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OREGON HEALTH AUTHORITY, DIVISION OF MEDICAL ASSISTANCE PROGRAMS




 

DIVISION 170
BEHAVIOR REHABILITATION
SERVICES PROGRAM

GENERAL RULES
410-170-0000
Effective Date and Administration of the
BRS Program
(1) OAR 410-170-0000 through 410-170-0120
are effective on January 1, 2014.
(2) All BRS contractor’s
and BRS provider’s programs must meet the requirements in the BRS program
general rules (OAR 410-170-0000 through 410-170-0120). Additional agency-specific
BRS program rules for the Department of Human Services are contained in 413-090-0055
through 413-090-0090, and for the Oregon Youth Authority are contained in 416-335-0000
through 416-335-0100.
(3) All references to federal
and state laws and regulations referenced in these rules are those in place on November
13, 2013, and the agency-specific BRS program rules that are effective on January
1, 2014.
(4) Delegation of Authority:
The Oregon Health Authority may delegate authority to another agency or a unit of
government to carry out some of its obligations under these rules.
Stat. Auth.: ORS 183.355, 413.042 &
414.065
Stats. Implemented: ORS 414.065
Hist.: DMAP 63-2013, f. 11-14-13,
cert. ef. 1-1-14
410-170-0010
Purpose
The purpose of the Behavior Rehabilitation
Services (BRS) Program is to remediate the BRS client’s debilitating psychosocial,
emotional and behavioral disorders by providing such services as behavioral intervention,
counseling, and skills-training. These rules describe the general program requirements
for the BRS program, prior authorization process, services and placement related
activities, BRS contractor and BRS provider requirements, reimbursement rates, and
compliance and oversight activities.
Stat. Auth.: ORS 413.042 & 414.065
Stats. Implemented: ORS 414.065
Hist.: DMAP 63-2013, f. 11-14-13,
cert. ef. 1-1-14
410-170-0020
Definitions
The following definitions apply to terms
used in OAR 410-170-0000 through 410-170-0120.
(1) Agency means the state
agency that has a contract with the BRS contractor to provide services and placement
related activities to the BRS client, and provides prior authorization for the BRS
client to receive services and placement related activities pursuant to the BRS
program general rules and, as applicable, agency-specific BRS program rules. The
agency will be one of the following state agencies: the Department of Human Services,
the Oregon Health Authority, or the Oregon Youth Authority.
(2) Approved provider parent
means an individual who a BRS contractor, a BRS provider, or OYA has approved to
provide services or placement related activities to the BRS client in the home of
that individual. Approved provider parents who provide services are considered direct
care staff, and must meet those qualifications in OAR 410-170-0030(4).
(3) Behavior Rehabilitation
Services (BRS) program is a program that provides services and placement related
activities to the BRS client to address their debilitating psychosocial, emotional
and behavioral disorders in a community placement utilizing either a residential
care model or therapeutic foster care model.
(4) Billable care day means
each calendar day the BRS client is in the direct care of the BRS provider at 11:59
p.m. or meets the requirements in OAR 410-170-0110.
(5) BRS client means the
person who has prior authorization from an agency to receive services or placement
related activities through the BRS program in accordance with the BRS program general
rules, and as applicable agency-specific BRS program rules.
(6) BRS contractor means
the entity contracted with an agency to be responsible for providing services and
placement related activities to the BRS client. The BRS contractor may also be the
BRS provider if it provides direct services and placement related activities to
the BRS client.
(7) BRS provider means a
facility, institution, corporate entity, or other organization that provides direct
services and placement related activities to the BRS client.
(8) BRS type of care means
the type of program model, services, placement related activities, staffing requirements
and qualifications which are necessary to meet the medical and other needs of the
BRS client.
(9) Caseworker means the
individual who coordinates the services and placement related activities for the
BRS client with the BRS contractor and BRS provider.
(10) Child or children means
a person or persons under 18 years of age.
(11) Children’s health
insurance program (CHIP) means the federal and state funded portion of the Oregon
Health Plan (OHP) established by Title XXI of the Social Security Act and administered
by the Authority.
(12) Designated LPHA means
a licensed practitioner of the healing arts, who has a contract with, is approved
by, or is employed by the agency to make a determination on the medical appropriateness
of the BRS program for the BRS client.
(13) DHS or Department means
the Department of Human Services, Child Welfare.
(14) Direct care staff means
an individual who is employed by or who has a contract or an agreement with the
BRS provider, and is responsible for assisting social service staff in providing
individual and group counseling, skills-training and therapeutic interventions,
and monitoring and managing the BRS client’s behavior to provide a safe, structured
living environment that is conducive to treatment.
(15) Initial service plan
(ISP) means the initial written individualized services plan, developed by the BRS
contractor or BRS provider, identifying the services that must be provided to the
BRS client during the first 45 days in its BRS program or until the master service
plan is written. Additional requirements are described in OAR 410-170-0070.
(16) Licensed practitioner
of the healing arts (LPHA) means a physician or other practitioner licensed in the
State of Oregon who is authorized within the scope of his or her practice, as defined
under state law, to diagnose and treat individuals with physical or mental disabilities,
or psychosocial, emotional and behavioral disorders.
(17) Master service plan
(MSP) means the written individualized services plan, developed by the BRS contractor
or BRS provider, identifying the services that must be provided to the BRS client
in its BRS program. Additional requirements are described in OAR 410-170-0070.
(18) Medicaid means the federal
and state funded portion of the medical assistance programs established by Title
XIX of the Social Security Act, as amended, administered in Oregon by the Authority.
(19) OHA or Authority means
the Oregon Health Authority. The Authority is the agency established in ORS Chapter
413 that administers the funds for Titles XIX and XXI of the Social Security Act.
It is the single state agency for the administration of the medical assistance program
under ORS chapter 414. For purposes of these rules, the agencies under the authority
of the Authority are the Public Health Division, the Addictions and Mental Health
Division, and the Division of Medical Assistance Programs.
(20) OYA means the Oregon
Youth Authority.
(21) Physical restraint means
the act of restricting the BRS client’s voluntary movement as an emergency
measure to manage and protect the BRS client or others from injury when no alternate
actions are sufficient to manage the BRS client’s behavior. Physical restraint
does not include temporarily holding a BRS client to assist him or her or assure
his or her safety, such as preventing a child from running onto a busy street.
(22) Placement related activities
means the BRS contractor’s or BRS provider’s activities related to the
operation of the program and the care of the BRS client as set forth in the BRS
program general rules, applicable agency-specific BRS program rules, the contract
or agreement with the agency or the BRS contractor, and applicable federal and state
licensing and regulatory requirements. Placement related activities may include
but are not limited to providing the BRS client with: food, clothing, shelter, daily
supervision, access to educational, cultural and recreational activities; and case
management. Room and board is not funded by Medicaid or CHIP.
(23) Private child-caring
agency is defined by the definitions in ORS 418.205, and means a “child-caring
agency” that is not owned, operated, or administered by any governmental agency
or unit:
(a) A child-caring agency
means an agency or organization providing:
(A) Day treatment for disturbed
children;
(B) Adoption placement services;
(C) Residential care, including
but not limited to foster care or residential treatment for children;
(D) Outdoor youth programs
(defined at OAR 413-215-0911); or
(E) Other similar services
for children;
(b) A child-caring agency
does not include residential facilities or foster care homes certified or licensed
by the Department under ORS 443.400 to 443.455, 443.830 and 443.835 for children
receiving developmental disability services.
(24) Proctor parent means
an approved provider parent who is certified by OYA and a private child-caring agency
in accordance with the applicable provisions in OAR 416-530-0000 through 416-530-0200
and 416-550-0000 through 416-550-0080, and who is employed by or who has a contract
or agreement with the private child-caring agency to provide some services and placement
related activities to the BRS client in the individual’s home.
(25) Program coordinator
or program director means an individual employed by or contracted with the BRS provider,
and is responsible for supervising staff, providing overall direction to the BRS
provider, planning and coordinating program activities and delivery of services
and placement related activities, and ensuring the safety and protection of the
BRS client and the BRS provider’s staff.
(26) Public child-caring
agency means, for purposes of this rule, an agency or institution operated by a
governmental agency or unit other than DHS, OYA, or OHA, which provides care to
the BRS client in a residential community setting.
(27) Residential care model
means that services and placement related activities are provided to the BRS client
in a residential community setting and not in the home of an approved provider parent.
(28) Respite care means a
formal planned arrangement to relieve an approved provider parent’s responsibilities
by an individual temporarily assuming responsibility for the care and supervision
of the BRS client in the home of the respite provider or approved provider parent.
Respite care must be less than 14 consecutive days.
(29) Seclusion means the
involuntary confinement of a BRS client to an area or room from which the BRS client
is physically prevented from leaving.
(30) Services means the treatment
provided to the BRS client in a BRS provider’s program, including but not
limited to treatment planning, individual and group counseling, skills-training,
and parent training.
(31) Social service staff
means an individual employed by or contracted with the BRS provider, and is responsible
for case management and the development of the ISP or MSP for the BRS client; individual,
group and family counseling; individual and group skills-training; assisting the
direct care staff in providing appropriate treatment to the BRS client; coordinating
services with other agencies; and documenting the BRS client’s treatment progress.
(32) Therapeutic foster care
model means services and placement related activities are provided to the BRS client
who resides in the home of an approved provider parent.
(33) Total daily rate means
the total amount of the service payment and placement related activities payment
for a billable care day.
(34) Young adult means a
person aged 18 through 20 years.
Stat. Auth.: ORS 413.042, 414.065
Stats. Implemented: ORS 414.065
Hist.: DMAP 63-2013, f. 11-14-13,
cert. ef. 1-1-14
410-170-0030
BRS Contractor and BRS Provider Requirements
(1) Conditions of BRS contractor and
BRS provider participation. The BRS contractor must ensure that itself and its BRS
providers meet the following minimum requirements:
(a) Have the necessary current
and valid licenses, approvals or certifications required by federal or state law
or regulations for the entity and its staff to operate a BRS program;
(b) Have a license to operate
a private child-caring agency or be approved by the Department of Human Services’
Office of Licensing and Regulatory Oversight to operate a public child-caring agency;
(c) Comply with all federal
and state laws and regulations required to be a licensed or an approved foster care
agency under OAR 413-215-0301 to 413-215-0396 or residential care agency under OAR
413-215-0501 to 413-215-0586 and, if the BRS client is a person age 18 or older,
comply with the licensing or approval requirements that would apply if the BRS client
was a child;
(d) Comply with the provider
enrollment requirements in OAR 410-120-1260;
(e) Comply with the requirements
in OAR 410-120-1380(1)(c)(J) for excluding individuals and entities from being subcontractors
if they are found on the listed exclusion list(s); and
(f) Have a contract or agreement
with an agency, or as applicable a BRS contractor, to provide services and placement
related activities to the BRS client.
(2) Compliance with Federal
and State Law. The BRS contractor must, and must ensure its BRS providers, comply
with all applicable federal and state laws and regulations pertaining to the provision
of Medicaid services under the Medicaid Act, Title XIX, 42 USC 1396 et seq. and
the BRS program, including but not limited to all applicable provisions in OAR 410-120-0000
through 410-120-1980.
(3) Confidentiality of BRS
client information:
(a) Confidentiality Generally:
The BRS contractor must not, and ensure its BRS providers do not, use or disclose
any information concerning a BRS client for any purpose not directly connected with
the administration of the BRS contractor’s or BRS provider’s program
or as otherwise permitted by law, except with the written consent of the agency,
or if the agency is not the BRS client’s guardian, on the written consent
of the person or persons authorized by law to consent to such use or disclosure.
The BRS contractor must, and must require its employees and BRS providers to, comply
with all appropriate federal and state laws, rules and regulations regarding the
confidentiality of records related to the BRS client;
(b) HIPAA Compliance and
Medical Privacy. The BRS contractor must, and ensure its BRS providers, comply with
all applicable confidentiality requirements in the Health Insurance Portability
and Accountability Act (HIPAA) of 1996 (Public Law 104-191, August 21, 1996) and
its implementing regulations in 45 CFR 160 and 164 et. seq., and all applicable
confidentiality requirements in state statutes and administrative rules, including
but not limited to ORS 179.505 and OAR chapter 410, division 120;
(c) Maintenance of Written
Records: The BRS contractor must, and ensure its BRS providers, appropriately secure
all records and files related to BRS clients to prevent access by unauthorized persons
or entities;
(d) Disclosure to the agency,
Authority or other governmental oversight or licensing entities:
(A) The BRS contractor must,
and ensure its BRS providers, promptly provide access to any information or written
documentation in its possession related to the BRS client or its BRS program upon
the request of the agency for any reason; and
(B) The BRS contractor must,
and ensure its BRS providers, promptly provide access to any information or written
documentation in its possession related to the BRS client or its BRS program that
is necessary for the purpose of evaluating, overseeing or auditing the BRS contractor’s
program upon the request of the Authority or other governmental oversight or licensing
entities.
(4) Staff Qualifications.
The BRS contractor must ensure that its BRS program, either operated by itself or
by its BRS provider, has a program coordinator, social service staff, and direct
care staff who meet and maintain the following minimum qualifications:
(a) No less than 50% of the
direct care staff for a BRS provider must have a Bachelor’s degree from an
accredited college or university. A combination of formal education and experience
with children or young adults may be substituted for a Bachelor’s degree.
Direct care staff must be under the direction of a qualified social service staff
member or a program coordinator;
(b) Direct care staff, social
service staff, and the program coordinator, who directly work with BRS clients,
must:
(A) Receive a minimum of
28 hours of initial training prior to or within 30 days of employment or certification
on the following topics: BRS services documentation, mandatory reporting of child
abuse, program policies and expectations, gender- and cultural-specific services,
behavior and crisis management, medication administration, discipline and restraint
policies, and suicide prevention. Any direct care staff, social service staff, or
program coordinator who has not yet completed this initial training prior to employment
or certification, must be supervised by a person who has completed this training
when having direct contact with BRS clients; and
(B) Receive a minimum of
16 hours of training annually on the following topics: skills-training that supports
evidence-based or promising practices, and other subjects relevant to the responsibilities
of providing services and placement related activities to the BRS client; and
(C) Have and maintain cardiopulmonary
resuscitation (CPR) and first aid certification;
(c) The program coordinator
or program director must have a Bachelor’s degree from an accredited college
or university, preferably with major study in psychology, sociology, social work,
social sciences, or a closely allied field, and two years of experience in the supervision
and management of a residential facility for the care and treatment of children
or young adults;
(d) Social service staff
must have a Master’s degree from an accredited college or university with
major study in social work or a closely allied field and one year of experience
in the care and treatment of children or young adults; or have a Bachelor’s
degree with major study in social work, psychology, sociology or a closely allied
field and two years of experience in the care and rehabilitation of children or
young adults.
(5) Fitness Determination:
(a) The BRS contractor and
BRS provider must ensure that its employees, volunteers, contractors, vendors, approved
provider parents, or other persons providing services or placement related activities
to BRS clients, comply with all applicable criminal record and child abuse background
checks and any fitness determination process required by federal or state law or
regulation;
(b) The BRS contractor and
the BRS provider must ensure that its employees, volunteers, contractors, vendors,
approved provider parents, or other persons providing services or placement related
activities to BRS clients, who have not yet successfully completed the requirements
in section (5)(a) of this rule, are supervised by a person who has successfully
met these requirements when having direct contact with BRS clients;
(c) Except in cases where
more stringent legal requirements apply, the BRS contractor and BRS provider must
ensure that its employees, volunteers, contractors, vendors, approved provider parents,
or other persons providing services or placement related activities to BRS clients,
report to it any arrests or court convictions, any known allegation of child abuse
or neglect, and any other circumstance that could reasonably affect a fitness determination
within one business day. The BRS contractor and BRS provider must report this information
to the agency on the same day it receives the information.
(6) Mandatory Reporting:
(a) The BRS contractor and
BRS provider must comply with the child abuse reporting laws in ORS 419B.010 through
419B.050;
(b) The BRS contractor and
BRS provider must require any staff member, including employees, volunteers, subcontractors,
approved provider parents, or other persons providing services or placement related
activities to BRS clients, to immediately make a report or cause a report to be
made under ORS 419B.015 anytime the staff member has reasonable cause to believe
that any child with whom the staff member comes in contact has suffered abuse, as
defined by 419B.005(1), or that any person with whom the staff member comes in contact
has abused a child;
(c) The BRS contractor and
BRS provider must train their staff regarding child abuse reporting requirements;
(d) The BRS contractor must
ensure that its BRS provider complies with the requirements of this section.
(7) Communication:
(a) The BRS contractor must
ensure that its BRS program, either operated by itself or by its BRS provider, maintains
a system for immediate and on-going communication amongst program staff regarding
the whereabouts, status and condition of the BRS clients in its program;
(b) The BRS contractor must
ensure that direct care staff and social service staff have access to a BRS client’s
information to the extent it is relevant to providing the BRS client with services
and placement related activities;
(c) The BRS contractor must
provide, or ensure that its BRS provider provides, immediate verbal notification
to the caseworker and the agency (if an additional contact person is designated)
when there is a communication outage at the program, and must provide an alternative
means by which the program may be contacted, if possible.
(8) Staffing Requirements:
(a) Supervision of BRS clients:
The BRS contractor must ensure that its BRS program, either operated by itself or
by its BRS provider, meets and maintains appropriate staffing levels to ensure supervision
of the BRS clients in its program at all times (24 hours a day, 7 days a week),
including taking steps to ensure that a BRS client is supervised while temporarily
outside of the program. The BRS provider must not leave a BRS client unsupervised,
except in cases where there is a service plan for the BRS client to be out of the
BRS provider’s direct supervision;
(b) Therapeutic Foster Care
Model:
(A) The Authority’s
or the Department’s BRS contractors. The BRS contractor must ensure that its
BRS program, either operated by itself or by its BRS provider, meets and maintains
the following adult to child ratios in its therapeutic foster care homes:
(i) Shelter Evaluation and
Assessment and Independent Living Services:
(I) A maximum of 3 BRS clients
shall be placed in the home of an approved provider parent;
(II) A maximum of 5 children
(including both BRS clients and non-BRS clients) and young adults (BRS clients only)
shall live in an approved provider parent home with two parents;
(III) A maximum of 4 children
(including both BRS clients and non-BRS clients) and young adults (BRS clients only)
shall live in an approved provider parent home with one parent; and
(IV) No more than two children
(including both BRS clients and non-BRS clients) under the age of three shall live
in an approved provider parent home;
(ii) Intensive Community
Care, Therapeutic Foster Care, and Enhanced Therapeutic Foster Care:
(I) A maximum of 2 BRS clients
shall be placed in the home of an approved provider parent;
(II) A maximum of 5 children
(including both BRS clients and non-BRS clients) and young adults (BRS clients only)
shall live in an approved provider parent home with two parents;
(III) A maximum of 4 children
(including both BRS clients and non-BRS clients) and young adults (BRS clients only)
shall live in an approved provider parent home with one parent; and
(IV) No more than two children
(including both BRS clients and non-BRS clients) under the age of three shall live
in an approved provider parent home;
(iii) Notwithstanding section
(8)(b)(A)(i) and (ii) of this rule, the BRS contractor or BRS provider may exceed
these limits on the maximum number of children and young adults who shall live in
a home when the approved provider parent is providing respite care;
(B) OYA’s BRS contractors.
The BRS contractor must ensure that its BRS program, either operated by itself or
by its BRS provider, meets and maintains the adult to child or young adult ratios
described in OYA-specific BRS program rules for therapeutic foster care homes;
(c) Residential Care Model:
The BRS contractor must ensure that its BRS program, either operated by itself or
by its BRS provider, meets and maintains the following direct care staff to BRS
client ratios for the BRS type of care it provides in its residential care BRS program:
(A) Shelter Assessment and
Evaluation, Intensive Community Care, and Independent Living Service: During scheduled
school days, weekends and non-scheduled school days, the program must:
(i) Have 1 direct care staff
member for every 7 BRS clients onsite between 7 a.m. and 3 p.m.;
(ii) Have 1 direct care staff
member for every 4.7 BRS clients onsite between 3 p.m. and 11 p.m.; and
(iii) Have 1 direct care
staff member for every 9.3 BRS clients onsite between 11 p.m. and 7 a.m.;
(B) Community Step-Down,
Independent Living Program, and BRS Basic Residential and Rehabilitation Services:
(i) During scheduled school
days, the program must:
(I) Have 1 direct care staff
member for every 7 BRS clients onsite between 7 a.m. and 3 p.m.;
(II) Have 1 direct care staff
member for every 4.7 BRS clients onsite between 3 p.m. and 11 p.m.;
(III) Have 1 direct care
staff member for every 9.3 BRS clients onsite between 11 p.m. and 7 a.m.; and
(ii) During weekends and
non-scheduled school days, the program must:
(I) Have 1 direct care staff
member for every 4.7 BRS clients onsite between 7 a.m. and 3 p.m.;
(II) Have 1 direct care staff
member for every 4.7 BRS clients onsite between 3p.m. and 11 p.m.;
(III) Have 1 direct care
staff member for every 9.3 BRS clients onsite between 11 p.m. and 7 a.m.;
(C) Intensive Rehabilitation
Residential Services, BRS Residential, BRS Enhanced, and Short-Term Stabilization
Program:
(i) During scheduled school
days, the program must:
(I) Have 1 direct care staff
member for every 7 BRS clients onsite between 7 a.m. and 3 p.m.;
(II) Have 1 direct care staff
member for every 2.8 BRS clients onsite between 3 p.m. and 11 p.m.;
(III) Have 1 direct care
staff member for every 9.3 BRS clients onsite between 11 p.m. and 7 a.m.; and
(ii) During weekends and
non-scheduled school days, the program must:
(I) Have 1 direct care staff
member for every 4.7 BRS clients onsite between 7 a.m. and 3 p.m.;
(II) Have 1 direct care staff
member for every 2.8 BRS clients onsite between 3 p.m. and 11 p.m.;
(III) Have 1 direct care
staff member for every 9.3 BRS clients onsite between 11 p.m. and 7 a.m.;
(d) For purposes of calculating
the number of direct care staff under section (8)(c) of this rule only, a social
service staff member or program coordinator may be included if that staff member
is specifically scheduled to and actually provides direct supervision to BRS clients
onsite during the relevant time period;
(e) Under section (8)(c)
of this rule only, in the event that no BRS clients are onsite at the program due
to home visits or other planned absences, the BRS contractor and BRS provider must
ensure that its program has the resources and procedures in place to serve the BRS
client who may need to return to the program prior to the scheduled return date;
(f) In the event a BRS client
is temporarily admitted to a hospital (other than to a psychiatric hospital) but
is still enrolled in the BRS provider’s program, the BRS contractor and BRS
provider must ensure that its program works with the caseworker, and the family
when appropriate, to develop a plan approved by the agency for supervision during
the BRS client’s hospitalization;
(g) The BRS contractor may,
or allow its BRS provider to, request prior written agency approval for its BRS
program to deviate from the ratios described in section (8)(b) and (c) of this rule
or agency-specific BRS program rules. If the agency grants a waiver, this shall
only apply to BRS program ratio requirements specified in these rules and agency-specific
BRS program rules. The BRS contractor and BRS provider must comply with any ratio
requirements applicable under federal or state licensing requirements or approvals;
(9) Physical Facility. The
BRS contractor must ensure that its BRS program, either operated by itself or by
its BRS provider, do the following:
(a) Provide an environment
suitable for the treatment of a BRS client, which meets all applicable safety, health
and general environment standards required for a residential community setting,
if services are provided to the BRS client in a residential care model, or in the
home of an approved provider parent certified by the BRS provider, if services are
provided to the BRS client in a therapeutic foster care model;
(b) Provide separate bedrooms
for children and persons 18 years or older, except in cases where the child shares
a bedroom with a young adult who is the child’s parent and caregiver or where
there is written approval from the Department of Human Services’ Office of
Licensing and Regulatory Oversight Coordinator and the agency;
(c) Provide separate bedrooms
for BRS clients who have inappropriate sexual behaviors identified in their service
plan and BRS clients who do not have those behaviors identified in their service
plan, unless there is written approval from the agency;
(d) Provide that BRS clients,
who have inappropriate sexual behaviors identified in their service plan, occupy
a bedroom either individually or in a group of three or more BRS clients who have
inappropriate sexual behaviors identified in their service plan, unless there is
written approval from the agency;
(e) Provide separate bedrooms
for BRS clients and other members of the household unless there is written approval
from the agency;
(f) Provide separate bedrooms
or dormitories for females and males;
(g) Provide physical separation
of BRS clients served in its BRS program from persons housed in a detention facility
or youth correction facility;
(h) Provide that at least
one door in each bedroom is unlocked at all times;
(i) Provide that at least
one door in each dormitory is unlocked at all times, unless the BRS contractor or
BRS provider receives prior written agency approval to lock all dormitory doors
for eight hours at night; and
(j) Provide a means of egress
for BRS clients to leave the facility.
(10) BRS providers and BRS
contractors are not required to comply with (9)(b) and (c) of this rule if they
provide services or placement related activities in a dormitory setting.
(11) BRS Program Policies
and Procedures:
(a) The BRS contractor must
ensure that its BRS program, either operated by itself or by its BRS provider, has
the following written policies and procedures, which have been reviewed and approved
by the agency:
(A) Admission criteria and
standards to accept a BRS client into its program;
(B) Staff training policies
and procedures, including child abuse reporting expectations under ORS 419B.005,
419B.010 and 419B.015;
(C) Policies and procedures
related to reviewing referrals to its program and notification of admission decisions;
(D) A behavior management
system policy designed to consistently encourage appropriate behaviors by the BRS
client in a non-punitive manner;
(E) A behavioral rehabilitation
program model that uses evidence-based or promising practices whenever possible
and the curriculum, policies, and procedures which implement that model;
(F) Policies regarding the
BRS client’s and family’s rights, including but not limited to the search
and seizure of the BRS client’s person, property, and mail; visitation and
communication; and discharges initiated by the BRS client;
(G) A grievance policy describing
the process through which the BRS client, and, if applicable, the BRS client’s
parent, guardian or legal custodian may present grievances to the BRS provider about
its operation and a process to resolve issues;
(H) A suicide prevention
policy and procedure that describes how the BRS provider must respond in the event
a BRS client exhibits self-injurious, self-harm or suicidal behavior. This policy
must describe warning signs of suicide; emergency protocol and contacts; training
requirements for staff, including suicide prevention training and suicide risk assessment
tool training; procedures for determining implementation of additional supervision
precautions and for determining removal of additional supervision precautions; suicide
risk assessment procedures on the day of intake; documentation requirements for
suicide ideation, self-harm, and special observation precautions to ensure immediate
communication to all staff; a process for tracking suicide behavioral patterns;
and a “post-intervention” plan with identified resources;
(I) A seclusion and physical
restraint policy that describes when such interventions may be used in compliance
with applicable federal and state laws and regulations, including but not limited
to requirements for licensed or approved public or private child-caring agencies
and agency-specific BRS program rules. Physical restraint or seclusion shall only
be used as a last resort, and shall not be used for discipline, punishment, convenience
of personnel, or as a substitute for activities, treatment or training. The policy
must describe how staff are trained and monitored and who may perform such interventions;
(J) A medication management
policy which complies with applicable licensing requirements and agency-specific
BRS program rules. At minimum, the policy must describe:
(i) How and where medications
are stored and dispensed; and
(ii) How the BRS provider
must notify the caseworker if the BRS client refuses prescribed medications for
more than 7 days or refuses a medication that has been identified by any LPHA as
requiring an immediate report for health care reasons;
(K) A quality improvement
policy and procedures that monitor the operation of the BRS program to ensure compliance
with all applicable laws and regulations, including but not limited to tracking
service hours, monitoring the timeliness of reporting requirements, and monitoring
the quality of service delivery;
(b) The BRS contractor must
ensure that its BRS program, either operated by itself or by its BRS provider, reviews
and updates its policies and procedures as listed in section (11)(a) of this rule
biannually, and has any updated policies and procedures reviewed and approved by
the agency;
(c) The BRS contractor must
ensure that its BRS program, either operated by itself or by its BRS provider, complies
with, and maintains documentation of its compliance, with all policies and procedures
described in section (11)(a) of this rule, and with any modifications to their policies
and procedures that are required by the agency.
(12) Documentation Requirements:
(a) The BRS contractor and
BRS provider must:
(A) Comply with all documentation
requirements in OAR 410-120-1360, BRS program general rules and agency-specific
BRS program rules;
(B) Use forms reviewed and
approved by the agency to document the following if required: the ISP, the assessment
and evaluation report, the MSP, the MSP 90 day updates, the daily and weekly log
for service hours, and the invoice form;
(C) Maintain current documentation
of its staff’s compliance with applicable training, qualifications, and licensing
requirements, which must be readily available for on-site review by the caseworker,
agency, and other appropriate licensing or oversight entity;
(D) Create, maintain and
update an individualized case file for each BRS client either in hard copy or electronically,
including but not limited to service documentation (service plans, weekly service
type and hour records, and discreet service notes), which must be readily available
for on-site review by the BRS provider’s direct care staff and social service
staff, the caseworker, the agency, and the appropriate licensing or oversight entity;
(E) Ensure that all documentation
about the BRS client is written in terms that are easily understood by all persons
involved in service planning and delivery, including but not limited to the service
plans, progress notes and reports, assessments, and incident reports; and
(F) Ensure that all documentation
(paper or electronic) identifies any corrections made, including the original information,
what was corrected or changed, the date of the correction, and who made the correction.
White out, eraser tape, electronic deletions or other means of eradicating information
to make corrections on documentation may not be used;
(b) Incident Reports: The
BRS contractor must ensure that its BRS program, either operated by itself or by
its BRS provider, creates and maintains a record of all incidents and crisis interventions
on a form approved by the agency, including but not limited to use of seclusion
and physical restraint, a risk to the status or custody of the BRS client, or other
incidents likely to cause complaints, generate safety, programmatic or other serious
concerns, or come to the attention of the media or law enforcement.
(A) Incident reports must
contain the following information:
(i) Name of the BRS client;
(ii) The date, location,
and type of incident or crisis intervention;
(iii) The duration of any
seclusions or physical restraints employed in the context of the incident;
(iv) Name of staff involved
in the incident or crisis intervention, including the names of any witnesses;
(v) Description of the incident
or crisis intervention, including precipitating factors, preventative efforts employed,
and description of circumstances during the incident;
(vi) Physical injuries to
the BRS client or others resulting from the incident or crisis intervention, including
information regarding any follow-up medical care or treatment;
(vii) Documentation showing
that any necessary reports were made to the appropriate agency, any other entity
required by law to be notified, and, as applicable the BRS client’s parent,
guardian or legal custodian;
(viii) Documentation indicating
the date that a copy of the incident report was sent to the caseworker;
(ix) Actions or interventions
taken by program staff;
(x) Any follow-up recommendations
for the BRS client or staff;
(xi) Any follow-up or investigation
conducted by the BRS contractor or BRS provider’s supervisory staff and administrative
personnel, DHS, OHA, OYA or other entities; and
(xii) The BRS contractors
or BRS provider’s review of the incident or crisis intervention.
(B) The BRS contractor must
ensure that its BRS program, either operated by itself or by its BRS provider, provides
immediate verbal notification to the caseworker, the agency’s designated contact,
and as applicable the appropriate licensing entity of the following types of incidents:
incidents posing a risk to the status or custody of the BRS client, and any other
incidents that are of a nature serious enough to raise safety, programmatic, or
other serious concerns. Verbal notification must be followed up by the submission
of a written incident report to the individuals or entities described in this section
within 1 business day. Compliance with this notification requirement does not satisfy
child abuse reporting requirements under ORS 419B.005 to 419B.045;
(C) The BRS contractor must
ensure that its BRS program, either operated by itself or by its BRS provider, provides
a written incident report within 5 business days to the caseworker regarding any
use of seclusion or physical restraint on a BRS client;
(D) At the end of each month,
the BRS contractor must ensure that its BRS program, either operated by itself or
by its BRS provider, sends copies of all incident reports for that month, not previously
submitted under section (12)(b)(B) of this rule, to the designated agency contact;
(c) The BRS contractor and
BRS provider must promptly provide documentation to the agency upon request or by
the deadline specified in a written request, whichever is sooner. The BRS contractor’s
or BRS provider’s failure to provide the agency with the requested documentation
by the agency’s deadline may result in the agency pursuing any one or a combination
of the sanctions or remedies against the BRS contractor described in OAR 410-170-0120
or agency-specific BRS rules.
(13) Overnight Absences:
The BRS contractor must ensure that its program, either operated by itself or by
its BRS provider, receives prior written approval from the caseworker whenever the
BRS client will be sleeping outside of its program for any reason (such as home
visits, camping trips, court appearances, hospital admissions, or detention) excluding
cases of emergency:
(a) Initial approval shall
be completed at intake and will include information from the caseworker documenting
any special instructions such as:
(A) Conditions under which
an overnight absence from the program would be approved;
(B) Home visit resources
that are acceptable;
(C) Any required notifications
to the community: victim, court, special interest group, or law enforcement;
(D) Approved and non-approved
contacts during absences, as applicable; and
(E) Approved and non-approved
activities, as applicable;
(b) After initial approval
by the caseworker, the BRS contractor must ensure that its BRS program, either operated
by itself or by its BRS provider, notifies the caseworker of each upcoming overnight
visit at least 2 business days prior to the visit, and provides the following information:
(A) Dates of visit;
(B) Type of visit or activity;
(C) Location of visit or
activity; and
(D) Explanation of how any
special conditions or requirements will be addressed;
(c) The BRS contractor and
BRS provider shall not permit the BRS client to leave the state or country without
prior written approval by the agency.
(14) Publicly-Operated Community
Residences. The BRS contractor must ensure that its BRS program, either operated
by itself or by its BRS provider, that provides services and placement related activities
in a publicly-operated community residence does not serve more than 16 residents,
unless it receives prior written approval from the Authority with a determination
that it is not an institution for mental diseases (see definitions in 42 CFR 435.1010).
(15) The BRS contractor’s
Supervision of the BRS Provider:
(a) The BRS contractor is
responsible for monitoring and ensuring that its BRS providers comply with all applicable
laws and regulations related to the BRS program. The Authority and agency may pursue
any sanctions, remedies, or recovery of an overpayment as described in OAR 410-170-0120
or agency-specific BRS rules against the BRS contractor for failing to monitor and
ensure its BRS providers are in compliance with all applicable laws and regulations
related to the BRS program;
(b) The BRS contractor is
solely responsible for any and all obligations owed to its BRS provider under its
subcontract or agreement;
(16) The BRS Contractor’s
Supervision of the Approved Provider Parent:
(a) The BRS contractor must,
or must ensure that its BRS provider, monitors and ensures that its approved provider
parents comply with all applicable laws and regulations related to the BRS program.
The Authority and agency may pursue any sanctions, remedies, or recovery of an overpayment
described in OAR 410-170-0120 or agency-specific BRS rules against the BRS contractor
for failing to monitor and ensure its approved provider parents are in compliance
with all applicable laws and regulations related to the BRS program;
(b) The BRS contractor must,
or ensure that its BRS provider:
(A) Recruits, trains, reimburses,
and supports the approved provider parent in providing services or placement related
activities to the BRS client;
(B) Visits the approved provider
parent’s home a minimum of one time each month for the purposes of supervision,
monitoring, training and support;
(C) Provides at minimum the
following support services to the approved provider parent:
(i) Twenty-four hour back-up
services: The BRS contractor must, or ensure that its BRS provider, have staff available
to provide the approved provider parent with back-up services at all times (24 hours
per day, 7 days a week), which includes on-call services, consultation, and direct
crisis counseling. Approved provider parents must be given the contact details (names
and phone numbers) of the program staff that are available to provide these back-up
services;
(ii) Forty eight hours of
respite care: The BRS contractor must provide, or ensure that its BRS provider provides,
the approved provider parent with the opportunity to receive 48 hours per month
of time away from approved provider parent responsibilities. Daytime supervision
and night-time monitoring equivalent to that provided by the approved provider parent
must be arranged and provided to the BRS client during that time;
(c) The BRS contractor, or
as applicable the BRS provider, is solely responsible for any and all obligations
owed to the approved provider parent under its subcontract or agreement.
(17) Conflict of Interest:
The BRS contractor must, or ensure that its BRS provider, notifies the agency in
writing when a current employee or newly hired employee is also an employee of the
agency. The BRS contractor must, or ensure that its BRS provider, submits the notification
to the contract administrator and the agency’s contracts unit and shall include
the name of the employee and their job description. The agency must review the employment
situation for any actual or potential conflicts of interest as identified under
ORS chapter 244.
Stat. Auth.: ORS 413.042 & 414.065
Stats. Implemented: ORS 414.065
Hist.: DMAP 63-2013, f. 11-14-13,
cert. ef. 1-1-14
410-170-0040
Prior Authorization for the BRS Program;
Appeal Rights
(1) The BRS program requires prior authorization
from the agency in accordance with the Authority’s rules, the general BRS
program rules and applicable agency-specific BRS program rules. A referral by a
LPHA or agency to the Authority for prior authorization of the BRS program is not
a prior authorization.
(2) Prior Authorization Criteria
for the BRS program:
(a) The Authority shall provide
prior authorization for the BRS program to a person who:
(A) Is enrolled in the Oregon
Health Plan (OHP), is eligible for Oregon’s Medicaid or CHIP program, and
is eligible for Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Services,
according to the procedures established by the Authority;
(B) Has a determination by
a designated LPHA that the BRS program is medically appropriate to meet his or her
medical needs;
(C) Is not receiving residential
mental health or residential developmental disability services from another governmental
unit or entity;
(D) Is a child or young adult;
and
(E) Does not have a current
prior authorization for the BRS program for the requested time period from OYA or
the Department;
(b) OYA or the Department
may provide prior authorization for the BRS program for a person that meets the
requirements in its agency-specific BRS program rules.
(3) In order to meet the
requirement in section (2)(a)(B) of this rule, the designated LPHA must determine
that the BRS program is medically appropriate because the person:
(a) Has a primary mental,
emotional or behavioral disorder, or developmental disability that prevents the
person from functioning at a developmentally appropriate level in the person’s
home, school or community;
(b) Demonstrates severe emotional,
social and behavioral problems, including but not limited to: drug and alcohol abuse;
anti-social behaviors requiring close supervision, intervention and structure; sexual
behavioral problems; or behavioral disturbances;
(c) Requires out-of-home
behavioral rehabilitation treatment in order to restore or develop the person’s
appropriate functioning at a developmentally appropriate level in the person’s
home, school or community;
(d) Is able to benefit from
the BRS program at a developmentally-appropriate level;
(e) Does not have active
suicidal, homicidal, or serious aggressive behaviors; and
(f) Does not have active
psychosis or psychiatric instability.
(4) The Authority may also
request that the designated LPHA determine the BRS type of care that is medically
appropriate for the person. The designated LPHA must make that determination based
on the following factors, including but not limited to the:
(a) Severity of the person’s
psychosocial, emotional and behavior disorders;
(b) Intensity and type of
services that would be appropriate to treat the person;
(c) Type of setting or treatment
model that would be most beneficial to the person;
(d) Least restrictive and
intensive setting based on the person’s treatment history, degree of impairment,
current symptoms and the extent of family and other supports; and
(e) Behavior management needs
of the person.
(5) The agency is not required
to provide prior authorization or to make payment for services or placement related
activities under the following circumstances:
(a) The person was not eligible
for the BRS program at the time services or placement related activities were provided;
(b) The documentation is
not adequate to determine the type, medical appropriateness, or frequency and duration
of services;
(c) The services or placement
related activities billed or provided are not consistent with the information submitted
when the prior authorization was requested;
(d) The services or placement
related activities billed are not consistent with those provided;
(e) The services or placement
related activities were not provided within the timeframe specified on the notice
of prior authorization;
(f) The BRS program is not
covered under the person’s medical assistance package;
(g) The services or placement
related activities were not authorized or provided in compliance with the BRS program
general rules, agency-specific BRS program rules, or applicable DMAP General Rules
(OAR 410-120-0000 to 410-120-1920);
(h) The person does not meet
the prior authorization requirements as stated above;
(i) The BRS contractor or
BRS provider was not eligible to receive reimbursement through the BRS program at
the time the services or placement related activities were provided; or
(j) The person’s needs
could be better met through another system of care, the individual is eligible for
services under that system of care; the individual has been given notice of that
eligibility; and the services necessary to support a successful transition to the
alternate system of care have been provided.
(6) Retroactive Eligibility
and Authorization:
(a) In those instances when
the BRS client is made retroactively eligible for the BRS program, the agency may
grant prior authorization if:
(A) The BRS contractor or
BRS provider received preliminary approval from the agency prior to admitting the
BRS client into its program while the prior authorization process was pending;
(B) The BRS client met all
prior authorization criteria and eligibility requirements on the date that the services
and placement related activities were provided;
(C) The BRS provider delivered
the services and placement related activities in accordance with all applicable
BRS program general rules and agency-specific BRS program rules; and
(D) Prior authorization was
retroactively approved by the agency within 5 business days from the date that the
BRS client was admitted into the BRS provider’s program;
(b) Prior authorization after
5 business days from the date the BRS client was admitted into the BRS contractor’s
or BRS provider’s program requires documentation that prior authorization
could not have been obtained within those 5 business days.
(7) Prior authorization is
valid for the time period specified on the agency’s prior authorization notice,
but is not to exceed 12 months from the date on the notice, unless the BRS client
is no longer eligible for a medical assistance program that covers the BRS program,
in which case the authorization shall terminate on the date coverage ends.
(8) The BRS contractor is
responsible for ensuring that there is a prior authorization from the agency for
the BRS client in advance of providing the services or placement related activities
for the applicable time period unless section (6) of this rule applies.
(9) If a person is denied
prior authorization for the BRS program under section (2)(a) of this rule, OAR 413-090-0075(1)(a),
or OAR 416-335-0040(1)(a), the person is entitled to notice and contested hearing
rights under OAR 410-120-1860 and 410-120-1865. The contested case hearing shall
be held by the Authority.
Stat. Auth.: ORS 413.042 & 414.065
Stats. Implemented: ORS 414.065
Hist.: DMAP 63-2013, f. 11-14-13,
cert. ef. 1-1-14
410-170-0050
Program Referrals and Admission to BRS
Provider
(1) After the BRS client has received
prior authorization for the BRS program, the agency shall refer the BRS client for
admission to one or more BRS contractors or BRS providers that provide the appropriate
BRS type of care.
(2) The agency shall provide
the BRS contractor, or as applicable the BRS provider, with the following documents
in the BRS client’s referral packet:
(a) Information identifying
the person or entity with legal authority over the BRS client, which may be the
BRS client’s parent, guardian or legal custodian;
(b) Any prior evaluations,
assessments, or other documents that provide background information about the BRS
client or that support the need for the BRS client’s current level of services;
and
(c) The caseworker’s
case plan describing necessary services or similar planning form for the BRS client.
(3) The BRS contractor, or
as applicable the BRS provider, must make admission decisions for the BRS client
based on its agency-approved written admission criteria unless provided with written
authorization from the agency to accept a BRS client who does not meet its admission
criteria.
(4) The BRS contractor, or
as applicable the BRS provider, shall not deny an eligible BRS client admission
to its program if a vacancy exists within the program at the time of referral and
the BRS client meets its agency-approved admission criteria, unless it receives
written approval from the referring agency.
(5) The BRS contractor must
not, and ensure its BRS providers do not, deny an eligible BRS client admission
to its program for any of the following reasons:
(a) The presence or absence
of family members to support the placement;
(b) The race, religion, sexual
orientation, color, or national origin of the BRS client involved;
(c) The BRS client’s
place of residence; or
(d) The absence of an identified
after-care resource.
(6) The BRS contractor must,
or must ensure its BRS provider, notifies the caseworker of its admission decision
within 5 business days of receiving the BRS client’s referral packet, unless
an earlier timeframe is required in agency-specific BRS rules. If the BRS provider
denies admission to the BRS client, then it must provide the caseworker with a written
explanation.
(7) The BRS contractor must,
or must ensure its BRS provider, maintains documentation (either electronically
or in hard copy) of all its admission decisions for BRS clients referred by an agency
or BRS contractor, which includes the following:
(a) The name of the BRS client
referred;
(b) The date the referral
was received;
(c) The reason the referral
was accepted or denied; and
(d) The date the referral
was responded to in writing.
(8) Intake Procedures:
(a) On the day that the BRS
client is physically admitted to the BRS contractor’s or BRS provider’s
program, its staff must provide the BRS client and, as applicable, the BRS client’s
parent, guardian or legal custodian, with copies of the following policies:
(A) Behavior management system
policy;
(B) Grievance policy;
(C) BRS client’s and
family’s rights policies, including but not limited to visitation and communication
policies and the policies regarding the search and seizure of the BRS client’s
person, property, and mail;
(D) Discharge polices, including
but not limited to a discharge initiated by the BRS client;
(E) Seclusion and physical
restraint policies;
(F) Suicide prevention policy
and procedures; and
(G) Medication management
policy;
(b) The BRS contractor must
ensure its program, either operated by itself or by its BRS provider, maintains
signed documentation indicating that the BRS client and, as applicable, the BRS
client’s parent, guardian or legal custodian received and understood the information
described in section (8)(a) of this rule;
(c) If any of the policies
described in section (8)(a) of this rule are individualized for a particular BRS
client and differ from the program’s standard documented practices, these
variations shall be explained and documented, and included in or attached to the
BRS client’s service plan;
(d) If the BRS client’s
parent, guardian or legal custodian is unavailable at the time of admission, the
BRS contractor must ensure its program, either operated by itself or by its BRS
provider, documents in the BRS client’s case file that it has forwarded this
information to the BRS client’s parent, guardian or legal custodian by facsimile,
mail or electronic mail within 48 hours of the BRS client’s admission to the
program;
(e) The agency is responsible
for notifying the BRS contractor or BRS provider of any changes to the information
described in section (2) of this rule. In addition, the agency must provide the
BRS contractor or BRS provider with the following information;
(A) Applicable written authorizations
by the BRS client or the BRS client’s parent, guardian or legal custodian
consenting to the BRS client’s participation in the BRS program;
(B) If applicable, the prepaid
health plan or coordinated care organization in which the BRS client is enrolled;
(C) The BRS client’s
current medical information, medication regime, and other medical needs; and
(D) If applicable, the BRS
client’s school information, parental contact information, or similar types
of information.
Stat. Auth.: ORS 413.042 & 414.065
Stats. Implemented: ORS 414.065
Hist.: DMAP 63-2013, f. 11-14-13,
cert. ef. 1-1-14
410-170-0060
Discharge from the BRS Contractor or BRS
Provider
(1) Discharge initiated by the BRS client:
(a) The BRS client’s
participation in the BRS program is voluntary. The BRS contractor must, or ensure
its BRS provider, develops and follows a process that allows the BRS client to provide
no more than 3 business days advance notice of his or her decision to leave the
BRS contractor’s or BRS provider’s program. If the BRS client wants
to be discharged from the program, the BRS client is only required to provide the
BRS contractor or BRS provider with 3 business days advance notice;
(b) If the BRS client wants
to be discharged from the program, the BRS client must give the BRS contractor or
BRS provider notice that complies with the policy described above. After receiving
that notice, the BRS contractor or BRS provider must provide immediate verbal notification
within 1 business day to the caseworker and the agency’s designated contact
and, if applicable, the BRS client’s parent, guardian or legal custodian to
allow for alternate placement arrangements. The BRS contractor or BRS provider must
provide written notification to the caseworker and the agency’s designated
contact within 1 business day of its verbal notification.
(2) Planned discharge initiated
by the BRS contractor, BRS provider, or the agency:
(a) Initiated by the BRS
contractor or BRS provider:
(A) The BRS contractor or
BRS provider must notify the caseworker in writing as soon as reasonably practicable
regarding its intent to initiate the planned discharge of the BRS client from its
program;
(B) Following notification,
the BRS contractor or BRS provider and caseworker shall meet to discuss the case.
If a discharge date can be agreed upon, the BRS client shall be discharged on that
date. If they cannot agree, the caseworker shall remove the BRS client from the
program within 30 days from the original written notice to the caseworker, resulting
in the BRS client’s planned discharge;
(b) Initiated by the agency:
(A) The BRS client’s
caseworker must notify the BRS contractor or BRS provider in writing as soon as
reasonably practicable regarding the agency’s intent to initiate the planned
discharge of the BRS client from its program;
(B) Following notification,
the caseworker and the BRS contractor or BRS provider must meet to discuss the case.
If a discharge date can be agreed upon, the BRS client must be discharged on that
date. If they cannot agree, the caseworker may remove the BRS client from the program
resulting in the BRS client’s planned discharge.
(3) Emergency Discharge:
(a) Initiated by the BRS
contractor or BRS provider:
(A) The BRS contractor or
BRS provider may request the immediate discharge of a BRS client from its program
if, after contact with the agency staff, there is mutual agreement that the BRS
client is a clear and immediate danger to self or others. In such situations, the
caseworker must consider the notification a priority and respond to the BRS contractor
or BRS provider as soon as practicable but no later than one business day;
(B) The BRS contractor or
BRS provider and caseworker must discuss the BRS client’s continuation in,
temporary removal or discharge from the program;
(b) Initiated by the agency:
The agency may immediately remove the BRS client from the BRS contractor’s
or BRS provider’s program for any reason, resulting in the BRS client’s
emergency discharge;
(c) Initiated by the parent
or guardian: A parent or guardian with appropriate legal authority, as determined
by the agency, may immediately remove the BRS client from the BRS contractor’s
or BRS provider’s program, resulting in the BRS client’s emergency discharge.
(4) Discharge from a particular
program does not impact a BRS client’s prior authorization for the BRS program
generally. A BRS client may be referred to another BRS contractor or BRS provider
or request re-referral to the same program, as long as the prior authorization remains
valid and the BRS client remains eligible for the BRS program.
(5) Temporary Removal: The
agency may temporarily remove the BRS client for any reason without resulting in
a discharge from the BRS contractor’s or BRS provider’s program.
(6) Storage of the BRS client’s
personal property:
(a) The BRS contractor or
BRS provider must store property belonging to the BRS client in its program for
up to 30 days in a secure location following discharge, when the BRS client exits
the program without his or her property;
(b) The BRS contractor or
BRS provider must contact the BRS client’s caseworker as soon as possible
to make arrangements for the property to be retrieved. If the property has not been
retrieved by the 15th day following discharge, the BRS contractor or BRS provider
must contact the caseworker once more in order to remind them of the need to retrieve
the property by the 30th day.
Stat. Auth.: ORS 413.042 & 414.065
Stats. Implemented: ORS 414.065
Hist.: DMAP 63-2013, f. 11-14-13,
cert. ef. 1-1-14
410-170-0070
BRS Service Planning
(1) Initial Service Plan (ISP):
(a) The BRS contractor or
BRS provider must:
(A) Ensure that a social
service staff member completes a written ISP within two business days of the BRS
client’s admission to its program;
(B) Provide an opportunity
for the following individuals to participate in developing the BRS client’s
ISP, including but not limited to: the BRS client, the BRS client’s family,
social service staff, the BRS client’s caseworker and any other significant
persons involved with the BRS client;
(C) Obtain and maintain the
signatures of all participants or documentation that the individuals listed in section
(1)(a)(B) of this rule were provided with the opportunity to participate in developing
the ISP;
(D) Obtain written approval
of the ISP prior to its implementation from the caseworker and, as applicable and
appropriate, the BRS client and the BRS client’s parent, guardian or legal
custodian; and
(E) Provide the services
identified in the ISP during the first 45 days in the BRS provider’s program
or until the MSP is written;
(b) The BRS contractor or
BRS provider must ensure that the ISP is individualized, developmentally appropriate,
and based on a thorough assessment of the BRS client’s referral information,
and include at minimum the following:
(A) A plan to address specific
behaviors identified in the referral information including the intervention to be
used;
(B) A plan for any overnight
home visits;
(C) The anticipated discharge
date;
(D) The anticipated type
of placement at discharge;
(E) A plan to address any
needs identified in the referral information;
(F) Existing orders for medication
and any prescribed treatments for medical conditions, mental health conditions,
or substance abuse;
(G) Any type of behavior
management system that will be used as an intervention; and
(H) Specific behavior management
needs.
(2) Assessment and Evaluation
Report (AER):
(a) The BRS contractor or
BRS provider must:
(A) Ensure that a social
service staff member conducts a comprehensive assessment of the BRS client and completes
a written AER; and
(B) Submit the written AER
to the caseworker within 30 days of the BRS client’s admission to its program;
(b) The BRS contractor or
BRS provider must ensure that the AER includes information about the BRS client
with regard to the following domains:
(A) Legal custody and basis
for custody;
(B) Medical information including
prescribed medications and dosages;
(C) Family information including
specific cultural factors;
(D) Mental health information;
(E) Alcohol and drug use
both current and historical;
(F) Educational needs;
(G) Vocational needs;
(H) Social living skills;
and
(I) Placement plans including
home visits, anticipated discharge date, and placement resources;
(c) The BRS contractor or
BRS provider must ensure that the AER describes the following:
(A) Identified problems,
reason for referral or placement, and pertinent historical information;
(B) The BRS client’s
behaviors, response to current services, and strengths and assets;
(C) Significant incidents
or interventions or both;
(D) The behavior management
level needed for the BRS client, specifically any behavior management needs greater
than usual for its program;
(E) Identification of any
service goals; and
(F) Identified needs by assessment
and history.
(d) Abbreviated AERs:
(A) Upon the request of the
caseworker, the BRS contractor or BRS provider must submit an abbreviated AER regarding
the BRS client’s current status by the deadline stated in the written request;
(B) If a BRS client is transferred
to the current BRS program from another BRS program and the BRS client’s most
recent AER is less than 90 days old, the current BRS contractor or BRS provider
may submit an abbreviated AER to the caseworker within 30 days of the BRS client’s
transfer to its program;
(C) The BRS contractor or
BRS provider must ensure an abbreviated AER includes at minimum the information
in section (2)(b)(A) of this rule and any other specific information requested by
the caseworker. If the information is available, the BRS contractor or BRS provider
must also include the information in section (2)(b)(B) through (D) of this rule;
(3) Master Service Plan (MSP):
(a) The BRS contractor or
BRS provider must:
(A) Ensure that a social
service staff member completes a written individualized MSP within 45 days of the
BRS client’s admission to its program;
(B) Provide the opportunity
for the individuals listed in section (1)(a)(B) of this rule to participate in developing
the BRS client’s MSP;
(C) Obtain and maintain the
signatures of all participants or documentation that the individuals listed in section
(1)(a)(B) of this rule were provided with the opportunity to participate in developing
the MSP;
(D) Obtain written approval
of the MSP prior to its implementation from the caseworker and, as applicable and
appropriate, the BRS client and the BRS client’s parent, guardian or legal
custodian; and
(E) Provide the services
identified in the MSP;
(b) The BRS contractor or
BRS provider must ensure that the MSP includes goals that are measurable and attainable
within a specified time frame, and address at minimum the following domains where
need is indicated by the BRS client’s assessment and history:
(A) Legal custody and basis
for custody;
(B) Medical information including
medications and dosages;
(C) Family information including
specific cultural factors;
(D) Mental health information;
(E) Alcohol and drug use
both current and historical;
(F) Educational needs;
(G) Vocational needs;
(H) Social living skills;
(I) Placement plans including
home visits, anticipated discharge date, and placement resources;
(J) Other needs identified
in the BRS client’s AER that do not fall in one of the other identified domains
above; and
(K) Completion criteria individualized
for each BRS client. Completion is defined by progress in acquiring pro-social behaviors,
attitudes, and beliefs while in the program, and not engaging in behavior that seriously
jeopardizes the safety of staff and other program participants;
(c) The BRS contractor or
BRS provider must ensure that the MSP is individualized and developmentally appropriate,
and includes:
(A) Specifically stated and
prioritized service goals for the BRS client that include the caseworker’s
recommendations and goals that the BRS client wants to achieve;
(B) Specific interventions
and services its program shall provide to address each goal, including the use of
a behavior management system as an intervention and any behavior management needs
that are greater than usual for the program;
(C) Staff responsible for
providing the identified services;
(D) Specifically stated behavioral
criteria for evaluating the achievement of goals;
(E) A timeframe for the completion
of goals;
(F) The method used to monitor
the BRS client’s progress towards completing goals and the person responsible
for monitoring progress; and
(G) Aftercare and transition
goals and planning;
(d) The BRS contractor or
BRS provider must identify in the MSP those needs identified in a BRS client’s
AER that will be addressed by an outside provider and identify that provider. The
BRS contractor or BRS provider must also facilitate the BRS client’s access
to other providers whenever needs identified in the AER cannot be met within the
scope of the services offered by its program;
(e) The BRS contractor or
BRS provider must also describe in the MSP any plan for the BRS client to participate
in overnight home visits, including but not limited to documenting when the home
visits are to occur, identifying the frequency of the visits (up to a maximum of
8 days per month), and describing how the visits relate to the BRS client’s
goals identified in the MSP. The BRS contractor or BRS provider must make every
attempt to schedule home visits so that they do not conflict with services. Any
deviation from the approved home visit plan requires prior written approval from
the agency.
(4) Master Service Plan 90
Day Updates:
(a) The BRS contractor or
BRS provider must:
(A) Ensure that a social
service staff member reviews and updates in writing the BRS client’s MSP no
later than 90 days from the date the MSP was first finalized or the last time it
was updated, and every 90 days thereafter. Social service staff must review the
MSP, and update it in writing if necessary, earlier whenever additional information
becomes available that suggests that other services should be provided;
(B) Provide the opportunity
for the individuals listed in section (1)(a)(B) of this rule to participate in developing
the BRS client’s MSP updates;
(C) Obtain and maintain the
signatures of all participants or documentation that the individuals listed in section
(1)(a)(B) of this rule were provided with the opportunity to participate in developing
the MSP updates;
(D) Obtain written approval
of an updated MSP prior to its implementation from the caseworker and, as applicable
and appropriate, the BRS client and the BRS client’s parent, guardian or legal
custodian; and
(E) Provide the services
identified in the most recent MSP update;
(b) The BRS contractor or
BRS provider must ensure that the written update to the MSP is individualized and
developmentally appropriate, and includes at minimum the following:
(A) The BRS client’s
progress towards achieving service goals;
(B) The BRS client’s
performance on the behavior management system;
(C) The BRS client’s
performance on any individualized plans developed to address specific behaviors;
(D) Any modifications to
services based on the BRS client’s new behaviors or identified needs;
(E) Any changes regarding
recommendations, the discharge date, or aftercare and transition plans; and
(F) A summary of incidents
involving the BRS client that have occurred since the last time the MSP was updated.
(5) Aftercare and Transition
Plan (ATP):
(a) The BRS contractor or
BRS provider must:
(A) Ensure that a social
service staff member develops and completes a written ATP at least 30 days prior
to or as close as possible to the BRS client’s planned discharge;
(B) Provide the opportunity
for the individuals listed in section (1)(a)(B) of this rule and members of the
service planning team to participate in developing the BRS client’s written
ATP;
(C) Obtain and maintain the
signatures of all participants or documentation that the individuals listed in section
(1)(a)(B) of this rule and members of the service planning team were provided with
the opportunity to participate in developing the written ATP;
(D) Provide a copy of the
written ATP to the individuals described in section (1)(a)(B) of this rule and members
of the service planning team; and
(E) Obtain written approval
of the written ATP from the caseworker and, as applicable and appropriate, the BRS
client and the BRS client’s parent, guardian or legal custodian;
(b) The BRS contractor or
BRS provider must ensure that the written ATP describe how the BRS client will successfully
transition from its program to the community, specifically addressing the period
of 90 days after discharge from its program. The BRS contractor or BRS provider
must ensure that the written ATP includes, at minimum, the following:
(A) Identification of the
BRS client’s individual needs and unmet goals;
(B) Identification of the
aftercare services and supports outside of its program that will be available for
the 90-day time period;
(C) Identification of the
person or entity responsible for providing the aftercare services; and
(D) Schedule for regular
telephone contact by BRS provider staff with the BRS client and, as applicable,
the BRS client’s family, caseworker or other identified significant persons;
(c) The BRS contractor or
BRS provider shall not be required to provide an initial and final written ATP under
the following circumstances:
(A) The agency, legal guardian,
or custodian removes the BRS client from the program with little or no advance notice
and in a manner not in accordance with the existing ATP;
(B) The BRS client is discharged
from the program on an emergency basis due to the BRS client’s behavior, runaway
status without a plan to return to the program, or transfer to another program or
higher level of care; or
(C) The BRS client initiates
an immediate voluntary discharge from the program.
(6) Discharge Summary: The
BRS contractor or BRS provider must ensure that a social service staff member completes
and provides a written discharge summary to the caseworker within 15 days following
the BRS client’s planned or actual discharge from its program. The discharge
summary must include the BRS client’s progress towards service goals.
(7) Aftercare Summary: The
BRS contractor or BRS provider must ensure that a social service staff member completes
and provides a written aftercare summary to the caseworker within 120 days following
the BRS client’s discharge from its program. An aftercare summary is not required
if the BRS provider was not required to complete an ATP. The aftercare summary must
summarize the BRS client’s status and progress on the ATP for the 90 days
following the BRS client’s discharge from the BRS provider, including but
not limited to the BRS client’s adjustment to the community and any further
recommendations.
(8) Notwithstanding sections
(5) through (7) of this rule, the BRS contractor or BRS provider is not required
to complete an ATP, discharge summary and aftercare summary for the BRS clients
receiving services and placement related activities in the following BRS types of
care:
(a) Shelter, Assessment and
Evaluation;
(b) Intensive Community Care;
and
(c) Independent Living Service.
(9) Independent Living Program:
A BRS contractor or BRS provider that provides services and placement related activities
in an Independent Living Program:
(a) Is not required to complete
an ISP, AER, ATP, and aftercare summary for the BRS clients in its program, notwithstanding
sections (1), (2) and (5) through (7) of this rule; and
(b) Must complete an MSP,
the MSP updates and a discharge summary for the BRS clients in its program consistent
with the requirements in sections (3) and (4) of this rule, and the additional requirements
for a master service plan — transition and the master service plan —
transition updates as described in OAR 416-335-0060.
(10) Short-Term Stabilization
Program: A BRS contractor or BRS provider that provides services and placement related
activities in a Short-Term Stabilization Program:
(a) Is not required to complete
an ISP and aftercare summary for the BRS clients in its program, notwithstanding
sections (1) and (7) of this rule;
(b) Must complete an AER
for the BRS clients in its program consistent with the requirements in section (2)
of this rule, except in cases where the BRS client is not expected to remain in
its program for more than 30 days;
(c) Must complete an ATP
for the BRS clients in its program consistent with the requirements in section (5)
of this rule except for those in section (5)(b)(D), and must complete the additional
requirements for an aftercare and transition plan — stabilization in OAR 416-335-0070
for BRS clients who are being discharged home or into a non-BRS foster care placement;
and
(d) Must complete a MSP and
the MSP updates for the BRS clients in its program consistent with the requirements
in sections (3) and (4) of this rule, and the additional requirements for a master
service plan — stabilization and the master service plan — stabilization
updates as described in OAR 416-335-0070.
(11) Documentation: The BRS
contractor or BRS provider must ensure that all BRS service plans described in this
rule are developed and maintained in the BRS client’s case file in accordance
with the timeframes and criteria in this rule, unless otherwise exempted.
Stat. Auth.: ORS 413.042 & 414.065
Stats. Implemented: ORS 414.065
Hist.: DMAP 63-2013, f. 11-14-13,
cert. ef. 1-1-14
410-170-0080
Services
(1) The BRS contractor or BRS provider
must provide services to the BRS client in accordance with the BRS client’s
ISP or MSP.
(2) All services must be
structured and directly supervised by the BRS contractor or BRS provider’s
staff.
(3) Types of Services:
(a) Crisis counseling: The
BRS contractor or BRS provider provides the BRS client with counseling on a 24-hour
basis in order to stabilize the BRS client’s behavior until the problem can
be resolved or assessed and treated by a qualified mental health professional or
licensed medical practitioner;
(b) Individual and group
counseling: The BRS contractor or BRS provider provides face-to-face individual
or group counseling sessions to the BRS client which are designed to remediate the
problem behaviors identified in the BRS client’s ISP or MSP;
(c) Milieu therapy: The BRS
contractor or BRS provider provides the BRS client with structured activities and
planned interventions designed to normalize psycho-social development, promote safety,
stabilize environment, and assist in responding in developmentally appropriate ways.
The program’s staff must monitor the BRS client in these activities, which
include developmental, recreational, academic, rehabilitative, or other productive
work. Milieu therapy occurs in concert with one of the other types of services;
(d) Parent training: Direct
care staff or social service staff provide planned activities or interventions (face-to-face
or by telephone) to the BRS client’s family or identified aftercare resource
family. Parent training is designed to assist the family in identifying the specific
needs of the BRS client, to support the BRS client’s efforts to change, and
to improve and strengthen parenting knowledge or skills indicated in the ISP or
MSP as being necessary for the BRS client to return home or to another community
living resource;
(e) Skills-training: The
BRS contractor or BRS provider provides the BRS client with planned, curriculum-based
individual or group sessions designed to improve specific areas of functioning in
the BRS client’s daily living as identified in the ISP or MSP. Skills-training
may be designed to develop appropriate social and emotional behaviors, improve peer
and family relationships, improve self-care, encourage conflict resolution, reduce
aggression, improve anger control, and reduce or eliminate impulse and conduct disorders;
(4) The BRS contractor or
BRS provider must:
(a) Provide a combination
of services necessary to comply with the BRS client’s ISP or MSP and the requirements
in OAR 410-170-0090 for the appropriate BRS type of care;
(b) Create and maintain written
documentation describing the services provided to each BRS client which includes
at a minimum the following information:
(A) Name of the BRS client;
(B) Date of service;
(C) Name and position of
the staff member providing the service to the BRS client;
(D) Length of time staff
spent providing the service to the BRS client;
(E) Description of the service
provided; and
(F) Description of the BRS
client’s participation in the service;
(c) Create and maintain a
written weekly record in each BRS client’s case file with the total number
of service hours provided each day to the BRS client and a breakdown of the number
of hours spent providing each particular type of service described in section (3)
of this rule; and
(d) Ensure that that social
service staff review the documentation described in this section each week for quality,
content, and appropriateness with the BRS client’s ISP or MSP.
Stat. Auth.: ORS 413.042 & 414.065
Stats. Implemented: ORS 414.065
Hist.: DMAP 63-2013, f. 11-14-13,
cert. ef. 1-1-14
410-170-0090
BRS Types of Care
The BRS types of care are as follows:
(1) Shelter Assessment and
Evaluation, Intensive Community Care, Independent Living Service, Community Step-Down,
and Independent Living Program:
(a) The BRS contractor or
BRS provider may use either a residential care model or therapeutic foster care
model for these BRS types of care;
(b) The BRS client is placed
in these BRS types of care to identify deficiencies and develop necessary skills;
(c) The BRS contractor or
BRS provider providing one of these BRS types of care must ensure that a minimum
of six hours of services are available per week to each BRS client as follows;
(A) One hour of individual
counseling or individual skills-training provided by social service staff; and
(B) Five hours of any combination
of individual or group counseling, crisis counseling, skills-training, or parent
training.
(2) Therapeutic Foster Care,
BRS Proctor and Multidimensional Treatment Foster Care:
(a) The BRS contractor or
BRS provider must use a therapeutic foster care model for these BRS types of care;
(b) The BRS client placed
in these BRS types of care requires structure, behavior management, and support
services to develop the skills necessary to be successful in a less restrictive
environment;
(c) The BRS contractor or
BRS provider providing one of these BRS types of care must ensure that a minimum
of 11 hours of services are available per week to each BRS client as follows:
(A) Two hours of individual
counseling or individual skills-training, one of which is provided by social service
staff; and
(B) Nine hours of any combination
of individual or group counseling, crisis counseling, skills-training, or parent
training.
(3) BRS Proctor Day Treatment:
(a) The BRS contractor or
BRS provider must use a therapeutic foster care model for this BRS type of care
and provide skills-training in a day treatment setting;
(b) The BRS client placed
in this BRS type of care requires enhanced structure during the day time hours.
This level of care provides the structure of day treatment for necessary skill development
and a less restrictive home setting with an approved provider parent;
(c) The BRS contractor or
BRS provider providing this BRS type of care must ensure that a minimum of eleven
hours of services are available per week to each BRS client as follows:
(A) Two hours of either individual
counseling or individual skills-training, one of which is provided by social service
staff; and
(B) Nine hours of individual
or group counseling, crisis counseling, skills- training, or parent training;
(4) BRS Basic Residential,
BRS Rehabilitation Services:
(a) The BRS contractor or
BRS provider must use a residential care model for these BRS types of care. The
BRS contractor or BRS provider must provide 24 hour supervision of the BRS client
by ensuring that at least one direct care staff is on duty and awake whenever a
BRS client is present in its program;
(b) The BRS client placed
in these BRS types of care requires the structure, behavior management, and support
services of a residential care model for necessary skill development;
(c) The BRS contractor or
BRS provider providing these BRS types of care must ensure that a minimum of eleven
hours of services are available per week to each BRS client as follows:
(A) Two hours of either individual
counseling or individual skills-training, one of which is provided by social service
staff; and
(B) Nine hours of any combination
of individual or group counseling, crisis counseling, skills-training, or parent
training.
(5) Intensive Rehabilitation
Services, BRS Residential, BRS Enhanced, Short-Term Stabilization Program:
(a) The BRS contractor or
BRS provider must use a residential care model for these BRS types of care. The
BRS contractor or BRS provider must provide 24-hour supervision of the BRS client
by ensuring that at least one direct care staff is on duty and awake whenever a
BRS client is present in its program;
(b) The BRS client placed
in these BRS types of care requires more intensive structure, behavior management
and support services than a BRS client in the BRS types of care described in section
(4) of this rule;
(c) The BRS contractor or
BRS provider providing one of these BRS types of care must ensure that a minimum
of 11 hours of services are available per week to each BRS client as follows:
(A) Two hours of either individual
counseling or individual skills-training, one of which is provided by social service
staff; and
(B) Nine hours of any combination
of individual or group counseling, crisis counseling, skills-training, or parent
training.
(6) Enhanced Therapeutic
Foster Care:
(a) The BRS contractor or
BRS provider must use a therapeutic foster care model for this BRS type of care;
(b) The BRS client placed
in this BRS type of care can be maintained in a home of an approved provider parent
with structure, behavior management and enhanced supports. The BRS client placed
in this BRS type of care has difficulty in a group setting and requires a placement
utilizing a therapeutic foster care model;
(c) The BRS contractor or
BRS provider providing this BRS type of care must ensure that a minimum of 13 hours
of services are available per week to each BRS client as follows:
(A) Two hours of either individual
counseling or individual skills-training, one of which is provided by social service
staff; and
(B) Eleven hours of any combination
of individual or group counseling, crisis counseling, skills-training, or parent
training.
Stat. Auth.: ORS 413.042 & 414.065
Stats. Implemented: ORS 414.065
Hist.: DMAP 63-2013, f. 11-14-13,
cert. ef. 1-1-14
410-170-0100
Placement Related Activities for the Authority’s
BRS Contractors and BRS Providers
(1) In cases where the Authority is
the agency, the BRS contractor or BRS provider must provide the following placement
related activities, and all facilities, personnel, materials, equipment, supplies
and services, and transportation necessary to provide those activities including
but not limited to:
(a) Transportation: The BRS
contractor or BRS provider is responsible for the transportation of the BRS client
to: attend school, to the extent not provided by the school district; medical, dental,
and therapeutic appointments, to the extent not provided through the Oregon Health
Plan; recreational and community activities; places of employment; and shopping
for incidental items;
(b) Educational and vocational
activities: The BRS contractor or BRS provider must have a system in place to meet
the educational and vocational needs of the BRS client in its program either on-site
or at an off-site location or a combination of the two;
(c) Recreational, social,
and cultural activities:
(A) The BRS contractor or
BRS provider shall provide recreation time for the BRS client on a daily basis,
and offer activities that are varied in type to allow BRS clients to obtain new
experiences. The BRS contractor or BRS provider shall document recreation as having
been provided, by recording the type of activity the BRS client participated in,
and the date it occurred;
(B) The BRS contractor or
BRS provider shall provide each BRS client 2 to 3 opportunities per week to participate
in recreational activities in the community, unless the BRS client is clearly unable
to participate in offsite activities due to safety issues. If a BRS client is restricted
from participation in community recreation, the BRS contractor or BRS provider shall
document the reason in the BRS client’s case file, and the reason must be
reviewed regularly to ensure that the BRS client is not unnecessarily restricted
from offsite activities. The BRS contractor or BRS provider shall offer any BRS
client who is restricted from community activities alternative opportunities for
recreation on-site;
(C) The BRS contractor or
BRS provider shall provide access to or make available social and cultural activities
for the BRS clients as part of the therapeutic milieu of the program. These activities
are to promote the BRS client’s normal development and help broaden the BRS
client’s understanding and appreciation of the community, arts, environment
and other cultural groups;
(D) The BRS contractor or
BRS provider may not permit BRS clients to participate in recreational activities
that present a higher level of risk to BRS clients without pre-approval by the caseworker.
This applies to activities that require a moderate to high level of technical expertise
to perform safely, present environmental hazards, or where special certification
or training is recommended or required such as: whitewater rafting, rock climbing,
ropes courses, activities on or in any body of water where a certified lifeguard
is not present and on duty, camping, backpacking, mountain climbing, using motorized
yard equipment, and horseback riding;
(d) Academic Assistance:
The BRS contractor or BRS provider shall provide adequate opportunities for the
BRS clients to complete homework assignments with assistance from staff if needed.
(2) Non BRS-Related Medical
Care:
(a) If there is no record
that the BRS client has received a physical examination within the six months immediately
prior to the BRS client’s placement with its program, the BRS contractor or
BRS provider shall ensure or make every effort to ensure that the BRS client receives
a general medical check, consistent with health insurance allowances, within 30
days of placement. The BRS contractor or BRS provider shall keep documentation of
this procedure in the BRS client’s file and send a copy to the BRS client’s
caseworker;
(b) The BRS contractor or
BRS provider shall ensure that each BRS client’s mental health, physical health,
(including alcohol and drug treatment services), dental and vision needs are arranged
for. This does not include paying the cost of services or medications which are
covered by the Oregon Health Plan (OHP) or by the BRS client’s third party
private insurance coverage. For services or medications not covered by OHP or third
party private insurance, the BRS contractor or BRS provider must notify and work
with the caseworker to resolve payment issues;
(c) The BRS contractor or
BRS provider shall administer and monitor medications consistent with all applicable
licensing rules and the program’s own medication management policy;
(d) The BRS contractor or
BRS provider shall facilitate the BRS client’s access to other providers whenever
identified needs cannot be met within the scope of services offered by the program.
If health care services are needed but the program is unable to access the needed
services for the BRS client, the BRS contractor or BRS provider shall immediately
notify the caseworker about this in writing and document its unsuccessful efforts
to access healthcare for the BRS client in the BRS client’s case file.
(3) The Authority’s
BRS contractor, if not also the BRS provider, is responsible for ensuring its BRS
provider provides the placement related activities to the BRS client as described
in this rule.
Stat. Auth.: ORS 413.042, 414.065
Stats. Implemented: ORS 414.06

Hist.: DMAP 63-2013, f. 11-14-13,
cert. ef. 1-1-14
410-170-0110
Billing and Payment for Services and Placement
Related Activities
(1) The BRS contractor is compensated
for a billable care day (service and placement related activities rates) on a fee-for-service
basis, except as otherwise provided for in these rules. The Authority does not make
payments for any calendar day that does not meet the definition of a billable care
day under this rule.
(2) Billable care day rates
are provided in the “BRS Rates Table,” dated July 1, 2015, which is
adopted as Exhibit 1 and incorporated by reference into this rule. The BRS Rates
Table is available at http://www.oregon.gov/OHA/healthplan/pages/brs.aspx. A printed
copy may be obtained from the agency.
(3) Billable Care Day:
(a) For purposes of computing
a billable care day, the BRS client must be in the direct care of the BRS provider
at 11:59 p.m. of that day or be on an authorized home visit in accordance with section
(4) of this rule;
(b) A billable care day does
not include any day where the BRS client is on runaway status, in detention, an
inpatient in a hospital, or has not yet entered or has been discharged from the
BRS contractor’s or BRS provider’s program.
(4) Home Visits:
(a) The BRS contractor shall
only include a maximum of eight calendar days of home visits in a month as billable
care days;
(b) In order to qualify as
an authorized home visit day, the BRS contractor must:
(A) Ensure that the home
visit is tied to the BRS client’s ISP or MSP;
(B) Work with the BRS client
and the BRS client’s family or substitute family on goals for the home visit
and receive regular reports from the family on the BRS client’s progress while
on the home visit;
(C) Have staff available
to answer calls from the BRS client and BRS client’s family or substitute
family and to provide services to the BRS client during the time planned for the
home visit if the need arises;
(D) Document communications
with the BRS client’s family or substitute family; and
(E) Document the BRS client’s
progress on goals set for the home visits.
(5) Invoice form:
(a) The BRS contractor must
submit a monthly billing form to the agency in a format acceptable to the agency
on or after the first day of the month following the month in which it provided
services and placement related activities to the BRS client. The billing form must
specify the number of billable care days provided to each BRS client in that month;
(b) The BRS contractor must
provide, upon request in a format that meets the agency’s approval, written
documentation of each BRS client’s location for each day claimed as a billable
care day;
(c) The BRS contractor may
only submit a claim for a billable care day consistent with the agency’s prior
authorization.
(6) Payment for a Billable
Care Day:
(a) The agency shall pay
the service and placement related activities rates to the BRS contractor for each
billable care day in accordance with the BRS Rates Table described in section (2)
of this rule;
(b) Notwithstanding section
(6)(a) of this rule, the Authority shall only pay the service rate for each billable
care day to a public child-caring agency, who by rule or contract provides the local
match share for Medicaid claims under OAR 410-120-0035 and 42 CFR 433 Subpart B.
The Authority may not pay the placement related activities rate for each billable
care day to these types of public child-caring agencies;
(c) To the extent the payment
for services is funded by Medicaid and CHIP funds, the BRS contractor and the BRS
provider are subject to Medicaid billing and payment requirements in these rules
and the Authority’s general rules (OAR 410-120-0000 to 410-120-1980).
(7) Third Party Resources:
(a) The Authority’s
BRS contractors must make reasonable efforts to obtain payment first from other
resources consistent with OAR 410-120-1280(16);
(b) The Department’s
and OYA’s BRS contractors are not required to review or pursue third party
resources. The Department and OYA must make reasonable efforts to obtain payment
first from other resources consistent with OAR 410-120-1280(16) for Medicaid-eligible
BRS clients.
(8) Public child-caring agencies
who are responsible by rule or contract for the local match share portion of eligible
Medicaid claims must comply with OAR 410-120-0035 and 42 CFR 433 Subpart B.
(9) In cases where the BRS
contractor is not also the BRS provider, the BRS contractor is responsible for compensating
the BRS provider for billable care days pursuant to the agency-approved subcontract
between the BRS contractor and the BRS provider.
(10) The Authority may not
be financially responsible for the payment of any claim that the Centers for Medicare
and Medicaid Services (CMS) disallows under the Medicaid or CHIP program. If the
Authority has previously paid the agency or BRS contractor for any claim that CMS
disallows, the payment shall be recouped pursuant to OAR 410-120-1397. The Authority
shall recoup or recover any other overpayments as described in OAR 410-120-1397
and OAR 943-120-0350 and 943-120-0360.
[ED. NOTE:
Tables referenced are not included in rule text. Click here for PDF copy of table(s).]
Stat. Auth.: ORS 413.042 & 414.065
Stats. Implemented: ORS 414.065
Hist.: DMAP 63-2013, f. 11-14-13,
cert. ef. 1-1-14; DMAP 42-2015(Temp), f. & cert. ef. 8-11-15 thru 2-6-16
410-170-0120
Compliance Reviews & Sanctions
(1) The BRS contractor must cooperate,
and ensure its BRS providers cooperate, with program compliance reviews or audits
conducted by any federal or state or local governmental agency or entity related
to the BRS program.
(2) The Authority or agency,
or both, must conduct compliance reviews periodically, including but not limited
to review of documentation and onsite inspections.
(3) If the agency determines
that the BRS contractor is not in compliance with its contract to provide BRS services
or placement related activities, including but not limited to non-compliance with
state or federal law or regulation, then the agency may:
(a) Provide technical assistance;
(b) Require the BRS contractor
or BRS provider to develop and implement a corrective action plan;
(c) Pursue any or all remedies
authorized under the contract;
(d) Pursue any other remedy
authorized by state or federal law; or
(e) Pursue any combination
of the above.
(4) If the agency determines
that the BRS contractor or the BRS provider is not in compliance with state or federal
law or regulation then, in addition to pursuing any contract remedy, the agency
may:
(a) Provide technical assistance;
(b) Require the BRS contractor
or BRS provider to develop and implement a corrective action plan;
(c) Refer the case to an
appropriate licensing or other oversight federal or state or local governmental
agency or entity;
(d) Pursue any other remedy
authorized by state or federal law; or
(e) Pursue any combination
of the above.
(5) In addition to the remedies
provided in section (3) and (4) above, if the Authority determines that the BRS
contractor or the BRS provider is not in compliance with state or federal law or
regulation, then the Authority may:
(a) Impose sanctions pursuant
to OAR 410-120-1400 and 410-120-1460;
(b) Recover an overpayment
pursuant to OAR 410-120-1397; or
(c) Any combination of the
above.
(6) Overpayment:
(a) The Authority Identified:
When an overpayment is identified, the Authority must notify the BRS contractor
or BRS provider in writing. The overpayment amount will be determined at the Authority’s
discretion through direct examination of claims, through statistical sampling and
extrapolation techniques or other means. Procedures for recovery of funds are as
described in OAR 410-120-1397 or by applicable contract language;
(b) BRS contractor or Provider
Identified: When a BRS contractor or BRS provider discovers that they requested
and may have received reimbursement not in compliance with all applicable rules
they must contact the Division’s Medicaid Policy Unit and Office of Payment
Accuracy and Recovery (OPAR) promptly to report the possible inappropriate payment
and discuss the manner by which the appropriateness will be determined as well as
programmatic changes and other notifications to be made.
(7) The BRS contractor or
the BRS provider may appeal an Authority’s notice of action for sanctions
or overpayments under the appeal processes specified in the notice and applicable
administrative rules for the Authority.
Stat. Auth.: ORS 413.042, 414.065
Stats. Implemented: ORS 414.065
Hist.: DMAP 63-2013, f. 11-14-13,
cert. ef. 1-1-14

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