Home Health Agencies

Link to law: http://arcweb.sos.state.or.us/pages/rules/oars_300/oar_333/333_027.html
Published: 2015

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

 

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OREGON HEALTH AUTHORITY,

PUBLIC HEALTH DIVISION

 

DIVISION 27
HOME HEALTH AGENCIES

333-027-0000
Purpose
The purpose of these rules is
to establish the standards for licensure of home health agencies.
Stat. Auth.: ORS 443.085

Stats. Implemented: ORS 443.005
- 443.090

Hist.: HD 19-1987, f. 11-10-87,
ef. 12-1-87; HD 22-1988, f. & cert. ef. 9-16-88; OHD 13-1998, f. & cert.
ef. 11-6-98; PH 7-2012, f. 3-30-12, cert. ef. 4-1-12
333-027-0005
Definitions
The following definitions shall
apply in OAR 333-027-0000 through 333-027-0190:
(1) "Admission" means acceptance
of a patient for the provision of services by an agency.
(2) “Authority”
means the Oregon Health Authority.
(3) “Agency” means
Home Health Agency.
(4) "Branch Office" means a
location or site from which a home health agency provides services to patients within
a portion of the total geographic area served by the parent agency and does not
exceed 60 miles from the parent agency.
(5) "Clinical Note" means a
dated, written, and signed notation by a member of the home health agency team of
a contact with the patient that describes care rendered, signs and symptoms, treatment
and/or drugs given, patient's reaction, and any changes in patient's physical or
mental condition.
(6) "Clinical Record" means
all information and documentation pertaining to the care of a patient.
(7) "Division" means the Public
Health Division of the Oregon Health Authority.
(8) "Governing Body" means the
designated person(s) having ultimate responsibility for the home health agency.
(9) "Home Health Agency" means
a public or private entity providing coordinated home health services on a home
visiting basis.
(10) "Home Health Aide" means
a person who is certified as a nursing assistant by the Oregon State Board of Nursing
in accordance with OAR chapter 851, division 062 and who assists licensed nursing
personnel in providing home health services.
(11) "Home Health Service" means
items and services furnished to an individual by a home health agency, or by others
under arrangement with such agency, on a visiting basis in a place of temporary
or permanent residence used as the individual's home for the purpose of maintaining
that individual at home.
(12) "Licensed Practical Nurse"
means a person licensed as such by the Oregon State Board of Nursing in accordance
with ORS chapter 678.
(13) "Nurse Practitioner" has
the meaning given that term in ORS 678.010.
(14) "Occupational Therapist"
has the meaning given that term in ORS 675.210.
(15) "Occupational Therapy Assistant"
has the meaning given that term in ORS 675.210.
(16) "Parent Home Health Agency"
("Parent Agency") means an agency that has branches or subunits.
(17) “Physical Therapist
Assistant" has the meaning given that term in ORS 688.010 and is licensed in accordance
with 688.020
(18) "Physical Therapist" has
the meaning given that term in ORS 688.010.
(19) "Physician" means a person
who is licensed by the Oregon Medical Board and that meets the definition in ORS
677.010(13) and (14).
(20) “Plan of treatment”
means a document developed by the treating physician or nurse practitioner in consultation
with agency staff after a patient assessment that identifies the patient’s
medical status and needs, and outlines the services that will be provided to the
patient to meet identified needs. The plan of treatment may also be referred to
as the plan of care.
(21) "Primary Agency" means
the agency that admits the patient for the provision of curative, rehabilitative,
and/or preventive services in the patient's home by home health professionals.
(22) "Professional Policy-Making
Committee" (Committee) means a group of individuals who are appointed by the governing
body of an agency, and who has authority and responsibility for the development
and monitoring of all professional policies pertaining to the home health agency.
(23) "Progress Note" means a
documented summary of a patient's response to care provided during a specific period
of time.
(24) "Registered Nurse" means
a person licensed as such by the Oregon State Board of Nursing in accordance with
ORS chapter 678.
(25) "Skilled Nursing" means
the patient care services pertaining to the curative, rehabilitative, or preventive
aspects of nursing performed by, or under the supervision of, a registered nurse
pursuant to the plan of treatment.
(26) "Social Worker" means a
person who has a master's degree from a school of social work accredited by the
Council on Social Work Education and has one year of social work experience in a
health care setting.
(27) "Social Work Assistant"
means a person who has a baccalaureate degree in social work, psychology, or another
field related to social work and has at least one year of social work experience
in a health care setting.
(28) "Speech Pathologist" means
a person who is licensed in accordance with ORS 681.250 and has a Certificate of
Clinical Competence in speech pathology or audiology from the American-Speech-Language-Hearing
Association.
(29) "Stable and predictable
condition" means a situation where the patient's clinical or behavioral state is
known, not characterized by rapid changes, and does not require continuous reassessment
and evaluation.
(30) "Subunit" means
an agency that provides services for a parent agency in a geographic area different
from that of the parent agency and at a distance that exceeds 60 miles from the
parent agency.
(31) “Survey” means an inspection
of an applicant for a home health agency license or licensed home health agency
to determine the extent to which the applicant or agency is in compliance with ORS
chapter 443 and these rules.
(32) "Therapeutic services"
means services provided for curative, rehabilitative, or preventive purposes.
Stat. Auth.: ORS 443.085

Stats. Implemented: ORS 443.005
& 443.085

Hist.: HD 151, f. & ef.
12-30-77; HD 1-1982, f. & ef. 2-4-82; HD 19-1987, f. 11-10-87, ef. 12-1-87;
HD 22-1988, f. & cert. ef. 9-16-88; HD 20-1993, f. & cert. ef. 10-28-93;
OHD 13-1998, f. & cert. ef. 11-6-98; OHD 9-2002, f. & cert. ef. 7-2-02;
PH 5-2011(Temp), f. & cert. ef. 7-1-11 thru 12-27-11; PH 11-2011, f. & cert.
ef. 10-27-11; PH 7-2012, f. 3-30-12, cert. ef. 4-1-12

Services and Administration

333-027-0010
Application for Licensure
(1) An agency that establishes,
purports to manage or operate as a home health agency must be licensed by the Division
and comply with ORS 443.005–443.095 and OAR chapter 333, division 027.
(2) An applicant wishing to
apply for a license to operate a home health agency shall submit an application
on a form prescribed by the Division and pay the applicable fee as specified in
OAR 333-027-0025.
(3) If an owner or administrator
will have direct contact with a patient, the owner or administrator must submit
background information to the Division, in accordance with OAR 333-027-0064 for
the purposes of conducting a criminal records check.
(4) If any of the information
delineated in the agency's most recent application changes at a time other than
the annual renewal date, the agency shall notify the Division in writing within
30 days.
(5) A subunit must independently
comply with all licensure requirements.
(6) A branch office is part
of the parent agency and therefore need not independently comply with these licensure
requirements. The Division shall determine on a case-by-case basis exceptions to
the 60 mile travel distance from the parent agency requirement for a branch office
and subunits as defined in OAR 333-027-0005.
Stat. Auth.: ORS 443.085

Stats. Implemented: ORS 443.015
& 443.065

Hist.: HD 151, f. & ef.
12-30-77; HD 19-1987, f. 11-10-87, ef. 12-1-87; OHD 13-1998, f. & cert. ef.
11-6-98; OHD 9-2002, f. & cert. ef. 7-2-02; PH 7-2012, f. 3-30-12, cert. ef.
4-1-12
333-027-0015
Review of License Application
(1) In reviewing an application
for a home health agency license, the Division shall verify that the agency:
(a) Is primarily engaged in
providing skilled nursing and at least one of the following other services: physical
therapy, occupational therapy, speech therapy, medical social services, home health
aide, or other therapeutic services;
(b) Has a governing body established
pursuant to ORS 443.055 and OAR 333-027-0060;
(c) Has policies established
by professional personnel associated with the entity, including one or more physicians
and one or more registered nurses, at least two of whom are neither owners or employees
of the agency, and two consumers, to govern the services that it provides;
(d) Has a physician, a nurse
practitioner or registered nurse supervise all services provided by the agency as
described under subsection (1)(a) of this rule;
(e) Maintains clinical and financial
records on all patients; and
(f) Has an overall plan and
budget in effect.
(2) The Division shall conduct
a survey in accordance with OAR 333-027-0035 of the agency, and may include subunits
or branch locations, to determine if the agency is in compliance with ORS chapter
443 and OAR chapter 333, division 027 and has the intent to provide home health
services. If an agency is in compliance and has the intent to provide home health
services to patients, a license may be issued for the operation of the agency.
Stat. Auth.: ORS 443.085

Stats. Implemented: ORS 443.015

Hist.: HD 151, f. & ef.
12-30-77; HD 1-1982, f. & ef. 2-4-82; HD 19-1987, f. 11-10-87, ef. 12-1-87;
HD 3-1989, f. & cert. ef. 5-24-89; HD 20-1993, f. & cert. ef. 10-28-93;
OHD 13-1998, f. & cert. ef. 11-6-98; OHD 9-2002, f. & cert. ef. 7-2-02;
PH 7-2012, f. 3-30-12, cert. ef. 4-1-12
333-027-0017
Approval of License Application
(1) The Division shall notify
an applicant in writing if a license application is approved.
(2) A license shall be issued
only for the agency and person(s) named in the application and may not be transferred
or assigned.
(3) The license shall be conspicuously
posted in an office that is viewable by the public.
(4) A licensed home health agency
that provides personal care services that are necessary to assist an individual’s
daily needs, but do not include curative or rehabilitative services is not required
to be licensed as an in-home care agency. Such agencies shall comply with ORS 443.305
through 443.355 and OAR 333-536-0000 through 333-536-0125 with the exception of
the licensing requirements.
Stat. Auth.: ORS 443.085

Stat. Implemented: ORS 443.015,
443.085 & 443.090

Hist.: PH 7-2012, f. 3-30-12,
cert. ef. 4-1-12
333-027-0018
Denial of License Application
If the Division intends to deny
a license application, it shall issue a Notice of Proposed Denial of License Application
in accordance with ORS 183.411 through 183.470.
Stat. Auth: ORS 443.085

Stat. Implemented: ORS 443.045

Hist.: PH 7-2012, f. 3-30-12,
cert. ef. 4-1-12
333-027-0020
Expiration and Renewal
of License
(1) Each license shall expire
on the 31st day of December of each calendar year.
(2) An agency shall submit a
completed application for renewal on a form prescribed by the Division, accompanied
by the required fee, to the Division not less than 30 days prior to the license
expiration date.
(3) The Division may issue a
renewal license contingent upon evidence of the agency's compliance with ORS chapter
443 and OAR chapter 333, division 027; attestation to the delivery of agency services
to patient(s) during the last calendar year; and, if requested, receipt of an annual
statistical report containing such information as may be prescribed by the Division.
Stat. Auth.: ORS 443.085

Stats. Implemented: ORS 443.015

Hist.: HD 151, f. & ef.
12-30-77; HD 19-1987, f. 11-10-87, ef. 12-1-87; HD 20-1993, f. & cert. ef. 10-28-93;
OHD 13-1998, f. & cert. ef. 11-6-98, Renumbered from 333-027-0095; OHD 9-2002,
f. & cert. ef. 7-2-02; PH 7-2012, f. 3-30-12, cert. ef. 4-1-12

Organization and Quality of Patient Care

333-027-0025
Fees
(1) The fee for an initial agency
license shall be $1,600 plus an additional $1,600 for each subunit of a parent agency.
(2) If the ownership of an agency
changes, other than at the time of the annual renewal, the agency's licensure fee
shall be $500, plus an additional $500 for each subunit. If the change of ownership
of the agency does not involve the majority owner or partner, or the administrator
operating the agency, the license fee shall be $100.
(3)
The annual license renewal fee for an agency shall be $850 plus an additional $850
for each subunit.
(4) A hospital exempted under ORS 443.025
may provide home health services without maintaining a separate governing body and
administrative services so long as the services provided meet the requirements of
443.005 through 443.095 and the hospital pays the home health licensing fee under
443.035.
(5) License fees will not be
prorated and are non-refundable.
Stat. Auth.: ORS 443.085

Stats. Implemented: ORS 443.015
& 443.035

Hist.: HD 151, f. & ef.
12-30-77; HD 20-1981, f. & ef. 10-9-81; HD 21-1986(Temp), f. & ef. 12-24-86;
HD 19-1987, f. 11-10-87, ef. 12-1-87; HD 20-1993, f. & cert. ef. 10-28-93; OHD
13-1998, f. & cert. ef. 11-6-98, Renumbered from 333-027-0075; PH 7-2012, f.
3-30-12, cert. ef. 4-1-12
333-027-0029
Denial, Suspension, or
Revocation of License
(1) The Division may deny an
agency's initial or renewal application, and may suspend or revoke an agency's license
for failure to comply with ORS 443.004, 443.005 through 443.105 or OAR chapter 333,
division 027.
(2) If the Division intends
to suspend or revoke an agency license, it shall do so in accordance with ORS Chapter
183.411 through 183.470.
Stat. Auth.: ORS 443.085

Stats. Implemented: ORS 443.045

Hist.: PH 7-2012, f. 3-30-12,
cert. ef. 4-1-12
333-027-0033
Return of Agency License
Each license certificate in
the licensee’s possession shall be returned to the Division immediately upon
the suspension or revocation of the license, failure to renew the license by the
date of expiration, or if operation is discontinued by the voluntary action of the
licensee.
Stat. Auth.: ORS 443.085

Stats. Implemented: ORS 443.085

Hist.: PH 7-2012, f. 3-30-12,
cert. ef. 4-1-12
333-027-0036
Surveys
(1) The Division shall, in addition
to any investigations conducted pursuant to OAR 333-027-0038, conduct at least one
on-site inspection of each agency prior to licensure and once every three years
thereafter as requirement of licensing and at such other times as the Division deems
necessary.
(2) In lieu of the on-site inspection
required by section (1) of this rule, the Division may accept a certification or
accreditation from a federal agency or an accrediting body approved by the Division
that the state licensing standards have been met if the agency:
(a) Notifies the Division to
participate in any exit interview conducted by the federal agency or accrediting
body; and
(b) Provides copies of all documentation
concerning the certification or accreditation requested by the Division.
(3) An agency shall permit Division
staff access to any location from which it is operating its agency or providing
services during a survey.
(4) A survey may include but
is not limited to:
(a) Interviews of patients,
patient family members, agency management and staff;
(b) On-site observations of
patients and staff performance;
(c) Review of documents and
records;
(d) Patient audits.
(5) An agency shall make all
requested documents and records available to the surveyor for review and copying.
(6) Following a survey, Division
staff may conduct an exit conference with the agency owner or his or her designee.
During the exit conference, Division staff shall:
(a) Inform the agency representative
of the preliminary findings of the inspection; and
(b) Give the person a reasonable
opportunity to submit additional facts or other information to the surveyor in response
to those findings.
(7) Following the survey, Division
staff shall prepare and provide the agency owner or his or her designee specific
and timely written notice of the findings.
(8) If the findings result in
a referral to another regulator agency, Division staff shall submit the applicable
information to that referral agency for its review and determination of appropriate
action.
(9) If no deficiencies are found
during a survey, the Division shall issue written findings to the agency owner indicating
that fact.
(10) If deficiencies are found,
the Division shall take informal or formal enforcement action in compliance with
OAR 333-027-0180 or 333-027-0185.
Stat. Auth.: ORS 443.085

Stats. Implemented: ORS 443.019
& 443.085

Hist.: PH 7-2012, f. 3-30-12,
cert. ef. 4-1-12
333-027-0037
Complaints
(1) Any person may make a complaint
verbally or in writing to the Division regarding an allegation as to the care or
services provided by a home health agency or violations of home health agency laws
or regulations.
(2) The identity of a person
making a complaint will be kept confidential.
(3) Information obtained by
the Division during an investigation of a complaint or reported violation under
this section is confidential and not subject to public disclosure under ORS 192.410
through 192.505.
(4) Upon the conclusion of the
investigation, the Division may publicly release a report of its findings but may
not include information in the report that could be used to identify the complainant
or any patient of a home health agency. The Division may use any information obtained
during an investigation in an administrative or judicial proceeding concerning the
licensing of a home health agency.
(5) An employee or contract
provider with knowledge of a violation of ORS Chapter 443 or OAR chapter 333, division
027, shall use the reporting procedures established by the home health agency before
notifying the Division or other state agency of the inappropriate care or violation,
unless the employee or contract provider:
(a) Believes a patient’s
health or safety is in immediate jeopardy; or
(b) Files a complaint in accordance
with section (1) of this rule.
(6) If the complaint involves
an allegation of criminal conduct or an allegation that is within the jurisdiction
of another local, state, or federal agency, the Division will refer the matter to
that agency.
Stat. Auth.: ORS 443.085

Stats. Implemented: ORS 443.355

Hist.: PH 7-2012, f. 3-30-12,
cert. ef. 4-1-12
333-027-0038
Investigations
(1) An unannounced complaint
investigation will be carried out within 45 calendar days of the receipt of the
complaint and may include, but is not limited to:
(a) Interviews of the complainant,
caregivers, patients, a patient’s representative, a patient’s family
members, witnesses, and agency management and staff;
(b) On-site observations of
the patient(s), staff performance, patient environment; and
(c) Review of documents and
records.
(2) Should the complaint allegation
represent an immediate threat to the health or safety of a patient, the Division
will notify appropriate authorities to ensure a patient's safety, and an investigation
will be commenced within two working days.
(3) An agency shall permit Division
staff access to the agency during an investigation.
(4) The agency shall cooperate
with investigations of allegations of client abuse and neglect conducted by the
Department of Human Services, Oregon
Health Authority, Adult Protective Services, and other agencies such as law enforcement.
Stat. Auth.: ORS 443.085

Stats. Implemented: ORS 443.355

Hist.: PH 7-2012, f. 3-30-12,
cert. ef. 4-1-12
333-027-0040
Services and Supplies
If services or supplies are
required by law to be prescribed by a physician or a nurse practitioner, the agency
shall offer or provide such services and supplies only under an order for treatment
and plan of treatment. Services and supplies offered or provided by an agency shall
include only the following:
(1) Nursing care provided by
or under the supervision of a registered nurse;
(2) Physical, occupational,
or speech therapy, or medical social services;
(3) Other therapeutic services
conforming to generally accepted and established standards;
(4) Home health aide services;
and
(5) Medical supplies, other
than drugs and biologicals, and medical appliances. When patient care supplies are
stored in the agency, the agency shall store such supplies in a manner that prevents
their contamination and ensures that the supplies do not exceed the manufacturer’s
expiration date.
Stat. Auth.: ORS 443.085

Stats. Implemented: ORS 443.075

Hist.: HD 151, f. & ef.
12-30-77; HD 19-1986, f. & ef. 12-9-86; HD 19-1987, f. 11-10-87, ef. 12-1-87;
HD 20-1993, f. & cert. ef. 10-23-93; OHD 13-1998, f. & cert. ef. 11-6-98;
OHD 9-2002, f. & cert. ef. 7-2-02; PH 7-2012, f. 3-30-12, cert. ef. 4-1-12
333-027-0050
Changes in Services Provided
(1) An agency must obtain written
approval from the Division prior to the implementation of the provision of additional
services. When an agency applies for approval of additional services, the agency
must provide evidence of:
(a) Governing body approval
of addition of the services and all revisions in agency policies pertaining to the
new services;
(b) The agency's professional
policy-making committee development and approval of all policies and procedures
pertaining to the new services; and
(c) Adherence to agency personnel
policies and ORS Chapter 443 and OAR chapter 333, division 027 by all individuals
providing services through the agency. If a new service is provided under the designation
of "other therapeutic services" and is not in a category of licensure/certification
covered by Oregon law, the governing body must designate and approve standards of
educational or technical qualifications of personnel providing the services.
(2) An agency must notify the
Division if it no longer provides a service listed on its current license.
Stat. Auth.: ORS 443.085

Stats. Implemented: ORS 443.085

Hist.: HD 151, f. & ef.
12-30-77; HD 1-1982, f. & ef. 2-4-82; HD 19-1987, f. 11-10-87, ef. 12-1-87;
HD 20-1993, f. & cert. ef. 10-28-93; OHD 13-1998, f. & cert. ef. 11-6-98;
OHD 9-2002, f. & cert. ef. 7-2-02; PH 7-2012, f. 3-30-12, cert. ef. 4-1-12
333-027-0060
Administration of Home
Health Agency
An agency shall clearly set
forth in writing the organization, services provided, administrative control, and
lines of authority for the delegation of responsibility to the patient care level.
An agency shall not delegate administrative and supervisory functions to another
agency, individual, or organization.
(1) The primary agency shall
monitor and control all services provided through contractual agreements between
the primary agency and any patient service provider.
(2) An agency shall maintain
appropriate administrative records for each of its offices. If an agency has any
branch offices, it shall ensure that each branch office is part of the agency and
shares administration, supervision, and services on a daily basis.
(3) If an agency chooses to
provide professional students with a practicum in home health, the governing body
must ensure that:
(a) A contract between the agency
and the accredited educational institution is in effect and it includes at a minimum,
a description of:
(A) Program objectives;
(B) Program coordination;
(C) Student supervision;
(D) Adherence to agency policy;
and
(E) Conformance with applicable
professional practice laws, rules, and regulations.
(b) The agency maintains documentation
of each practicum and the student's activities, supervision and the evaluation of
these activities.
(c) The agency maintains documentation
of patient care services provided by the student.
(4) An agency's governing body,
or its designee, shall assume full legal and fiscal responsibility for the agency's
operation. The agency's governing body shall provide for effective communication
with administration of the agency and the owner of the agency.
(5) An agency's governing body
shall:
(a) Employ a qualified administrator,
unless exempted under ORS 443.025, who may also serve as Director of Professional
Services;
(b) Regularly monitor the performance
of the administrator;
(c) Appoint a professional policy-making
committee;
(d) Adopt and annually review
its written by-laws or acceptable equivalent; and
(e) Document all decisions affecting
home health services.
(6) The Administrator shall
have the following qualifications:
(a) A physician or registered
nurse, currently licensed in Oregon, who has education, experience, and knowledge
in community health service systems appropriate to the fulfillment of his/her responsibilities;
or
(b) An individual who has education,
experience, and knowledge in a related community health service systems and at least
one year overall administrative experience in home health care or related community
health program appropriate to the fulfillment of his/her responsibilities.
(7) The Administrator shall:
(a) Have authority and responsibility
for the agency's overall management and operation;
(b) Organize and direct the
agency's ongoing functions;
(c) Maintain ongoing communication
between agency's governing body, professional policy-making committee, and staff;
(d) Employ qualified personnel
and ensure the provision of adequate staff education and the completion of performance
evaluations;
(e) Involve the Director of
Professional Services in health care decisions;
(f) Ensure the accuracy of information
provided to the public regarding the agency and its services;
(g) Implement an effective budgeting
and accounting system;
(h) Designate, in writing, an
individual qualified to serve as acting administrator in the administrator's absence;
and
(i) Ensure that adequate and
appropriate staff resources are available and used to meet the care needs of the
agency's patients as identified in the plans of treatment.
(8) The agency shall employ
a Director of Professional Services who must be a physician or registered nurse.
The agency shall ensure that the Director of Professional Services or a similarly
qualified alternate, designated in writing, is available for consultation at all
times during operating hours of the agency. The Director of Professional Services
or designee shall have written authority, responsibility, and accountability for:
(a) Functions, activities, and
evaluations of all health care personnel;
(b) The quality of home health
services;
(c) Orientation and in-service
education for all agency health care personnel;
(d) Coordination of home health services;
(e) Development and documentation
of all written material related to agency services, including policies, procedures,
and standards;
(f) Participation and involvement
in employment decisions affecting home health care personnel;
(g) Assignment of adequate and
appropriate staff resources to meet the home health care needs of the agency's patients;
and
(h) Designating, in writing,
a person qualified to serve as acting Director of Professional Services in the Director's
absence.
(9)(a) The agency shall develop
personnel policies which must be appropriate to the agency, be documented, and include:
(A) Hours of work;
(B) Orientation that is appropriate
to the classification of the employee. The following portions of the orientation
shall be completed within two weeks of employment; and shall include at a minimum:
policies and procedures of the agency; job description and responsibility; role
as team member providing services in the home setting; and information regarding
other community agencies, infection control, ethics and confidentiality.
(C) An inservice program that
provides ongoing education to ensure that staff skills are maintained for the responsibilities
assigned and ensures that staff are educated in their responsibility in infection
control;
(D) Work performance evaluations;
(E) Employee health program;
(F) Provisions for tuberculosis
screening in accordance with OAR 333-019-0041; and
(G) Provisions for the completion
of criminal records checks in accordance with ORS 443.004 and OAR 333-027-0064.
(b) Personnel records shall
include job descriptions, personnel qualifications, evidence of any required licensure
or certification, evidence of orientation and performance evaluations, evidence
of a completed criminal records check and fitness determination.
(c) An agency may provide services
by agency personnel working out of their individual homes within a portion of the
geographic area served by an agency. The individual homes are not construed to be
a branch. These services must be controlled, supervised, and evaluated by the agency,
in accordance with all written agency policies. Such policies shall, at a minimum
require documentation of:
(A) A meeting at least every
two weeks of the supervisor and the individual to review the plan(s) of treatment;
(B) A telephone conference on
at least a weekly basis between meetings;
(C) Supervisor participation
in the development of each plan of treatment; and
(D) Procedures for submitting
clinical and progress notes, summary reports, schedule of visits and periodic evaluations.
(10) An agency contracting with
individual personnel or public or private entities for home health care services
shall maintain written contracts and shall clearly designate:
(a) That patients are accepted
for care only by the primary agency;
(b) The services to be provided;
(c) The rights and responsibilities
of the contracting individual or entity in the coordination, supervision, and evaluation
of the care or service provided;
(d) The obligation to comply
with all applicable agency policies;
(e) The party with responsibility
for development and revisions of the plan of treatment, patient assessment, progress
reports, and patient care conferences, scheduling of visits or hours, and discharge
planning;
(f) Appropriate documentation
of services provided on record forms provided by the agency; and
(g) The terms of the agreement
and basis for renewal or termination.
(11) An agency, under the direction
of the governing body, shall prepare and document an overall program plan and annual
operating budget. The agency's operating budget shall include all anticipated income
and expenses related to items that would, under generally accepted accounting principles,
be considered income and expense items. The agency's overall program plan and budget
shall be reviewed and updated at least annually by a committee consisting of representatives
of the governing body, the administrative staff, and the professional staff of the
agency.
(12) An agency's governing body
shall appoint a professional policy-making committee composed of professional personnel
associated with the agency.
(a) The committee shall include
one or more physicians and one or more registered nurses, at least two of whom are
neither owners nor employees of the agency, and two consumers.
(b) The committee shall establish
in writing and review annually, the agency's policies governing scope of services,
admission and discharge policies, medical supervision, plans of treatment, emergency
care, clinical records, personnel qualifications, and program evaluation.
(c) The committee shall meet
as needed to advise the agency on other professional issues.
(d) The committee members shall
participate with the agency staff in the annual evaluation of the agency's program.
(e) The agency shall document
the committee's systematic involvement and effective communication with the governing
body and the management of the agency.
Stat. Auth.: ORS 443.085

Stats. Implemented: ORS 443.004,
443.055, 443.065 & 443.085

Hist.: HD 151, f. & ef.
12-30-77; HD 19-1987, f. 11-10-87, ef. 12-1-87; HD 22-1988, f. & cert. ef. 9-16-88;
HD 20-1993, f. & cert. ef. 10-28-93; OHD 13-1998, f. & cert. ef. 11-6-98;
PH 7-2012, f. 3-30-12, cert. ef. 4-1-12
333-027-0064
Criminal Records Check
(1) For the purposes of this
rule, the following definitions apply:
(a) “Direct contact with”
means to provide home health services and includes meeting in person with a potential
or current patient to discuss services offered by an agency or other matters relating
to the business relationship between an agency and client;
(b) “Disqualifying condition”
means a non-criminal personal history issue that makes an individual unsuitable
for employment, contracting or volunteering for an agency, including but not limited
to discipline by a licensing or certifying agency, or drug or alcohol dependency;
(c) “Subject Individual”
(SI) means an individual on whom an agency may conduct a criminal records check
and from whom an agency may require fingerprints for the purpose of conducting a
national criminal records check, including:
(A) An employee or prospective
employee;
(B) A contractor, temporary
worker, volunteer or owner of an agency who has direct contact with an agency client
or potential client; and
(C) A prospective contractor,
temporary worker, or volunteer or owner who may have direct contact with an agency
client.
(d) “Vendor” means
a researcher or company hired to provide a criminal records check on a subject individual.
(2) An agency shall conduct
a criminal records check before hiring or contracting with an SI and before allowing
an SI to volunteer to provide services on behalf of the agency, if the SI will have
direct contact with a patient of the agency.
(3) An SI who has or will have
direct contact with a recipient of home health services may not be employed, contract
with, or volunteer with an agency in any capacity if the criminal records check
conducted reveals the SI has been convicted of a crime as described in ORS 443.004(3).
(4) An agency shall have a policy
on criminal records check requirements which shall include weighing test actions
should the background check screening indicate that an SI has been convicted for
crimes against an individual or property other than those identified in ORS 443.004(3). The policy must include the
following provisions for performing a weighing test:
(a) The agency shall consider circumstances
regarding the nature of potentially disqualifying convictions and conditions including
but not limited to:
(A) The details of incidents
leading to the charges of potentially disqualifying convictions or resulting in
potentially disqualifying conditions;
(B) Age of the SI at time of
the potentially disqualifying convictions or conditions;
(C) Facts that support the convictions
or potentially disqualifying conditions; and
(D) Passage of time since commission
of the potentially disqualifying convictions or conditions.
(b) Other factors which should
be considered when available include but are not limited to:
(A) Other information related
to criminal activity including charges, arrests, pending indictments and convictions.
Other behavior involving contact with law enforcement may also be reviewed if information
is relevant to other criminal records or shows a pattern relevant to criminal history;
(B) Periods of incarceration;
(C) Status of and compliance
with parole, post-prison supervision or probation;
(D) Evidence of alcohol or drug
issues directly related to criminal activity or potentially disqualifying conditions;
(E) Evidence of other treatment
or rehabilitation related to criminal activity or potentially disqualifying conditions;
(F) Likelihood of repetition
of criminal behavior or behaviors leading to potentially disqualifying conditions,
including but not limited to patterns of criminal activity or behavior;
(G) Changes in circumstances
subsequent to the criminal activity or disqualifying conditions including but not
limited to:
(i) History of high school,
college or other education related accomplishments;
(ii) Work history (employee
or volunteer);
(iii) History regarding licensure,
certification or training for licensure or certification; or
(iv) Written recommendations
from current or past employers;
(H) Indication of the SI’s
cooperation, honesty or the making of a false statement during the criminal records
check process, including acknowledgment and acceptance of responsibility of criminal
activity and potentially disqualifying conditions.
(c) An agency shall consider
the relevancy of the SI’s criminal activity or potentially disqualifying conditions
to the paid or volunteer position, or to the environment in which the SI will work,
especially, but not exclusively:
(A) Access to medication;
(B) Access to clients’
personal information;
(C) Access to vulnerable populations.
(5) An agency shall document
the weighing test and place in the employee’s file.
(6) A background check shall
be performed by:
(a) The Department of Human
Services Background Check Unit; or
(b) A vendor that:
(A) Is accredited by the National
Association of Professional Background Screeners (NAPBS); or
(B) Meets the following criteria:
(i) Has been in business for
at least two years;
(ii) Has a current business
license and private investigator license, if required in the company’s home
state; and
(iii) Maintains an errors and
omissions insurance policy in an amount not less than $1 million.
(7) An agency may use the Oregon
State Police, Open Records Unit in order to fulfill the state records requirement
for a criminal records check, however, an agency would still need to complete a
nationwide check through a qualified vendor.
(8) The criminal records check
must include the following:
(a) Name and address history
trace;
(b) Verification that the SI’s
records have been correctly identified, via date of birth check and Social Security
number trace;
(c) A local criminal records
check, including city and county records for SI’s places of residence for
the last seven years;
(d) A nationwide multijurisdictional
criminal database search, including state and federal records;
(e) A nationwide sex offender
registry search;
(f) The name and contact information
of the vendor who completed the background check;
(g) Arrest, warrant and conviction
data, including but not limited to:
(A) Charge(s);
(B) Jurisdiction; and
(C) Date.
(h) Source(s) for data included
in the report.
(9) An agency shall perform
and document a query of an SI with the National Practitioner Data Bank (NPDB) and
the List of Excluded Individuals and Entities (LEIE).
(10) All criminal records checks
conducted under this rule shall be documented in writing and made part of the agency’s
personnel files.
(11) An agency that has a contract
with the Department of Human Services (Department) or Oregon Health Authority for
the provision of home health services on or after April 1, 2012 and who is subject
to the Department’s criminal records check rules does not have to comply with section
(12) of this rule.
(12) For an SI working or volunteering
for an agency on or after July 6, 2011, an agency shall have until July 1, 2012
to ensure that the agency is in compliance with section (3) of this rule.
(13) On or after April 1, 2012
an agency shall ensure that a criminal records check is performed on an SI every
three years from the date of the SIs last criminal records check in accordance with
these rules.
(14) Notwithstanding sections (12) and (13) of this rule, the Division and not the agency shall conduct a criminal
records check on an owner of any agency who is subject to a criminal records check
under subsection (1)(c) of this rule. The Division shall conduct a criminal records
check:
(a) At the time of application
for a person who applies for a license on or after April 1, 2012 and every three
years thereafter.
(b) By April 1, 2013 for an
agency that is licensed on or before April 1, 2012, and every three years thereafter.
Stat. Auth.: ORS 443.085

Stats. Implemented: ORS 443.004
& 443.085

Hist.: PH 7-2012, f. 3-30-12,
cert. ef. 4-1-12
333-027-0070
Acceptance of Patients
An agency shall accept patients for treatment on the basis of a reasonable expectation that the patient's needs can adequately be met by the agency in the patient's residence. The agency shall consider the following in relation to acceptance of its patients:
(1) Adequacy and suitability of the agency's staff and resources to provide needed services;
(2) Assessment of the patients' medical, nursing, and social needs as they relate to the benefits of home care;
(3) The services provided by the agency;
(4) Assurance that services can be effectively coordinated with care provided by other organizations and individuals;
(5) Degree of patient and family awareness of their rights and responsibilities;
(6) A plan to meet medical emergencies;
(7) Availability, ability, and willingness of others to participate in the care;
(8) Adequacy of physical facilities and equipment; and
(9) Attitudes of the patient and family.
Stat. Auth.: ORS 443.085

Stats. Implemented: ORS 443.085

Hist.: HD 151, f. & ef. 12-30-77; HD 19-1987, f. 11-10-87, ef. 12-1-87; HD 20-1993, f. & cert. ef. 10-28-93; OHD 13-1998, f. & cert. ef. 11-6-98
333-027-0080
Patients' Rights
(1) Bill of Rights: An agency
must provide each patient with a written notice of the patient's rights prior to
furnishing care to the patient or during the initial evaluation visit prior to the
initiation of treatment. This notice shall state that a patient of the agency has
the following rights:
(a) The right to have personal
property treated with respect;
(b) The right to voice grievances
regarding treatment or care, a lack of respect for property by anyone furnishing
services on behalf of the agency, or any other issue, without discrimination or
reprisal for exercising such rights. The agency must investigate all complaints
made by the patient or the patient's family or guardian regarding the above and
must document the investigation and the resolution of the complaint;
(c) The right to be informed,
in advance, about the care to be furnished, any changes in the care to be furnished,
the disciplines that will furnish care, and the frequency of visits proposed to
be furnished;
(d) The right to participate
in the planning of care;
(e) The right to have clinical
records confidentially maintained by the agency;
(f) The right to be advised,
before care is initiated, of the extent that payment for the agency services may
be expected from Medicare or other sources, and the extent that payment may be required
from the patient. The agency must provide this information orally and in writing
before care is initiated; and
(g) The right to be advised
orally and in writing of any changes in the information provided in accordance with
subsection (1)(f) as soon as possible, but no later than 30 working days from the
date that the agency becomes aware of a change.
(2) Health Care Directives:
An agency shall maintain written policies and procedures, applicable to any person
18 years of age or older, or to any adult as defined under ORS 127.505, who is receiving
health care by, or through, the agency, that provide for:
(a) Delivery to the patient
or the patient's legal representative of the following information and materials,
in written form, without recommendation:
(A) Information on the rights
of the individual under Oregon law to make health care decisions;
(B) Information on the policies
of the agency with respect to the implementation of the rights of the individual
under Oregon law to make health care decisions;
(C) A copy of the advance directive
set forth in ORS 127.531 along with a disclaimer attached to each form in at least
16-point bold type stating "You do not have to fill out and sign this form"; and
(D) The name of a resource that
can provide additional information concerning the forms for advance directives.
(b) Documentation placed prominently
in the patient's record and reflecting whether the patient has executed an advance
directive.
(c) Compliance by the agency
with Oregon law relating to advance directives; and
(d) Education of agency personnel
and the community on issues relating to advance directives.
(3) An agency shall provide
the written information described in section (2) to the patient not later than 15
days after the initial provision of care by the agency, but in any event before
discharge of the patient;
(4) An agency need not furnish
a copy of an advance directive to a patient or the patient's legal representative
if it has reason to believe that the patient has received a copy of an advance directive
in the form set forth in ORS 127.531 within the preceding 12-month period or has
previously executed an advance directive.
Stat. Auth.: ORS 443.085

Stats. Implemented: ORS 443.085

Hist.: HD 151, f. & ef.
12-30-77; HD 19-1987, f. 11-10-87. ef. 12-1-87; OHD 13-1998, f. & cert. ef.
11-6-98; PH 7-2012, f. 3-30-12, cert. ef. 4-1-12
333-027-0090
Plan of Treatment
The primary agency is responsible
for the patient's plan of treatment signed by the physician or nurse practitioner,
including home health services provided to the patient through contractual arrangements
with other organizations or individuals. A registered nurse must conduct an initial
assessment visit to determine the immediate care and support needs of the patient.
When rehabilitation therapy service (speech therapy, physical therapy or occupational
therapy) is the only service ordered by the physician, and if the need for that
service establishes program eligibility, the initial assessment visit may be made
by the appropriate rehabilitation skilled professional.
(1) The agency shall ensure
that the plan of treatment is developed in consultation with the agency personnel
and established at the time of, or prior to, acceptance of the patient.
(2) The agency shall ensure
that the plan of treatment is transmitted to the patient's physician or nurse practitioner
for signature within 10 calendar days of admission to service.
(3) The plan of treatment shall
cover the following:
(a) All pertinent diagnoses,
mental status, types of services and equipment required;
(b) Frequency of visits;
(c) Prognosis;
(d) Rehabilitation potential;
(e) Functional limitations;
(f) Activities permitted;
(g) Nutritional requirements;
(h) Medications and treatments;
(i) Safety measures to protect
against injury;
(j) Instructions for timely
discharge or referral; and
(k) Any other appropriate items.
(4) If a patient is accepted
under a plan of treatment that cannot be completed until after an evaluation visit,
the physician or nurse practitioner shall be consulted to approve revisions to the
original plan.
(5) Orders for therapy services
shall include the specific procedures and modalities to be used and, as appropriate,
the amount, frequency, and duration.
(6) The therapist and other
agency personnel shall participate in developing the plan of treatment.
(7) The plan of treatment shall
be signed by the physician or nurse practitioner and included in the patient's clinical
record within the time period specified in the agency's policy but no longer than
30 calendar days after admission.
(8) The agency shall submit
all plans of treatment to the primary physician or nurse practitioner and shall
send copies to other physicians or nurse practitioners involved in the patient's
care.
Stat. Auth.: ORS 443.085

Stats. Implemented: ORS 443.075
& 443.085

Hist.: HD 151, f. & ef.
12-30-77; HD 20-1993, f. & cert. ef. 10-28-93; OHD 13-1998, f. & cert. ef.
11-6-98; OHD 9-2002, f. & cert. ef. 7-2-02; PH 7-2012, f. 3-30-12, cert. ef.
4-1-12
333-027-0100
Periodic Review of Plan
of Treatment
An agency shall ensure that:
(1) The plan of treatment shall
be reviewed by the attending physician or nurse practitioner and agency personnel
as often as the patient's condition requires, but at least once every two months;
(2) Agency professional personnel
promptly alert the physician or nurse practitioner to any changes that suggest a
need to alter the plan of treatment;
(3) Information provided to
the physician or nurse practitioner is documented in the clinical record; and
(4) The updated plan of treatment
is included in the patient's clinical record within 30 calendar days of the revision.
Stat. Auth.: ORS 443.085

Stats. Implemented: ORS 443.075
& 443.085

Hist.: HD 151, f. & ef.
12-30-77; HD 20-1993, f. & cert. ef. 10-28-93; OHD 13-1998, f. & cert. ef.
11-6-98; OHD 9-2002, f. & cert. ef. 7-2-02; PH 7-2012, f. 3-30-12, cert. ef.
4-1-12
333-027-0110
Conformance with Physician's or Nurse Practitioner's Orders
(1) Agency personnel shall administer
drugs and treatments only as ordered by the patient's physician in accordance with
42 CFR 484.18 or by other providers as authorized by Oregon law.
(2) The nurse or therapist who
receives a verbal order shall immediately record the order and transmit it to the
physician or nurse practitioner within 72 hours.
(3) The physician's or nurse
practitioner's countersignature shall be obtained within 30 calendar days of the
verbal order.
(4) Agency professional personnel
shall check all medicines that a patient may be taking to identify possible ineffective
drug therapy, adverse reactions, significant side effects, drug allergies, and contraindicated
medication.
(5) Agency professional personnel
shall promptly report any problems to the patient's physician or nurse practitioner.
(6) Only medications and treatments
that must be administered to the patient by agency personnel need to be on a written
order form from the physician or nurse practitioner.
Stat. Auth.: ORS 443.085

Stats. Implemented: ORS 443.075
& 443.085

Hist.: OHD 13-1998, f. &
cert. ef. 11-6-98; OHD 9-2002, f. & cert. ef. 7-2-02; PH 7-2012, f. 3-30-12,
cert. ef. 4-1-12
333-027-0120
Coordination of Patient
Services
(1) All personnel furnishing
services shall ensure that their efforts are coordinated effectively and support
the objectives outlined in the patient's plan of care.
(2) The clinical record or minutes
of case conferences shall reflect that effective communication and coordination
of patient care occurs.
(3) A written summary report
for each patient shall be sent to the attending physician or nurse practitioner
at least every 62 days.
Stat. Auth.: ORS 443.085

Stats. Implemented: ORS 443.085

Hist.: OHD 13-1998, f. &
cert. ef. 11-6-98; OHD 9-2002, f. & cert. ef. 7-2-02; PH 7-2012, f. 3-30-12,
cert. ef. 4-1-12
333-027-0130
Nursing Services
The agency shall provide skilled
nursing service by or under the supervision of a registered nurse in accordance
with agency policies and the plan of treatment. Such services shall comply with
applicable laws. For the purposes of this rule, “critical and fluctuating”
means a situation where the patient's clinical or behavioral state is of a serious
nature, expected to rapidly change, and in need of continuous reassessment and evaluation.
(1) Registered Nurse's Duties:
The registered nurse shall make the initial visit, regularly reevaluate the patient's
nursing needs, initiate appropriate preventive and rehabilitative nursing procedures,
provide those services requiring substantial specialized nursing skills, prepare
clinical and progress notes, coordinate services, inform the physician or nurse
practitioner and other personnel (including paid caregivers) of changes in the patient's
condition and needs, counsel the patient, family or other caregivers (as applicable)
in meeting nursing and related needs, participate in inservice programs, and supervise,
teach, and assign care tasks to other nursing personnel. The registered nurse may
delegate aspects of patient care to unlicensed individuals in accordance with OAR
chapter 851, division 047.
(a) Supervision of the licensed
practical nurse shall include:
(A) Initial evaluation of the
patient to identify appropriate tasks to be performed by the licensed practical
nurse. These tasks shall be documented in the patient's clinical record; and
(B) A supervisory visit every
60 days when the patient's condition is stable and predictable, and at least every
two weeks when the patient's condition is critical and fluctuating. This visit shall
be made either when the licensed practical nurse is present to observe and assist
or when the licensed practical nurse is absent, to assess relationships and determine
that goals are being met. Documentation of these activities shall be maintained
in the patient's clinical record.
(b) Home Health Aide Supervision:
The registered nurse is responsible for supervising for quality and appropriateness
of care provided by the home health aide service. The registered nurse shall be
readily available to the home health aide by telephone at all hours services are
provided. Supervisory visits by the registered nurse or therapist shall be documented
in the patient's clinical record.
(A) When skilled nursing services
and home health aide services are being furnished to the patient, the registered
nurse shall make a supervisory visit to the patient's residence at least every two
weeks, either when the home health aide is present to observe and assist, or when
the home health aide is absent to assess relationships and determine if goals are
being met.
(B) If a patient is receiving
only skilled therapy services and home health aide services, a skilled therapist
may make the supervisory visits at least every two weeks, in lieu of a registered
nurse. The therapist must convey information about the performance of the home health
aide to the aide's registered nurse supervisor.
(C) When only home health aide
services are being furnished to a patient, a registered nurse must make a supervisory
visit to the patient's residence at least once every 60 days. Each supervisory visit
must occur when the aide is furnishing patient care.
(2) Licensed Practical Nurse:
(a) Duties: The licensed practical
nurse shall provide services in accordance with agency policies, prepare clinical
and progress notes, assist the physician or nurse practitioner or registered nurse
in performing specialized procedures, prepare equipment and materials for treatments,
observe aseptic techniques as required, and assist the patient in learning designated
self-care techniques.
(b) Supervision of Licensed
Practical Nurse: A licensed practical nurse shall provide services only under the
supervision of a registered nurse.
(3) Home Health Aide: When an
agency provides or arranges for home health aide service, an aide shall be assigned
if the plan of treatment, as described in OAR 333-027-0090, specifies that the patient
needs personal care. Home health aide services shall be provided under the supervision
of the registered nurse and in accordance with the registered nurse's assignment
and agency policies.
(a) The duties of a home health
aide shall include:
(A) Performance of simple procedures
as assigned by the registered nurse;
(B) Personal care;
(C) Ambulation and exercise;
(D) Household services essential
to health care at home;
(E) Assistance with medications
that are ordinarily self-administered;
(F) Reporting changes in the
patient's condition and needs; and
(G) Completing appropriate records.
(b) A home health aide must
have the following qualifications:
(A) Oregon Certified Nursing
Assistant (CNA) certification and inclusion on the Oregon State Board of Nursing
Nurse Aide Registry.
(B) Prior to providing care
to a patient, the home health aide must be evaluated by a registered nurse for competency
in each of the following areas:
(i) Communication skills;
(ii) Observation of, reporting
of, and documentation about the patient and care provided;
(iii) Maintenance of a clean,
safe and healthy environment;
(iv) Basic infection control
procedures;
(v) Basic nutrition and fluid
intake, including food preparation techniques as appropriate;
(vi) Reading and recording temperature,
pulse, and respiration;
(vii) Basic elements of body
functioning and changes in body function that must be reported to an aide's supervisor;
(viii) Recognizing emergencies and knowledge of emergency
procedures;
(ix) The physical, emotional, and developmental
needs of, and ways to work with, the populations served by the agency, including
the need for respect for the patient, the patient's privacy, and the patient's property;
(x) Appropriate and safe techniques
in personal hygiene and grooming that include:
(I) Bed bath;
(II) Sponge, tub, or shower
bath;
(III) Shampoo: sink, tub, or
bed;
(IV) Nail and skin care;
(V) Oral hygiene; and
(VI) Toileting and elimination.
(xi) Safe transfer techniques
and ambulation;
(xii) Normal range of motion
and positioning; and
(xiii) Any other task the agency
may choose to have the home health aide perform.
(c) Home health aide competency
evaluation:
(A) An individual may furnish
home health aide services on behalf of an agency only after that individual has
successfully completed a competency evaluation program that meets the following
requirements:
(i) The competency evaluation
program must address each of the subjects listed in subparagraphs (3)(b)(B)(i) through
(xiii) of this rule;
(ii) The subject areas listed
at subparagraphs (3)(b)(B)(vi), (x), (xi), and (xii) of this rule must be evaluated
through observation of the aide's performance of the tasks with a patient; and
(iii) All other subject areas
listed in paragraph (3)(b)(B) of this rule may be evaluated through written examination,
oral examination, or observation of the aide with a patient.
(B) A home health aide is not
considered competent in any task for which the aide's performance is evaluated as
unsatisfactory. The aide must not perform that task without direct supervision by
a licensed nurse until the aide receives training in the tasks for which the aide's
performance was evaluated as unsatisfactory and passes a subsequent evaluation with
a satisfactory rating.
(C) A home health aide has not
successfully passed a competency evaluation if the aide's performance is unsatisfactory
in more than one of the areas delineated in paragraph (3)(b)(B) of this rule.
(D) The agency must maintain
documentation that demonstrates that the home health aide has met competency evaluation
requirements.
(d) Home Health Aide Orientation:
The agency shall complete orientation of the home health aide to the agency's program
and document the completion within two weeks of employment. This orientation must
include information about:
(A) Policies and objectives
of the agency;
(B) The duties of a home health
aide;
(C) The functions of other agency
personnel and how they relate to each other in caring for the patient;
(D) Other community agencies;
and
(E) Ethics and confidentiality.
(e) Training on the Job: In
addition to orientation, an agency shall provide the home health aide patient-specific,
on-the-job instruction for carrying out procedures that are not transferable to
another patient. Such training shall be in accordance with OAR chapter 851, division
061, and shall be documented in the patient's clinical record.
(f) Inservice Training: The
agency shall arrange for and document at least 12 hours of inservice training annually.
These training sessions shall pertain to the role and responsibilities of the home
health aide.
(g) Home Health Aide Assignment:
The agency shall provide teaching and supervision of the home health aide in accordance
with OAR chapter 851, division 061. All assignments for patient care shall be written,
prepared by a registered nurse, and updated on a monthly basis, or more often if
the patient's condition requires. Special tasks of nursing care may be delegated
by a registered nurse to a home health aide according to the provisions of OAR chapter
851, division 047.
Stat. Auth.: ORS 443.085

Stats. Implemented: ORS 443.065
& 443.085

Hist.: OHD 13-1998, f. &
cert. ef. 11-6-98; OHD 9-2002, f. & cert. ef. 7-2-02; PH 7-2012, f. 3-30-12,
cert. ef. 4-1-12
333-027-0140
Therapy Services
(1) Physical Therapy Services:
If an agency provides physical therapy services, either directly or under contract,
these services shall be provided only by a physical therapist or by a physical therapist
assistant. The physical therapist and the physical therapist assistant shall provide
physical therapy services in accordance with applicable laws, rules, agency policies
and the patient's plan of treatment. Services provided by a physical therapist assistant
shall be supervised by a physical therapist.
(a) Duties of a physical therapist
include: assisting a physician in evaluating levels of function, helping to develop
and revise the plan of treatment, preparing clinical and progress notes, advising
and consulting with the family and other agency personnel, participating in inservice
programs, and providing services.
(b) Duties of the physical therapist
assistant include: performing services that are planned, assigned, delegated, and
supervised by the physical therapist; assisting in preparation of clinical notes
and progress reports; participating in the education of the patient and family;
and participating in inservice programs.
(c) Supervision of the physical
therapist assistant shall include at a minimum:
(A) Initial evaluation of the
patient by the physical therapist to identify appropriate tasks to be performed
by the physical therapist assistant. These tasks shall be documented in each patient's
clinical records; and
(B) A visit to the patient's
residence by the physical therapist at least once a month when the patient's condition
is no longer stable and predictable, or at 60-day intervals when the patient's condition
is stable, either when the assistant is present to observe and assist or when the
assistant is absent, to assess relationships and determine that goals are being
met. Documentation of these visits by the physical therapist shall be maintained
in the patient's clinical record.
(2) Occupational Therapy Services:
If an agency provides occupational therapy services, either directly or under contract
these services shall be provided only by an occupational therapist or by an occupational
therapy assistant under the supervision of an occupational therapist. The occupational
therapist and occupational therapy assistant shall provide occupational therapy
services in accordance with applicable statutes, rules, agency policies and the
patient's plan of treatment. The agency shall assure that services provided by an
occupational therapy assistant shall be supervised by an occupational therapist.
(a) Duties of the occupational
therapist include: assisting the physician in evaluating levels of function, helping
to develop and revise the plan of treatment, preparing clinical and progress notes,
advising and consulting with the family and other agency personnel, participating
in inservice programs, and providing services.
(b) Duties of the occupational
therapy assistant include: performing services planned, assigned, delegated, and
supervised by the occupational therapist; assisting in the preparation of clinical
notes and progress reports; participating in the education of the patient and family;
and participating in inservice programs.
(c) Supervision of the occupational
therapy assistant shall include at a minimum:
(A) Initial evaluation of the
patient by the occupational therapist to identify appropriate tasks to be performed
by the occupational therapy assistant. These tasks shall be documented in each patient's
clinical record; and
(B) A visit to the patient's
residence by the occupational therapist at least once a month when the patient's
condition is no longer stable and predictable, or at 60-day intervals when the patient's
condition is stable, either when the assistant is present to observe and assist
or when the assistant is absent, to assess relationships
and determine that goals are being met. The occupational therapist shall document
these visits in each patient's clinical record.
(3)(a) Speech Therapy Services: If an agency
provides speech therapy services, either directly or under contract, these services
shall be provided only by a speech pathologist. The speech pathologist shall provide
speech therapy services in accordance with applicable statutes, rules, agency policies
and the patient's plan of treatment.
(b) Duties of the speech pathologist
include: assisting the physician in evaluating the patient's level of function;
helping to develop and revise the plan of treatment; preparing clinical and progress
notes; advising and consulting with the family and other agency personnel; participating
in inservice programs; and providing services.
(4) Medical Social Services:
If an agency provides medical social services, either directly or under contract
these services shall be provided only by a social worker, or by a social work assistant.
The social worker or the social work assistant shall provide social work services
in accordance with applicable statutes, rules, agency policies and the patient's
plan of treatment.
(a) Duties of the social worker
include: assisting the physician, other team members, and the family in understanding
the significant social and emotional factors related to health problems of the patient;
participating in the development of the plan of treatment; preparing clinical and
progress notes; working with the family; utilizing appropriate community resources;
participating in discharge planning and inservice programs; and acting as a consultant
to other agency personnel.
(b) Duties of the social work
assistant include: performing services planned, assigned, delegated, and supervised
by the qualified social worker, preparing clinical notes and progress reports; and
participating in inservice programs.
(c) Supervision of the social
work assistant shall include at a minimum:
(A) Initial evaluation of the
patient by the social worker to identify appropriate tasks to be performed by the
social work assistant. These tasks shall be documented in the individual patient's
clinical records; and
(B) After the initial evaluation
by the social worker and development of the plan of treatment, documented supervisory
conferences with the social work assistant shall be held at least two times monthly
to assess adherence to the goals and quality of relationships. In the event the
patient's situation changes and requires a change in the treatment plan and goals,
the social worker will make a joint visit with the social work assistant to revise
the plan of treatment.
Stat. Auth.: ORS 443.085

Stats. Implemented: ORS 443.065
& 443.085

Hist.: HD 151, f. & ef.
12-30-77; HD 19-1987, f. 11-10-87, ef. 12-1-87; HD 20-1993, f. & cert. ef. 10-28-93;
Renumbered from 333-027-0055, OHD 13-1998, f. & cert. ef. 11-6-98; PH 7-2012,
f. 3-30-12, cert. ef. 4-1-12
333-027-0150
Clinical Records
General Requirements for Clinical
Records:
(1) An agency shall maintain,
for each patient, a clinical record that covers the service(s) the agency provides
directly, or through contract with another agency. All entries in the patient's
clinical record must be dated and authenticated. Authentication of an entry requires
the use of a unique identifier such as a signature, code thumbprint, voice print,
or other means, that provides identification and the title of the individual responsible
for the entry. Clinical notes shall be written the day services are rendered and
shall be incorporated into the clinical record at least weekly. The agency shall
maintain an approved list of standard abbreviations, signs and symbols for use in
the clinical record.
(a) The record of each patient
receiving home health services shall contain pertinent past and current findings.
The findings shall include, but not be limited to, history and physical examination,
and hospital discharge summary. The record shall contain other appropriate information
such as: patient identifying information; name of physician; signed and dated clinical
and progress notes; copies of summary reports that have been sent to the physician;
and a discharge summary.
(b) The record shall contain
the patient's plan of treatment.
(c) Clinical records shall contain
all original or facsimile physician orders and agency caregiver documentation.
(2) Retention and Protection
of Records:
(a) The administrator of the
agency shall be responsible for proper preparation, adequate content, and preservation
of the clinical records. The agency shall permit authorized personnel of the Division
to review clinical records as necessary to determine compliance with these rules.
(b) An agency shall have written
policies governing access to, and maintenance, retention, utilization, storage,
and disposition of all clinical records.
(c) An agency shall complete
all clinical records of discharged patients within 30 calendar days of the patient's
discharge.
(d) Clinical records are the
property of the agency.
(e) Upon a patient's request,
the agency shall provide information from the patient's clinical record related
to the patient's condition and the care provided.
(f) An agency shall ensure that
original clinical records are readily retrievable. Clinical records may be retained
on paper, microfilm, electronic, or other media.
(g) An agency shall keep all
clinical records for a period of 10 years after the date of the patient's last discharge
from the agency.
(h) An agency shall keep clinical
records in a safe and secure environment that will protect them from damage and
harm.
(i) If an agency changes ownership,
the agency shall retain all clinical records in original or microfilmed form and
it shall be the responsibility of the successor agency to protect and maintain these
records.
(j) In the event of dissolution
of an agency, the agency administrator shall notify the Division where the clinical
records will be stored.
(k) The agency shall retain
non-medical records according to the policy of the individual agency.
(l) An agency shall comply with
ORS 192.518 through 192.529, which governs the use and disclosure of patient’s
protected health information.
Stat. Auth.: ORS 443.085

Stats. Implemented: ORS 443.065
& 443.085

Hist.: OHD 13-1998, f. &
cert. ef. 11-6-98; PH 7-2012, f. 3-30-12, cert. ef. 4-1-12
333-027-0160
Program Evaluation
An agency shall conduct an overall
evaluation of its program at least annually. The Committee and the agency shall
conduct the review. The evaluation shall consist of reviews of overall policies,
administrative practices, and quality assurance activities. The evaluation shall
assess the extent to which the agency’s program is appropriate, adequate,
effective, and efficient. The Committee shall provide a written report of the evaluation
to the governing body of the agency. Evaluation reports shall be maintained in its
admini?strative records. The agency shall take corrective action, if appro?priate,
on negative findings identified as a result of the pro?g?ram evaluation.
(1) Policy and Administrative
Review: As part of the evalua?tion process, the agency shall review its policies
and adminis?trative practices to determine the extent to which they promote patient
care that is appropriate, adequate, effective, and efficient.
(2) Quality assurance: The agency
shall implement an on?go?ing quality assurance program designed to objectively and
system?a?tically monitor the quality and appropriateness of patient care. The agency
shall perform this review at least quarterly. The agen?cy’s quality assurance
program must include a review of clinical records.
(a)
The quality assurance program shall consist of problem identification, implementation
of a corrective action plan, and re-monitoring of identified problems.
(b) Quality assurance activities shall
be performed by a multi?disciplinary team consisting of health professionals from
each of the services the agency provides.
Stat. Auth.: ORS 443.085

Stats. Implemented: ORS 443.085

Hist.: HD 151, f. & ef.
12-30-77; HD 19-1987, f. 11-10-87, ef. 12-1-87; HD 20-1993, f. & cert. ef. 10-28-93;
Renumbered from 333-027-0065, OHD 13-1998, f. & cert. ef. 11-6-98
333-027-0170
Waivers
(1) Each agency must comply
with ORS chapter 443 and OAR chapter 333, division 027. However, an agency may request
that the Division grant an exception to these rules for the use of alternative concepts,
methods, procedures, techniques, equipment, facilities, personnel qualifications
or the conducting of pilot projects or research. If an agency seeks an exception
to the Division's rules, it must:
(a) Submit the request in writing
to the Division;
(b) Identify the specific rule
for which an exception is requested;
(c) Explain the special circumstances
relied upon to justify the exception;
(d) List any alternatives that
were considered and the reasons those alternatives were not selected;
(e) Demonstrate that the proposed
exception is desirable to maintain or improve the health and safety of the patients
and will not jeopardize patient health and safety; and
(f) State the proposed duration
of the exception.
(2) After reviewing the written
request, the Division may grant the exception. If the Division grants an exception,
it shall issue its decision in writing.
(3) An agency may not implement
any exception until it has received the Division's written approval of the exception.
Stat. Auth.: ORS 443.085

Stats. Implemented: ORS 443.085

Hist.: HD 20-1993, f. &
cert. ef. 10-28-93; Renumbered from 333-027-0067, OHD 13-1998, f. & cert. ef.
11-6-98; OHD 9-2002, f. & cert. ef. 7-2-02; PH 7-2012, f. 3-30-12, cert. ef.
4-1-12
333-027-0175
Violations
In addition to non-compliance
with any law that governs a home health agency, it is a violation to:
(1) Refuse to cooperate with
an investigation or survey, including but not limited to failure to permit Division
staff access to the agency, its documents or records;
(2) Fail to implement an approved
plan of correction;
(3) Refuse or fail to comply
with an order issued by the Division;
(4) Refuse or fail to pay a
civil penalty;
(5) Fail to comply with rules
governing the storage of records following the closure of an agency;
(6) Fail to report suspected
abuse of elderly persons as defined in ORS 124.050;
(7) Fail to return a license
as provided in OAR 333-027-0033; or
(8) Operate without a license.
Stat. Auth.: ORS 443.085

Stats. Implemented: ORS 443.045
& 443.085

Hist.: PH 7-2012, f. 3-30-12,
cert. ef. 4-1-12
333-027-0180
Informal Enforcement
(1) If during an investigation
or survey Division staff document violations of home health licensing rules or laws,
the Division may issue a statement of deficiencies that cites the law alleged to
have been violated and the facts supporting the allegation.
(2) A signed plan of correction
must be mailed to the Division within 10 business days from the date the statement
of deficiencies was received by the agency. A signed plan of correction will not
be used by the Division as an admission of the violations alleged in the statement
of deficiencies.
(3) An agency shall correct
all deficiencies within 60 days from the date of the exit conference, unless an
extension of time is requested from the Division. A request for such an extension
shall be submitted in writing and must accompany the plan of correction.
(4) The Division shall determine
if a written plan of correction is acceptable. If the plan of correction is not
acceptable to the Division, the Division shall notify the agency owner in writing
or by telephone:
(a) Identifying which provisions
in the plan the Division finds unacceptable;
(b) Citing the reasons the Division
finds them unacceptable; and
(c) Requesting that the plan
of correction be modified and resubmitted no later than 10 working days from the
date the letter of non-acceptance was received by the owner.
(5) If the agency does not come
into compliance by the date of correction reflected on the plan of correction or
60 days from date of the exit conference, whichever is sooner, the Division may
propose to deny, suspend, or revoke the agency license, or impose civil penalties.
Stat Auth.: ORS 443.085

Stats. Implemented: ORS 443.045
& 443.085

Hist.: PH 7-2012, f. 3-30-12,
cert. ef. 4-1-12
333-027-0185
Formal Enforcement
(1) If during an investigation
or survey Division staff document a substantial failure to comply with home health
licensing laws or rules, or if an agency fails to pay a civil penalty imposed under
ORS 443.045, the Division may issue a Notice of Proposed Suspension or Notice of
Proposed Revocation in accordance with 183.411 through 183.470.
(2) The Division may issue a
Notice of Imposition of Civil Penalty for violations of home health licensing laws.
(3) At any time the Division
may issue a Notice of Emergency License Suspension under ORS 183.430(2).
(4) If the Division revokes
an agency license, the order shall specify when, if ever, the agency may reapply
for a license.
Stat. Auth.: ORS 443.085

Stats. Implemented: ORS 443.045
& 443.085

Hist.: PH 7-2012, f. 3-30-12,
cert. ef. 4-1-12
333-027-0190
Civil Penalties
(1) An agency that violates
home health licensing laws or rules, an administrative order, or settlement agreement
is subject to the imposition of a civil penalty not to exceed $1,000 per violation
and may not total more than $2,000.
(2) In determining the amount
of a civil penalty, the Division shall consider whether:
(a) The Division made repeated
attempts to obtain compliance;
(b) The licensee has a history
of non-compliance with home health licensing laws and rules;
(c) The violation poses a serious
risk to the public’s health; and
(d) There are mitigating factors,
such as a licensee’s cooperation with an investigation or actions to come
into compliance.
(3) The Division shall document
its consideration of the factors in section (2) of this rule.
(4) Each day a violation continues
is an additional violation.
(5) A civil penalty imposed
under this rule shall comply with ORS 183.746.
Stat. Auth.: ORS 443.085

Stats. Implemented: ORS 443.045
& 443.085

Hist.: PH 7-2012, f. 3-30-12,
cert. ef. 4-1-12

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