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DEPARTMENT OF HUMAN SERVICES,

AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES




 

DIVISION 317
GENERAL DEFINITIONS
411-317-0000
Definitions for Developmental Disability
Services
Unless the context indicates otherwise,
the following definitions apply to the rules in OAR chapter 411, divisions 300 to
375:
(1) "Abuse Investigation"
means the reporting and investigation activities as required by OAR 407-045-0300
and any subsequent services or supports necessary to prevent further abuse as required
by 407-045-0310.
(2) "Accident" means an event
that results in injury or has the potential for injury even if the injury does not
appear until after the event.
(3) "Activities of Daily
Living (ADL)" are the basic personal everyday activities, such as eating, using
the restroom, grooming, dressing, bathing, and transferring.
(4) "Administration of Medication"
means the act of placing a medication in or on the body of an individual by a person
responsible for the care of the individual and employed by, or under contract to,
the individual or as applicable the legal or designated representative of the individual
or provider organization.
(5) "Administrator Review"
means the Director of the Department reviews a decision upon request, including
the documentation related to the decision, and issues a determination.
(6) "Adult" means an individual
who is 18 years or older with an intellectual or developmental disability.
(7) "Advocate" means a person
other than paid staff who has been selected by an individual or by the legal representative
of an individual to help the individual understand and make choices in matters relating
to identification of needs and choices of services, especially when rights are at
risk or have been violated.
(8) "Aids to Physical Functioning"
means any special equipment prescribed for an individual by a physician, therapist,
or dietician that maintains or enhances physical functioning.
(9) "Alternative Resources"
mean possible resources, not including developmental disability services, for the
provision of supports to meet the needs of an individual. Alternative resources
include, but are not limited to, private or public insurance, vocational rehabilitation
services, supports available through the Oregon Department of Education, or other
community supports.
(10) "Case Management" means
the functions performed by a services coordinator or personal agent. Case management
includes, but is not limited to, determining service eligibility, developing a plan
of authorized services, and monitoring the effectiveness of services and supports.
(11) "Centers for Medicare
and Medicaid Services (CMS)". The Centers for Medicare and Medicaid Services is
the federal agency within the United States Department of Health and Human Services
responsible for the administration of Medicaid and the Health Insurance Portability
and Accountability Act (HIPAA) and overseeing Medicaid programs administered by
the states through survey and certification.
(12) "Child" means an individual
who is less than 18 years of age that has a provisional determination of an intellectual
or developmental disability.
(13) "Choice" means the expression
of preference, opportunity for, and active role of an individual in decision-making
related to services received and from whom including, but not limited to, case management,
providers, services, and service settings. Individuals are supported in opportunities
to make changes when so expressed. Choice may be communicated through a variety
of methods, including orally, through sign language, or by other communication methods.
(14) "Community First Choice
(K Plan)" means the state plan amendment for Oregon authorized under section 1915(k)
of the Social Security Act.
(15) "Complaint" means an
oral or written expression of dissatisfaction with a developmental disability service
or provider.
(16) "Complaint Investigation"
means the investigation of a complaint that has been made to a proper authority
that is not covered by an investigation of abuse.
(17) "Day" means a calendar
day unless otherwise specified.
(18) "Denial" means any rejection
of a request for a developmental disability service or an increase in a developmental
disability service. A denial of a Medicaid service requires a Notification of Planned
Action.
(19) "Designated Representative"
means any adult, such as a parent, family member, guardian, advocate, or other person,
who is chosen by an individual or the legal representative of the individual, not
a paid provider for the individual, and authorized by the individual or the legal
representative of the individual to serve as the representative of the individual
or the legal representative of the individual in connection with the provision of
funded supports. An individual or a legal representative of the individual is not
required to appoint a designated representative.
(20) "Entry" means admission
to a Department-funded developmental disability service.
(21) "Exit" means termination
or discontinuance of a Department-funded developmental disability service.
(22) "Family Member" means
husband or wife, domestic partner, natural parent, child, sibling, adopted child,
adoptive 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.
(23) "Founded Report" means
the determination by the Department or Law Enforcement Authority (LEA), based on
the evidence, that there is reasonable cause to believe that conduct in violation
of the child abuse statutes or rules has occurred and such conduct is attributable
to the person alleged to have engaged in the conduct.
(24) "Guardian" means the
parent for an individual less than 18 years of age or a person or agency appointed
and authorized by a court to make decisions about services for an individual.
(25) "Health Care Provider"
means the person or health care facility licensed, certified, or otherwise authorized
or permitted by Oregon law to administer health care in the ordinary course of business
or practice of a profession. Examples of a health care provider include, but are
not limited to, a registered nurse (RN), nurse practitioner (NP), licensed practical
nurse (LPN), medical doctor (MD), osteopathic physician (DO), chiropractor, respiratory
therapist (RT), physical therapist (PT), physician assistant (PA), dentist, or occupational
therapist (OT).
(26) "Hearing" means a contested
case hearing subject to OAR 137-003-0501 to 137-003-0070, which results in a final
order.
(27) "Home and Community-Based
Waiver Services" mean the services approved by the Centers for Medicare and Medicaid
Services in accordance with section 1915(c) of the Social Security Act.
(28) "Independence" means
the extent to which an individual exerts control and choice over his or her own
life.
(29) "Individual" means a
child or an adult with an intellectual or developmental disability applying for,
or determined eligible for, Department-funded services. Unless otherwise specified,
references to individual also include the legal or designated representative of
the individual, who has the ability to act for the individual and to exercise the
rights of the individual.
(30) "Instrumental Activities
of Daily Living (IADL)" are the activities other than activities of daily living
required to continue independent living, such as:
(a) Meal planning and preparation;
(b) Managing personal finances;
(c) Shopping for food, clothing,
and other essential items;
(d) Performing essential
household chores;
(e) Communicating by phone
or other media; and
(f) Traveling around and
participating in the community.
(31) "Integration" as defined
in ORS 427.005 means:
(a) Use by individuals with
intellectual or developmental disabilities of the same community resources used
by and available to other people;
(b) Participation by individuals
with intellectual or developmental disabilities in the same community activities
in which people without disabilities participate, together with regular contact
with people without disabilities; and
(c) Residence by individuals
with intellectual or developmental disabilities in homes or in home-like settings
that are in proximity to community resources, together with regular contact with
people without disabilities in their community.
(32) "Legal Representative"
means a person who has the legal authority to act for an individual.
(a) For a child, the legal
representative is the parent of the child unless a court appoints another person
or agency to act as the guardian of the child; and
(b) For an adult, the legal
representative is the attorney at law who has been retained by or for the adult,
the person acting under the authority granted in a power of attorney, or the person
or agency authorized by a court to make decisions about services for the adult.
(33) "Mandatory Reporter":
(a) Means any public or private
official as defined in OAR 407-045-0260 who:
(A) Comes in contact with
a child with or without an intellectual or developmental disability and has reasonable
cause to believe the child has suffered abuse, or comes in contact with any person
whom the public or private official has reasonable cause to believe abused the child,
regardless of whether or not the knowledge of the abuse was gained in the official
capacity of the public or private official.
(B) While acting in an official
capacity, comes in contact with an adult with an intellectual or developmental disability
and has reasonable cause to believe the adult has suffered abuse, or comes in contact
with any person whom the public or private official has reasonable cause to believe
abused the adult.
(b) Nothing contained in
ORS 40.225 to 40.295 affects the duty to report imposed by this definition, except
that a psychiatrist, psychologist, clergy, attorney, or guardian ad litem appointed
under 419B.231 is not required to report if the communication is privileged under
40.225 to 40.295.
(34) "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.
(35) "Monitoring" means the
periodic review of the implementation of services and supports identified in an
Individual Support Plan or Annual Plan and the quality of services delivered by
other organizations.
(36) "Natural Support" means:
(a) For a child, the parental
responsibilities for a child and the voluntary resources available to the child
from the relatives, friends, neighbors, and the community of the child that are
not paid for by the Department.
(b) For an adult, the voluntary
resources available to an adult from the relatives, friends, significant others,
neighbors, roommates, and the community of the adult that are not paid for by the
Department.
(37) "Nurse" means a person
who holds a current license from the Oregon Board of Nursing as a registered nurse
or licensed practical nurse pursuant to ORS chapter 678.
(38) "Nursing Tasks" mean
the care or services that require the education and training of a licensed professional
nurse to perform. Nursing tasks may be delegated.
(39) "OHP Plus" means only
the Medicaid benefit packages provided under OAR 410-120-1210(4)(a) and (b). This
excludes individuals receiving Title XXI benefits.
(40) "OSIPM" means "Oregon
Supplemental Income Program-Medical" as described in OAR 461-001-0030. OSIPM is
Oregon Medicaid insurance coverage for individuals who meet the eligibility criteria
described in OAR chapter 461.
(41) "Person-Centered Planning":
(a) Means a timely and formal
or informal process driven by an individual, includes people chosen by the individual,
ensures the individual directs the process to the maximum extent possible, and the
individual is enabled to make informed choices and decisions consistent with 42
CFR 441.540.
(b) Person-centered planning
includes gathering and organizing information to reflect what is important to and
for the individual and to help:
(A) Determine and describe
choices about personal goals, activities, services, providers, service settings,
and lifestyle preferences;
(B) Design strategies and
networks of support to achieve goals and a preferred lifestyle using individual
strengths, relationships, and resources; and
(C) Identify, use, and strengthen
naturally occurring opportunities for support at home and in the community.
(c) The methods for gathering
information vary, but all are consistent with the cultural considerations, needs,
and preferences of the individual.
(42) "Prescription Medication"
means any medication that requires a prescription from a physician before the medication
may be obtained from a pharmacist.
(43) "Primary Caregiver"
means the person identified in an Individual Support Plan as providing the majority
of services and support for an individual in the home of the individual.
(44) "Primary Care Provider"
means the health care provider who delivers day-to-day comprehensive health care.
Typically, the primary care provider acts as the first contact and principal point
of continuing care for an individual within the health care system and coordinates
other specialist care that the individual may need.
(45) "PRN (pro re nata)"
means the administration of a medication to an individual on an 'as needed' basis.
(46) "Productivity" as defined
in ORS 427.005 means regular engagement in income-producing work, preferable competitive
employment with supports and accommodations to the extent necessary, by an individual
that is measured through improvements in income level, employment status, or job
advancement or engagement by an individual in work contributing to a household or
community.
(47) "Protection" means the
necessary actions offered to an individual as soon as possible to prevent subsequent
abuse or exploitation of the individual, to prevent self-destructive acts, or to
safeguard the person, property, and funds of the individual.
(48) "Protective Physical
Intervention" means any manual physical holding of, or contact with, an individual
that restricts freedom of movement.
(49) "Protective Services"
mean the necessary actions offered to an individual as soon as possible to prevent
subsequent abuse or exploitation of the individual, to prevent self-destructive
acts, or to safeguard the person, property, and funds of the individual.
(50) "Provider" means a person,
agency, organization, or business selected by an individual that provides recognized
Department-funded services and is approved by the Department or other appropriate
agency to provide Department-funded services.
(51) "Restraint" means any
physical hold, device, or chemical substance that restricts, or is meant to restrict,
the movement or normal functioning of an individual.
(52) "Review" means a request
for reconsideration of a decision.
(53) "Self-Administration
of Medication" means an individual manages and takes his or her own medication,
identifies his or her own medication and the times and methods of administration,
places the medication internally in or externally on his or her own body without
staff assistance upon written order of a physician, and safely maintains the medication
without supervision.
(54) "Self-Direction" means
that an individual, or as applicable the legal or designated representative of the
individual, has decision-making authority over services and takes direct responsibility
for managing services with the assistance of a system of available supports that
promotes personal choice and control over the delivery of waiver and state plan
services.
(55) "Services" include,
but are not limited to, supervision, protection, and assistance in bathing, dressing,
grooming, eating, management of money, or transportation. Services also include
being aware of the general whereabouts of an individual at all times and monitoring
the activities of the individual to ensure the health, safety, and welfare of the
individual.
(56) "Significant Other"
means a person selected by an individual to be the friend of the individual.
(57) "Staff" means paid employees
who are responsible for providing services and supports to individuals and whose
wages are paid in part or in full with funds sub-contracted with a community developmental
disability program, support services brokerage, or contracted directly through the
Department.
(58) "Substantiated" means
an abuse investigation has been completed by the Department or the designee of the
Department and the preponderance of the evidence establishes the abuse occurred.
(59) "Support" means the
assistance that an individual requires, solely because of the effects of an intellectual
or developmental disability, to maintain or increase independence, achieve community
presence and participation, and improve productivity. Support is subject to change
with time and circumstances.
(60) "Transfer" means movement
of an individual from one type of service to another type of service administered
or operated by the same provider.
(61) "Volunteer" means any
person assisting a provider without pay to support the services and supports provided
to an individual.
Stat. Auth.: ORS 409.050
Stats. Implemented: ORS 409.050
Hist.: APD 22-2014(Temp),
f. & cert. ef. 7-1-14 thru 12-28-14; APD 39-2014, f. 12-26-14, cert. ef. 12-28-14;
APD 40-2014, f. 12-26-14, cert. ef. 12-28-14


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