The Oregon Administrative Rules contain OARs filed through November 15, 2015

 

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OREGON HEALTH AUTHORITY,

ADDICTIONS AND MENTAL HEALTH DIVISION: MENTAL HEALTH SERVICES

 

DIVISION 91
STATE HOSPITAL ADMISSIONS
AND DISCHARGES
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
Civil Commitment and Guardian
Admissions and Discharges
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
Forensic Admissions and Discharges
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
(1) For the purposes of this rule, discharge
occurs when the state hospital moves the individual from the state hospital’s
psychiatric care to either a community setting or other institutional setting, including
but not limited to discharge to a jail.
(2) Individuals committed
to the state hospital pursuant to ORS 161.370 shall be discharged from the state
hospital upon the any of the following:
(a) The court has ordered
that the individual be discharged from the state hospital or that the underlying
criminal charges be dismissed;
(b) The state hospital both:
(A) Has sent notice to the
court pursuant to ORS 161.370 subsection (5)(a), (5)(b)(A), (5)(b)(B), or subsection
(8); and
(B) Has transported the individual
to a jail;
(c) A period of time has
passed which is equal to the maximum sentence the court could have imposed if the
individual had been convicted; or
(d) A period of time has
passed which is equal to 1,095 days from the individual’s initial custody
date at the hospital under ORS 161.370.
(3) In counting the maximum
period of time under (2)(c) through (d) of this section, the state hospital shall
count the days in which the defendant was admitted to the state hospital pursuant
to ORS 161.370 on any charge alleged in the accusatory instrument and shall not
count any days in which the individual had been discharged from the state hospital.
Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 179.321,
426.010, 426.020, 161.370, 179.360 & 2011 SB 432
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;
MHS 7-2015(Temp), f. & cert. ef. 10-28-15 thru 4-22-16

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contained in the Administrative Order filed at the Archives Division,
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