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OREGON HEALTH AUTHORITY,

ADDICTIONS AND MENTAL HEALTH DIVISION: MENTAL HEALTH SERVICES

 

DIVISION 39
STANDARDS FOR THE APPROVAL OF PROVIDERS OF

NON-INPATIENT MENTAL HEALTH TREATMENT SERVICES 

309-039-0500
Purpose and Scope
These rules apply to certifications
of provider organizations that render non-inpatient mental health treatment services.
The certifications exist solely for the purpose of qualifying for insurance reimbursement.
Agencies that contract with OHA, subcontract with OHA, or contract with a Community
Mental Health Program are not eligible for the “non-inpatient” certification.
Stat. Auth.: ORS 413.042 & 743A.168
Stats. Implemented: ORS 743A.160
& 743.168
Hist.: MHD 2-1989(Temp),
f. 3-13-89, cert. ef. 3-14-89; MHD 4-1989, f. & cert. ef. 8-25-89; MHD 1-1993,
f. 2-24-93, cert. ef. 2-26-93; MHS 13-2013(Temp), f. & cert. ef. 12-20-13 thru
6-18-14; MHS 11-2014, f. 6-17-14, cert. ef. 6-19-14
309-039-0510
Definitions
As used in these rules:
(1) “Community Mental
Health Program” means the organization of all services for persons with mental
or emotional disturbances, drug abuse problems, mental retardation or other developmental
disabilities, 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.
(2) “Certificate of
Approval” means a Certificate of Approval as defined in OAR 309-012-0130 through
309-012-0220.
(3) “Division”
means the Addictions and Mental Health Division of the Oregon Health Authority.
(4) “Facility”
means a corporate or other entity which provides services for the treatment of mental
health conditions.
(5) “Non-Related Adult”
means any person over 18 years of age who is not related by blood, marriage or living
situation. Foster parents and adults co-habitating with a child may be considered
to be related adults.
(6) “Outpatient Program”
means a program that provides evaluation, treatment and rehabilitation on a regularly
scheduled basis or in response to crisis in a setting outside an inpatient program,
residential program, day treatment or partial hospitalization program.
(7) “Program”
means a particular type or level of service that is organizationally distinct within
a facility.
(8) “Provider”
means a program operated by either a licensed business or a corporation that provides
mental health services.
(9) "Qualified Mental Health
Associate (QMHA)” means a person delivering services under the direct supervision
of a QMHP who meets the minimum qualifications as authorized by the LMHA, or designee,
and specified in 309-019-0125(7).
(10) "Qualified Mental Health
Professional (QMHP)" means a LMP or any other person meeting the minimum qualifications
as authorized by the LMHA, or designee, and specified in 309-019-0125(8).
(11) “Qualified Supervisor”
means any person meeting the following qualifications:
(a) A medical or osteopathic
physician licensed by the Board of Medical Examiners for the State of Oregon and
who is board eligible for the practice of psychiatry;
(b) A psychologist licensed
by the State Board of Psychologist Examiners;
(c) A registered nurse certified
as a psychiatric nurse practitioner by the Oregon State Board of Nursing;
(d) A clinical social worker
licensed by the State Board of Clinical Social Workers;
(e) A Licensed Professional
Counselor (LPC) licensed by the State of Oregon; or
(f) A Licensed Marriage and
Family Therapist (LMFT), licensed by the State of Oregon.
(12) “Residential Program”
means a program that provides room, board, and an organized full-day program of
mental health services in a facility for six or more persons who do not require
24-hour nursing care.
Stat. Auth.: ORS 413.042 & 743A.168
Stats. Implemented: ORS 743A.160
& 743.168
Hist.: MHD 2-1989(Temp),
f. 3-13-89, cert. ef. 3-14-89; MHD 4-1989, f. & cert. ef. 8-25-89; MHD 1-1993,
f. 2-24-93, cert. ef. 2-26-93; MHS 13-2013(Temp), f. & cert. ef. 12-20-13 thru
6-18-14; MHS 11-2014, f. 6-17-14, cert. ef. 6-19-14
309-039-0520
Eligible Providers
(1) Agencies that currently hold a Certificate
of Approval for the provision of mental health services as a contractor of OHA,
a subcontractor of OHA, or a contractor of a Community Mental Health Program, or
a license to provide residential or adult foster care services, are not eligible
for the “non-inpatient” certification.
(2) Certification as a non-inpatient
mental health provider is not a substitute for the certification and Medicaid provider
enrollment processes that are required to render services to individuals enrolled
in the Oregon Health Plan, or to individuals whose services are otherwise funded
by the State.
(3) Only providers as defined
in OAR 309-039-0510(10) are eligible for approval under 309-039-0500 through 309-039-0580.
An eligible provider must:
(a) Control the office space,
such as by owning, renting or leasing it;
(b) Control the intake to
the program and determine which therapist provides assessment and treatment;
(c) Control all clinical
records, including storage;
(d) Do all the billing and
collect all fees, including deductibles and co-payments;
(e) Pay staff for clinical
services provided; and
(f) Display the provider
name on the premises so as to be clearly visible to clients.
(4) An individual operating
as a private practitioner, whether or not a licensed business or corporation, is
not eligible for approval under these rules.
Stat. Auth.: ORS 413.042 & 743A.168
Stats. Implemented: ORS 743A.160
& 743.168
Hist.: MHD 2-1989(Temp),
f. 3-13-89, cert. ef. 3-14-89; MHD 4-1989, f. & cert. ef. 8-25-89; MHD 1-1993,
f. 2-24-93, cert. ef. 2-26-93; MHS 13-2013(Temp), f. & cert. ef. 12-20-13 thru
6-18-14; MHS 11-2014, f. 6-17-14, cert. ef. 6-19-14
309-039-0530
Approval Process
(1) Request for approval or renewal
shall be submitted to the Division with an application form, materials specified
in the application instructions and a check or money order in the amount of $600.00
payable to the Division. This application fee shall be non-refundable irrespective
of whether the provider is issued a Certificate of Approval.
(a) Any provider submitting
an application for approval or renewal after the effective date of this rule shall
pay the application and certification fees;
(b) The fees shall be increased
biennially at the same rate as approved by the Legislative Assembly or the Emergency
Board for other services and programs of the Division.
(2) A Certificate of Approval,
valid for up to three years, shall be issued to the provider when the administrative
and certification reviews of the program by the Division indicate the provider is
in compliance with the applicable parts of OAR 309-039-0500 through 309-039-0580.
The Certificate may be for a period of time shorter than three years if the provider
is not in full compliance with these rules.
(3) A Certificate of Approval
is not transferable or applicable to any location, facility, or management other
than that indicated on the Certificate of Approval.
(4) The award, renewal, and
duration of Certificates of Approval as well as periodic and interim reviews, establishment
of conditions, denial, revocation and hearings shall comply with OAR 309-012-0130
through 309-012-0220.
Stat. Auth.: ORS 413.042 & 743A.168
Stats. Implemented: ORS 743A.160
& 743.168
Hist.: MHD 2-1989(Temp),
f. 3-13-89, cert. ef. 3-14-89; MHD 4-1989, f. & cert. ef. 8-25-89; MHD 1-1993,
f. 2-24-93, cert. ef. 2-26-93; MHS 13-2013(Temp), f. & cert. ef. 12-20-13 thru
6-18-14; MHS 11-2014, f. 6-17-14, cert. ef. 6-19-14
309-039-0540
General Standards
Each provider is required to meet all
applicable standards from the following standards:
(1) Specific Staff Qualifications
and Compentencies, detailed in OAR 309-019-0125; and
(2) Personnel Documentation,
Training and Supervision, detailed in OAR 309-019-0130.
Stat. Auth.: ORS 413.042 & 743A.168
Stats. Implemented: ORS 743A.160
& 743.168
Hist.: MHD 2-1989(Temp),
f. 3-13-89, cert. ef. 3-14-89; MHD 4-1989, f. & cert. ef. 8-25-89; MHD 1-1993,
f. 2-24-93, cert. ef. 2-26-93; MHS 13-2013(Temp), f. & cert. ef. 12-20-13 thru
6-18-14; MHS 11-2014, f. 6-17-14, cert. ef. 6-19-14
309-039-0560
Standards for Mental Health Partial
Hospitalization and Day Treatment Programs
In addition to OAR 309-039-0500 through
309-039-0540, each provider operating a mental health partial hospitalization or
day treatment program shall comply with the following standards:
(1) Facility standards. The
facility shall meet all applicable state and local fire, safety, and health standards.
(2) Treatment standards.
Each provider shall provide four hours a day, five days a week, structured treatment
activities which address mental health conditions and which includes the following
services each week:
(a) Daily group therapy for
mental health conditions;
(b) Individual counseling
with a primary therapist;
(c) Family therapy, as appropriate
to the individual needs of the client;
(d) Psychotropic medication
management or monitoring; and
(e) Skills training, vocational
training, socialization or structured recreational/physical fitness activities.
Stat. Auth.: ORS 413.042 & 743A.168
Stats. Implemented: ORS 743A.160
& 743.168
Hist.: MHD 2-1989(Temp),
f. 3-13-89, cert. ef. 3-14-89; MHD 4-1989, f. & cert. ef. 8-25-89; MHD 1-1993,
f. 2-24-93, cert. ef. 2-26-93; MHS 11-2014, f. 6-17-14, cert. ef. 6-19-14
309-039-0570
Standards for Mental Health Residential
Programs
In addition to meeting OAR 309-039-0500
through 309-039-0540 each provider operating a mental health residential program
shall meet the following standards:
(1) Facility standards. Each
provider shall meet OAR 309-035-0100 through 309-035-0190.
(2) Treatment standards.
Each provider shall provide eight hours of structured services out of every 12 hours
from 8 a.m. to 8 p.m. which, each week, includes:
(a) Daily group therapy which
addresses the mental health or nervous condition;
(b) Individual counseling
which addresses the mental health or nervous condition with a primary therapist
two times per week;
(c) Family therapy, as appropriate
to the individual needs of the client;
(d) Psychotropic medication
management or monitoring, as appropriate to the individual needs of the client;
(e) One hour per day of structured
recreational/physical fitness activities; and
(f) Structured skills training,
vocational training, or socialization activities.
(3) Treatment standards for
children and adolescents:
(a) Each provider shall comply
with OAR 309-035-0100 through 309-035-0190;
(b) Each residential facility
serving children or adolescents shall meet the standards described by OAR 413-210-0100
through 413-210-0250, Standards for reviewing, inspecting and licensing those private
child caring agencies which are for residential care and treatment services for
children and which are subject to the provisions of ORS Chapter 418, for licensure
by the Children’s Services Division.
(4) Staffing standards. Each
provider shall:
(a) Provide staff coverage
24 hours-a-day, seven days-a-week;
(b) Employ sufficient qualified
mental health professionals to maintain a maximum caseload of no more than eight
clients;
(c) Have a mental health
associate on site, and awake, from 8 p.m. to 8 a.m.; and
(d) Have available a mental
health professional on-call from 8 p.m. to 8 a.m.
Stat. Auth.: ORS 413.042 & 743A.168
Stats. Implemented: ORS 743A.160
& 743.168
Hist.: MHD 2-1989(Temp),
f. 3-13-89, cert. ef. 3-14-89; MHD 4-1989, f. & cert. ef. 8-25-89; MHS 13-2013(Temp),
f. & cert. ef. 12-20-13 thru 6-18-14; MHS 11-2014, f. 6-17-14, cert. ef. 6-19-14
309-039-0580
Variance
A variance from these rules
may be granted to a provider in the following manner:
(1) A provider requesting a
variance shall submit, in writing, to the Division:
(a) The section of the rule
from which the variance is sought;
(b) The reason for the proposed
variance;
(c) The alternative practice,
service, method, concept or procedure proposed;
(d) A plan and timetable for
compliance, if appropriate, with the section of the rule from which the variance
is sought.
(2) The Assistant Administrator
or designee of the Division shall approve or deny the request for variance.
(3) The Division shall forward
the decision and reasons therefor to the provider requesting the variance. This
notice shall be given the provider within 30 days of receipt of the request by the
Division.
(4) Appeal of the denial of
a variance request shall be made in writing to the Administrator of the Division,
whose decision shall be final.
Stat. Auth.: ORS 413.042 &
743A.168

Stats. Implemented: ORS 743A.160
& 743.168

Hist.: MHD 2-1989(Temp), f.
3-13-89, cert. ef. 3-14-89; MHD 4-1989, f. & cert. ef. 8-25-89; MHD 1-1993,
f. 2-24-93, cert. ef. 2-26-93

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