Or. Admin. R. 309-048-0060 - Definitions

As used in these rules:

(1) "Annual resident review" means the review of referrals from the annual resident screening process by designees of the Addictions and Mental Health Division. The purpose of the review is to determine the need for a Level II psychiatric evaluation.

(2) "Annual resident screening" means the annual screening by nursing facility staff of all residents for acute symptoms or indicators of mental illness.

(3) "Categorical determination" means a decision made by a contractor of the Aging and People with Disabilities Division (APD) based on a functional assessment. This determination identifies a person who, despite the presence of mental illness, can be admitted to a nursing facility. The categories are:

(a) Individuals requiring nursing facility care for 30 days or less for convalescent care following an acute care hospitalization for illness or surgery;

(b) Persons with terminal illness with a prognosis of six months or less; and

(c) Persons with severe medical condition that precludes participation in or benefit from specialized services.

(4) "Client Process Monitoring System (CPMS)" means the automated client data system maintained by the Division.

(5) "Community Mental Health Program (CMHP)" means the organization of all services for persons experiencing problems related to mental illness, drug and alcohol abuse, and mental retardation or other developmental disabilities, operated by, or contractually affiliated with, a local mental health authority operated in a specific geographic area of the state under an intergovernmental agreement or direct contract with the Division.

(6) "Determination" means the decision/recommendation made by a designee of the Division regarding an individual's eligibility for Level II evaluation, i.e., presence of a serious mental illness and need for "specialized services" as required by Public Law 100-203. Determinations regarding an individual's need for nursing facility services are the responsibility of the APD.

(7) "Division" means the Addictions and Mental Health Division of the Oregon Health Authority.

(8) "Indicators of mental illness - applicants." Applicants to nursing facilities with a diagnosis of a major mental disorder and a history of treatment related to his diagnosis in the past two years are considered to have indicators of mental illness. Alzheimer's and/or a diagnoses of dementia are excluded from this definition of major mental disorder.

(9) "Indicators of mental illness - residents." Residents of nursing facilities with psychiatric or behavioral symptoms that indicate a need for "specialized services" are considered to have indicators of mental illness regardless of diagnosis or history of treatment.

(10) "Level I" means the federally required screening for indicators of mental illness process implemented by APD under OAR 411-070-0043. All applicants to nursing facilities are screened for indicators of mental illness and a determination made whether the applicant requires nursing facility care based on a functional assessment.

(11) "Level II" means the evaluation process conducted by designees of the Division to determine whether an individual with mental illness requires specialized services. The determination is based on a current functional assessment, history and physical, psychosocial evaluation, a mental health assessment and a medication review.

(12) "Level II summary" means the form approved by OMHS which identifies data to be collected by Division designees in the Level II evaluation.

(13) "Licensed medical professional" means a medically trained person who is licensed to practice in the State of Oregon and has one of the following degrees: MD (Medical Doctor); DO (Doctor of Osteopathy); NP (Nurse Practitioner); PA (Physician's Assistant); or RN (Registered Nurse).

(14) "Nursing facility (NF)" means a facility that contains Medicaid certified inpatient beds and provides medical services but excludes hospital/surgical procedures. The facility must be licensed and certified by APD.

(15) "Office of Mental Health Services (OMHS)" means that portion of the Division responsible for mental health services.

(16) "Pre-admission screening (PAS)" is the state required process used by APD to screen all Medicaid eligible persons seeking admission to nursing facilities. This screening covers functional, medical, economic and psychosocial variables and is the basis for making a determination regarding the individual's categorical status and his/her need for nursing facility services.

(17) "Pre-Admission Screening and Annual Resident Review (PASARR)" is the assessment process conducted by agencies within the Oregon Health Authority that implements the Omnibus Budget Reconciliation Act of 1987 ( Public Law 100-203 ), Subsection 1919(e)(7), which prohibits a Medicaid certified nursing facility from admitting any individual until a screening is completed to determine mental illness or mental retardation (or related conditions), and whether the individual requires nursing facility services or specialized services for mental illness.

(18) "Private admission assessment" is the process that APD uses to screen for indicators of mental illness and categorical status in non-Medicaid applicants to nursing facilities.

(19) "Qualified mental health professional (QMHP)" means a mental health practitioner with qualifications defined in OAR 309-032-1505.

(20) "Senior and Disabled Services Division (SDSD)" means the Oregon Health Authority agency responsible for the provision of nursing facility services as specified in OAR chapter 411.

(21) "Specialized psychiatric rehabilitative services" means services of a lesser intensity than required under specialized services for mental illness. The nursing facility may provide these services directly or make arrangements for their provision with private sector practitioners or community mental health programs.

(22) "Specialized services for mental illness" means the implementation of an individualized plan of care developed, provided and supervised by a physician and qualified mental health professionals in an inpatient psychiatric hospital. This plan of care shall prescribe specific therapies and activities for the treatment of persons who are experiencing an acute episode of severe mental illness. A nursing facility resident requiring specialized services shall be considered to be eligible for the level of services provided in an inpatient psychiatric hospital. Residents requiring this level of care will require relocation to an inpatient facility until the "acute" nature of their symptoms are stabilized.

Notes

Or. Admin. R. 309-048-0060

MHD 2-1995, f. & cert. ef. 4-6-95

Stat. Auth.: ORS 413.042 & 426.500

Stats. Implemented: ORS 410.535, 414.065 & 426.490 to 426.500