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

 

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OREGON HEALTH AUTHORITY,

ADDICTIONS AND MENTAL HEALTH DIVISION: MENTAL HEALTH SERVICES

 

DIVISION 19
OUTPATIENT ADDICTIONS
AND MENTAL HEALTH SERVICES
309-019-0100
Purpose and Scope
(1) Purpose: These rules prescribe minimum
standards for services and supports provided by addictions and mental health providers
approved by the Addictions and Mental Health Division of the Oregon Health Authority.
(2) Scope: In addition to
applicable requirements in OAR 410-120-0000 through 410-120-1980 and 943-120-0000
through 943-120-1550, these rules specify standards for addictions and mental health
services and supports provided in:
(a) Outpatient Community
Mental Health Services and Supports for Children and Adults;
(b) Outpatient Substance
Use Disorders Treatment Services; and
(c) Outpatient Problem Gambling
Treatment Services.
Stat. Auth.: ORS 161.390, 413.042 ,
430.256, 428.205 - 428.270, 430.640
Stats. Implemented: ORS 109.675,
161.390 - 161.400, 413.520 - 413.522, 430.010, 430.205- 430.210, 430.240 - 430.640,
430.850 - 430.955, 461.549, 743A.168, 813.010 - 813.052 & 813.200 - 813.270
Hist.: MHS 6-2013(Temp),
f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14; MHS 4-2014, f. & cert. ef. 2-3-14
309-019-0105
Definitions
(1) "Abuse of an adult" means the circumstances
defined in 943-045-0250 through 943-045-0370 for abuse of an adult with mental illness.
(2) “Abuse of a child”
means the circumstances defined in ORS 419B.005.
(3) “Addictions and
Mental Health Services and Supports” means all services and supports including
but not limited to, Outpatient Community Mental Health Services and Supports for
Children and Adults, Intensive Treatment Services for Children, Outpatient and Residential
Substance Use Disorders Treatment Services and Outpatient and Residential Problem
Gambling Treatment Services.
(4) “Adolescent”
means an individual from 12 through 17 years of age, or those individuals who are
determined to be developmentally appropriate for youth services.
(5) "Adult" means a person
18 years of age or older, or an emancipated minor. An individual with Medicaid eligibility,
who is in need of services specific to children, adolescents, or young adults in
transition, must be considered a child until age 21 for the purposes of these rules.
Adults who are between the ages of 18 and 21, who are considered children for purposes
of these rules, must have all rights afforded to adults as specified in these rules.
(6) “Assessment”
means the process of obtaining sufficient information, through a face-to-face interview
to determine a diagnosis and to plan individualized services and supports.
(7) "ASAM PPC" means the
most current publication of the American Society of Addiction Medicine Patient Placement
Criteria for the Treatment of Substance-related Disorders, which is a clinical guide
used in matching individuals to appropriate levels of care, and incorporated by
reference in these rules.
(8) “Authority”
means the Oregon Health Authority.
(9) “Behavioral Health”
means mental health, mental illness, addictive health and addiction disorders.
(10) "Behavior Support Plan"
means the individualized proactive support strategies that are used to support positive
behavior.
(11) “Behavior Support
Strategies” means proactive supports designed to replace challenging behavior
with functional, positive behavior. The strategies address environmental, social,
neuro-developmental and physical factors that affect behavior.
(12) “Care Coordination”
means a process-oriented activity to facilitate ongoing communication and collaboration
to meet multiple needs. Care coordination includes facilitating communication between
the family, natural supports, community resources, and involved providers and agencies;
organizing, facilitating and participating in team meetings; and providing for continuity
of care by creating linkages to and managing transitions between levels of care
and transitions for young adults in transition to adult services.
(13) "Case Management" means
the services provided to assist individuals, who reside in a community setting,
or are transitioning to a community setting, in gaining access to needed medical,
social, educational, entitlement and other applicable services.
(14) "Child" means a person
under the age of 18. An individual with Medicaid eligibility, who is in need of
services specific to children, adolescents, or young adults in transition, must
be considered a child until age 21 for purposes of these rules.
(15) "Child and Family Team"
means the people who are responsible for creating, implementing, reviewing, and
revising the service coordination section of the Service Plan in ICTS programs.
At a minimum, the team must be comprised of the family, care coordinator, and child
when appropriate. The team should also include any involved child-serving providers
and agencies and any other natural, formal, and informal supports as identified
by the family.
(16) "Clinical Supervision"
means oversight by a qualified Clinical Supervisor of addictions and mental health
services and supports provided according to this rule, including ongoing evaluation
and improvement of the effectiveness of those services and supports.
(17) "Clinical Supervisor"
means a person qualified to oversee and evaluate addictions or mental health services
and supports.
(18) “Co-occurring
substance use and mental health disorders (COD)” means the existence of a
diagnosis of both a substance use disorder and a mental health disorder.
(19) "Community Mental Health
Program (CMHP)" means an entity that is responsible for planning and delivery of
services for persons with substance use disorders or a mental health diagnosis,
operated in a specific geographic area of the state under an intergovernmental agreement
or direct contract with the Division.
(20) “Coordinated Care
Organization (CCO)” is a network of all types of health care providers (physical
health care, addictions and mental health care and sometimes dental care providers)
who have agreed to work together in their local communities to serve people who
receive health care coverage under the Oregon Health Plan (Medicaid).
(21) "Conditional Release"
means placement by a court or the Psychiatric Security Review Board (PSRB), of a
person who has been found eligible under ORS 161.327(2)(b) or 161.336, for supervision
and treatment in a community setting.
(22) "Court" means the last
convicting or ruling court unless specifically noted.
(23) "Criminal Records Check"
means the Oregon Criminal Records Check and the processes and procedures required
by OAR 407-007-0000 through 407-007-0370.
(24) "Crisis" means either
an actual or perceived urgent or emergent situation that occurs when an individual’s
stability or functioning is disrupted and there is an immediate need to resolve
the situation to prevent a serious deterioration in the individual’s mental
or physical health or to prevent referral to a significantly higher level of care.
(25) "Cultural Competence"
means the process by which people and systems respond respectfully and effectively
to people of all cultures, languages, classes, races, ethnic backgrounds, disabilities,
religions, genders, sexual orientations and other diversity factors in a manner
that recognizes, affirms, and values the worth of individuals, families and communities
and protects and preserves the dignity of each.
(26) “Culturally Specific
Program” means a program that is designed to meet the unique service needs
of a specific culture and that provides services to a majority of individuals representing
that culture.
(27) "Declaration for Mental
Health Treatment" means a written statement of an individual’s preferences
concerning his or her mental health treatment. The declaration is made when the
individual is able to understand and legally make decisions related to such treatment.
It is honored, as clinically appropriate, in the event the individual becomes unable
to make such decisions.
(28) "Deputy Director”
means the Deputy Director of the Addictions and Mental Health Division, or that
person's designee.
(29) "Diagnosis" means the
principal mental health, substance use or problem gambling diagnosis listed in the
Diagnostic and Statistical Manual of Mental Disorders (DSM). The diagnosis is determined
through the assessment and any examinations, tests, or consultations suggested by
the assessment, and is the medically appropriate reason for services.
(30) "Director” means
the Director of the Addictions and Mental Health Division, or that person's designee.
(31) “Division”
means the Addictions and Mental Health Division.
(32) "DSM" means the most
recent version of the Diagnostic and Statistical Manual of Mental Disorders, published
by the American Psychiatric Association.
(33) “Driving Under
the Influence of Intoxicants (DUII) Substance Use Disorders Rehabilitation Program”
means a program of treatment and therapeutically oriented education services for
an individual who is either:
(a) A violator of ORS 813.010
Driving Under the Influence of Intoxicants; or
(b) A defendant who is participating
in a diversion agreement under ORS 813.200.
(34) “Emergent”
means the onset of symptoms requiring attention within 24 hours to prevent serious
deterioration in mental or physical health or threat to safety.
(35) “Enhanced Care
Services (ECS)” and “Enhanced Care Outreach Services (ECOS)” means
intensive behavioral and rehabilitative mental health services to eligible individuals
who reside in Aging and People with Disabilities (APD) licensed homes or facilities.
(36) “Entry”
means the act or process of acceptance and enrollment into services regulated by
this rule.
(37) "Family" means the biological
or legal parents, siblings, other relatives, foster parents, legal guardians, spouse,
domestic partner, caregivers and other primary relations to the individual whether
by blood, adoption, legal or social relationships. Family also means any natural,
formal or informal support persons identified as important by the individual.
(38) "Family Support" means
the provision of supportive services to persons defined as family to the individual.
It includes support to caregivers at community meetings, assistance to families
in system navigation and managing multiple appointments, supportive home visits,
peer support, parent mentoring and coaching, advocacy, and furthering efforts to
develop natural and informal community supports.
(39) “Gender Identity”
means a person’s self-identification of gender, without regard to legal or
biological identification, including, but not limited to persons identifying themselves
as male, female, transgender and transsexual.
(40) “Gender Presentation”
means the external characteristics and behaviors that are socially defined as either
masculine or feminine, such as dress, mannerisms, speech patterns and social interactions.
(41) "Grievance" means a
formal complaint submitted to a provider verbally, or in writing, by an individual,
or the individual’s chosen representative, pertaining to the denial or delivery
of services and supports.
(42) "Guardian" means a person
appointed by a court of law to act as guardian of a minor or a legally incapacitated
person.
(43) “HIPAA”
means the federal Health Insurance Portability and Accountability Act of 1996 and
the regulations published in Title 45, parts 160 and 164, of the Code of Federal
Regulations (CFR).
(44) “Individual”
means any person being considered for or receiving services and supports regulated
by these rules.
(45) "Informed Consent for
Services" means that the service options, risks and benefits have been explained
to the individual and guardian, if applicable, in a manner that they comprehend,
and the individual and guardian, if applicable, have consented to the services on,
or prior to, the first date of service.
(46) “Intensive Outpatient
Substance Use Disorders Treatment Services” means structured nonresidential
evaluation, treatment, and continued care services for individuals with substance
use disorders who need a greater number of therapeutic contacts per week than are
provided by traditional outpatient services. Intensive outpatient services may include,
but are not limited to, day treatment, correctional day treatment, evening treatment,
and partial hospitalization.
(47) “Intensive Community-based
Treatment and Support Services (ICTS)” means a specialized set of comprehensive
in-home and community-based supports and mental health treatment services, including
care coordination as defined in these rules, for children that are developed by
the child and family team and delivered in the most integrated setting in the community.
(48) “Interim Referral
and Information Services” means services provided by an substance use disorders
treatment provider to individuals on a waiting list, and whose services are funded
by the Substance Abuse Prevention and Treatment (SAPT) Block Grant, to reduce the
adverse health effects of substance use, promote the health of the individual and
reduce the risk of disease transmission.
(49) "Intern" or "Student"
means a person who provides a paid or unpaid program service to complete a credentialed
or accredited educational program recognized by the state of Oregon.
(50) “Juvenile Psychiatric
Security Review Board (JPSRB)” means the entity described in ORS 161.385.
(51) "Level of Care" means
the range of available services provided from the most integrated setting to the
most restrictive and most intensive in an inpatient setting.
(52) "Level of Service Intensity
Determination." means the Division approved process by which children and young
adults in transition are assessed for ITS and ICTS services.
(53) "Licensed Health Care
Professional" means a practitioner of the healing arts, acting within the scope
of his or her practice under State law, who is licensed by a recognized governing
board in Oregon.
(54) "Licensed Medical Practitioner
(LMP)” means a person who meets the following minimum qualifications as documented
by the Local Mental Health Authority (LMHA) or designee:
(a) Physician licensed to
practice in the State of Oregon; or
(b) Nurse practitioner licensed
to practice in the State of Oregon; or
(c) Physician's Assistant
licensed to practice in the State of Oregon; and
(d) Whose training, experience
and competence demonstrate the ability to conduct a mental health assessment and
provide medication management.
(e) For ICTS and ITS providers,
LMP means a board-certified or board-eligible child and adolescent psychiatrist
licensed to practice in the State of Oregon.
(55) “Local Mental
Health Authority (LMHA)” means one of the following entities:
(a) The board of county commissioners
of one or more counties that establishes or operates a CMHP;
(b) The tribal council, in
the case of a federally recognized tribe of Native Americans that elects to enter
into an agreement to provide mental health services; or
(c) A regional local mental
health authority comprised of two or more boards of county commissioners.
(56) "Mandatory Reporter"
means any public or private official, as defined in ORS 419B.005(3), who comes in
contact with or has reasonable cause to believe that an individual has suffered
abuse, or that any person with whom the official comes in contact with, has abused
the individual. Pursuant to 430.765(2) psychiatrists, psychologists, clergy and
attorneys are not mandatory reporters with regard to information received through
communications that are privileged under 40.225 to 40.295.
(57) "Medicaid" means the
federal grant-in-aid program to state governments to provide medical assistance
to eligible persons, under Title XIX of the Social Security Act.
(58) "Medical Director" means
a physician licensed to practice medicine in the State of Oregon and who is designated
by a substance use disorders treatment program to be responsible for the program's
medical services, either as an employee or through a contract.
(59) "Medical Supervision"
means an LMP's review and approval, at least annually, of the medical appropriateness
of services and supports identified in the Service Plan for each individual receiving
mental health services for one or more continuous years.
(60) "Medically Appropriate"
means services and medical supplies required for prevention, diagnosis or treatment
of a physical or behavioral health condition, or injuries, and which are:
(a) Consistent with the symptoms
of a health condition or treatment of a health condition;
(b) Appropriate with regard
to standards of good health practice and generally recognized by the relevant scientific
community and professional standards of care as effective;
(c) Not solely for the convenience
of an individual or a provider of the service or medical supplies; and
(d) The most cost effective
of the alternative levels of medical services or medical supplies that can be safely
provided to an individual.
(61) “Mental Health
Intern” means a person who meets qualifications for QMHA but does not have
the necessary graduate degree in psychology, social work or behavioral science field
to meet the educational requirement of QMHP. The person must:
(a) Be currently enrolled
in a graduate program for a master’s degree in psychology, social work or
in a behavioral science field;
(b) Have a collaborative
educational agreement with the CMHP, or other provider, and the graduate program;
(c) Work within the scope
of his/her practice and competencies identified by the policies and procedures for
credentialing of clinical staff as established by provider; and
(d) Receive, at minimum,
weekly supervision by a qualified clinical supervisor employed by the provider of
services.
(62) “Mental Health
Organization (MHO)” means an approved organization that provides most mental
health services through a capitated payment mechanism under the Oregon Health Plan.
MHOs may be fully capitated health plans, community mental health programs, private
mental health organizations or combinations thereof.
(63) “Oregon Health
Authority” means the Oregon Health Authority of the State of Oregon.
(64) “Outpatient Substance
Use Disorders Treatment Program” means a program that provides assessment,
treatment, and rehabilitation on a regularly scheduled basis or in response to crisis
for individuals with alcohol or other drug use disorders and their family members,
or significant others.
(65) “Outpatient Community
Mental Health Services and Supports” means all outpatient mental health services
and supports provided to children, youth and adults.
(66) “Outpatient Problem
Gambling Treatment Services” means all outpatient treatment services and supports
provided to individuals with gambling related problems and their families.
(67) "Outreach" means the
delivery of behavioral health services, referral services and case management services
in non-traditional settings, such as, but not limited to, the individual's residence,
shelters, streets, jails, transitional housing sites, drop-in centers, single room
occupancy hotels, child welfare settings, educational settings or medical settings.
It also refers to attempts made to engage or re-engage an individual in services
by such means as letters or telephone calls.
(68) “Peer” means
any person supporting an individual, or a family member of an individual, who has
similar life experience, either as a current or former recipient of addictions or
mental health services, or as a family member of an individual who is a current
or former recipient of addictions or mental health services.
(69) “Peer Delivered
Services” means an array of agency or community-based services and supports
provided by peers, and peer support specialists, to individuals or family members
with similar lived experience, that are designed to support the needs of individuals
and families as applicable.
(70) "Peer Support Specialist"
means a person providing peer delivered services to an individual or family member
with similar life experience, under the supervision of a qualified Clinical Supervisor.
A Peer Support Specialist must complete a Division approved training program as
required by OAR 410-180-0300 to 0380 and be:
(a) A self-identified person
currently or formerly receiving mental health services; or
(b) A self-identified person
in recovery from a substance use or gambling disorder, who meets the abstinence
requirements for recovering staff in substance use disorders or gambling treatment
programs; or
(c) A family member of an
individual who is a current or former recipient of addictions or mental health services.
(71) “Problem Gambling
Treatment Staff” means a person certified or licensed by a health or allied
provider agency to provide problem gambling treatment services that include assessment,
development of a Service Plan, group and family counseling.
(72) "Program" means a particular
type or level of service that is organizationally distinct.
(73) "Program Administrator"
or "Program Director" means a person with appropriate professional qualifications
and experience, who is designated to manage the operation of a program.
(74) "Program Staff" means
an employee or person who, by contract with the program, provides a service and
who has the applicable competencies, qualifications or certification, required in
this rule to provide the service.
(75) "Provider" means an
organizational entity, or qualified person, that is operated by or contractually
affiliated with, a community mental health program, or contracted directly with
the Division, for the direct delivery of addictions, problem gambling or mental
health services and supports.
(76) "Psychiatric Security
Review Board (PSRB)" means the entity described in ORS 161.295 through 161.400.
(77) "Psychiatrist" means
a physician licensed pursuant to ORS 677.010 to 677.228 and 677.410 to 677.450 by
the Board of Medical Examiners for the State of Oregon and who has completed an
approved residency training program in psychiatry.
(78) "Psychologist" means
a psychologist licensed by the Oregon Board of Psychologist Examiners.
(79) “Publicly Funded”
means financial support, in part or in full, with revenue generated by a local,
state or federal government.
(80) "Qualified Mental Health
Associate (QMHA)” means a person delivering services under the direct supervision
of a QMHP who meets the minimum qualifications as authorized by the LMHA, or designee,
and specified in 309-019-0125(7).
(81) "Qualified Mental Health
Professional (QMHP)" means a LMP or any other person meeting the minimum qualifications
as authorized by the LMHA, or designee, and specified in 309-019-0125(8).
(82) "Qualified Person" means
a person who is a QMHP, or a QMHA, and is identified by the PSRB and JPSRB in its
Conditional Release Order. This person is designated by the provider to deliver
or arrange and monitor the provision of the reports and services required by the
Conditional Release Order.
(83) "Quality Assessment
and Performance Improvement" means the structured, internal monitoring and evaluation
of services to improve processes, service delivery and service outcomes.
(84) “Recovery”
means a process of healing and transformation for a person to achieve full human
potential and personhood in leading a meaningful life in communities of his or her
choice.
(85) "Representative" means
a person who acts on behalf of an individual, at the individual’s request,
with respect to a grievance, including, but not limited to a relative, friend, employee
of the Division, attorney or legal guardian.
(86) “Resilience”
means the universal capacity that a person uses to prevent, minimize, or overcome
the effects of adversity. Resilience reflects a person’s strengths as protective
factors and assets for positive development.
(87) "Respite care" means
planned and emergency supports designed to provide temporary relief from care giving
to maintain a stable and safe living environment. Respite care can be provided in
or out of the home. Respite care includes supervision and behavior support consistent
with the strategies specified in the Service Plan.
(88) "Screening" means the
process to determine whether the individual needs further assessment to identify
circumstances requiring referrals or additional services and supports.
(89) “Screening Specialist“
means a person who possesses valid certification issued by the Division to conduct
DUII evaluations.
(90) "Service Plan" means
a comprehensive plan for services and supports provided to or coordinated for an
individual and his or her family, as applicable, that is reflective of the assessment
and the intended outcomes of service.
(91) “Service Note”
means the written record of services and supports provided, including documentation
of progress toward intended outcomes, consistent with the timelines stated in the
Service Plan.
(92) “Service Record”
means the documentation, written or electronic, regarding an individual and resulting
from entry, assessment, orientation, services and supports planning, services and
supports provided, and transfer.
(93) "Services" means those
activities and treatments described in the Service Plan that are intended to assist
the individual's transition to recovery from a substance use disorder, problem gambling
disorder or mental health condition, and to promote resiliency, and rehabilitative
and functional individual and family outcomes.
(94) “Signature”
means any written or electronic means of entering the name, date of authentication
and credentials of the person providing a specific service or the person authorizing
services and supports. Signature also means any written or electronic means of entering
the name and date of authentication of the individual receiving services, the guardian
of the individual receiving services, or any authorized representative of the individual
receiving services.
(95) "Skills Training" means
providing information and training to individuals and families designed to assist
with the development of skills in areas including, but not limited to, anger management,
stress reduction, conflict resolution, self-esteem, parent-child interactions, peer
relations, drug and alcohol awareness, behavior support, symptom management, accessing
community services and daily living.
(96) "Substance Abuse Prevention
and Treatment Block Grant" or “SAPT Block Grant” means the federal block
grants for prevention and treatment of substance abuse under Public Law 102-321
(31 U.S.C. 7301-7305) and the regulations published in Title 45 Part 96 of the Code
of Federal Regulations.
(97) "Substance Use Disorders"
means disorders related to the taking of a drug of abuse including alcohol, to the
side effects of a medication, and to a toxin exposure. The disorders include substance
use disorders such as substance dependence and substance abuse, and substance-induced
disorders, including substance intoxication, withdrawal, delirium, and dementia,
as well as substance induced psychotic disorder, mood disorder, etc., as defined
in DSM criteria.
(98) “Substance Use
Disorders Treatment and Recovery Services” means outpatient, intensive outpatient,
and residential services and supports for individuals with substance use disorders.
(99) “Substance Use
Disorders Treatment Staff” means a person certified or licensed by a health
or allied provider agency to provide substance use disorders treatment services
that include assessment, development of a Service Plan, and individual, group and
family counseling.
(100) “Successful DUII
Completion” means that the DUII program has documented in its records that
for the period of service deemed necessary by the program, the individual has:
(a) Met the completion criteria
approved by the Division;
(b) Met the terms of the
fee agreement between the provider and the individual; and
(c) Demonstrated 90 days
of continuous abstinence prior to completion.
(101) “Supports”
means activities, referrals and supportive relationships designed to enhance the
services delivered to individuals and families for the purpose of facilitating progress
toward intended outcomes.
(102) “Transfer”
means the process of assisting an individual to transition from the current services
to the next appropriate setting or level of care.
(103) “Trauma Informed
Services” means services that are reflective of the consideration and evaluation
of the role that trauma plays in the lives of people seeking mental health and addictions
services, including recognition of the traumatic effect of misdiagnosis and coercive
treatment. Services are responsive to the vulnerabilities of trauma survivors and
are delivered in a way that avoids inadvertent re-traumatization and facilitates
individual direction of services.
(104) "Treatment" means the
planned, medically appropriate, individualized program of medical, psychological,
and rehabilitative procedures, experiences and activities designed to remediate
symptoms of a DSM diagnosis, that are included in the Service Plan.
(105) "Urinalysis Test" means
an initial test and, if positive, a confirmatory test:
(a) An initial test must
include, at a minimum, a sensitive, rapid, and inexpensive immunoassay screen to
eliminate "true negative" specimens from further consideration.
(b) A confirmatory test is
a second analytical procedure used to identify the presence of a specific drug or
metabolite in a urine specimen. The confirmatory test must be by a different analytical
method from that of the initial test to ensure reliability and accuracy.
(c) All urinalysis tests
must be performed by laboratories meeting the requirements of OAR 333-024-0305 to
333-024-0365.
(106) "Urgent" means the
onset of symptoms requiring attention within 48 hours to prevent a serious deterioration
in an individual's mental or physical health or threat to safety.
(107) "Variance" means an
exception from a provision of these rules, granted in writing by the Division, upon
written application from the provider. Duration of a variance is determined on a
case-by-case basis.
(108) "Volunteer" means an
individual who provides a program service or who takes part in a program service
and who is not an employee of the program and is not paid for services. The services
must be non-clinical unless the individual has the required credentials to provide
a clinical service.
(109) “Wellness”
means an approach to healthcare that emphasizes good physical and mental health,
preventing illness, and prolonging life.
(110) “Young Adult
in Transition” means an individual who is developmentally transitioning into
independence, sometime between the ages of 14 and 25.
Stat. Auth.: ORS 161.390, 413.042, 430.256, 428.205 - 428.270, 430.640
Stats. Implemented: ORS 109.675,
161.390 - 161.400, 413.520 - 413.522, 430.010, 430.205 - 430.210, 430.240 - 430.640,
430.850 - 430.955, 461.549, 743A.168, 813.010 - 813.052 & 813.200 - 813.270
Hist.: MHS 6-2013(Temp),
f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14; MHS 4-2014, f. & cert. ef. 2-3-14
309-019-0110
Provider Policies
(1) Personnel Policies: All providers
must develop and implement written personnel policies and procedures, compliant
with these rules, including:
(a) Personnel Qualifications
and Credentialing;
(b) Mandatory abuse reporting,
compliant with ORS 430.735-430.768 and OAR 943-045-0250 through 943-045-0370. ;
(c) Criminal Records Checks,
compliant with ORS 181.533 through 181.575 and 407-007-0000 through 407-007-0370;
and
(d) Fraud, waste and abuse
in Federal Medicaid and Medicare programs compliant with OAR 410-120-1380 and 410-120-1510.
(2) Service Delivery Policies:
All providers must develop and implement written service delivery policies and procedures,
compliant with these rules.
(a) Service delivery policies
must be available to individuals and family members upon request; and
(b) Service delivery policies
and procedures must include, at a minimum:
(A) Fee agreements;
(B) Confidentiality and compliance
with HIPAA, Federal Confidentiality Regulations (42 CFR, Part 2), and State confidentiality
regulations as specified in ORS 179.505 and 192.518 through 192.530;
(C) Compliance with Title
2 of the Americans with Disabilities Act of 1990 (ADA);
(D) Grievances and Appeals;
(E) Individual Rights;
(F) Quality Assessment and
Performance Improvement;
(G) Trauma Informed Service
Delivery, consistent with the AMH Trauma Informed Services Policy;
(H) Provision of culturally
and linguistically appropriate services;
(I) Crisis Prevention and
Response; and
(J) Incident Reporting.
(3) Behavior Support Policies:
Providers of ECS Services must develop policies consistent with 309-019-0155 (3)
of these rules.
Stat. Auth.: ORS 161.390, 413.042, 430.256, 428.205 - 428.270, 430.640
Stats. Implemented: ORS 109.675,
161.390 - 161.400, 179.505, 413.520 - 413.522, 430.010, 430.205 - 430.210, 430.240
- 430.640, 430.850 - 430.955, 461.549, 743A.168, 813.010 - 813.052 & 813.200
- 813.270
Hist.: MHS 6-2013(Temp),
f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14; MHS 4-2014, f. & cert. ef. 2-3-14
309-019-0115
Individual Rights
(1) In addition to all applicable statutory
and constitutional rights, every individual receiving services has the right to:
(a) Choose from available
services and supports, those that are consistent with the Service Plan, culturally
competent, provided in the most integrated setting in the community and under conditions
that are least restrictive to the individual’s liberty, that are least intrusive
to the individual and that provide for the greatest degree of independence;
(b) Be treated with dignity
and respect;
(c) Participate in the development
of a written Service Plan, receive services consistent with that plan and participate
in periodic review and reassessment of service and support needs, assist in the
development of the plan, and to receive a copy of the written Service Plan;
(d) Have all services explained,
including expected outcomes and possible risks;
(e) Confidentiality, and
the right to consent to disclosure in accordance with ORS 107.154, 179.505, 179.507,
192.515, 192.507, 42 CFR Part 2 and 45 CFR Part 205.50.
(f) Give informed consent
in writing prior to the start of services, except in a medical emergency or as otherwise
permitted by law. Minor children may give informed consent to services in the following
circumstances:
(A) Under age 18 and lawfully
married;
(B) Age 16 or older and legally
emancipated by the court; or
(C) Age 14 or older for outpatient
services only. For purposes of informed consent, outpatient service does not include
service provided in residential programs or in day or partial hospitalization programs;
(g) Inspect their Service
Record in accordance with ORS 179.505;
(h) Refuse participation
in experimentation;
(i) Receive medication specific
to the individual’s diagnosed clinical needs;
(j) Receive prior notice
of transfer, unless the circumstances necessitating transfer pose a threat to health
and safety;
(k) Be free from abuse or
neglect and to report any incident of abuse or neglect without being subject to
retaliation;
(l) Have religious freedom;
(m) Be free from seclusion
and restraint;
(n) Be informed at the start
of services, and periodically thereafter, of the rights guaranteed by this rule;
(o) Be informed of the policies
and procedures, service agreements and fees applicable to the services provided,
and to have a custodial parent, guardian, or representative, assist with understanding
any information presented;
(p) Have family and guardian
involvement in service planning and delivery;
(q) Make a declaration for
mental health treatment, when legally an adult;
(r) File grievances, including
appealing decisions resulting from the grievance;
(s) Exercise all rights set
forth in ORS 109.610 through 109.697 if the individual is a child, as defined by
these rules;
(t) Exercise all rights set
forth in ORS 426.385 if the individual is committed to the Authority; and
(u) Exercise all rights described
in this rule without any form of reprisal or punishment.
(2) Notification of Rights:
The provider must give to the individual and, if appropriate, the guardian, a document
that describes the applicable individual’s rights as follows:
(a) Information given to
the individual must be in written form or, upon request, in an alternative format
or language appropriate to the individual’s need;
(b) The rights, and how to
exercise them, must be explained to the individual, and if appropriate, to her or
his guardian; and
(c) Individual rights must
be posted in writing in a common area.
Stat. Auth.: ORS 161.390, 413.042, 430.256, 426.490 - 426.500, 428.205 - 428.270, 430.640 & 443.450
Stats. Implemented: ORS 109.675,
161.390 - 161.400, 179.505, 413.520 - 413.522, 426.380- 426.395, 426.490 - 426.500,
430.010, 430.205 - 430.210, 430.240 - 430.640, 430.850 - 430.955, 443.400 - 443.460,
443.991, 461.549, 743A.168, 813.010 - 813.052 & 813.200 - 813.270
Hist.: MHS 6-2013(Temp),
f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14; MHS 4-2014, f. & cert. ef. 2-3-14
Personnel
309-019-0120
Licensing and Credentialing
Program staff in the following positions
must meet applicable credentialing or licensing standards, including those outlined
in these rules:
(1) Substance Use Disorders
Treatment Staff;
(2) Clinical Supervisors;
(3) LMPs;
(4) Medical Directors;
(5) Peer Support Specialists;
(6) Problem Gambling Treatment
Staff;
(7) QMHAs; and
(8) QMHPs.
Stat. Auth.: ORS 428.205 - 428.270,430.256,
430.640
Stats. Implemented: ORS 109.675,
161.390 - 161.400, 179.505, 413.520 - 413.522, , 430.010, 430.205 - 430.210, 430.240
- 430.640, 430.850 - 430.955, 461.549, 743A.168, 813.010 - 813.052 & 813.200
- 813.270
Hist.: MHS 6-2013(Temp),
f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14; MHS 4-2014, f. & cert. ef. 2-3-14
309-019-0125
Specific Staff Qualifications and
Competencies
(1) Program Administrators or Program
Directors must demonstrate competence in leadership, program planning and budgeting,
fiscal management, supervision of program staff, personnel management, program staff
performance assessment, use of data, reporting, program evaluation, quality assurance,
and developing and coordinating community resources.
(2) Clinical Supervisors
in all programs must demonstrate competence in leadership, wellness, oversight and
evaluation of services, staff development, service planning, case management and
coordination, utilization of community resources, group, family and individual therapy
or counseling, documentation and rationale for services to promote intended outcomes
and implementation of all provider policies.
(3) Clinical supervisors
in mental health programs must meet QMHP requirements and have completed two years
of post-graduate clinical experience in a mental health treatment setting.
(4) Clinical Supervisors
in substance use disorders treatment programs must be certified or licensed by a
health or allied provider agency as follows:
(a) For supervisors holding
a certification or license in addiction counseling, qualifications for the certificate
or license must have included at least:
(A) 4000 hours of supervised
experience in substance use counseling;
(B) 300 contact hours of
education and training in substance use related subjects; and
(C) Successful completion
of a written objective examination or portfolio review by the certifying body.
(b) For supervisors holding
a health or allied provider license, the license or registration must have been
issued by one of the following state bodies and the supervisor must possess documentation
of at least 120 contact hours of academic or continuing professional education in
the treatment of substance use disorders:
(A) Board of Medical Examiners;
(B) Board of Psychologist
Examiners;
(C) Board of Licensed Social
Workers;
(D) Board of Licensed Professional
Counselors and Therapists; or
(E) Board of Nursing.
(c) Additionally, clinical
supervisors in substance use disorders programs must have one of the following qualifications:
(A) Five years of paid full-time
experience in the field of substance use disorders counseling; or
(B) A Bachelor's degree and
four years of paid full-time experience in the social services field, with a minimum
of two years of direct substance use disorders counseling experience; or
(C) A Master's degree and
three years of paid full-time experience in the social services field with a minimum
of two years of direct substance use disorders counseling experience;
(5) Clinical Supervisors
in problem gambling treatment programs must meet the requirements for clinical supervisors
in either mental health or substance use disorders treatment programs, and have
completed 10 hours of gambling specific training within two years of designation
as a problem gambling services supervisor.
(6) Substance use disorders
treatment staff must:
(a) Demonstrate competence
in treatment of substance-use disorders including individual assessment and individual,
group, family and other counseling techniques, program policies and procedures for
service delivery and documentation, and identification, implementation and coordination
of services identified to facilitate intended outcomes; and
(b) Be certified or licensed
by a health or allied provider agency, as defined in these rules, to provide addiction
treatment within two years of the first hire date and must make application for
certification no later than six months following that date. The two years is not
renewable if the person ends employment with a provider and becomes re-employed
with another provider.
(c) For treatment staff holding
certification in addiction counseling, qualifications for the certificate must have
included at least:
(A) 750 hours of supervised
experience in substance use counseling;
(B) 150 contact hours of
education and training in substance use related subjects; and
(C) Successful completion
of a written objective examination or portfolio review by the certifying body.
(d) For treatment staff holding
a health or allied provider license, the license or registration must have been
issued by one of the following state bodies and the person must possess documentation
of at least 60 contact hours of academic or continuing professional education in
substance use disorders treatment:
(A) Board of Medical Examiners;
(B) Board of Psychologist
Examiners;
(C) Board of Licensed Social
Workers;
(D) Board of Licensed Professional
Counselors and Therapists; or
(E) Board of Nursing.
(7) Problem Gambling treatment
staff must:
(a) Demonstrate competence
in treatment of problem gambling including individual assessment and individual,
group, family and other counseling techniques, program policies and procedures for
service delivery and documentation, and identification, implementation and coordination
of services identified to facilitate intended outcomes.
(b) Be certified or licensed
by a health or allied provider agency, as defined in these rules, to provide problem
gambling treatment within two years of the first hire date and must make application
for certification no later than six months following that date. The two years is
not renewable if the person ends employment with a provider and becomes re-employed
with another provider.
(c) For treatment staff holding
certification in problem gambling counseling, qualifications for the certificate
must have included at least:
(A) 500 hours of supervised
experience in problem gambling counseling;
(B) 60 contact hours of education
and training in problem gambling related subjects; and
(C) Successful completion
of a written objective examination or portfolio review by the certifying body.
(d) For treatment staff holding
a health or allied provider license, the license or registration must have been
issued by one of the following state bodies and the person must possess documentation
of at least 60 contact hours of academic or continuing professional education in
problem gambling treatment:
(A) Board of Medical Examiners;
(B) Board of Psychologist
Examiners;
(C) Board of Licensed Social
Workers;
(D) Board of Licensed Professional
Counselors and Therapists; or
(E) Board of Nursing.
(8) QMHAs must demonstrate
the ability to communicate effectively, understand mental health assessment, treatment
and service terminology and apply each of these concepts, implement skills development
strategies, and identify, implement and coordinate the services and supports identified
in a Service Plan. QMHAs must meet the follow minimum qualifications:
(a) Bachelor's degree in
a behavioral science field; or
(b) A combination of at least
three years of relevant work, education, training or experience; or
(c) A qualified Mental Health
Intern, as defined in 309-019-0105(61).
(9) QMHPs must demonstrate
the ability to conduct an assessment, including identifying precipitating events,
gathering histories of mental and physical health, substance use, past mental health
services and criminal justice contacts, assessing family, cultural, social and work
relationships, and conducting a mental status examination, complete a DSM diagnosis,
write and supervise the implementation of a Service Plan and provide individual,
family or group therapy within the scope of their training. QMHPs must meet the
following minimum qualifications:
(a) Bachelor’s degree
in nursing and licensed by the State or Oregon;
(b) Bachelor’s degree
in occupational therapy and licensed by the State of Oregon;
(c) Graduate degree in psychology;
(d) Graduate degree in social
work;
(e) Graduate degree in recreational,
art, or music therapy;
(f) Graduate degree in a
behavioral science field; or
(g) A qualified Mental Health
Intern, as defined in 309-019-0105(61).
(10) Peer support specialists
must demonstrate knowledge of approaches to support others in recovery and resiliency,
and demonstrate efforts at self-directed recovery.
(11) Recovering Staff: Program
staff, contractors, volunteers and interns recovering from a substance use disorder,
providing treatment services or peer support services in substance use disorders
treatment programs, must be able to document continuous abstinence under independent
living conditions or recovery housing for the immediate past two years.
Stat. Auth.: ORS 161.390, 413.042, 428.205
- 428.270, 430.256, 430.640
Stats. Implemented: ORS 109.675,
413.520 - 413.522, 426.380, 430.010, 430.205 - 430.210, 430.240 - 430.640, 430.850
- 430.955, 461.549,

743A.168, 813.010 - 813.052 & 813.200 - 813.270
Hist.: MHS 6-2013(Temp),
f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14; MHS 4-2014, f. & cert. ef. 2-3-14;
MHS 1-2015(Temp), f. & cert. ef. 3-25-15 thru 9-20-15; MHS 3-2015, f. &
cert. ef. 5-28-15
309-019-0130
Personnel Documentation, Training
and Supervision
(1) Providers must maintain personnel
records for each program staff which contains all of the following documentation:
(a) Where required, verification
of a criminal record check consistent with OAR 407-007-0000 through 407-007-0370;
(b) A current job description
that includes applicable competencies;
(c) Copies of relevant licensure
or certification, diploma, or certified transcripts from an accredited college,
indicating that the program staff meets applicable qualifications;
(d) Periodic performance
appraisals;
(e) Staff orientation documentation;
and
(f) Disciplinary documentation.
(2) Providers utilizing contractors,
interns or volunteers must maintain the following documentation, as applicable:
(a) A contract or written
agreement;
(b) A signed confidentiality
agreement;
(c) Orientation documentation;
and
(d) For subject individuals,
verification of a criminal records check consistent with OAR 407-007-0000 through
407-007-0370.
(3)Training: Providers must
ensure that program staff receives training applicable to the specific population
for whom services are planned, delivered, or supervised as follows:
(a) Orientation training:
The program must document appropriate orientation training for each program staff,
or person providing services, within 30 days of the hire date. At minimum, orientation
training for all program staff must include, but not be limited to,
(A) A review of crisis prevention
and response procedures;
(B) A review of emergency
evacuation procedures;
(C) A review of program policies
and procedures;
(D) A review of rights for
individuals receiving services and supports;
(E) Mandatory abuse reporting
procedures;
(F) HIPAA, and Fraud, Waste
and Abuse; and
(G) For Enhanced Care Services,
positive behavior support training.
(4) Clinical Supervision:
Persons providing direct services must receive supervision by a qualified Clinical
Supervisor, as defined in these rules, related to the development, implementation
and outcome of services.
(a) Clinical supervision
must be provided to assist program staff and volunteers to increase their skills,
improve quality of services to individuals, and supervise program staff and volunteers'
compliance with program policies and procedures, including:
(b) Documentation of two
hours per month of supervision for each person supervised. The two hours must include
one hour of individual face-to-face contact for each person supervised, or a proportional
level of supervision for part-time program staff. Individual face-to-face contact
may include real time, two-way audio visual conferencing;
(c) Documentation of two
hours of quarterly supervision for program staff holding a health or allied provider
license, including at least one hour of individual face-to-face contact for each
person supervised; or
(d) Documentation of weekly
supervision for program staff meeting the definition of Mental Health Intern.
Stat. Auth.: ORS 161.390, 413.042, 428.205
- 428.270, 430.256, 430.640
Stats. Implemented: ORS 109.675,
413.520 - 413.522, 426.380, 430.010, 430.205 - 430.210, 430.240 - 430.640, 430.850
- 430.955, 461.549, 743A.168, 813.010 - 813.052 & 813.200 - 813.270
Hist.: MHS 6-2013(Temp),
f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14; MHS 4-2014, f. & cert. ef. 2-3-14
Service and Documentation Standards
309-019-0135
Entry and Assessment
(1) Entry Process: The program must
utilize an entry procedure to ensure the following:
(a) Individuals must be considered
for entry without regard to race, ethnicity, gender, gender identity, gender presentation,
sexual orientation, religion, creed, national origin, age, except when program eligibility
is restricted to children, adults or older adults, familial status, marital status,
source of income, and disability.
(b) Individuals must receive
services in the most timely manner feasible consistent with the presenting circumstances.
(c) Written informed consent
for services must be obtained from the individual or guardian, if applicable, prior
to the start of services. If such consent is not obtained, the reason must be documented
and further attempts to obtain informed consent must be made as appropriate.
(d) The provider must develop
and maintain adequate clinical records and other documentation which supports the
specific care, items, or services for which payment has been requested.
(e) The provider must report
the entry of all individuals on the mandated state data system.
(f) In accordance with ORS
179.505 and HIPAA, an authorization for the release of information must be obtained
for any confidential information concerning the individual being considered for,
or receiving, services.
(g) Orientation: At the time
of entry, the program must offer to the individual and guardian if applicable, written
program orientation information. The written information must be in a language understood
by the individual and must include:
(A) An opportunity to complete
a declaration for mental health treatment with the individual's participation and
informed consent;
(B) A description of individual
rights consistent with these rules;
(C) Policies concerning grievances;
(D) Notice of privacy practices;
and
(E) An opportunity to register
to vote.
(2) Entry Priority: Entry
of individuals whose services are funded by the SAPT Block Grant, must be prioritized
in the following order:
(A) Women who are pregnant
and using substances intravenously;
(B) Women who are pregnant;
(C) Individuals who are using
substances intravenously; and
(D) Women with dependent
children.
(3) Assessment:
(a) At the time of entry,
an assessment must be completed.
(b) The assessment must be
completed by qualified program staff as follows:
(A) A QMHP in mental health
programs. A QMHA may assist in the gathering and compiling of information to be
included in the assessment.
(B) Supervisory or treatment
staff in substance use disorders treatment programs, and
(C) Supervisory or treatment
staff in problem gambling treatment programs.
(c) Each assessment must
include sufficient information and documentation to justify the presence of a diagnosis
that is the medically appropriate reason for services.
(d) For Substance Use Disorders
services, each assessment must be consistent with the dimensions described in the
ASAM PPC, and must document a diagnosis and level of care determination consistent
with the DSM and ASAM PPC.
(e) When the assessment process
determines the presence of co-occurring substance use and mental health disorders,
or any significant risk to health and safety, all providers must document referral
for further assessment, planning and intervention from an appropriate professional,
either with the same provider or with a collaborative community provider.
(e) Providers must periodically
update assessments as applicable, when there are changes in clinical circumstances;
and
(f) Any individual continuing
to receive mental health services for one or more continuous years, must receive
an annual assessment by a QMHP.
Stat. Auth.: ORS 161.390, 413.042, 430.256, 428.205 - 428.270, 430.640
Stats. Implemented: ORS 109.675,
161.390 - 161.400, 413.520 - 413.522, 430.010, 430.205- 430.210, 430.240 - 430.640,
430.850 - 430.955, 461.549, 743A.168, 813.010 - 813.052 & 813.200 - 813.270
Hist.: MHS 6-2013(Temp),
f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14; MHS 4-2014, f. & cert. ef. 2-3-14
309-019-0140
Service Plan and Service Notes
(1) The Service Plan must be a written,
individualized plan to improve the individual’s condition to the point where
the individual’s continued participation in the program is no longer necessary.
The Service Plan is included in the individual’s service record and must:
(a) Be completed prior to
the start of services;
(b) Reflect the assessment
and the level of care to be provided;
(c) Include the participation
of the individual and family members, as applicable;
(d) Be completed by qualified
program staff as follows:
(A) A QMHP in mental health
programs;
(B) Supervisory or treatment
staff in substance use disorders treatment programs, and
(C) Supervisory or treatment
staff in problem gambling treatment programs.
(e) For mental health services,
a QMHP, who is also a licensed health care professional, must recommend the services
and supports by signing the Service plan within ten (10) business days of the start
of services; and
(f) A LMP must approve the
Service Plan at least annually for each individual receiving mental health services
for one or more continuous years. The LMP may designate annual clinical oversight
by documenting the designation to a specific licensed health care professional.
(2) At minimum, each Service
Plan must include:
(a) Individualized treatment
objectives;
(b) The specific services
and supports that will be used to meet the treatment objectives;
(c) A projected schedule
for service delivery, including the expected frequency and duration of each type
of planned therapeutic session or encounter;
(d) The type of personnel
that will be furnishing the services; and
(e) A projected schedule
for re-evaluating the Service Plan.
(3) Service Notes:
(a) Providers must document
each service and support. A Service Note, at minimum, must include:
(A) The specific services
rendered
(B) The date, time of service,
and the actual amount of time the services were rendered;
(C) Who rendered the services;
(D) The setting in which
the services were rendered;
(E) The relationship of the
services to the treatment regimen described in the Service Plan; and
(F) Periodic Updates describing
the individual’s progress.
(4) Decisions to transfer
individuals must be documented, including the reason for the transfer.
Stat. Auth.: ORS 161.390, 413.042, 430.256, 428.205 - 428.270, 430.640
Stats. Implemented: ORS 109.675,
161.390 - 161.400, 413.520 - 413.522, 430.010, 430.205- 430.210, 430.240 - 430.640,
430.850 - 430.955, 461.549, 743A.168, 813.010 - 813.052 & 813.200 - 813.270
Hist.: MHS 6-2013(Temp),
f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14; MHS 4-2014, f. & cert. ef. 2-3-14
Program Specific Minimum Service
Standards
309-019-0145
Co-Occurring Mental Health and Substance
Use Disorders (COD)
Providers approved and designated to
provide services and supports for individuals diagnosed with COD must provide concurrent
service and support planning and delivery for substance use, gambling disorder,
and mental health diagnosis, including integrated assessment, Service Plan and Service
Record.
Stat. Auth.: ORS 430.640
Stats. Implemented: ORS 430.010,
430.205 - 430.210, 430.240 - 430.640, 430.850 - 430.955
Hist.: MHS 6-2013(Temp),
f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14; MHS 4-2014, f. & cert. ef. 2-3-14
309-019-0150
Outpatient Mental Health Services
to Children and Adults
(1) Crisis services must be provided
directly or through linkage to a local crisis services provider and must include
the following:
(a) 24 hours, seven days
per week telephone or face-to-face screening to determine an individual's need for
immediate community mental health services; and
(b) 24 hour, seven days per
week capability to conduct, by or under the supervision of a QMHP, an assessment
resulting in a Service Plan that includes the crisis services necessary to assist
the individual and family to stabilize and transition to the appropriate level of
care.
(2) Available case management
services must be provided, including the following:
(a) Assistance in applying
for benefits to which the individual may be entitled. Program staff must assist
individuals in gaining access to, and maintaining, resources such as Social Security
benefits, general assistance, food stamps, vocational rehabilitation, and housing.
When needed, program staff must arrange transportation or accompany individuals
to help them apply for benefits; and
(b) Referral and coordination
to help individuals gain access to services and supports identified in the Service
Plan;
(3) When significant health
and safety concerns are identified, program staff must assure that necessary services
or actions occur to address the identified health and safety needs for the individual.
Stat. Auth.: ORS 161.390, 413.042, 430.256, 428.205 - 428.270, 430.640
Stats. Implemented: ORS 109.675,
161.390 - 161.400, 413.520 - 413.522, 430.010, 430.205 - 430.210, 430.240 - 430.640,
430.850 - 430.955, 461.549, 743A.168, 813.010 - 813.052 & 813.200 - 813.270
Hist.: MHS 6-2013(Temp),
f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14; MHS 4-2014, f. & cert. ef. 2-3-14
309-019-0155
Enhanced Care Services and Enhanced
Care Outreach Services
(1) Services will be provided in a facility
or program approved by the Department of Human Services (DHS), Aging and People
with Disabilities (APD) as follows:
(a) Enhanced Care Services
(ECS) must be provided in designated DHS licensed facilities that have a multipurpose
room, an environment with low stimulation, an accessible outdoor space with a covered
area, security doors, a refrigerator, a microwave conveniently located for program
activities, space for interdisciplinary meetings, space for mental health treatment
and space for storage of records. A minimum of one private room is required in facilities
opened after January 1, 1994; and
(b) Enhanced Care Outreach
Services (ECOS) must be provided to residents of DHS licensed facilities and include
individualized wrap-around rehabilitative mental health services.
(2) To be eligible for ECS/ECOS
an individual must:
(a) Be APD service eligible;
(b) Meet the diagnostic criteria
of severe mental illness with problematic behavior or be approved by the Enhanced
Care Services Team;
(c) Require intensive community
mental health services to transition to a lower level of care;
(d) Have a history of multiple
APD placements due to problematic behavior; and
(e) Be currently or have
been a patient at Oregon State Hospital or have received in-patient services in
an acute psychiatric unit for over 14 days and have been referred to non-enhanced
APD facilities and denied admission due to severe mental illness with problematic
behavior and be currently exhibiting two or more of the following: self-endangering
behavior, aggressive behavior, intrusive behavior, intractable psychiatric symptoms,
medication needs, sexually inappropriate behavior and elopement behavior.
(3) ECS/ECOS providers must:
(a) For ECS, provide a minimum
of 12 hours per day, 7 days per week of mental health services, provided or arranged
for by the contracted mental health provider. Services must include a minimum of
3 hours rehabilitative services per day;
(b) For ECOS, services based
on the assessed need of the individual will not exceed 5 days per week;
(c) Coordinate Interdisciplinary
team meetings (IDT) to develop the Service Plan, review the behavior support plan
and to coordinate care planning with the DHS licensed provider staff, APD case manager,
QMHP, prescriber and related professionals such as DHS licensed facility/program
direct care staff, DHS licensed facility RN and facility administrator. IDTs in
ECS programs must be held weekly and at least quarterly for ECOS;
(d) Conduct quarterly mental
health in-service trainings for DHS-licensed providers and related program staff
providing services to ECS/ECOS recipients; and
(e) Ensure the availability
of crisis services staffed by a QMHP, or the local CMHP, available to the ECS/ECOS
provider and DHS licensed facility direct care staff 24-hours per day.
(4) Behavior support services
must be designed to facilitate positive alternatives to challenging behavior, and
to assist the individual in developing adaptive and functional living skills. Providers
must:
(a) Develop and implement
individual behavior support strategies, based on a functional or other clinically
appropriate assessment of challenging behavior;
(b) Document the behavior
support strategies and measures for tracking progress as a behavior support plan
in the Service Plan;
(c) Establish a framework
which assures individualized positive behavior support practices throughout the
program and articulates a rationale consistent with the philosophies supported by
the Division, including the Division’s Trauma-informed Services Policy;
(d) Obtain informed consent
from the individual or guardian, if one is appointed, in the use of behavior support
strategies and communicate both verbally and in writing the information to the individual
or guardian, if one is appointed, in a language understood;
(e) Establish outcome-based
tracking methods to measure the effectiveness of behavior support strategies in:
(A) The use of least restrictive
interventions possible; and
(B) Increasing positive behavior.
(f) Require all program staff
to receive quarterly mental health in-service training in Evidence-based Practices
to promote positive behavior support and related to needs of each individual; and
(g) Review and update behavior
support policies, procedures, and practices annually.
(5) Providers must develop
a transition plan for each individual as part of the initial assessment process.
Each individual’s mental health service plan will reflect their transition
goal and the supports necessary to achieve transition.
(6) Staffing requirements:
(a) Each ECS/ECOS program
must have a minimum of 1 FTE QMHP for programs serving five or more individuals
who is responsible for coordinating entries, transitions and required IDT’s,
assuring the completion of individual assessments, mental health service and behavior
support plans; providing supervision of QMHP’s and QMHA’s and to coordinate
services and trainings with facility staff;
(b) Each ECS/ECOS program
must have psychiatric consultation available. For ECS programs serving more than
10 individuals, the psychiatrist must participate.
(7) In ECS programs, the
CMHP and the DHS licensed provider must develop a written collaborative agreement
that addresses at minimum: risk management, census management, staff levels, training,
treatment and activity programs, entry and transition procedures, a process for
reporting and evaluating critical incidents, record keeping, policy and procedure
manuals, dispute resolution and service coordination.
Stat. Auth.: ORS 161.390, 413.042, 428.205
- 428.270, 430.640 & 443.450
Stats. Implemented: ORS 109.675,
161.390 - 161.400, 430.010, 430.205 - 430.210, 430.240 - 430.640, 430.850 - 430.955,
743A.168, 813.010 - 813.052
Hist.: MHS 6-2013(Temp),
f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14; MHS 4-2014, f. & cert. ef. 2-3-14
309-019-0160
Psychiatric Security Review Board
and Juvenile Psychiatric Security Review Board
(1) Services and supports must include
all appropriate services determined necessary to assist the individual in maintaining
community placement and which are consistent with Conditional Release Orders and
the Agreement to Conditional Release.
(2) Providers of PSRB and
JPSRB services acting through the designated Qualified Person, must submit reports
to the PSRB or JPSRB as follows:
(a) Orders for Evaluation:
For individuals under the jurisdiction of the PSRB or the JPSRB, providers must
take the following action upon receipt of an Order for Evaluation:
(A) Within 15 days of receipt
of the Order, schedule an interview with the individual for the purpose of initiating
or conducting the evaluation;
(B) Appoint a QMHP to conduct
the evaluation and to provide an evaluation report to the PSRB or JPSRB;
(C) Within 30 days of the
evaluation interview, submit the evaluation report to the PSRB or JPSRB responding
to the questions asked in the Order for Evaluation; and
(D) If supervision by the
provider is recommended, notify the PSRB or JPSRB of the name of the person designated
to serve as the individual’s Qualified Person, who must be primarily responsible
for delivering or arranging for the delivery of services and the submission of reports
under these rules.
(b) Monthly reports consistent
with PSRB or JPSRB reporting requirements as specified in the Conditional Release
Order that summarize the individual’s adherence to Conditional Release requirements
and general progress; and
(c) Interim reports, including
immediate reports by phone, if necessary, to ensure the public or individual’s
safety including:
(A) At the time of any significant
change in the individual’s health, legal, employment or other status which
may affect compliance with Conditional Release orders;
(B) Upon noting major symptoms
requiring psychiatric stabilization or hospitalization;
(C) Upon noting any other
major change in the individual’s Service Plan;
(D) Upon learning of any
violations of the Conditional Release Order; and
(E) At any other time when,
in the opinion of the Qualified Person, such an interim report is needed to assist
the individual.
(3) PSRB and JPSRB providers
must submit copies of all monthly reports and interim reports to both the PSRB or
JPSRB and the Division.
(4) When the individual is
under the jurisdiction of the PSRB or JPSRB, providers must include the following
additional documentation in the Service Record:
(a) Monthly reports to the
PSRB or JPSRB;
(b) Interim reports, as applicable;
(c) The PSRB or JPSRB Initial
Evaluation; and
(d) A copy of the Conditional
Order of Release.
Stat. Auth.: ORS 161.390, 413.042, 430.256, 426.490 - 426.500, 428.205 - 428.270, 430.640 & 443.450
Stats. Implemented: ORS 109.675,
161.390 - 161.400, 179.505, 413.520 - 413.522, 426.380 - 426.395, 426.490 - 426.500,
430.010, 430.205 - 430.210, 430.240 - 430.640, 430.850 - 430.955, 443.400 - 443.460,
443.991
Hist.: MHS 6-2013(Temp),
f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14; MHS 4-2014, f. & cert. ef. 2-3-14
309-019-0165
Intensive Community-Based Treatment
and Support Services (ICTS) for Children
(1) ICTS services may be delivered at
a clinic, facility, home, school, other provider or allied agency location or other
setting as identified by the child and family team. In addition to services specified
by the Service Plan and the standards for outpatient mental health services, ICTS
services must include:
(a) Care coordination provided
by a QMHP or a QMHA supervised by a QMHP;
(b) A child and family team,
as defined in these rules;
(c) Service coordination
planning, to be developed by the child and family team;
(d) Review of progress at
child and family team meetings to occur at a frequency determined by the child and
family team and consistent with needs;
(e) A Proactive safety and
crisis plan developed by the child and family team, including:
(A) Strategies designed to
facilitate positive alternatives to challenging behavior and to assist the individual
in developing adaptive and functional living skills;
(B Strategies to avert potential
crisis without placement disruptions;
(C) Professional and natural
supports to provide 24 hours, seven days per week flexible response; and
(D) Documented informed consent
from the parent or guardian.
(2) ICTS providers must include
the following additional documentation in the Service Record:
(a) Level of Service Intensity
Determination;
(b) Names and contact information
of the members of the child and family team;
(c) Documented identification
of strengths and needs;
(d) A summary and review
of service coordination planning by the participating team members; and
(e) A proactive safety and
crisis plan.
Stat. Auth.: ORS 161.390, 413.042, 430.256, 428.205 - 428.270, 430.640
Stats. Implemented: ORS 109.675,
161.390 - 161.400, 430.010, 430.205 - 430.210, 430.240- 430.640, 430.850 - 430.955
Hist.: MHS 6-2013(Temp),
f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14; MHS 4-2014, f. & cert. ef. 2-3-14
309-019-0170
Outpatient Problem Gambling Treatment
Services
These services include group, individual
and family treatment consistent with the following requirements:
(1) The first offered service
appointment must be five business days or less from the date of request for services;
(2) Service sessions must
address the challenges of the individual as they relate, directly or indirectly,
to the problem gambling behavior;
(3) Telephone counseling:
Providers may provide telephone counseling when person-to-person contact would involve
an unwise delay, as follows:
(a) Individual must be currently
enrolled in the problem gambling treatment program;
(b) Phone counseling must
be provided by a qualified program staff within their scope of practice;
(c) Service Notes for phone
counseling must follow the same criteria as face-to-face counseling and identify
the session was conducted by phone and the clinical rationale for the phone session;
(d) Telephone counseling
must meet HIPAA and 42 CFR standards for privacy; and
(e) There must be an agreement
of informed consent for phone counseling that is discussed with the individual and
documented in the individual’s service record.
(4) Family Counseling: Family
counseling includes face-to-face or non face-to-face service sessions between a
program staff member delivering the service and a family member whose life has been
negatively impacted by gambling.
(a) Service sessions must
address the problems of the family member as they relate directly or indirectly
to the problem gambling behavior; and
(b) Services to the family
must be offered even if the individual identified as a problem gambler is unwilling,
or unavailable to accept services.
(5) 24-hour crisis response
accomplished through agreement with other crisis services, on-call program staff
or other arrangement acceptable to the Division.
(6) A financial assessment
must be included in the entry process and documented in the assessment; and
(7) The service plan must
include a financial component, consistent with the financial assessment.
(8) A risk assessment for
suicide ideation must be included in the entry process and documented in the assessment,
as well as appropriate referrals made; and
(9) The service plan must
address suicidal risks if determined within the assessment process.
Stat. Auth.: ORS 161.390, 428.205 -
428.270, 430.640, 461.549
Stats. Implemented: ORS 109.675,
161.390 - 161.400, 179.505, 409.430 - 409.435, 426.380- 426.395, 426.490 - 426.500,
430.010, 430.205 - 430.210, 430.240 - 430.640, 430.850 - 430.955, 443.400 - 443.460,
443.991, 461.549
Hist.: MHS 6-2013(Temp),
f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14; MHS 4-2014, f. & cert. ef. 2-3-14;
MHS 1-2015(Temp), f. & cert. ef. 3-25-15 thru 9-20-15; MHS 3-2015, f. &
cert. ef. 5-28-15
309-019-0175
Outpatient Substance Use Disorders
Treatment and Recovery Services
(1) Interim Referral and Information
Services: Pregnant women or other individuals using substances intravenously, whose
services are funded by the SAPT Block Grant, must receive interim referrals and
information prior to entry, to reduce the adverse health effects of substance use,
promote the health of the individual, and reduce the risk of transmission of disease.
At a minimum, interim referral and informational services must include:
(a) Counseling and education
about blood borne pathogens including Hepatitis, HIV, STDs and Tuberculosis (TB);
the risks of needle and paraphernalia sharing and the likelihood of transmission
to sexual partners and infants;
(b) Counseling and education
about steps that can decrease the likelihood of Hepatitis, HIV, STD, and TB transmission;
(c) Referral for Hepatitis,
HIV, STD and TB testing, vaccine or care services if necessary; and
(d) For pregnant women, counseling
on the likelihood of blood borne pathogen transmission as well as the effects of
alcohol, tobacco and other drug use on the fetus and referral for prenatal care.
(2) Culturally Specific Services:
Programs approved and designated as culturally specific programs must meet the following
criteria:
(a) Serve a majority of individuals
representing culturally specific populations;
(b) Maintain a current demographic
and cultural profile of the community;
(c) Ensure that individuals
from the identified cultural group receive effective and respectful care that is
provided in a manner compatible with their cultural health beliefs, practices, and
preferred language;
(d) Implement strategies
to recruit, retain, and promote a diverse staff at all levels of the organization
that are representative of the population being served;
(e) Ensure that staff at
all levels and across all disciplines receive ongoing education and training in
culturally and linguistically appropriate service delivery;
(f) Providers should ensure
that a majority of the substance use disorders treatment staff be representative
of the specific culture being served;
(g) Ensure that individuals
are offered customer satisfaction surveys that address all areas of service and
that the results of the surveys are used for quality improvement;
(h) Consider race, ethnicity,
and language data in measuring customer satisfaction;
(i) Develop and implement
cultural competency policies;
(j) Ensure that data on individual’s
race, ethnicity, and spoken and written language are collected in health records,
integrated into the organization’s management information systems, and periodically
updated;
(k) Develop and maintain
a Governing or Advisory Board as follows:
(A) Have a majority representation
of the culturally specific group being served;
(B) Receive training concerning
the significance of culturally relevant services and supports;
(C) Meet at least quarterly;
and
(D) Monitor agency quality
improvement mechanisms and evaluate the ongoing effectiveness and implementation
of culturally relevant services (CLAS) and supports within the organization.
(l) Maintain accessibility
to culturally specific populations including:
(A) The physical location
of the program must be within close proximity to the culturally specific populations;
(B) Where available, public
transportation must be within close proximity to the program; and
(C) Hours of service, telephone
contact, and other accessibility issues must be appropriate for the population.
(m) The physical facility
where the culturally specific services are delivered must be psychologically comfortable
for the group including:
(A) Materials displayed must
be culturally relevant; and
(B) Mass media programming
(radio, television, etc.) must be sensitive to cultural background;
(n) Other cultural differences
must be considered and accommodated when possible, such as the need or desire to
bring family members to the facility, play areas for small children and related
accommodations; and
(o) Ensure that grievance
processes are culturally and linguistically sensitive and capable of identifying,
preventing and resolving cross-cultural conflicts or complaints.
Stat. Auth.: ORS 413.042, 428.205 -
428.270, 430.640 & 443.450
Stats. Implemented: ORS 430.010,
430.205 - 430.210, 430.240 - 430.640, 430.850 - 430.955, 443.400 - 443.460, 443.991
Hist.: MHS 6-2013(Temp),
f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14; MHS 4-2014, f. & cert. ef. 2-3-14
309-019-0180
Outpatient Adolescent Substance Use
Disorders Treatment and Recovery Services
Programs approved to provide adolescent
substance use disorders treatment services or those with adolescent-designated service
funding must meet the following standards:
(1) Development of Service
Plans and case management services must include participation of parents, other
family members, schools, children's services agencies, and juvenile corrections,
as appropriate;
(2) Services, or appropriate
referrals, must include:
(a) Family counseling;
(b) Community and social
skills training; and
(c) Smoking cessation service.
(3) Continuing care services
must be of appropriate duration and designed to maximize recovery opportunities.
The services must include:
(a) Reintegration services
and coordination with family and schools;
(b) Youth dominated self-help
groups where available;
(c) Linkage to emancipation
services when appropriate; and
(d) Linkage to physical or
sexual abuse counseling and support services when appropriate.
Stat. Auth.: ORS 161.390, 413.042, 428.205
- 428.270, 430.640
Stats. Implemented: ORS 109.675,
161.390 - 161.400, 430.010, 430.205 - 430.210, 430.240- 430.640, 430.850 - 430.955,
743A.168, 813.010 - 813.052 & 813.200 - 813.270
Hist.: MHS 6-2013(Temp),
f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14; MHS 4-2014, f. & cert. ef. 2-3-14
309-019-0185
Outpatient Women’s Substance
Use Disorders Treatment and Recovery Programs
(1) Programs approved to provide women’s
substance use disorders treatment services or those with women-specific designated
service funding must meet the following standards:
(a) The Assessment must contain
an evaluation that identifies and assesses needs specific to women's issues in service
such as social isolation, self-reliance, parenting issues, domestic violence, women’s
physical health, housing and financial considerations;
(b) The service plan must
address all areas identified in the assessment and applicable service coordination
details to address the identified needs;
(c) The program must provide
or coordinate services and supports that meet the special access needs of women
such as childcare, mental health services, and transportation, as indicated; and
(d) The program must provide,
or coordinate, the following services and supports unless clinically contraindicated:
(A) Gender-specific services
and supports;
(B) Family services, including
therapeutic services for children in the custody of women in treatment;
(C) Reintegration with family;
(D) Peer delivered supports;
(E) Smoking cessation;
(F) Housing; and
(G) Transportation.
(2) Services must include
the participation of family and other agencies as appropriate, such as social service,
child welfare, or corrections agencies;
(3) Referral Services: The
program must coordinate services with the following, if indicated:
(a) Agencies providing services
to women who have experienced physical abuse, sexual abuse or other types of domestic
violence; and
(b) Parenting training; and
(c) Continuing care treatment
services must be consistent with the ASAM PPC and must include referrals to female
dominated support groups where available; and
(4) Programs that receive
SAPT Block Grant funding must provide or coordinate the following services for pregnant
women and women with dependent children, including women who are attempting to regain
custody of their children:
(a) Primary medical care
for women, including referral for prenatal care and, while the women are receiving
such services, child care;
(b) Primary pediatric care,
including immunizations for their children;
(c) Gender specific substance
abuse treatment and other therapeutic interventions for women which may include,
but are not limited to:
(A) Relationship issues;
(B) Sexual and physical abuse;
(C) Parenting;
(D) Access to child care
while the women are receiving these services; and
(E) Therapeutic interventions
for children in the custody of women in treatment which may include, but are not
limited to:
(i) Their developmental needs;
(ii) Any issues concerning
sexual and physical abuse, and neglect; and
(iii) Sufficient case management
and transportation to ensure that women and their children have access to services.
Stat. Auth.: ORS 161.390, 413.042, 428.205
- 428.270, 430.640
Stats. Implemented: ORS 109.675,
161.390 - 161.400, 430.010, 430.205 - 430.210, 430.240- 430.640, 430.850 - 430.955,
743A.168, 813.010 - 813.052 & 813.200 - 813.270
Hist.: MHS 6-2013(Temp),
f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14; MHS 4-2014, f. & cert. ef. 2-3-14
309-019-0190
Community-Based Substance Use Treatment
Programs for Individuals in the Criminal Justice System
(1) These services and supports are
for individuals who are under the supervision of a probation officer or on parole
or post-prison supervision or participating in a drug treatment court program or
otherwise under the direct supervision of the court.
(2) Services and supports
must incorporate interventions and strategies that target criminogenic risk factors
and include:
(a) Cognitive behavioral
interventions;
(b) Motivational interventions;
(c) Relapse prevention; and
(d) Healthy relationships
education;
(3) Providers must demonstrate
coordination of services with criminal justice partners through written protocols,
program staff activities, and individual record documentation.
(4) Program Directors or
clinical supervisors must have experience in community-based offender treatment
programs and have specific training and experience applying effective, evidence-based
clinical strategies and services for individuals receiving community-based substance
use disorders treatment services to individuals in the criminal justice system;
(5) Within the first six
months of hire, program staff must:
(a) Receive training on effective
principles of evidenced-based practices for individuals with criminogenic risk factors;
and
(b) Have documented knowledge,
skills, and abilities demonstrating treatment strategies for individuals with criminogenic
risk factors.
Stat. Auth.: ORS 161.390, 413.042, 428.205
- 428.270, 430.640
Stats. Implemented: ORS 109.675,
161.390 - 161.400, 430.010, 430.205 - 430.210, 430.240- 430.640, 430.850 - 430.955,
743A.168, 813.010 - 813.052 & 813.200 - 813.270
Hist.: MHS 6-2013(Temp),
f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14; MHS 4-2014, f. & cert. ef. 2-3-14
309-019-0195
DUII Rehabilitation Programs
(1) In addition to the general standards
for substance use disorders treatment programs, those programs approved to provide
DUII rehabilitation services must meet the following standards:
(a) DUII rehabilitation programs
must assess individuals referred for treatment by the screening specialist. Placement,
continued stay and transfer of individuals must be based on the criteria described
in the ASAM PPC, subject to the following additional terms and conditions:
(A) Abstinence: Individuals
must demonstrate continuous abstinence for a minimum of 90 days prior to completion
as documented by urinalysis tests and other evidence;
(B) Treatment Completion:
Only DUII rehabilitation programs may certify treatment completion;
(C) Residential Treatment:
Using the criteria from the ASAM PPC, the DUII program's assessment may indicate
that the individual requires treatment in a residential program. When the individual
is in residential treatment, it is the responsibility of the DUII program to:
(i) Monitor the case carefully
while the individual is in residential treatment;
(ii) Provide or monitor outpatient
and follow-up services when the individual is transferred from the residential program;
and
(iii) Verify completion of
residential treatment and follow-up outpatient treatment.
(2) Urinalysis Testing: A
minimum of one urinalysis sample per month must be collected during the period of
service, the total number deemed necessary to be determined by an individual's DUII
rehabilitation program:
(a) Using the process defined
in these rules, the samples must be tested for at least five controlled drugs, including
alcohol;
(b) At least one of the samples
is to be collected and tested in the first two weeks of the program and at least
one is to be collected and tested in the last two weeks of the program;
(c) If the first sample is
positive, two or more samples must be collected and tested, including one sample
within the last two weeks before completion; and
(d) Programs may use methods
of testing for the presence of alcohol and other drugs in the individual's body
other than urinalysis tests if they have obtained the prior review and approval
of such methods by the Division.
(3) Reporting: The program
must report:
(a) To the Division on forms
prescribed by the Division;
(b) To the screening specialist
within 30 days from the date of the referral by the screening specialist. Subsequent
reports must be provided within 30 days of completion or within 10 days of the time
that the individual enters noncompliant status; and
(c) To the appropriate screening
specialist, case manager, court, or other agency as required when requested concerning
individual cooperation, attendance, treatment progress, utilized modalities, and
fee payment.
(4) Certifying Completion:
The program must send a numbered Certificate of Completion to the Department of
Motor Vehicles to verify the completion of convicted individuals. Payment for treatment
may be considered in determining completion. A certificate of completion must not
be issued until the individual has:
(a) Met the completion criteria
approved by the Division;
(b) Met the terms of the
fee agreement between the provider and the individual; and
(c) Demonstrated 90 days
of continuous abstinence prior to completion.
(5) Records: The DUII rehabilitation
program must maintain in the permanent Service Record, urinalysis results and all
information necessary to determine whether the program is being, or has been, successfully
completed.
(6) Separation of Screening
and Rehabilitation Functions: Without the approval of the Director, no agency or
person may provide DUII rehabilitation to an individual who has also been referred
by a Judge to the same agency or person for a DUII screening. Failure to comply
with this rule will be considered a violation of ORS chapter 813. If the Director
finds such a violation, the Director may deny, suspend, revoke, or refuse to renew
a letter of approval.
Stat. Auth.: ORS 161.390, 413.042, 428.205
- 428.270, 430.640 & 443.450
Stats. Implemented: ORS 161.390
- 161.400, 430.010, 430.205 - 430.210, 430.240 - 430.640, 430.850 - 430.955, 443.400
- 443.460, 443.991, 743A.168, 813.010 - 813.052 & 813.200 - 813.270
Hist.: MHS 6-2013(Temp),
f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14; MHS 4-2014, f. & cert. ef. 2-3-14
309-019-0200
Medical Protocols in Outpatient Substance
Use Disorders Treatment and Recovery Programs
Medical protocols must be approved by
a medical director under contract with a program or written reciprocal agreement
with a medical practitioner under managed care. The protocols must:
(1) Require a medical history
be included in the Assessment;
(2) Designate those medical
symptoms that, when found, require further investigation, physical examinations,
service, or laboratory testing;
(3) Require that individuals
admitted to the program who are currently injecting or intravenously using a drug,
or have injected or intravenously used a drug within the past 30 days, or who are
at risk of withdrawal from a drug, or who may be pregnant, must be referred for
a physical examination and appropriate lab testing within 30 days of entry to the
program. This requirement may be waived by the medical director if these services
have been received within the past 90 days and documentation is provided;
(4) Require pregnant women
be referred for prenatal care within two weeks of entry to the program;
(5) Require that the program
provide HIV and AIDS, TB, sexually transmitted disease, Hepatitis and other infectious
disease information and risk assessment, including any needed referral, within 30
days of entry; and
(6) Specify the steps for
follow up and coordination with physical health care providers in the event the
individual is found to have an infectious disease or other major medical problem.
Stat. Auth.: ORS 428.205 - 428.270,
430.640 & 443.450
Stats. Implemented: ORS 109.675,
430.010, 430.205 - 430.210, 430.240 - 430.640, 430.850- 430.955, 443.400 - 443.460,
443.991
Hist.: MHS 6-2013(Temp),
f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14; MHS 4-2014, f. & cert. ef. 2-3-14
Building Requirements, Quality
Assessment,Grievances and Variances
309-019-0205
Building Requirements in Outpatient
Substance Use Disorders Treatment Programs
All substance use disorders treatment
programs must:
(1) Comply with all applicable
state and local building, electrical, plumbing, fire, safety, and zoning codes;
(2) Maintain up-to-date documentation
verifying that they meet applicable local business license, zoning and building
codes and federal, state and local fire and safety regulations. It is the responsibility
of the program to check with local government to make sure all applicable local
codes have been met;
(3) Provide space for services
including but not limited to intake, assessment, counseling and telephone conversations
that assures the privacy and confidentiality of individuals and is furnished in
an adequate and comfortable fashion including plumbing, sanitation, heating, and
cooling;
(4) Provide rest rooms for
individuals, visitors, and staff that are accessible to persons with disabilities
pursuant to Title II of the Americans with Disabilities Act if the program receives
any public funds or Title III of the Act if no public funds are received;
(5) Adopt and implement emergency
policies and procedures, including an evacuation plan and emergency plan in case
of fire, explosion, accident, death or other emergency. The policies and procedures
and emergency plans must be current and posted in a conspicuous area; and
(6) Tobacco Use: Outpatient
programs must not allow tobacco use in program facilities and on program grounds.
Stat. Auth.: ORS 413.042, 428.205 -
428.270, 430.640 & 443.450
Stats. Implemented: ORS 430.010,
430.205 - 430.210, 430.240 - 430.640, 430.850 - 430.955, 443.400 - 443.460, 443.991
Hist.: MHS 6-2013(Temp),
f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14; MHS 4-2014, f. & cert. ef. 2-3-14
309-019-0210
Quality Assessment and Performance
Improvement
Providers must develop and implement
a structured and ongoing process to assess, monitor, and improve the quality and
effectiveness of services provided to individuals and their families.
Stat. Auth.: ORS 430.640
Stats. Implemented: ORS 430.010,
430.205 - 430.210, 430.240 - 430.640, 430.850 - 430.955
Hist.: MHS 6-2013(Temp),
f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14; MHS 4-2014, f. & cert. ef. 2-3-14
309-019-0215
Grievances and Appeals
(1) Any individual receiving services,
or the parent or guardian of the individual receiving services, may file a grievance
with the provider, the individual’s managed care plan or the Division.
(2) For individuals whose
services are funded by Medicaid, grievance and appeal procedures outlined in OAR
410-141-0260 through 410-141-0266, must be followed.
(3) For individuals whose
services are not funded by Medicaid, providers must:
(a) Notify each individual,
or guardian, of the grievance procedures by reviewing a written copy of the policy
upon entry;
(b) Assist individuals and
parents or guardians, as applicable, to understand and complete the grievance process;
and notify them of the results and basis for the decision;
(c) Encourage and facilitate
resolution of the grievance at the lowest possible level;
(d) Complete an investigation
of any grievance within 30 calendar days;
(e) Implement a procedure
for accepting, processing and responding to grievances including specific timelines
for each;
(f) Designate a program staff
person to receive and process the grievance;
(g) Document any action taken
on a substantiated grievance within a timely manner; and
(h) Document receipt, investigation
and action taken in response to the grievance.
(4) Grievance Process Notice.
The provider must have a Grievance Process Notice, which must be posted in a conspicuous
place stating the telephone number of:
(a) The Division;
(b) The CMHP;
(c) Disability Rights Oregon;
and
(d) The applicable managed
care organization.
(5) Expedited Grievances:
In circumstances where the matter of the grievance is likely to cause harm to the
individual before the grievance procedures outlined in these rules are completed,
the individual, or guardian of the individual, may request an expedited review.
The program administrator must review and respond in writing to the grievance within
48 hours of receipt of the grievance. The written response must include information
about the appeal process.
(6) Retaliation: A grievant,
witness or staff member of a provider must not be subject to retaliation by a provider
for making a report or being interviewed about a grievance or being a witness. Retaliation
may include, but is not limited to, dismissal or harassment, reduction in services,
wages or benefits, or basing service or a performance review on the action.
(7) Immunity: The grievant
is immune from any civil or criminal liability with respect to the making or content
of a grievance made in good faith.
(8) Appeals: Individuals
and their legal guardians, as applicable, must have the right to appeal entry, transfer
and grievance decisions as follows:
(a) If the individual or
guardian, if applicable, is not satisfied with the decision, the individual or guardian
may file an appeal in writing within ten working days of the date of the program
administrator's response to the grievance or notification of denial for services
as applicable. The appeal must be submitted to the CMHP Director in the county where
the provider is located or to the Division as applicable;
(b) If requested, program
staff must be available to assist the individual;
(c) The CMHP Director or
Division, must provide a written response within ten working days of the receipt
of the appeal; and
(d) If the individual or
guardian, if applicable, is not satisfied with the appeal decision, he or she may
file a second appeal in writing within ten working days of the date of the written
response to the Director.
Stat. Auth.: ORS 161.390, 413.042, 430.256, 428.205 - 428.270, 430.640
Stats. Implemented: ORS 109.675,
161.390 - 161.400, 179.505, 413.520 - 413.522, 430.010, 430.205 - 430.210, 430.240
- 430.640, 430.850 - 430.955, 461.549, 743A.168, 813.010 - 813.052 & 813.200
- 813.270
Hist.: MHS 6-2013(Temp),
f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14; MHS 4-2014, f. & cert. ef. 2-3-14
309-019-0220
Variances
(1) Criteria for a Variance: Variances
may be granted to a LMHA, CMHP or provider holding a certificate directly with the
Division, by the Division:
(a) If there is a lack of
resources to implement the standards required in these rules; or
(b) If implementation of
the proposed alternative services, methods, concepts or procedures would result
in improved outcomes for the individual.
(2) Application for a Variance:
(a) CMHPs and other providers
may submit their variance request directly to the Division;
(b) Providers who hold Certificates
of Approval jointly with CMHP’s and the Division must submit their variance
requests to the CMHP. The CMHP must then submit the variance request, along with
the CMHP’s written recommendation;
(c) The LMHA, CMHP or provider
requesting a variance must submit a written application to the Deputy Director;
and
(d) Variance requests must
contain the following:
(A) The section of the rule
from which the variance is sought;
(B) The reason for the proposed
variance;
(C) The alternative practice,
service, method, concept or procedure proposed;
(D) A proposal for the duration
of the variance; and
(E) A plan and timetable
for compliance with the section of the rule for which the variance applies.
(3) Division Review and Notification:
The Deputy Director of the Division must approve or deny the request for a variance
and must notify the LMHA, CMHP or provider in writing of the decision to approve
or deny the requested variance, within 30 days of receipt of the variance. The written
notification must include the specific alternative practice, service, method, concept
or procedure that is approved and the duration of the approval.
(4) Appeal Application: Appeal
of the denial of a variance request must be made in writing to the Director of the
Division, whose decision will be final and must be provided in writing within 30
days of receipt of the appeal.
(5) Written Approval: The
LMHA, CMHP or provider may implement a variance only after written approval from
the Division.
(6) Duration of Variance:
It is the responsibility of the LMHA, CMHP or the provider to submit a request to
extend a variance in writing prior to a variance expiring. Extension must be approved
in writing by the Division.
(7) Granting a variance for
one request does not set a precedent that must be followed by the Division when
evaluating subsequent requests for variance.
Stat. Auth.: ORS 161.390, 413.042, 430.256, 428.205 - 428.270, 430.640
Stats. Implemented: ORS 109.675,
161.390 - 161.400, 179.505, 413.520 - 413.522, 430.010, 430.205 - 430.210, 430.240
- 430.640, 430.850 - 430.955, 461.549, 743A.168, 813.010 - 813.052 & 813.200
- 813.270
Hist.: MHS 6-2013(Temp),
f. 8-8-13, cert. ef. 8-9-13 thru 2-5-14; MHS 4-2014, f. & cert. ef. 2-3-14

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