Or. Admin. Code § 411-318-0005 - Definitions and Acronyms
In addition to the following definitions and acronyms, OAR 411-317-0000 includes general definitions for words and terms frequently used in OAR chapter 411, division 318. If a word or term is defined differently in OAR 411-317-0000, the definition in this rule applies.
(1) "CDDP" means
"Community Developmental Disabilities Program" as defined in OAR
411-317-0000.
(2) "Claimant" means the person directly
impacted by an action that is the subject of a hearing request.
(3) "Complainant" means an individual, as
defined in OAR 411-317-0000, or an individual's
representative.
(4) "Complaint"
means a complainant expresses dissatisfaction with a case management entity or
provider, in their preferred language, and requests a formal
response.
(5) "Complaint Form"
means the form used to file a complaint (form 0946).
(6) "Complaint Investigation" means the
investigation of a non-abuse related complaint that has been made to the
Department or a local program.
(7)
"Complaint Log" means a list of complaint-related information.
(8) "Continuing Services" means the
continuation of a developmental disabilities service following the request for
a hearing. Services continue until a Final Order is issued.
(9) "DD Administrative Hearing Request" means
the form used to request an administrative hearing to contest an action related
to developmental disabilities services (form 0443DD).
(10) "Denial" means a rejection of a request
for a developmental disabilities service or for an increase in a developmental
disabilities service. A denial of a Medicaid service requires a Notification of
Planned Action.
(11) "Department"
means the Oregon Department of Human Services, including the Office of
Developmental Disabilities Services.
(12) "Department Hearing Representative"
means a person authorized by the Department to represent the Department in a
hearing as described in OAR
411-001-0510.
(13) "Department Staff" means a person
employed by the Department who is knowledgeable in a particular subject
matter.
(14) "Exit" means
termination or discontinuance of a Department-funded developmental disabilities
service.
(15) "eXPRS" means the
Department's electronic payment and reporting system.
(16) "Good Cause" means an excusable mistake,
surprise, excusable neglect (which may include neglect due to a significant
cognitive or health issue), circumstances beyond the control of a claimant,
reasonable reliance on the statement of Department staff or an adverse provider
relating to procedural requirements, [or due to] fraud, misrepresentation, or
other misconduct of the Department or a party adverse to a claimant.
(17) "Hearing" means a contested case hearing
subject to OAR 137-003-0501 through
137-003-0700, which results in a
Final Order.
(18) "Informal
Conference" means the discussion between a claimant, the claimant's
representative, Department staff, and a Department hearing representative that
is held prior to a hearing to address any matters pertaining to the hearing, as
described in OAR 411-318-0025. An administrative
law judge does not participate in an informal conference. An informal
conference may result in resolution of the issue.
(19) "Involuntary Reduction" means a provider
has made the decision to reduce services provided to an individual without
prior approval from the individual.
(20) "Involuntary Transfer" means a provider
has made the decision to transfer an individual to another setting operated by
the same provider without prior approval from the individual.
(21) "Local Program" means the case
management entity, provider organization, or other certified, licensed, or
endorsed provider or agency that contracts with the Department to provide
developmental disabilities services, including services to an individual
associated with a complaint.
(22)
"Notice of Involuntary Reduction, Transfer, or Exit" means:
(a) Notice of Exit or Transfer for
Residential Settings (form 0719R).
(b) Notice of Exit, Suspension, or Reduction
for Community Living and Supported Living Services (form 0719C).
(c) Notice of Exit, Suspension, Transfer, or
Reduction for Day Support Activities and Employment Services (form
0719E).
(23)
"Notification of Planned Action" means the written decision notice issued to an
individual in the event that a developmental disabilities service is denied,
reduced, suspended, or terminated (form 0947).
(24) "OAH" means the Office of Administrative
Hearings.
(25) "Personnel
Complaint" means a complaint involving the conduct of a person receiving funds
to deliver developmental disabilities services.
(26) "Program Director" means the Director of
a local program, or the Director's designee.
(27) "Program Staff" means a person employed
by the local program who is knowledgeable in a particular subject
matter.
(28) "Representative" means
an adult, such as a parent, family member, guardian, legal representative,
advocate, or any other person, who is chosen by an individual or the
individual's legal representative to represent the individual in connection
with the provision of developmental disabilities services or during the
complaint or hearing process. A representative may not be an employee of the
Department, CDDP, or Brokerage acting in official capacity. An individual or
the individual's legal representative is not required to choose a
representative.
(29) "Request for
Service" means:
(a) Submission of a completed
application for developmental disabilities services as described in OAR
411-320-0080;
(b) A written request for a new developmental
disabilities service or provider; or
(c) A written request for a change in a
developmental disabilities service currently provided.
(30) "Service" means the developmental
disabilities services and service settings described in OAR chapter 411,
divisions 004 and 300 to 455.
(31)
"These Rules" mean the rules in OAR chapter 411, division 318.
(32) "Transfer" means an exit immediately
followed by an entry at another location administered or operated by the same
provider. A transfer is subject to the same standards as an entry and
exit.
(33) "Written Outcome" means
the written response from the Department or the local program to a complaint
following a review of the complaint.
Notes
Statutory/Other Authority: ORS 409.050, 427.104, 427.107 & 430.662
Statutes/Other Implemented: ORS 183.411-183.471, 409.010, 427.007, 427.101, 427.104, 427.107, 427.109, 430.215, 430.610 & 430.662
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