Or. Admin. Code § 411-055-0310 - Definitions

Unless the context indicates otherwise, the following definitions apply to the rules in OAR chapter 411, division 55:

(1) "Activities of Daily Living (ADL)" means those personal functional activities required by an individual for continued well-being, which are essential for health, and safety. Activities include eating, dressing and grooming, bathing and personal hygiene, mobility, elimination, and cognition as described in OAR 411-054-0005.

(2) "Adult Protective Services" (APS) means the services defined in OAR 411-020-0002(7).

(3) "Aging and People with Disabilities (APD)" means the Aging and People with Disabilities program within the Department of Human Services.

(4) "Approved Advanced Behavior Support Services Curriculum" means a course in procedures and techniques for intervening in behavioral emergency situations.

(5) "Area Agency on Aging (AAA)" means the Department designated agency charged with the responsibility to provide a comprehensive and coordinated system of services to individuals in a planning and service area. The term Area Agency on Aging is inclusive of both Type A and Type B Area Agencies on Aging as defined in ORS 410.040 and described in ORS 410.210 to 410.300.

(6) "Behavior Coordinator (BC)" is a Department-approved employee or a contractor of the service provider who is qualified as a Behavior Support Service Provider (BSSP) under OAR chapter 411, division 46 who, in addition, has received training to provide the Intensive Intervention Services in this rule.

(7) "Behavior Interventions" means any planned pattern of interventions or interactions intended to modify an individual's environment or behavior to support the individual.

(8) "Behavioral Support" means the theories and evidenced-based practices supporting a proactive approach to behavioral intervention.

(9) "Behavior Support Plan" (BSP) means the written document that describes individualized support strategies designed to decrease challenging behaviors, while reinforcing alternative behavior that supports the individual's needs developed by the Behavior Coordinator.

(10) "Business day" means the days the Department of Human Services, APD or AAA office is open.

(11) "Care coordination" means the coordinated involvement of a team that may include the individual, Interdisciplinary Team, APD or AAA office case manager, mental health program staff, Central Office staff, and healthcare providers, when participants are dependent upon each other to carry out disparate activities regarding an individual's care to ensure the individual's needs are met.

(12) "Case manager" (CM) means a Department employee or an employee of the Department's designee who meets the minimum qualifications in OAR 411-028-0040. The CM:

(a) Assesses the service needs of the individual.

(b) Determines eligibility.

(c) Offers service choices to eligible individuals.

(d) Authorizes referrals for a Behavior Support Service consultation, or placement in a program where Intensive Intervention Services (IIS) are provided.

(e) Evaluates the effectiveness of Medicaid home and community-based services.

(13) "Chemical restraints" means the use of any substance or drug used for the purpose of discipline or convenience that has the effect of restricting the individual's freedom of movement or behavior and is not used to treat the individual's medical or psychiatric condition.

(14) "Contract Administrator" means the Department staff person who administers the Special Needs Contract with the Behavior Support Service Provider to ensure these providers provide appropriate specialized services to individuals living in Intensive Intervention Services settings.

(15) "Crisis Plan" means a required documented component of the Behavior Support Plan that direct care staff on actions to be taken if an individual's behavior deteriorates and the approaches in the other part of the Behavior Support Plan are no longer effective.

(16) "Dementia" means the major neurocognitive disorders listed in the Diagnostic and Statistical Manual of Mental Disorders (DMS-V).

(17) "Department" means the Department of Human Services (DHS).

(18) "Direct care staff" means an employee of a facility or program as defined in OAR 411-054-0005 who has successfully completed training in an approved Intensive Intervention Services curriculum and is approved by the Department to use Intensive Intervention Services.

(19) "Emergency medication" means the use of medication to deescalate an individual's behavior and the use must be defined in the Behavior Support Plan and requires an Individually Based Limitation as described in OAR 411-004-0040. It does not include the medication administered as treatment for a medical or psychiatric condition.

(20) "Excessive use of force" means force beyond the minimum necessary to mitigate an individual's behavior.

(21) "Healthcare Provider" means a licensed provider licensed to provide services to an eligible individual including, but not limited to:

(a) Home health.

(b) Hospice.

(c) Mental health.

(d) Primary care.

(e) Specialty care.

(f) Pharmacy.

(g) Hospital.

(22) "Home and Community-Based Services" (HCBS) means the requirements as defined and described in OAR Chapter 411, division 4.

(23) "Individual" means a person enrolled in or using HCBS and eligible for and receiving Intensive Intervention Services.

(24) "Injury" means the result of an act or failure to act, that damages or hurts an individual or others.

(25) "Intensive Intervention Services (IIS)" means services for individuals with mental, emotional or behavioral disturbances that help these individuals remain safe in a community setting. Specific services are individualized and determined by the individual, their representative, and their IDT.

(26) "Interdisciplinary Team (IDT)" means the team of individuals that plans and ensures delivery of the services that the individual receives. At a minimum, the IDT must include individual, the individual's legal representative (if applicable), the case manager or Department designee, the Behavior Coordinator, RN, the individual's healthcare providers, and at least one direct care staff.

(27) "Involuntary Seclusion" has the meaning as defined in OAR 411-020-0002(1)(g).

(28) "Involuntary Move-Out" means a decision by a service provider to evict an individual, when the individual, or as applicable the legal or designated representative of the individual, has not given prior approval that complies with the requirements in OAR 411-054-0080.

(29) "Legal Representative" means a person who has the legal authority to act for an individual as defined in OAR 411-054-0005.

(30) "Licensed Medical Professional (LMP)" means the licensed physician or Registered Nurse Practitioner who either prescribes most of the individual's medications or who consults with the prescribing medical professional.

(31) "Mechanical Restraint" means any restrictive device (e.g., seatbelt, straitjacket (camisole), vest, or physical confinement) used to restrict a person's free movement.

(32) "Medication review" means a review conducted by a physician or prescriber that focuses on all existing or potential medications that may impact the individual's behaviors.

(33) "Person-Centered Service Plan (PSP)" means the written details of the supports, activities and resources required for an individual to achieve personal goals. The PSP is developed to articulate decisions and agreements made during a person-centered process of planning and information gathering. For Medicaid consumers, this is provided by the Case Manager and includes the need for IIC services and supports.

(34) "Physical Restraint" means any manual method which restricts freedom of movement or normal access of the individual to the individual's body. Any manual method includes physically restraining someone by manually holding someone in place.

(35) "Protection" means the necessary and immediate actions taken to prevent abuse or exploitation of an individual, to prevent self-destructive acts, or to safeguard the individual, property, and funds of an individual.

(36) "Safeguarding Intervention" means a manual physical restraint that requires an individually-based limitation, is defined in the behavior support plan, included in the IBL and is used as an emergency crisis strategy to protect an individual from:

(a) Harming themselves;

(b) Harming others; or

(c) To stop behavior that is likely to lead to intervention by law enforcement.

(37) "Service Plan" means the plan defined in OAR 411-054-0005 and also includes additional elements designed to meet the intensive needs of the IIC residents.

(38) "Service Provider" means a Department-approved provider authorized to provide IIS in a residential care facility to the eligible population.

(39) "These rules" means the rules in OAR chapter 411, division 055.

(40) "Unencumbered License" means a Residential Care Facility license that has not been sanctioned during the previous two years with either of the following:

(a) Any substantiation of Level 3 or Level 4 abuse.

(b) Any pending Notice of Denial, Suspension, Non-renewal or Revocation.

Notes

Or. Admin. Code § 411-055-0310

APD 20-2019, adopt filed 06/26/2019, effective 6/28/2019

Statutory/Other Authority: ORS 409.050, 410.070, 443.450

Statutes/Other Implemented: ORS 409.050, 410.070, 443.400 - 443.455, 443.991