Or. Admin. R. 411-360-0140 - AFH-DD Standards and Practices for Health Care
(1) INDIVIDUAL HEALTH CARE. An individual
must receive care and services that supports and promotes their health and
well-being.
(a) A provider must ensure each
individual has a primary physician or primary licensed health care provider the
individual, or as applicable the legal representative of the individual, has
chosen from among qualified providers.
(b) A provider must ensure each individual
receives a medical evaluation by a licensed health care provider no less than
every two years or as recommended by the licensed health care
provider.
(c) A provider must
monitor the health status and physical conditions of each individual and take
action in a timely manner in response to identified changes or conditions that
may lead to deterioration or harm.
(d) A written and signed order from a
physician or licensed health care provider is required prior to the use or
implementation of any of the following:
(A)
Prescription medications;
(B)
Non-prescription medications, except over the counter topicals;
(C) Treatments other than basic first
aid;
(D) Modified or special diets;
and
(E) Adaptive
equipment.
(e) A provider
must implement the order of a physician or licensed health care
provider.
(f) Injections may be:
(A) Self-administered by an individual;
or
(B) Administered by the
following:
(i) A relative of the
individual;
(ii) A currently
licensed registered nurse;
(iii) A
licensed practical nurse under registered nurse supervision; or
(iv) A provider, resident manager, or
substitute caregiver who has been trained and is monitored by a physician or
delegated by a registered nurse in accordance with the rules of the Board of
Nursing in OAR chapter 851, divisions 045 and 047. Documentation regarding the
physician training or registered nurse delegation must be maintained in the
individual's record.
(2) REQUIRED DOCUMENTATION.
(a) A provider must maintain and keep current
records on each individual to aid physicians, licensed health care providers,
the CDDP, and the Department in understanding the medical history of the
individual. Each individual's record must include the following:
(A) A list of known health conditions,
medical diagnoses, any known allergies, immunizations, Hepatitis B status,
previous TB tests, incidents or injuries affecting the health, safety, or
emotional well-being of the individual, and history of emotional or mental
health status pertinent to the individual's current care and
services.
(B) A record of visits
and appointments to licensed health care providers, including documentation of
the consultation, any treatment provided, and any follow-up reports provided to
the provider.
(C) A record of known
hospitalizations and surgeries.
(D)
Current signed orders for all medications, treatments, therapies, special
diets, and adaptive equipment.
(E)
Medication administration records (MARs).
(F) Documentation of the consent from the
individual's legal representative for non-routine medical treatment, including
surgery and anesthesia.
(G) Copies
of previous mental health assessments and assessment updates, including
multi-axial DSM diagnosis, treatment recommendations, and progress records for
mental health treatment services.
(b) When requested, copies of medical records
and MARs must be provided to the legal representative, Department case manager,
or services coordinator.
(3) MEDICATION PROCUREMENT AND STORAGE A
provider must ensure prescription drugs dispensed to individuals are packaged
in a manner that reduces errors in the tracking and administration of drugs
including, but not limited to, the use of unit dose systems or blister packs.
All medications must be:
(a) Kept in the
original containers or unit dosage packs;
(b) Labeled by the dispensing pharmacy,
product manufacturer, or physician, as specified by the written order of a
physician or licensed health care provider; and
(c) Kept in a secured, locked container and
stored as indicated by the product manufacturer.
(4) MEDICATION ADMINISTRATION.
(a) All medications and treatments must be
recorded on an individualized MAR. The MAR must include the following:
(A) The name of the individual.
(B) A transcription of the written order of
the physician or licensed health care provider, including the brand or generic
name of the medication, prescribed dosage, frequency, and method of
administration.
(C) For an over the
counter topical medication without a written order from a physician or licensed
health care provider, a transcription of the printed instructions from the
topical medication package.
(D) The
time and date of administration or self-administration of the
medication.
(E) Signature of the
person administering the medication or the person monitoring the
self-administration of the medication.
(F) Method of administration.
(G) An explanation of why a PRN (as needed)
medication was administered.
(H)
Documented effectiveness of any PRN (as needed) medication
administration.
(I) An explanation
of all medication administration or documentation errors, including identifying
information for the person making the correction.
(J) Documentation of any known allergy or
adverse drug reaction.
(b) Any errors on a paper MAR must be
corrected with a circle of the error and the initials of the person making the
correction.
(5)
SELF-ADMINISTRATION OF MEDICATION.
(a) For an
individual who independently self-administers medication, the individual's ISP
team must determine a plan for the periodic monitoring and review of the
self-administration of medications.
(b) A provider must ensure individuals able
to self-administer medications keep the medications in a place unavailable to
other individuals and store the medications as recommended by the product
manufacturer.
(6) USE OF
MEDICAL MARIJUANA.
(a) Prior to using medical
marijuana in an AFH-DD, an individual must:
(A) Possess a valid OMMP registry card. A
copy of the current OMMP registry card for the individual must be made
available to the provider and maintained in the record for the
individual;
(B) Provide a copy of
the written statement by the physician that indicates medical marijuana may
mitigate the symptoms of the qualifying condition of the individual and
includes instructions for the use of medical marijuana;
(C) Be responsible for obtaining the
marijuana from an OMMP approved third party grower who is not the provider,
caregiver, resident manager, or any other occupant in or on the premises of the
AFH-DD; and
(D) Sign an agreement
that the individual understands the following:
(i) Marijuana is not allowed to be grown by
any person in or on the premises of the AFH-DD;
(ii) A participant in the OMMP may not
possess more than one ounce of marijuana at any one time while in or on the
premises of the AFH-DD;
(iii)
Medical marijuana may only be administered by ingesting it with food and by a
vaporizer. If assistance with administration is necessary, the individual must
agree to arrange for a "designated primary caregiver". The designated primary
caregiver must be authorized by the OMMP and identified on the OMMP registry
card for the individual;
(iv) A
provider, caregiver, resident manager, or any occupants of the AFH-DD cannot be
designated as the OMMP-approved designated primary caregiver of the individual
and identified on the OMMP registry card for the individual;
(v) A provider, caregiver, resident manager,
or any occupants of the AFH-DD cannot assist with the preparation,
administration, or delivery of medical marijuana;
(vi) The individual must maintain any
equipment used to administer marijuana;
(vii) Marijuana must be kept in locked
storage in the bedroom of the individual when not being administered;
(viii) The individual must immediately notify
the OMMP of any change in status, such as a change in address, designated
primary caregiver, or person responsible for the marijuana grow site. A copy of
the updated OMMP registry card for the individual must be made available to the
provider for the record of the individual; and
(ix) Failure to comply with Oregon laws,
Oregon rules, or the Residency Agreement of the AFH-DD may result in additional
action.
(b) An
individual must comply with the Oregon Medical Marijuana Act, the rules for the
OMMP in OAR chapter 333, division 008, these rules, and any other requirements
for the OMMP.
(c) An individual
must self-administer medical marijuana by ingesting the marijuana or inhaling
the marijuana with a vaporizer. Smoking marijuana in or on the premises of the
AFH-DD is prohibited. Marijuana must be administered privately in a room that
is not shared with another person. The individual may not have visitors, other
individuals, or any other person in this private space while self-administering
the marijuana.
(d) An individual
must designate a grower to provide the marijuana as necessary. The grower must
not be the provider, resident manager, caregiver, or any occupant in or on the
premises of the AFH-DD. The grower designated by the individual must be
authorized by OMMP and identified on the OMMP registry card for the individual.
(A) The designated grower for individuals
being served in the foster care system must accommodate the specific needs
related to the dispensation and tracking of the controlled substance. Not more
than 28 grams at a time may be stored on the property of the AFH-DD per card
holder. The remainder of the OMMP card holder's marijuana must be stored at the
site of the grower.
(B) Each 28
grams, as needed, must be packaged in an airtight container clearly dated and
labeled as to the total amount in grams with the name of the OMMP card holder.
The container must be stored in a locked cabinet as is done with all controlled
medications. Each administration must be tracked on the individual's MAR as to
dosage in grams as weighed on a scale, date, and time of day.
(e) A provider, caregiver,
resident manager, or any other occupants in or on the premises of the AFH-DD
must not prepare or in any way assist with the administration or procurement of
an individual's marijuana. The provider must monitor the individual's usage of
medical marijuana to ensure safety and to document that the individual's use of
medical marijuana is in compliance with the physician's instructions for using
marijuana as documented in the ISP or Service Agreement.
(f) If a provider, resident manager, or
caregiver also has an OMMP card for medical purposes, a substitute caregiver
must be available to support the individuals when the provider, resident
manager, or caregiver is under the influence of the medical marijuana. Any OMMP
card holder in or on the premises of the AFH-DD must not smoke marijuana in or
on the premises of the AFH-DD but may ingest the marijuana or inhale the
marijuana with a vaporizer.
(7) PSYCHOTROPIC MEDICATIONS.
(a) Psychotropic medications and medications
for behavior must be:
(A) Prescribed by a
physician or licensed health care provider through a written order;
and
(B) Monitored by the
prescribing physician or licensed health care provider, ISP team, and provider
for desired responses and adverse consequences.
(b) A provider, resident manager, or any
caregiver may not discontinue, change, or otherwise alter the prescribed
administration of a psychotropic medication for an individual without direction
from a physician or licensed health care provider.
(c) A provider, resident manager, or any
caregiver may not use alternative medications intended to alter or affect mood
or behavior, such as herbals or homeopathic remedies, without direction and
supervision of a physician or licensed health care provider.
(d) PRN (as needed) psychotropic medication
orders are not allowed.
(e)
PSYCHOTROPIC MEDICATIONS FOR YOUNG ADULTS. A qualified mental health
professional or a licensed health care provider must provide a mental health
assessment prior to a young adult individual being prescribed one or more
psychotropic medications or an antipsychotic medication.
(A) A mental health assessment is not
required in the following situations:
(i) In
case of urgent medical need;
(ii)
For a change in the delivery system of the same medication;
(iii) For a change in medication within the
same classification;
(iv) A
one-time medication order given prior to a medical procedure; or
(v) An anti-epileptic medication prescribed
for a seizure disorder.
(B) When a mental health assessment is
required, a provider must notify and inform the following of the need for a
mental health assessment:
(i) The legal
guardian of the young adult, or the case manager of the Department when the
Department is the legal guardian of the young adult; and
(ii) The services coordinator.
(C) The required mental health
assessment:
(i) Must be completed within three
months prior to the prescription of a psychotropic medication; or
(ii) May be an update of a prior mental
health assessment that focuses on a new or acute problem.
(D) Information from the mental health
assessment must be provided to a physician or licensed health care provider
prior to the issuance of a prescription for a psychotropic
medication.
(E) Within one business
day after receiving a new prescription or knowledge of a new prescription for a
psychotropic medication for a young adult, the provider must notify the
following:
(i) The legal guardian of the young
adult, or the case manager of the Department when the Department is the legal
guardian of the young adult; and
(ii) The services coordinator.
(F) The notification described in
subsection (E) of this section must contain the following:
(i) The name of the prescribing physician or
licensed health care provider;
(ii)
The name of the medication;
(iii)
The dosage, any change of dosage, or suspension or discontinuation of the
current psychotropic medication;
(iv) The dosage administration schedule
prescribed; and
(v) The reason the
medication was prescribed.
(G) A provider must get a written informed
consent from one of the following prior to filling a prescription for any new
psychotropic medication, except in case of urgent medical need:
(i) The legal guardian of the young adult;
or
(ii) The Department when the
Department is the legal guardian of the young adult.
(H) When a young adult has more than two
prescriptions for psychotropic medications, an annual review of the
psychotropic medications must occur by a physician, licensed health care
provider, or a qualified mental health professional who has the authority to
prescribe drugs, such as the Oregon Medicaid Drug Use Review Program.
(f) BALANCING TEST. When a
psychotropic medication is first prescribed and annually thereafter, a provider
must obtain a signed balancing test from the prescribing physician or licensed
health care provider using the Balancing Test Form (form APD 4110), or by
inserting the required form content into a form maintained by the provider.
(A) The provider must present the physician
or licensed health care provider with a full and clear description of the
behavior and symptoms to be addressed, as well as any side effects
observed.
(B) The provider must
keep signed copies of the balancing test in the individual's medical record for
seven years.
(8) MEDICATION SAFEGUARDS.
(a) A provider must use the following
safeguards to prevent adverse effects or medication reactions:
(A) Whenever possible, obtain all
prescription medication for an individual, except samples provided by the
physician or licensed health care provider, from a single pharmacy that
maintains a medication profile for the individual.
(B) Maintain information about each desired
effect and side effect of the medication.
(C) Ensure medications prescribed for one
individual are not administered to, or self-administered by, another individual
or caregiver.
(b) If all
medications for an individual are not provided through a single pharmacy, the
provider must document the reason why in the individual's record.
(9) MEDICATION DISPOSAL. All
unused, discontinued, outdated, recalled, or contaminated medications,
including over-the-counter medications, may not be kept in the AFH-DD and must
be disposed of within 10 calendar days of expiration, discontinuation, or the
provider's knowledge of a recall or contamination. Prescription medications for
an individual that has died must be disposed of within three calendar days.
(a) A provider must contact the local
Department of Environmental Quality waste management company in the area of the
AFH-DD for instructions on proper disposal of medications.
(b) Disposal of all controlled medications
must be documented and witnessed by at least one other person who is 18 years
of age or older.
(c) A written
record of the disposal of the medication must be maintained and include
documentation of the following:
(A) Date of
disposal;
(B) Description of the
medication, including dosage, strength, and amount being disposed;
(C) Name of the individual for whom the
medication was prescribed;
(D)
Reason for disposal;
(E) Method of
disposal;
(F) Signature of the
person disposing of the medication; and
(G) For controlled medications, the signature
of a witness to the disposal.
(10) NURSING SERVICES.
(a) When nursing services are provided to an
individual a provider must:
(A) Coordinate
with the registered nurse and the ISP team to ensure the nursing services being
provided are sufficient to meet the health needs of the individual;
and
(B) Implement the Nursing
Service Plan, or appropriate portions therein, as agreed upon by the ISP team
and registered nurse.
(b)
COMMUNITY NURSING SERVICES. When community nursing services, as described in
OAR chapter 411, division 048, are provided to an individual, a provider must:
(A) Coordinate with the registered nurse and
the ISP team to ensure the nursing services being provided are sufficient to
meet the health needs of the individual; and
(B) Implement the Nursing Service Plan, or
appropriate portions therein, as agreed upon by the ISP team and registered
nurse.
(c) PRIVATE DUTY
NURSING. Under OAR chapter 410, division 132, young adults aged 18 through 20
who reside in a foster home and who meet the clinical criteria described in OAR
411-300-0120 are eligible for private duty nursing services.
(A) A Nursing Service Plan must be present
when Department funds are used for private duty nursing services. A services
coordinator must authorize the provision of private duty nursing services as
identified in an individual's ISP.
(B) When private duty nursing services are
provided to a young adult, a provider must:
(i) Coordinate with the registered nurse and
the ISP team to ensure the private duty nursing services being delivered are
sufficient to meet the health needs of the young adult; and
(ii) Implement the Nursing Service Plan, or
appropriate portions therein, as agreed upon by the ISP team and registered
nurse.
(C) Under OAR
410-132-0080, a provider is not authorized to deliver private duty nursing
services.
(d) DIRECT
NURSING SERVICES. Direct nursing services may be provided to individuals 21
years of age and older as described in OAR chapter 411, division 380.
(A) A Nursing Service Plan must be present
when Department funds are used for direct nursing services. A services
coordinator must authorize the provision of direct nursing services as
identified in an ISP.
(B) When
direct nursing services are provided to an individual a provider must:
(i) Coordinate with the registered nurse and
the ISP team to ensure the direct nursing services being provided are
sufficient to meet the health needs of the individual;
(ii) Implement the Nursing Service Plan, or
appropriate portions therein, as agreed upon by the ISP team and registered
nurse; and
(iii) While delivering a
direct nursing service exclusively to an eligible individual in the AFH-DD,
ensure the needs of other individuals in the home are met, up to and including
additional staffing, such as resident managers, substitute caregivers, or
additional nurses in the home. Documentation must record staffing
coverage.
(C) A provider
licensed by the Department may provide direct nursing services to an individual
in the AFH-DD under the following conditions:
(i) The provider must meet the qualifications
to provide direct nursing services as described in OAR chapter 411, division
380;
(ii) More than one individual
resides in the AFH-DD;
(iii) The
provider is the choice of the individual or the legal representative of the
individual and is not for the convenience of the provider; and
(iv) The provider meets the requirements as
an enrolled Medicaid Provider as described in OAR chapter 411, division 380 and
has a separate and distinct Medicaid provider number.
(11) DELEGATION AND
SUPERVISION OF NURSING TASKS. Nursing tasks must be delegated by a registered
nurse to a provider, resident manager, and substitute caregiver in accordance
with the rules of the Oregon State Board of Nursing in OAR chapter 851,
divisions 045 and 047.
(12)
COVID-19. A provider must implement all directives related to an AFH-DD to
reduce the spread of the Coronavirus (COVID-19) issued by any of the following:
(a) Governor's Executive Order.
(b) Written instruction to the provider from
the Local Public Health Authority or the Oregon Health Authority Public Health
Division.
(c) Written guidance
directed at the provider through Department policy.
Notes
Statutory/Other Authority: ORS 409.050, 427.104, 443.001, 443.004, 443.725, 443.730, 443.735, 443.738, 443.742, 443.760, 443.765, 443.767, 443.775 & 443.790
Statutes/Other Implemented: ORS 409.010, 427.104, 443.001-443.004, 443.705-443.825, 443.875 & 443.991
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.