c) “Involuntary Restriction” means the involuntary restriction of an individual for the convenience of a caregiver or to discipline the individual. Involuntary restriction may include but is not limited to placing restrictions on an individual’s freedom of movement by restriction to his or her room or a specific area, or restriction from access to ordinarily accessible areas of the facility, residence or program, unless agreed to by the treatment plan. Restriction may be permitted on an emergency or short term basis when an individual’s presence would pose a risk to health or safety to the individual or others.

(d) “Neglect” means active or passive failure to provide the care, supervision, or services necessary to maintain the physical and mental health of an individual that creates a significant risk of harm to an individual or results in significant mental injury to an individual. Services include but are not limited to the provision of food, clothing, medicine, housing, medical services, assistance with bathing or personal hygiene, or any other services essential to the well-being of the individual.

(e) “Verbal Mistreatment” means threatening significant physical harm or emotional harm to an individual through the use of:

(A) Derogatory or inappropriate names, insults, verbal assaults, profanity, or ridicule.

(B) Harassment, coercion, punishment, deprivation, threats, implied threats, intimidation, humiliation, mental cruelty, or inappropriate sexual comments.

(C) A threat to withhold services or supports, including an implied or direct threat of termination of services. “Services” include but are not limited to the provision of food, clothing, medicine, housing, medical services, assistance with bathing or personal hygiene, or any other services essential to the well-being of an individual.

(D) For purposes of this definition, verbal conduct includes but is not limited to the use of oral, written, or gestured communication that is directed to an individual or within their hearing distance or sight, regardless of their ability to comprehend. In this circumstance the assessment of the conduct is based on a reasonable person standard.

(E) The emotional harm that can result from verbal abuse may include but is not limited to anguish, distress, or fear.

(f) “Wrongful Restraint” means:

(A) A wrongful use of a physical or chemical restraint excluding an act of restraint prescribed by a licensed physician pursuant to OAR 309-033-0730.

(B) Wrongful restraint does not include physical emergency restraint to prevent immediate injury to an individual who is in danger of physically harming himself or herself or others, provided that only the degree of force reasonably necessary for protection is used for the least amount of time necessary.

(33) “Nursing Care” means the practice of nursing by a licensed nurse, including tasks and functions that are delegated by a registered nurse to a person other than a licensed nurse, which are governed by ORS Chapter 678 and rules adopted by the Oregon State Board of Nursing in OAR Chapter 851.

(34) “Owner” means the person or entity including the Division that is legally responsible for the operation of the facility.

(35) “Plumbing Code” means the Oregon Plumbing Specialty Code adopted by the Building Codes Division of the Oregon Department of Consumer and Business Services.

(36) “P.R Nn. (pro re nata) Medications and Treatments” means those medications and treatments that have been ordered to be given as needed.

(37) “Program” means the Residential Treatment Home and may refer to the owner, staff, or services as applicable to the context.

(38) “Program staff” means an employee or person who, by contract with an RTH, provides a service and who has the applicable competencies, qualifications, and certification, required by the Integrated Services and Supports Rule (ISSR) (OAR 309-032-1500 to 309-032-1565) to provide the service.

(39) “Progress Notes” means the notations in the resident record documenting significant information concerning the resident and summarizing progress made relevant to the objectives outlined in the residential service plan.

(40) “Protection” means the necessary actions taken by the program to prevent abuse, mistreatment, or exploitation of the residents, to prevent self-destructive acts, and to safeguard residents, property, and funds.

(41) “Provider” means a qualified individual or an organizational entity operated by or contractually affiliated with a community mental health program, or contracted directly with the Division for the direct delivery of mental health services and supports to adults receiving residential and supportive services in an RTH.

(42) “Qualified Health Care Professional” means a health care professional licensed to practice in the state of Oregon who is approved to perform certain health care tasks referenced in the relevant section of these rules consistent with the scope of practice specified by the licensing board for the profession. In accordance with the referenced health care task, the qualified health care professional may include a physician, a physician’s assistant, a nurse practitioner, a registered nurse, or a pharmacist.

(43) “Qualified Mental Health Professional (QMHP)” means a Licensed Medical Practitioner (LMP) or any other person meeting the following minimum qualifications as documented by the LMHA or designee:

(a) Graduate degree in psychology;

(b) Bachelor’s degree in nursing and licensed by the State of Oregon;

(c) Graduate degree in social work;

(d) Graduate degree in behavioral science field;

(e) Graduate degree in recreational, art, or music therapy; or

(f) Bachelor’s degree in occupational therapy and licensed by the State of Oregon; and

(g) Whose education and experience demonstrates the competencies to identify precipitating events; gather histories of mental and physical disabilities, alcohol and drug use, past mental health services and criminal justice contacts; assess family, social and work relationships; conduct a mental status examination; document a multiaxial DSM diagnosis; write and supervise a Treatment Plan; conduct a Comprehensive Mental Health Assessment; and provide individual, family, and group therapy within the scope of his or her practice.

(44) “Resident” means any adult residing in the RTH who receives services on a 24-hour basis, except as excluded under ORS 443.400(3).

(45) “Residential Service Plan” means an individualized, written plan outlining the care and treatment to be provided to a resident in or through the RTH based upon an individual assessment of care and treatment needs. The residential service plan may be a section or subcomponent of the individual’s overall mental health treatment plan when the RTH is operated by a mental health service agency that provides other services to the resident.

(46) “Residential Treatment Home (RTH)” means a home that is operated to provide services on a 24-hour basis for five or fewer residents.

(47) “Restraints” means any chemical or physical methods or devices that are intended to restrict or inhibit the movement, functioning, or behavior of a resident.

(48) “Seclusion” means placing an individual in a locked room. A locked room includes a room with any type of door locking device, such as a key lock, spring lock, bolt lock, foot pressure lock, or physically holding the door shut.

(49) “Secure Residential Treatment Facility” means any residential treatment facility, or portion thereof, that restricts a resident’s exit from the facility or its grounds through the use of approved locking devices on resident exit doors, gates or other closures.

(50) “Services” means the care and treatment provided to residents as part of the RTH program.

(51) “Supervision” means the daily observation, and monitoring of residents by direct care staff or oversight of staff by the administrator or administrator’s designee, as applicable to the context.

(52) “Termination of Residency” means the time at which the resident ceases to live in the RTH and includes the transfer of the resident to another facility, but does not include absences from the RTH for the purpose of taking a planned vacation, visiting family or friends, or receiving time-limited medical or psychiatric treatment.

(53) “Treatment” means a planned, individualized program of medical, psychological or rehabilitative procedures, experiences and activities consistent with ORS 443.400(12).

(54) “Volunteer” means a person who provides a service or who takes part in a service provided to individuals receiving supportive services in an RTH or other provider, and who is not a paid employee of the RTH or other provider. The services must be non-clinical unless the person has the required credentials to provide a clinical service.

Stat. Auth.: ORS 413.042 & 443.450
Stats. Implemented: ORS 443.400 - 443.455, 443.875, 443.991
Hist.: MHD 7-1999, f. 11-15-99, cert. ef. 12-1-99; MHD 5-2005, f. & cert. ef. 4-1-05; MHS 6-2007(Temp), f. & cert. ef. 5-25-07 thru 11-21-07; MHS 13-2007, f. & cert. ef. 8-31-07; MHS 10-2011(Temp), f. & cert. ef. 12-5-11 thru 5-31-12; MHS 5-2012, f. 5-3-12, cert. ef. 5-4-12


 

Rule Caption: State Hospital Admissions and Discharges.

Adm. Order No.: MHS 6-2012

Filed with Sec. of State: 5-3-2012

Certified to be Effective: 5-4-12

Notice Publication Date: 4-1-2012

Rules Adopted: 309-091-0000, 309-091-0005, 309-091-0010, 309-091-0015, 309-091-0020, 309-091-0025, 309-091-0030, 309-091-0035, 309-091-0040, 309-091-0045, 309-091-0050

Rules Repealed: 309-091-0000(T), 309-091-0005(T), 309-091-0010(T), 309-091-0015(T), 309-091-0020(T), 309-091-0025(T), 309-091-0030(T), 309-091-0035(T), 309-091-0040(T), 309-091-0045(T), 309-091-0050(T)

Subject: These rules establish and define the criteria which support the proper management and utilization of services provided by the Oregon State Hospital system by limiting admissions those most severely symptomatic individuals whose treatment and recovery needs cannot be met in a community treatment setting.

Rules Coordinator: Nola Russell—(503) 945-7652

309-091-0000

Purpose and Scope

(1) These rules establish and define the criteria which support the proper management and utilization of services provided by the Oregon state hospital system, by limiting admissions to those most severely symptomatic individuals whose treatment and recovery needs cannot be met in a community treatment setting.

(2) These rules apply to all individuals admitted into any state hospital setting, and address differences which occur due to each individual’s legal status.

Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 179.321, 426.010, 426.020, 426.072
Hist.: MHS 16-2011(Temp), f. 12-29-11, cert. ef. 1-1-12 thru 6-29-12; MHS 6-2012, f. 5-3-12, cert. ef. 5-4-12

309-091-0005

Definitions

(1) “AMH” means the Addictions and Mental Health Division of the Oregon Health Authority.

(2) “Authority” means the Oregon Health Authority.

(3) “Chief Medical Officer” (CMO) means the physician designated by the superintendent of each state institution who is responsible for the administration of medical treatment, or his or her designee.

(4) “Civil Commitment” means the individual has been committed to the Authority for emergency psychiatric care and treatment pursuant to ORS 426.070, 426.228 to 426.235 or 426.237.

(5) “Clinical Reviewer” means the Division employee designated to the role of determining eligibility for state hospital admissions.

(6) “Division” means the Addictions and Mental Health Division of the Oregon Health Authority.

(7) “DSM” means the most recent edition of the Diagnostic and Statistical Manual of Psychiatric Disorders, published by the American Psychiatric Association.

(8) “Forensic” means related to the law, and references individuals committed to treatment and supervision by the courts pursuant to Oregon Revised Statutes (ORS) 161.290 – 161.400.

(9) “Legal Guardian” in this rule means an individual appointed by a court of law to act as guardian of an adult having been determined to be legally incapacitated.

(10) “Licensed Residential Facility or Licensed Residential Home” means those residences defined in OAR 309, Chapter 035.

(11) “Local Mental Health Authority” (LMHA) means one of the following entities:

(a) The Board of County Commissioners of one or more counties that establishes or operates a CMHP;

(b) The tribal council of a federally recognized tribe of Native Americans that elects to enter into an agreement to provide mental health services or

(c) A regional LMHA comprised of two or more boards of county commissioners.

(12) “Primary Diagnosis” means the diagnosis which identified the condition considered the most severe for which the individual receives treatment.

(13) “Psychiatric Security Review Board” (PSRB) means board appointed by the Governor and authorized in ORS 161.385.

(14) “Responsible Party” means the LMHA, community mental health program, the Medicaid managed care organization, when applicable the individual’s legal guardian, and other parties identified by AMH.

(15) “Severe Mental Illness” (SMI) means an individual’s symptoms meet the criteria in OAR 309-091-0010.

(16) “State Hospital” means any campus of the Oregon State Hospital (OSH) system, and the Blue Mountain Recovery Center (BMRC).

Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 179.321, 426.010, 426.020, 426.072
Hist.: MHS 16-2011(Temp), f. 12-29-11, cert. ef. 1-1-12 thru 6-29-12; MHS 6-2012, f. 5-3-12, cert. ef. 5-4-12

309-091-0010

Civilly Committed and Guardian Authorized Admission Criteria

Each non-forensic individual admitted to a state hospital must meet the following criteria:

(1) The individual must be age 18 or older;

(2) The individual must be named in a current civil commitment order, or the individual’s legal guardian must have signed consent for admission;

(3) There must be recent documentation by a qualified professional that the individual is experiencing an Axis I diagnosis of a mental disorder with severe psychotic symptoms, such as schizophrenia, delusional disorder, affective disorder, mood disorder or other disorders which manifest psychotic symptoms as defined in the most recent version of the DSM; and

(4) The current symptoms must be of such severity that the resulting symptoms require extended placement in a 24-hour medically supervised psychiatric hospital. Severity is established by a determination of:

(a) The degree of dangerousness to self;

(b) The degree of dangerousness to others; and

(c) The degree of the individual’s inability to meet his or her basic health and safety needs.

Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 179.321, 426.010, 426.020, 426.072
Hist.: MHS 16-2011(Temp), f. 12-29-11, cert. ef. 1-1-12 thru 6-29-12; MHS 6-2012, f. 5-3-12, cert. ef. 5-4-12

309-091-0015

Determining Need for State Hospital Care

(1) State hospital level of care is determined appropriate when the individual’s condition or symptoms have not improved in an acute care setting despite having received comprehensive psychiatric and medical assessment, treatment and/or community services typical for a psychiatric illness or psychiatric emergency.

(2) Prior to referral for admission to a state hospital, the individual should have received:

(a) A comprehensive medical assessment to identify conditions that may be causing, contributing to, or exacerbating the mental illness;

(b) Services from an appropriate medical professional for the treatment and stabilization of any medical or surgical conditions that may be contributing to or exacerbating the mental illness and

(c) Treatment in an acute setting within the parameters of the most recent version of the American Psychiatric Association Practice Guidelines for the Treatment of Psychiatric Disorders.

(d) In addition there must be evidence of additional treatment and services having been attempted, including:

(A) Use of evidence-based or promising psychosocial interventions which were delivered in relevant culturally-competent, strength-based, person-centered and trauma-informed manners and which adequately treated the assessed and/or expressed needs of the individual. When requested by the individual, treatments should include members of the individual’s family, support network and /or peers;

(B) Documentation of ongoing review and discussion of options for discharge to non-hospital levels of care; and

(C) Documentation of services and supports attempted by the responsible party to divert admission and establish treatment and recovery in a non-hospital setting.

Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 179.321, 426.010, 426.020, 426.072
Hist.: MHS 16-2011(Temp), f. 12-29-11, cert. ef. 1-1-12 thru 6-29-12; MHS 6-2012, f. 5-3-12, cert. ef. 5-4-12

309-091-0020

Neuropsychiatric and Geropsychiatric Admissions

Admissions due primarily to symptoms resulting from a traumatic or acquired brain injury, dementia or other cognitive disorders, or an organic brain syndrome due to a medical condition may occur on a case-by-case basis when, as determined by the designated clinical reviewer, the individual’s condition or symptoms would likely improve if treated in a state hospital, and at least one of the following:

(1) Denial of admission will result in a serious health or safety issue for the individual; or

(2) Denial of admission will cause a specifically described community safety issue; or

(3) Denial of admission will result in the significant worsening of the individual’s condition.

Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 179.321, 426.010, 426.020, 426.072
Hist.: MHS 16-2011(Temp), f. 12-29-11, cert. ef. 1-1-12 thru 6-29-12; MHS 6-2012, f. 5-3-12, cert. ef. 5-4-12

309-091-0025

Exclusion Criteria and Exceptions

(1) State hospitals are intended to provide recovery-oriented intervention for individuals experiencing symptoms related to a severe, persistent and disabling mental illness.

(2) Admissions must not be based upon a primary diagnosis of the following related conditions:

(a) An acute or existing medical or surgical condition which requires primary placement in a medical setting and which cannot be safely or adequately treated within a state hospital facility;

(b) Delirium;

(c) Pervasive Developmental Disorder;

(d) Intellectual Developmental Disorder;

(e) Substance Use or Substance Abuse Disorder or

(f) Personality Disorder.

(3) Administrative transfers from the Oregon Department of Correction of individuals for the purpose of treatment may occur in accordance with OAR 291-047-0021. Individuals civilly committed upon discharge from the Oregon Department of Correction must meet the admission criteria and the process defined in this rule.

(4) Administrative transfers from the Oregon Youth Authority of individuals over the age of 18 for the purpose of stabilization and evaluation not exceeding 30 days may occur in accordance with OAR 416-425-020.

(a) Individuals transferred for the purpose of stabilization and evaluation for a period of time exceeding 30 days may occur in accordance with OAR 416-425-020.

(b) Individuals over the age of 18 who are civilly committed upon discharge from the Oregon Youth Authority must meet the admission criteria and the process defined in this rule.

Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 179.321, 426.010, 426.020, 426.072
Hist.: MHS 16-2011(Temp), f. 12-29-11, cert. ef. 1-1-12 thru 6-29-12; MHS 6-2012, f. 5-3-12, cert. ef. 5-4-12

309-091-0030

Discharge Planning

(1) The state hospital will notify the responsible parties of each admission, unit or campus transfer, and each hospital treatment team determination related to assessing discharge readiness.

(2) The responsible party must arrange housing, treatment and other services assessed as needed to support the continuity of care necessary to maintain the individual’s stability in the community.

Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 179.321, 426.010, 426.020, 426.072
Hist.: MHS 16-2011(Temp), f. 12-29-11, cert. ef. 1-1-12 thru 6-29-12; MHS 6-2012, f. 5-3-12, cert. ef. 5-4-12

309-091-0035

Discharge Criteria and Procedures for Civil Commit or Guardian

(1) The state hospital will periodically assess the individual’s continued need for state hospital level of care based upon the admission criteria established in these rules.

(2) The state hospital retains the authority to solely determine when someone no longer needs state hospital level of care based on standardized criteria adopted by the hospital. Whenever possible, the decision should be made in collaboration with the responsible party and legal guardian, when applicable.

(3) An individual determined ready for discharge may later be determined not ready for discharge and removed from the discharge ready list.

(4) Individuals with an active discharge and community placement plan who no longer meet the state hospital criteria as defined in these rules shall not remain in an Oregon state hospital.

(5) Prior to an individual no longer needing state hospital level of care, the hospital will collaborate with the responsible party and with the patient’s legal guardian if assigned by the courts, to identify appropriate services and supports for the patient.

(6) When an individual no longer needs state hospital level of care, and an appropriate community transition plan and additional necessary supports are in place, the patient will be discharged.

Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 179.321, 426.010, 426.020, 426.072
Hist.: MHS 16-2011(Temp), f. 12-29-11, cert. ef. 1-1-12 thru 6-29-12; MHS 6-2012, f. 5-3-12, cert. ef. 5-4-12

309-091-0040

Forensic Admission Criteria and Procedures

Forensic admissions will occur as prescribed ORS 161.327, 161.328, 161.365, 161.370.

Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 179.321, 426.010, 426.020, 426.072
Hist.: MHS 16-2011(Temp), f. 12-29-11, cert. ef. 1-1-12 thru 6-29-12; MHS 6-2012, f. 5-3-12, cert. ef. 5-4-12

309-091-0045

Discharge Criteria and Procedures

(1) Individuals admitted by court order after a finding of guilty except for insanity of a felony will be discharged when approved by the PSRB and in accordance with the state hospital policies and procedures.

(2) Individuals whose jurisdiction under the PSRB has ended as identified by the state hospital Legal Department shall be allowed to discharge on midnight of the final day of PSRB jurisdiction unless the hospital determines the need for civil commitment or some other legal hold.

(3) The responsible party will assess individuals ending jurisdiction and when determined appropriate, arrange housing, treatment and other services assessed as needed to support the continuity of care necessary to maintain the individual’s stability in the community.

Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 179.321, 426.010, 426.020, 426.072
Hist.: MHS 16-2011(Temp), f. 12-29-11, cert. ef. 1-1-12 thru 6-29-12; MHS 6-2012, f. 5-3-12, cert. ef. 5-4-12

309-091-0050

Other Forensic Discharges and Roles of Responsible Parties

(1) Individuals committed to the state hospital pursuant to ORS 161.328 and 161.370 will be discharged upon determination by the superintendent that the individual no longer presents a substantial danger to others.

(2) The responsible party must provide assistance to individuals determined through assessment as needing treatment, services or supports upon discharge.

Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 179.321, 426.010, 426.020, 426.072
Hist.: MHS 16-2011(Temp), f. 12-29-11, cert. ef. 1-1-12 thru 6-29-12; MHS 6-2012, f. 5-3-12, cert. ef. 5-4-12

Notes
1.) This online version of the OREGON BULLETIN is provided for convenience of reference and enhanced access. The official, record copy of this publication is contained in the original Administrative Orders and Rulemaking Notices filed with the Secretary of State, Archives Division. Discrepancies, if any, are satisfied in favor of the original versions. Use the OAR Revision Cumulative Index found in the Oregon Bulletin to access a numerical list of rulemaking actions after November 15, 2011.

2.) Copyright 2012 Oregon Secretary of State: Terms and Conditions of Use

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Phone: (503) 986-1523 • Fax: (503) 986-1616 • oregon.sos@state.or.us

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