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OREGON HEALTH AUTHORITY,

ADDICTIONS AND MENTAL HEALTH DIVISION: MENTAL HEALTH SERVICES

 

DIVISION 32

COMMUNITY TREATMENT AND SUPPORT SERVICES





Mental Health
Services For Homeless Individuals

309-032-0301
Purpose and Scope
These rules prescribe the standards
for community-based programs that serve individuals with a serious mental illness
experiencing homelessness under the Projects for Assistance in Transition from Homelessness
(PATH) program.
Stat. Auth.: ORS 413.042 &
430.640

Stats. Implemented: ORS 430.610
– 430.695

Hist.: MHS 7-2011, f. &
cert. ef. 9-26-11; MHS 9-2011(Temp), f. & cert. ef. 11-22-11 thru 5-18-12; MHS
2-2012, f. & cert. ef. 2-9-12
309-032-0311
Definitions
(1) “Co-Occurring Disorders”
(COD) means the existence of at least one diagnosis of a substance use disorder
and one diagnosis of a serious mental illness.
(2) “Community Mental
Health Program” (CMHP) means an entity that is responsible for planning and
delivery of services for individuals with substance use or mental illness diagnoses,
operated in a specific geographic area of the state under an intergovernmental agreement
or a direct contract with the Addictions and Mental Health Division (AMH).
(3) “Division” means
the Addictions and Mental Health Division of the Oregon Health Authority (OHA).
(4) “Eligible Individual”
means an individual who, as defined in these rules:
(a) Is homeless or at imminent
risk of becoming homeless and
(b) Who has, or is reasonably
assumed to have, a serious mental illness.
(c) The individual may also
have a co-occurring substance use disorder.
(5) “Enrolled” means
an eligible individual who:
(a) Receives services supported
at least partially with PATH funds and
(b) Has an individual service
record that indicates enrollment in the PATH program.
(6) “Homeless Individual”
means an individual who:
(a) Lacks housing without regard
to whether the individual is a member of a family and whose primary residence during
the night is a supervised public or private facility that provides temporary living
accommodations; or
(b) Is a resident in transitional
housing that carries time limits.
(7) “Individual”
means an individual potentially eligible for or who has been enrolled to receive
services described in these rules.
(8) “Individual Service
and Support Plan” (ISSP) means a comprehensive plan for services and supports
provided to or coordinated for an eligible individual that is reflective of the
intended outcomes of service.
(9) “Imminent Risk of
Homelessness” means that an individual is:
(a) Living in a doubled-up living
arrangement where the individual’s name is not on the lease;
(b) Living in a condemned building
without a place to move;
(c) In arrears in their rent
or utility payments;
(d) Subject to a potential eviction
notice without a place to move; or
(e) Being discharged from a
health care or criminal justice institution without a place to live.
(10) “Individual Service
Record” means the written or electronic documentation regarding an enrolled
individual that summarizes the services and supports provided from point of entry
to service conclusion.
(11) “Literally Homeless
Individual” means an individual who lacks housing without regard to whether
the individual is a member of a family, including an individual whose primary residence
during the night is a supervised public or private facility that provides temporary
living accommodations.
(12) “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.
(13) “Outreach”
means the process of bringing individuals into treatment who do not access traditional
services.
(14) “Projects for Assistance
in Transition from Homelessness” (PATH) means the Formula Grants, 42 U.S.C.
290cc-21 to 290-cc-35.
(15) “Qualified Mental
Health Professional” (QMHP) means any person who meets one of the following
minimum qualifications as authorized by the LMHA or designee:
(a) A Licensed Medical Practitioner;
(b) A graduate degree in psychology,
social work, or recreational, art or music therapy;
(c) A graduate degree in a behavioral
science field;
(d) A bachelor’s degree
in occupational therapy and licensed by the State or Oregon; or
(e) A bachelor’s degree
in nursing and licensed by the State of Oregon.
(16) “Secretary”
means the Secretary of the U.S. Department of Health and Human Services.
(17) “Serious Mental Illness”
means a psychiatric condition experienced by an individual who is 18 years of age
or older and who is:
(a) Diagnosed by a QMHP as suffering
from a serious mental disorder as defined in Oregon Revised Statutes (ORS) 426.495
which includes, but is not limited to conditions such as schizophrenia, affective
disorder, paranoid disorder, and other disorders which manifest psychotic symptoms
that are not solely a result of a developmental disability, epilepsy, drug abuse
or alcoholism; and which continue for more than one year, or
(b) Is impaired to an extent
which substantially limits the individual’s consistent ability to function
in one or more of the following areas:
(A) Independent attendance to
the home environment including shelter needs, personal hygiene, nutritional needs
and home maintenance;
(B) Independent and appropriate
negotiation within the community such as utilizing community resources for shopping,
recreation, transportation and other needs;
(C) Establishment and maintenance
of supportive relationships; or
(D) Maintained employment sufficient
to meet personal living expenses or engagement in other age appropriate activities.
Stat. Auth.: ORS 413.042 &
430.640

Stats. Implemented: ORS 430.610
– 430.695
Hist.: MHS 7-2011, f.
& cert. ef. 9-26-11; MHS 9-2011(Temp), f. & cert. ef. 11-22-11 thru 5-18-12;
MHS 2-2012, f. & cert. ef. 2-9-12
309-032-0321
Eligible Services
(1) Effective outreach to engage
people in the following array of services:
(a) Identification of individuals
in need;
(b) Screening for symptoms of
serious mental illness;
(c) Development of rapport with
the individual;
(d) Offering support while assisting
with immediate and basic needs;
(e) Referral to appropriate
resources; or
(f) Distribution of information
including but not limited to:
(A) Flyers and other written
information;
(B) Public service announcements;
or
(C) Other indirect methods of
contact.
(2) Methods of active outreach
including but not limited to face-to-face interaction with literally homeless people
in streets, shelters, under bridges and in other non-traditional settings, in order
to seek out eligible individuals.
(3) Methods of in-reach, including
but not limited to placing outreach staff in a service site frequented by homeless
people, such as a shelter or community resource center, where direct, face to face
interactions occur, in order to allow homeless individuals to seek out outreach
workers.
(4) Screening and diagnosis.
(5) Habilitation and rehabilitation
services.
(6) Community mental health
services.
(7) Alcohol or drug treatment
services.
(8) Staff training, including
the training of those who work in shelters, mental health clinics, substance abuse
programs, and other sites where homeless individuals require services.
(9) Case management including
the following.
(a) Preparing a plan for the
provision of community mental health services to the eligible individual and reviewing
the plan not less than once every three months;
(b) Assistance in obtaining
and coordinating social and maintenance services for the eligible individual, including
services related to daily living activities, personal financial planning, transportation,
and housing services;
(c) Assistance to the eligible
individual in obtaining income support services including housing assistance, food
stamps and supplemental security income benefits;
(d) Referring the eligible individual
for such other services as may be appropriate and
(e) Providing representative
payee services in accordance with section 1631(a)(2) of the Social Security Act
[42 U.S.C. 1383(a)(2)] if the eligible individual is receiving aid under title XVI
of such act [42 U.S.C. 1381 et seq.] and if the applicant is designated by the Secretary
to provide such services;
(10) Supportive and supervisory
services in residential settings;
(11) Housing services, which
shall not exceed twenty percent of all total PATH expenses and which may include:
(a) Minor renovation, expansion
and repair of housing;
(b) Planning of housing;
(c) Technical assistance in
applying for housing assistance;
(d) Improving the coordination
of housing services;
(e) Security deposits;
(f) The costs associated with
matching eligible individuals with appropriate housing situations; or
(g) One time rental payments
to prevent eviction; and
(12) Referrals to other appropriate
services or agencies, for those determined ineligible for other PATH services.
(13) Other appropriate services
as determined by the Secretary.
Stat. Auth.: ORS 413.042 &
430.640

Stats. Implemented: ORS 430.610
– 430.695

Hist.: MHS 7-2011, f. &
cert. ef. 9-26-11; MHS 9-2011(Temp), f. & cert. ef. 11-22-11 thru 5-18-12; MHS
2-2012, f. & cert. ef. 2-9-12
309-032-0331
Staff Qualifications
and Training Standards
(1) Staff delivering case management
and outreach services to individuals shall have demonstrated ability to:
(a) Identify individuals who
appear to be seriously mentally ill;
(b) Identify service goals and
objectives and incorporate them into an ISSP; and
(b) Refer the individuals for
services offered by other agencies.
(2) All staff delivering PATH
services shall have training, knowledge and skills suitable to provide the services
described in these rules.
Stat. Auth.: ORS 413.042 &
430.640

Stats. Implemented: ORS 430.610
– 430.695

Hist.: MHS 7-2011, f. &
cert. ef. 9-26-11; MHS 9-2011(Temp), f. & cert. ef. 11-22-11 thru 5-18-12; MHS
2-2012, f. & cert. ef. 2-9-12
309-032-0341
Rights of Eligible Individuals
(1) In addition to all applicable
statutory and constitutional rights, every eligible individual receiving services
has the right to:
(a) Choose from available services
and supports;
(b) Be treated with dignity
and respect;
(c) Have all services explained,
including expected outcomes and possible risks;
(d) Confidentiality and the
right to consent to disclosure in accordance with ORS 107.154, 179.505, 192.515
and 42 CFR Part 2 and 45 CFR Part 205.50;
(e) Give informed consent to
services in writing prior to the start of services, except in a medical emergency
or as otherwise permitted by law;
(f) Inspect their Individual
Service Record in accordance with ORS 179.505;
(g) Not participate in experimentation;
(h) Receive medications specific
to the individual’s diagnosed clinical needs;
(i) Receive prior notice of
service conclusion or transfer, unless the circumstances necessitating service conclusion
or transfer pose a threat to health or safety;
(j) Be free from abuse or neglect
and to report any incident of abuse or neglect without being subject to retaliation;
(k) Have religious freedom;
(l) Be informed at the start
of services and periodically thereafter of the rights guaranteed by these rules;
(m) Be informed of the policies
and procedures, service agreements and fees applicable to the services provided,
and to have a custodial parent, guardian or representative assist with understanding
any information presented;
(n) Have family involvement
in service planning and delivery;
(o) Make a declaration for mental
health treatment, when legally an adult;
(p) File grievances, including
appealing decisions resulting from the grievance; and
(q) Exercise all rights described
in this rule without any form of reprisal or punishment.
(2) The provider will give to
the individual and if applicable, to the guardian, a document that describes the
preceding individual rights.
(a) Information given to the
individual must be in written form or, upon request, in an alternative format or
language appropriate to the individual’s need;
(b) The rights and how to exercise
them will be explained and
(c) Individual rights will be
posted in writing in a common area.
Stat. Auth.: ORS 413.042 &
430.640

Stats. Implemented: ORS 430.610
– 430.695

Hist.: MHS 7-2011, f. &
cert. ef. 9-26-11; MHS 9-2011(Temp), f. & cert. ef. 11-22-11 thru 5-18-12; MHS
2-2012, f. & cert. ef. 2-9-12
309-032-0351
Enrollment and Record Requirements
(1) An individual’s eligibility
shall be determined and documented at the earliest possible date.
(2) A record shall be maintained
for each enrolled individual receiving services under this rule. The record shall
contain the following:
(a) An enrollment form which
includes:
(A) The individual’s name
and PATH enrollment date;
(B) A list or description of
the criteria determining the individual’s PATH eligibility; and
(C) The individual’s PATH
services discharge date.
(b) A plan defining the enrolled
individual’s goals and service objectives including one or more of the following:
(A) Accessing community mental
health services for the eligible individual, which includes reviewing the plan not
less than once every three months;
(B) Accessing and coordinating
needed services for the eligible individual, as detailed in these rules.
(C) Accessing income and income
support services, including housing assistance, food stamps, and supplemental security
income; and
(D) Referral to other appropriate
services.
(c) Progress notes that provide
an on-going account of contacts with enrolled individual, a description of services
delivered, and progress toward the enrolled individual’s service plan goals;
and
(d) A termination summary describing
reasons for the enrolled individual no longer being involved in service.
(3) A record shall be maintained
for individuals served but not yet enrolled under the provisions of these rules.
The record shall contain:
(a) A description of the potentially
eligible individual, which may include but not be limited to:
(A) A physical description of
the individual;
(B) The location where the individual
was served; and
(C) A description of the individual’s
personal belongings.
(b) A preliminary assessment
of the potentially eligible individual’s needs based on available information;
and
(c) A record of where and when
contacts with the potentially eligible individual were made and the outcome of those
contacts.
(4) Records shall be confidential
in accordance with ORS 179.505, 45 CFR Part 2 and OAR 032-1535 pertaining to individuals’
records.
Stat. Auth.: ORS 413.042 &
430.640

Stats. Implemented: ORS 430.610
– 430.695

Hist.: MHS 7-2011, f. &
cert. ef. 9-26-11; MHS 9-2011(Temp), f. & cert. ef. 11-22-11 thru 5-18-12; MHS
2-2012, f. & cert. ef. 2-9-12
Community Treatment and Support
Services
309-032-0850
Standards for Regional
Acute Care Psychiatric Services for Adults
(1) Purpose: These rules prescribe
standards and procedures for regional acute care psychiatric services for adults.
(2) Statutory Authority: These
rules are authorized by ORS 413.042 and 430.640 to carry out the provisions of ORS
430.630.
Stat. Auth.: ORS 413.042 &
430.640

Stats. Implemented: ORS 430.630
& 430.640

Hist. MHD 8-1994, f. & cert.
ef. 11-28-94
309-032-0860
Definitions
As used in these rules:
(l) “Adult” means
a person age 18 years or older.
(2) “Clinical record”
means a separate file established and maintained under these rules for each patient.
(3) “Community mental
health program” or “CMHP” means the organization of all services
for persons with mental or emotional disturbances, drug abuse problems, developmental
disabilities, and alcoholism and alcohol abuse problems, operated by, or contractually
affiliated with, a local mental health authority, and operated in a specific geographic
area of the state under an omnibus contract with the Division.
(4) “Council” means
an organization of persons, with a mission statement and by-laws, comprised of representatives
of the regional acute care psychiatric service, state hospital, community mental
health programs served, consumers, and family members. The Council is advisory to
the regional acute care facility for adults.
(5) “Diagnosis”
means a DSM diagnosis determined through the mental health assessment and any examinations,
laboratory, medical or psychological tests, procedures, or consultations suggested
by the assessment.
(6) “Division” means
the Addictions and Mental Health Division of the Oregon Health Authority.
(7) “DSM” means
the current edition of the “Diagnostic and Statistical Manual of Mental Disorders,”
published by the American Psychiatric Association.
(8) “Goal” means
the broad aspirations or outcomes toward which the patient is striving, and toward
which all services are intended to assist the patient.
(9) “Guardian” means
a person appointed by a court of law to act as a guardian of a legally incapacitated
person.
(10) “Independent medical
practitioner” means a medically trained person who is licensed to practice
independently in the State of Oregon and has one of the following degrees: MD (Medical
Doctor), DO (Doctor of Osteopathy), or NP (Nurse Practitioner).
(11) “Legally incapacitated”
means having been found by a court of law under ORS 126.103 or 426.295 to be unable,
without assistance, to properly manage or take care of one’s personal affairs.
(12) “Linkage agreement”
means a written agreement between the regional acute care psychiatric services,
the local community mental health programs,
and state hospitals which describes the roles and responsibilities each assumes
in order to assure that the goals of the regional acute care psychiatric services
are achieved.
(13) “Medical director” means
a board eligible psychiatrist who oversees the patient care program. The medical
director shall have the final authority concerning inpatient medical care including
admissions, continuing care, and discharges.
(14) “Medical history”
means a review of the patient’s current and past state of health as reported
by the patient or other reliable sources, including, but not limited to:
(a) History of any significant
illnesses, injuries, allergies, or drug sensitivities; and
(b) History of any significant
medical treatments, including hospitalizations and major medical procedures.
(15) “Mental health assessment”
means a process in which the person’s need for mental health services is determined
through evaluation of the patient’s strengths, goals, needs, and current level
of functioning.
(16) “Mental status examination”
means an overall assessment of a person’s mental functioning that includes
descriptions of appearance, behavior, speech, mood and affect, suicidal/homicidal
ideation, thought processes and content, and perceptual difficulties including hallucinations
and delusions. Cognitive abilities are also assessed and include orientation, memory,
concentration, general knowledge, abstraction abilities, judgment, and insight.
(17) “Objective”
means an interim level of progress or a component step the specification of which
is necessary or helpful in moving toward a goal.
(18) “Office” means
the Office of Mental Health Services of the Division.
(19) “OPRCS” means
the Oregon Patient/Resident Care System. OPRCS is a Division operated, on-line computerized
information system which accepts, stores and returns information about patients
from state operated institutions and other designated inpatient services.
(20) “Patient” means
a person who is receiving care and treatment in a regional acute care psychiatric
service.
(21) “Person committed
to the Division” means a patient committed under ORS 161.327 or 426.130.
(22) “Program administrator”
means a person, with appropriate professional qualifications and experience, appointed
by the governing body to manage the operation of the regional acute care psychiatric
services.
(23) “Psychiatrist”
means a physician licensed as provided pursuant to ORS 677.010 to 677.492 by the
Board of Medical Examiners for the State of Oregon and who has completed an approved
residency training program in psychiatry.
(24) “Qualified mental
health professional” or “QMHP” means a person who is one of the
following:
(a) Psychiatrist or physician,
licensed to practice in the State of Oregon; an individual with a graduate degree
in psychology, social work, or other mental health related field; a registered nurse
with a graduate degree in psychiatric nursing, licensed in the State of Oregon;
an individual with registration as an occupational therapist; an individual with
a graduate degree in recreational therapy; or
(b) Any other person whose education,
experience, and competence have been documented by the CMHP director or designee
as able 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
assessment; document a DSM diagnosis; write and supervise a rehabilitation plan;
and provide individual, family, and/or group therapy.
(25) “Regional acute care
psychiatric service” or “service” means a Division funded service
provided under contract with the Division or county, and operated in cooperation
with a regional or local council. A regional acute care psychiatric service must
include 24 hour-a-day psychiatric, multi-disciplinary, inpatient or residential
stabilization, care and treatment, for adults ages 18 and older with severe psychiatric
disabilities in a designated region of the State. For the purpose of these rules,
a state hospital is not a regional acute care psychiatric service. The goal of a
regional acute care service is the stabilization, control and/or amelioration of
acute dysfunctional symptoms or behaviors that result in the earliest possible return
of the person to a less restrictive environment.
(26) “Supervisor”
means a person who has two years of experience as a qualified mental health professional
and who, in accordance with Section 309-032-0870 of these rules, reviews the services
provided to patients by qualified persons.
(27) “Treatment plan”
means an individualized, written plan defining specific rehabilitation objectives
and proposed service interventions derived from the patient’s mental health
assessment.
Stat. Auth.: ORS 413.042 &
430.640

Stats. Implemented: ORS 430.630
& 430.640

Hist. MHD 8-1994, f. & cert.
ef. 11-28-94
309-032-0870
Standards for Approval
of Regional Acute Care Psychiatric Service
(1) State approvals and licenses.
The facility in which a regional acute care psychiatric service is provided shall
maintain state approvals and licenses as required by Oregon law for the health,
safety, and welfare of the persons served. Non-hospital facilities shall be licensed
by the Division as required by ORS 443.410. The facility must also be approved under
OAR 309-033-0530 Approval of Hospitals and Nonhospital Facilities that Provide Services
to Committed Persons and to Persons in Custody or on Diversion and OAR 309-033-0540,
Administrative Requirements for Hospitals and Nonhospital Facilities Approved to
Provide Services to Persons in Custody, Psychiatric Hold or Certified for 14 Days
of Intensive Treatment.
(2) Clinical record management.
A regional acute care psychiatric service shall maintain clinical records as follows:
(a) Clinical records are confidential,
as set forth in ORS 179.505 and 192.502 and any other applicable state or federal
law, except as otherwise indicated by applicable rule or law. For the purposes of
disclosure from non-medical individual records, both the general prohibition against
disclosure of “information of a personal nature” and limitations to
the prohibition in ORS 192.502 shall be applicable.
(b) Clinical records shall be
secured, safeguarded, stored, and retained in accordance with OAR 166-030-1015.
(c) Clinical record entries
required by these rules must be signed by the staff providing the service and making
the entry. Each signature must include the person’s academic degree or professional
status and the date signed.
(3) Clinical record content.
The clinical record shall contain:
(a) Identifying demographic
information, including, if available, who to contact in an emergency and the names
of persons who encompass the support system of the patient.
(b) Consent to release information
and explanation of fee policies. At the time of admission staff shall present the
patient with forms for obtaining consent so that information may be shared with
family and others. An explanation of fee policies shall also be provided in written
form at the earliest time possible. The patient shall be asked to sign each. If
the patient is unwilling or unable to sign, staff shall record that the person is
unable or unwilling to do so.
(c) Admitting mental health
assessment. An admitting mental health assessment shall be completed, by or under
the supervision of an independent medical practitioner with supervised training
or experience in a mental health related setting, within 24 hours of admission.
The admitting mental health assessment shall include a description of the presenting
problem(s), a mental status examination, an initial DSM diagnosis, and an assessment
of the resources currently available to the person. The assessment shall result
in a plan for the initial services to be provided. The admitting mental health assessment
shall also include documentation that a medical history and physical examination
of the person has been performed within 24 hours after admission by a physician,
physician assistant, or nurse practitioner.
If the independent medical practitioner believes a new medical history and physical
examination are not necessary, and if within 30 days of admission a complete physical
history has been recorded and a complete physical examination has been performed,
the signed report of the history and examination may be placed in the clinical record
and may be considered to constitute an appropriate physical health assessment.
(d) Psycho-social assessment. A psycho-social
assessment shall be completed for each patient within 72 hours of admission. If
the patient stays less than 72 hours, a psycho-social assessment need not be written.
The assessment must be completed by a qualified mental health professional or supervisor.
The assessment does not need to be a single document but must include the following
elements:
(A) A description of events
precipitating admission and any goal(s) of the patient in seeking or entering services.
(B) When relevant to the patient’s
service needs, historical information including: mental health history; medical
history; substance use and abuse history; developmental history; social history,
including family and interpersonal history; sexual and other abuse history; educational,
vocational, employment history; and legal history.
(C) An identification of the
patient’s need for assistance in maintaining financial support, employment,
housing, and other support needs.
(D) Recommendations for discharge
planning and any additional services, interventions, additional examinations, tests,
and evaluations that are needed.
(e) Treatment plan. A treatment
plan, individually developed with the patient from the findings of the admitting
mental health assessment and psycho-social assessment, must be completed by a QMHP
or supervisor within 72 hours of the person’s admission. The plan must be
written at a level of specificity that will permit its subsequent implementation
to be efficiently monitored and reviewed. The recorded plan shall contain the following
components:
(A) The rehabilitation and other
goals, including those articulated by the patient.
(B) Specific objectives, including
discharge objectives, and the measurable or observable criteria for determining
when each objective is attained;
(C) Specific services to be
used to achieve each objective;
(D) The projected frequency
and duration of services;
(E) Identification of the QMHP
or supervisor assigned to the patient who is responsible for coordinating services;
(F) The signature of the patient
indicating he/she has participated in the development of the plan to the degree
possible. If the patient is unwilling or unable to sign the plan, staff shall record
on the plan that the patient is unable or unwilling to do so.
(G) The plan must be reviewed
weekly and updated with the participation of the patient when needed to reflect
significant changes in the patient’s status, and when significant new goals
are identified.
(f) Progress notes. Progress
notes shall document observations, treatment rendered. response to treatment, and
changes in the patient’s condition, and other significant information relating
to the patient. All entries involving subjective interpretation of the patient’s
progress shall be supplemented by a description of the actual behavior observed.
(g) Reports of medication administration,
medical treatments, and diagnostic procedures.
(h) Telephone communications
about the patient, releases of information, and reports from other sources.
(i) The record shall contain
medical and mental health advance directives or note that the patient has been provided
this information.
(j) The record shall contain
documentation that the person has been provided information on patient rights, grievance
procedure, and abuse reporting.
(k) The record shall contain
documentation including physician’s orders and reasons for all restraint and
seclusion episodes.
(l) Discharge plan. The discharge
planning shall begin at the time of admission with the participation of the patient
and, when indicated, the family, guardian and significant others. The discharge
plan shall include the results of the admitting mental health assessment; DSM diagnoses;
summary of the course of treatment, including prescribed medications; final assessment
of the person’s condition; recommendations and arrangements for further treatment
including prescribed medications and continuing care; and documentation of the planning
for, and securing of appropriate living arrangements.
(4) Patient data management.
The regional acute care psychiatric service shall supply to the Division, using
the Division’s on-line Oregon Patient/Resident Client System (OPRCS), via
computer and modem, information about persons admitted to and discharged from the
service. Such information shall include the patient’s name, DSM diagnosis,
admission date, discharge date, legal status, Medicaid eligibility, Medicaid Prime
Number and various patient demographics. Such information shall be entered on the
day of admission and updated on the day of discharge.
(5) Professional staff standards.
The regional acute care psychiatric service shall:
(a) Have sufficient appropriately
qualified professional, administrative and support staff to assess and address the
identified clinical needs of persons served, provide needed services, and coordinate
the services provided.
(b) Designate a program administrator
to oversee the administration of the services and carry out these rules.
(c) Designate a medical director
to oversee the patient care program. The medical director shall have the final authority
concerning inpatient medical care including admissions, continuing care, and discharges.
(d) Designate an individual
responsible for maintaining, controlling and supervising medical records and be
responsible for maintaining the quality of clinical records.
(e) Designate an individual
responsible for the development, implementation and monitoring of a written safety
management plan and program, who shall keep records of identified concerns and problems
and actions taken to resolve them.
(f) Designate an individual
responsible for the development, implementation and monitoring of a written infection
control plan and program, who shall keep records of identified concerns and problems
and action taken to resolve them.
(g) Designate, or contract with,
a licensed pharmacist to be responsible for the development of pharmacy policies
and procedures, and to assure that the service adheres to standards of practice
and applicable state and federal laws and regulations.
(h) Maintain a schedule of unit
staffing which shall be readily available to the Division for a period of at least
the three previous years.
(i) Have on duty at least one
registered nurse at all times.
(j) Maintain a personnel file
for each patient care staff which includes a written job description; the minimum
level of education or training required for the position; copies of applicable licenses,
certifications, or degrees granted; annual performance appraisals; a biennial, individualized
staff development plan signed by the staff; documentation of CPR training; documentation
of annual training and certification in managing aggressive behavior, including
seclusion and restraint; and other staff development and/or skill training received.
(k) A physician must be available,
at least on-call, at all times.
(6) Policies and procedures
manual. The regional acute care psychiatric service shall have a policy and procedure
manual. The policy and procedure manual must be made available to any person upon
request. The manual shall describe:
(a) The following policies and
procedures:
(A) Governance and management,
including: a table of organization describing the agency structure and lines of
authority; a plan for professional services; and a plan for financial management
and accountability.
(B) Procedures for
the management of disasters, fire, and other emergencies.
(C) Policies and procedures required under
OAR 309-033-0700 through 309-033-0740, Standards for the Approval of Community Hospitals
and Nonhospital Facilities to Provide Seclusion and Restraint to Committed Persons
and to Persons in Custody or on Diversion addressing seclusion and restraint.
(D) Patient rights, including
informed consent, access to records, and grievance procedure. The manual shall assure
rights guaranteed by ORS 426.380 to 426.395 for committed persons and ORS 430.205
to 430.210 for those not committed. The grievance procedure must be in writing and
include written responses, time limits for responses, use of a neutral party and
a method of appeal. Programs shall post copies of the rights and grievance procedures
in places accessible to all persons. Programs shall provide written copies of the
rights and grievance procedure upon request.
(E) Abuse reporting for mentally
ill or developmentally disabled as required by ORS 430.731 through 430.768.
(F) Clinical record content
and management policies and procedures, including the requirements of these rules.
(G) Psychiatric, medical, and
dental emergency services policies and procedures.
(H) Pharmacy services policies
and procedures approved by a licensed pharmacist.
(I) Quality assessment and improvement
processes.
(J) Procedures for documenting
privileges granted by the service in personnel records or other records.
(K) Policies and procedures
for transfer of patients to other hospitals.
(b) The following policies and
procedures, developed and amended in consultation with the council:
(A) Patient admission and discharge
criteria. Unless the service has a policy and procedure recommended by the council
and approved by the Division, the service shall only admit persons age 18 and older.
(B) Quality assessment and improvement
processes relating to regional admissions and discharges.
(C) Patient admission, discharge
and aftercare planning; including scheduling and planning for transportation of
patients to the service by the referring county and from the service to the county
of residence.
(D) Procedures for admission
and discharge of geropsychiatric patients and persons with physical disabilities,
including designation of a county or regional geropsychiatric liaison staff member.
(E) Linkage agreements with
community mental health programs it serves and state hospitals.
(F) Medical and emergency care
procedures, approved by the Division.
(G) Criteria for accepting pre-admission
medical screening.
(H) Billing and collecting reimbursement
from patients and third-party payors.
(7) Holding allegedly mentally
ill persons. The service shall have an adequate number of hold rooms but at least
one holding room and hold a current Certificate of Approval to hold and treat persons
who are alleged to be mentally ill under OAR 309-033-0500 through 309-033-0560,
Approval of Hospital and Nonhospital Facilities that Provide Services to Committed
Persons or to Persons in Custody or on Diversion.
(8) Federal rules and regulations.
The facility in which a service is operated shall comply with all applicable federal
rules and regulations.
(9) Medical care. If the facility
in which the regional acute care psychiatric service is operated is not in a general
hospital, it shall have a letter of agreement with a general hospital for both emergency
and medical care, which shall be renewed every two years.
(10) Quality assessment and
improvement. The regional acute care psychiatric service shall have an ongoing quality
assessment and improvement program to objectively and systematically monitor and
evaluate the quality of care provided to patients served, pursue opportunities to
improve care and correct identified problems. The program shall include:
(a) Policies and procedures
that describes the quality assessment and improvement program’s objectives,
organization, scope, and mechanisms for improving services.
(b) A written annual plan to
monitor and evaluate services. The written plan shall result in reports of findings,
conclusions, and recommendations. Reports shall address:
(A) The care of patients served,
including admission and discharge planning;
(B) Resource utilization, including
the appropriateness and clinical necessity of admissions and continued stay, services
provided, staffing levels, space, and support services;
(C) Quality and content of clinical
records;
(D) Medication usage, including
records, adverse reactions, and medication errors;
(E) Accidents, injuries, safety
of patients, and safety hazards; and
(F) Uses of seclusion and restraint.
(c) A report to the governing
board and council, at least annually, addressing:
(A) Findings and conclusions
from studies;
(B) Recommendations, action
taken, and results of the action taken; and
(C) An assessment of the effectiveness
of the quality assessment and improvement program; including a review of the program’s
objectives, scope, organization and effectiveness.
(11) Council. The regional acute
care psychiatric service shall have a council to ensure appropriate and effective
care and treatment. The council shall meet to assess and collaboratively plan for
improving care and treatment to patients, including patient transitions into and
out of the service.
Stat. Auth.: ORS 413.042 &
430.640

Stats. Implemented: ORS 430.630
& 430.640

Hist. MHD 8-1994, f. & cert.
ef. 11-28-94
309-032-0890
Variances
(1) Criteria for a variance. Variances may be granted to a regional acute care psychiatric service if implementation of the proposed alternative services, methods, concepts or procedures would result in service or system that meet or exceeds the standards in these rules.
(2) Variance application. The service requesting a variance shall submit, in writing, an application to the Division which contains the following:
(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 with the section of the rule from which the variance is sought; and
(e) Signed documentation from the council indicating its position on the proposed variance.
(3) Office of Mental Health Services review. The Assistant Administrator or designee of the Office shall approve or deny the request for a variance.
(4) Notification. The Office shall notify the regional acute care psychiatric service of the decision. This notice shall be given to the service, with a copy to the council, within 30 days of the receipt of the request by the Office.
(5) Appeal application. Appeal of the denial of a variance request shall be made in writing to the Administrator of the Division, whose decision shall be final.
(6) Written approval. The regional acute care psychiatric service may implement a variance only after written approval from the Division. The Intergovernmental Agreement shall be amended to the extent that the variance changes a term in that agreement.
(7) Duration of variance. A variance shall be reviewed by the Division at least every 2 years.
Stat. Auth.: ORS 426.490 - 426.500& 430.630(3)

Stats. Implemented:

Hist. MHD 8-1994, f. & cert. ef. 11-28-94

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