Or. Admin. Code § 309-040-0395 - Standards for Admission, Transfers, Respite, Discharges, and Closures
(1) Each adult
referred for placement in an AFH may select and choose from available service
settings.
(2) A provider may only
admit a resident with a referral from, or prior written approval of the CMHP or
the Division. At the time of the referral, a provider must obtain complete
information about the case history of the resident as it relates to behavior,
skill level, medical needs, or other relevant information. The provider may
deny admission of any person if the provider believes the person cannot be
managed effectively in the AFH, or for any other reason not specifically
prohibited by this rule. AFHs may not be used as a site for foster care for
children, adults from other agencies, or any type of shelter or day care
without the written approval of the CMHP or the Division.
(3) The provider must screen a prospective
resident before admitting the resident.
(a)
The screening must include but is not limited to diagnoses, medications,
personal care needs, individually based limitations, nursing care needs, night
care needs, nutritional needs, activities and lifestyle preferences.
(b) The screening process must include
interviews with the resident and the resident's representative, as
applicable.
(c) Verify the
individual's resources including potential benefit eligibility and coverage as
described in OAR 410-120-1280(2).
(d) A copy of the screening must be given to
the resident and the resident's legal representative, as applicable.
(4) The provider must provide a
copy of the house policies and the provider's residency agreement to the
resident and the resident's representative, as applicable, at the time of the
screening.
(5) Each provider's
discharge and transfer policy and procedure must be described in each
resident's Residential Agreement and include the right to at least a written 30
day-notice of discharge or transfer unless discharged under the circumstances
described in 309-040-0395(14),
right to remedy, and right to appeal. The provider is required to give the
resident a written notice of discharge or transfer, that clearly documents the
provider reviewed the reason for the discharge or transfer with the resident
and the resident's rights to request an informal conference and administrative
hearing. If the resident's location is unknown, the notice may be given to a
legal representative of the resident. The provider must make efforts to prevent
unnecessary discharges and transfers by making reasonable accommodations within
the program setting.
(6) The
resident or the resident's legal representative, as applicable, may end the
residency in a facility upon providing at least 30-days' written notice. Upon
mutual agreement between the provider and the resident or legal representative,
less than 30 days' notice may be provided.
(a)
The provider must promptly notify the CMHP or Division if a resident gives
notice or plans to leave the AFH or if a resident abruptly leaves;
(b) The provider must immediately document
plans to move and voluntary moves in the resident's record; and
(c) The provider remains responsible for the
provision of personal care, services, and supports until the resident has moved
from the home including the provision of one-to-one supervision if necessary to
ensure the safety of all residents.
(7) Residents may only be involuntarily moved
from the AFH for the following reasons:
(a)
The resident is assessed by a Licensed Medical Professional (LMP) or other
qualified health professional to require services such as continuous nursing
care or extended hospitalization that are not available in the local community
or cannot be provided in the current placement as determined by the
LMP;
(b) The resident has engaged
in a pattern of behaviors or activities that:
(A) Repeatedly and substantially interfere
with the rights, health, or safety of the resident or other individuals
residing in the AFH; and
(B)
Presents an imminent threat to the health or safety of the resident or other
individuals; and
(C) The pattern of
behaviors have been documented in individual and facility records and
demonstrate the interventions and supports that have been attempted or
considered to address the behaviors, including treatment goals, safety plans
and progress notes.
(c)
The resident cannot safely evacuate the setting in accordance with the
program's evacuation plan after efforts described in OAR 309-040-00370(5)(b)
have been taken;
(d) For private
paying individuals, failure of the resident or resident's representative to
make payment for care or failure to make payment for room and board as
described in the resident's residential agreement. For Medicaid recipients,
failure to make payment for room and board as described in the resident's
residential agreement;
(e) The home
was not notified before the individual's admission or learns following the
individual's admission that the individual is on probation, parole or
post-prison supervision after being convicted of a sex crime defined in ORS
163A.005;
(f) The provider's Medicaid Provider
Enrollment Agreement is terminated; or
(g) The facility license was revoked, not
renewed, suspended, or voluntarily surrendered, or the home was voluntarily
closed.
(8) The provider
must make reasonable and good faith efforts to prevent unnecessary transfers or
discharges by making reasonable accommodation with the AFH.
(9) Prior to initiating an involuntary
transfer process, the AFH must consider the following:
(a) The availability of alternatives to
transfer;
(b) The resident's ties
to family and community;
(c) The
relationships the resident has developed with other residents and facility
staff;
(d) The duration of the
resident's stay at the facility;
(e) The mental health needs of the resident
and the availability of mental health services;
(f) The availability of a receiving facility
that would accept the resident and provide service consistent with the
resident's needs;
(g) The
consistency of the receiving facility's services with the activities and
routine with which the resident is familiar, and the receiving facility's
ability to provide the resident with similar access to personal items
significant to the resident and enjoyed by the resident at the transferring
facility;
(h) The probability that
the transfer would result in improved or worsened mental, physical, or social
functioning, or in reduced dependency of the resident;
(i) The type and amount of preparation for
the move, including but not limited to:
(j) Solicitation of the resident's friends
and/or family in preparing the resident for the move; and
(k) Visitation by the resident to (prior to
actual transfer) or familiarity of the resident with the place to which the
resident is to be transferred; and On-site consultation or new mental health
assessment by an individual with specific expertise in mental health services
if the basis for considering transfer is behavioral.
(10) An individual must not be involuntarily
transferred to another room in the AFH or moved out of the AFH without the
approval of the Division and a minimum of 30 days advance written notice to the
individual, the individual's representative, as applicable, and the CMHP,
unless discharged under the circumstances described in
309-040-0395(14).
(11) The provider must submit a completed
notice of involuntary transfer or discharge request form to the Division in
writing using the Division approved form prior to issuing a notice of
involuntary transfer or discharge to a resident or representative.
(a) The provider must offer the resident the
right to remedy when the reason for involuntary transfer or discharge is not
due to the closure of the facility, long-term incarceration, or need to
transfer as identified by the LMP. The right to remedy must:
(A) Be developed in cooperation with the
resident, their representative if applicable, the CMHP, and the
Division;
(B) Identify reasonable
behavioral goals that measurable and consistent with standard behavioral
treatment practices, and must ensure protection of the individual's
rights;
(C) Establish a specific
period for the resident to demonstrate compliance with the agreed upon remedy
and cannot be used to support future notices of involuntary transfer or
discharge; and
(D) Document the
provider's reasonable efforts to prevent unnecessary transfer or discharge
including, but not limited to, clinical consultations, amending the
individual's residential care plan, requesting updated assessments for changes
in behaviors, and developing safety plans.
(b) The provider must make reasonable efforts
to establish a reasonable end of residency date in consideration of both the
program's needs, and the resident's needs to find alternative living
arrangements;
(c) The Division must
review the cause for notice, interventions and supports attempted to address
the cause for notice, and provide a written response of approval or denial to
the provider within two business days of receiving the completed
form.
(d) Upon receipt of written
approval from the Division, the provider must consult with the resident or
their representative and present a '30-day' or 'less than 30-day' notice of
involuntary transfer or discharge and the ODHS/OHA form MSC 0443,
Administrative Hearing Request
(12) The provider must provide at least 30
days' written notice to the resident and their representative, if applicable,
specifying the cause(s) and include steps the individual can take to remedy the
cause.
(13) The provider may issue
a 'less than 30-day' notice of involuntary transfer or discharge to the
resident and their representative, if applicable, once approved by the
Division, if a resident has intentionally injured another resident or staff,
has caused intentional significant destruction of property, or is engaged in
behaviors that immediately jeopardize the health and safety of others that
cannot be mitigated with a safety plan. The provider will not give a 'less then
30-day' notice of involuntary transfer or discharge to a resident receiving
treatment or services for the purpose of stabilization, in a hospital, at a
respite location, or temporarily placed in police custody.
(14) Notifications of involuntary transfer or
discharge must:
(a) Be delivered to the
resident in person;
(b) Be given to
the resident's legal representative (guardian) as applicable; and
(c) Specify the individual's right to an
administrative hearing in accordance with ORS
443.738(11)(c).
(15) The provider must hold a pre
transfer or discharge meeting with the individual and their representative, if
applicable, and with the individual's permission other individuals with an
interest in the individual's circumstances. The purpose of the meeting is to:
(a) Provide copies of the notice;
(b) Explain the cause for the notice and the
right to remedy;
(c) Explain the
resident's right to request an administrative hearing regarding the notice;
and
(d) Plan any arrangements
necessary to facilitate the transfer or move.
(16) The provider must ensure the resident
has supports, including interpreter or translation services, to understand the
involuntary transfer or discharge notice and the resident's rights to an
administrative hearing regarding the notice.
(17) Residents who object to the involuntary
transfer or discharge must be given the opportunity for a hearing as provided
in ORS 443.738(11)(b)
and 441.605(4).
Participants may include the resident, and at the resident's request, the
provider, a family member, and a CMHP staff member.
(18) Residents must not be involuntary
transferred or discharged while in the process of an appeal or after the
program has knowledge of any indication of a resident's desire to appeal the
notice of involuntary transfer or discharge.
(19) The Division determines if the cause for
involuntary transfer or discharge is sufficient according to the licensing
rules and may take action on a license if the resident is wrongfully
discharged.
(20) Upon transfer or
discharge from the facility, program staff must offer two doses of an
FDA-approved short-acting, non-injectable, opioid antagonist medication to the
individual. If the individual accepts, program staff must:
(a) Provide the individual with an
instruction card on the use of short-acting, non-injectable, opioid antagonist
medication; and
(b) Document
distribution of the short-acting, non-injectable, opioid antagonist medication
in the individual's record.
(21) At the time of involuntary transfer or
discharge, the resident must be given a statement of account, any balance of
funds held by the provider, and all property held in trust or custody by the
provider.
(a) The provider may withhold funds
to cover pending charges. Within 30 days after the resident is transferred or
discharged, or as soon as pending charges are confirmed, the provider must
provide the resident with a final financial statement along with any funds
due;
(b) If a resident's property
has been left at the AFH for longer than seven days after transfer or discharge
of the resident, the provider must make a reasonable attempt to contact the
resident or their representative, if applicable. The provider must allow the
resident or their representative, if applicable, a minimum of 15 days to make
arrangements concerning the property; and
(c) If the provider determines the resident
has abandoned the property, the provider may then dispose of the property. If
the property is sold, proceeds of the sale, minus the amount of any expenses
incurred and any amounts owed the provider by or on behalf of the resident,
must be forwarded to the resident or their representative, as
applicable.
(22)
Providers must provide written notification to the Division within 10 calendar
days after receipt of any notice of default, or any notice of potential default
(commonly referred to as foreclosure), with respect to a real estate contract,
trust deed, mortgage, or other security interest affecting any property
occupied or used by the provider.
(23) The provider must provide a copy of the
notice of default or warning of potential default to the Division.
(24) The provider must provide written
updates to the Division at least every 30 days until the default or warning of
potential default has been resolved and no additional defaults or potential
defaults have been declared and no additional warnings have been issued.
Written updates must include:
(a) The current
status on what action has been or is about to be taken by the provider with
respect to the notice received;
(b)
The action demanded or threatened by the holder of the security interest;
and
(c) Any other information
reasonably requested by the Division.
(25) The provider must provide written
notification within 24 hours to the Division upon final resolution of the
matters leading up to or encompassed by the notice of default or the notice
warning of potential default.
(26)
If the subject default property is licensed as an AFH, the provider must
provide written notification of the following within 24 hours to the Division,
and all the residents and the residents' representatives, if applicable,
regarding:
(a) The filing of any litigation
regarding such security interest, including the filing of a bankruptcy petition
by or against the provider or an entity owning any property occupied or used by
the provider;
(b) The entry of any
judgment with respect to such litigation;
(c) The passing of the date 40 days before
any sale scheduled pursuant to the exercise of legal rights under a security
interest, or a settlement or compromise related thereto, of the provider's
property or property occupied or used by the provider; and
(d) The sale, pursuant to the exercise of
legal rights under a security interest, or a settlement or compromise related
thereto, of the provider's property or property occupied or used by the
provider.
(27) Providers
must notify the Division prior to the voluntary closure, proposed sale, or
transfer of ownership of an AFH and give residents, families, and the CMHP 30
days' written notice, except in circumstances where undue delay might
jeopardize the health, safety, or well-being of a resident, provider, or
caregiver. If a provider has more than one AFH, a resident cannot be shifted
from one house to another house without the same period of notice unless prior
approval is given and agreement obtained from residents or their guardians, and
the CMHP.
(28) Provider's must
surrender the physical license to operate their adult foster home to the
Division at the time of closure.
Notes
Statutory/Other Authority: ORS 413.042
Statutes/Other Implemented: ORS 443.705 - 443.825
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