Or. Admin. Code § 411-450-0080 - Minimum Standards for Provider Agencies Delivering Community Living Supports
(1) CERTIFICATION,
ENDORSEMENT, AND ENROLLMENT. To be endorsed to operate a community living
support program, a provider agency must have all of the following:
(a) A certificate and an endorsement, in
accordance with OAR chapter 411, division 323, to deliver community living
supports as a community living supports agency or a standard model
agency.
(b) A Medicaid Agency
Identification Number assigned by the Department in accordance with OAR chapter
411, division 370.
(2)
INSPECTIONS AND INVESTIGATIONS. A provider agency must allow inspections and
investigations in accordance with OAR
411-323-0040.
(3) MANAGEMENT AND PERSONNEL PRACTICES. A
provider agency must comply with the management and personnel practices in OAR
411-323-0050.
(4) PRE-SERVICE TRAINING. A provider agency
must maintain written documentation of six hours of pre-service training prior
to staff supporting individuals that includes mandatory abuse reporting, ISPs,
and Service Agreements.
(5) PARENT
PROVIDER TRAINING. A provider agency must ensure a parent provider completes
the training required in OAR
411-440-0060(1),
prior to delivering services to their child.
(6) CONFIDENTIALITY OF RECORDS. A provider
agency must ensure the confidentiality of individuals' records in accordance
with OAR 411-323-0060.
(7) DOCUMENTATION REQUIREMENTS. Unless stated
otherwise, all entries required by these rules must comply with the agency
documentation requirements in OAR
411-323-0060.
(8) DAY SUPPORT ACTIVITIES. For DSA, a
provider agency must develop and share the following information with an
individual and the individual's case manager:
(a) A written plan or implementation
strategies. The written strategies for service implementation must be given to
an individual and the individual's case manager within 60 calendar days of
providing services for the ISP year.
(b) A risk mitigation strategy or protocol
that addresses each identified relevant risk. The risk mitigation strategy or
protocol must be given to an individual and the individual's case manager
before services begin for the ISP year.
(c) Other documents requested by the ISP
team.
(9) PROGRESS NOTES
AND RECORDS.
(a) A provider agency must
maintain progress notes regarding the delivery of community living supports. A
progress note must include, at minimum, all of the following information
regarding the supports rendered:
(A) The date
and time the support was delivered.
(B) The staff involved.
(C) Information regarding the nature of the
support provided and how the support met an identified ADL or IADL support need
or was a health-related task.
(b) Progress notes must be made available
monthly and upon request by a case management entity.
(c) Failure to furnish written documentation
upon the written request from the Department, the Oregon Department of Justice
Medicaid Fraud Unit, Centers for Medicare and Medicaid Services, or their
authorized representatives, immediately or within timeframes specified in the
written request, may be deemed reason to recover payment.
(d) Records must be retained in accordance
with OAR chapter 166, division 150, Secretary of State, Archives Division.
(A) Financial records, supporting documents,
statistical records, and all other records (except individual records) must be
retained for at least three years after the close of a contract
period.
(B) Individual records must
be kept for at least seven years.
(10) ABUSE AND INCIDENT HANDLING AND
REPORTING. Complaints of abuse and the occurrence of serious incidents must be
treated in accordance with OAR
411-323-0063.
(11) POLICIES AND PROCEDURES. A provider
agency must develop and implement policies and procedures required for
administration and operation in compliance with these rules including, but not
limited to, all of the following:
(a) A
provider agency must have, and implement, written policies and procedures
protecting the individual rights in OAR
411-318-0010 and that:
(A) Provide for individual participation in
selection, training, and evaluation of staff assigned to provide services to
the individuals;
(B) Protect
individuals during hours of service from financial exploitation that may
include, but is not limited to, any of the following:
(i) Staff borrowing from, or loaning money
to, an individual.
(ii) Witnessing
wills in which staff or the provider agency may benefit directly or
indirectly.
(iii) Adding the name
of a staff member or provider agency to the bank account or other personal
property of an individual without the approval of the individual or their legal
representative (as applicable).
(b) Policies and procedures appropriate to
the scope of service including, but not limited to, those required to meet the
minimum standards in sections (15) through (28) of this rule and consistent
with the ISPs or written Service Agreements for individuals currently receiving
services.
(12) SERVICE
DELIVERY. A provider agency must deliver services according to an individual's
ISP or written Service Agreement.
(13) SERVICE RATES. Service rates, as
authorized in the Department's electronic payment and reporting system for
individuals authorized to receive community living supports and paid to a
provider agency for delivering services as described in these rules, shall be
reimbursed at the rate for a community living supports agency identified in the
Expenditure Guidelines unless the provider agency is endorsed to operate a
standard model agency in accordance with OAR
411-450-0090.
(14) BILLING. For a provider agency offering
services to the general public, billings for Medicaid funds may not exceed the
customary charges to private individuals for any like item or services charged
by the provider agency.
(15)
SERVICE RECORD. A provider agency must maintain a current service record for
each individual receiving services. The individual's service record must
include all of the following:
(a) The
individual's name, current home address, and home phone number.
(b) The individual's current ISP or written
Service Agreement.
(c) Contact
information for the individual's legal or designated representative (as
applicable) and any other people designated by the individual to be contacted
in case of incident or emergency.
(d) Contact information for the case
management entity assisting the individual to obtain services.
(e) Records of service provided, including
type of services, dates, hours, and staff involved.
(f) For skills training, relief care
services, and attendant care that does not meet the definition of DSA, an
electronic system must record all of the following for a service provided at
the time of service:
(A) Type of service
provided.
(B) Individual receiving
service.
(C) Date of service
provided.
(D) Location of
service.
(E) Staff member providing
the service.
(F) Start time of the
service.
(G) End time of the
service.
(16)
TRAINING. A provider agency must ensure staff, contractors, and volunteers
receive appropriate and necessary training.
(17) DRUG-FREE WORKPLACE. A provider agency
regulated by these rules must be a drug-free workplace.
(18) SAFETY AND EMERGENCY PLANNING. A
provider agency that owns or leases a site, delivers services to individuals at
the site, and regularly has individuals present and receiving services at the
site, must meet all of the following minimum requirements:
(a) A written emergency plan must be
developed and implemented and must include instructions for staff and
volunteers in the event of fire, explosion, accident, or other emergency,
including evacuation of individuals receiving services.
(b) Posting of emergency information
including, but not limited to, posting the following telephone numbers by
designated telephones:
(A) Local fire, police
department, and ambulance service, or "911".
(B) The executive director of the provider
agency and other people to be contacted in case of emergency.
(c) A documented safety review
must be conducted quarterly to ensure the service site is free of hazards.
Safety review reports must be kept in a central location by a provider agency
for three years.
(d) When an
individual begins receiving services at a service site, a provider agency must
deliver training to the individual to leave the site in response to an alarm or
other emergency signal and to cooperate with assistance to exit the
site.
(e) EVACUATION DRILLS. A
provider agency must conduct an unannounced evacuation drill each month when
individuals are present.
(A) Exit routes must
vary based on the location of a simulated fire.
(B) Any individual failing to evacuate the
service site unassisted within the established time limits set by the local
fire authority for the site must be provided specialized training or support in
evacuation procedures.
(C) Written
documentation must be made at the time of the drill and kept by the provider
agency for at least two years following the drill. The written documentation
must include all of the following:
(i) Date
and time of the drill.
(ii)
Location of the simulated fire.
(iii) Last names of all individuals and staff
present at the time of the drill.
(iv) Amount of time required by each
individual to evacuate if the individual needs more than the established time
limit.
(v) Signature of the staff
conducting the drill.
(D) In sites delivering services to an
individual who is medically fragile or has severe physical limitations,
requirements of evacuation drill conduct may be modified. The modified plan
must:
(i) Be developed with the local fire
authority, the individual or the individual's legal or designated
representative (as applicable), and the provider agency's executive director;
and
(ii) Be submitted as a variance
request according to OAR
411-450-0100.
(f) A provider agency
must provide necessary adaptations to ensure fire safety for sensory and
physically impaired individuals.
(g) HEALTH AND SAFETY INSPECTIONS. At least
once every five years, a provider agency must conduct a health and safety
inspection.
(A) The inspection must cover all
areas and buildings where services are delivered to individuals, including
administrative offices and storage areas.
(B) The inspection must be performed by:
(i) The Oregon Occupational Safety and Health
Division;
(ii) The provider
agency's worker's compensation insurance carrier;
(iii) An appropriate expert, such as a
licensed safety engineer or consultant as approved by the Department;
or
(iv) The Oregon Health
Authority, Public Health Division, when necessary.
(C) The inspection must cover all of the
following:
(i) Hazardous material handling and
storage.
(ii) Machinery and
equipment used at the service site.
(iii) Safety equipment.
(iv) Physical environment.
(v) Food handling, when necessary.
(D) The documented results of the
inspection, including recommended modifications or changes and documentation of
any resulting action taken, must be kept by the provider agency for five
years.
(h) FIRE AND LIFE
SAFETY INSPECTIONS. A provider agency must ensure each service site has
received initial fire and life safety inspections performed by the local fire
authority or a Deputy State Fire Marshal. The documented results of the
inspection, including documentation of recommended modifications or changes and
documentation of any resulting action taken, must be kept by the provider
agency for five years.
(i)
STAFFING. Direct service staff must be present in sufficient number to meet
health, safety, and service needs specified in the individual ISP or Service
Agreement for each individual present. When individuals are present, at least
one staff member on duty must have the following minimum skills and training:
(A) CPR certification.
(B) Current First Aid
certification.
(C) Training to meet
other specific medical needs identified in individual ISPs or Service
Agreements.
(D) Training to meet
other specific behavior support needs identified in individual ISPs or Service
Agreements.
(19) MEDICATIONS AND HEALTH AND MEDICAL
NEEDS. A provider agency delivering services to individuals that involve
assistance with meeting health and medical needs must:
(a) Develop and implement written policies
and procedures addressing all of the following:
(A) Emergency medical intervention.
(B) Treatment and documentation of illness
and health care concerns.
(C)
Administering, storing, and disposing of prescription and non-prescription
drugs, including self-administration.
(D) Emergency medical procedures, including
the handling of bodily fluids.
(E)
Confidentiality of medical records.
(b) Maintain a current written record for
each individual receiving assistance with meeting health and medical needs that
includes all of the following:
(A) Health
status as known.
(B) Changes in
health status observed during hours of service.
(C) Any remedial and corrective action
required and when such actions were taken if occurring during hours of
service.
(D) A description of any
known restrictions on activities due to medical limitations.
(c) If providing medication
administration when an individual is unable to self-administer medications and
there is no other responsible person present who may lawfully direct
administration of medications, the provider agency must:
(A) Have a written order or copy of the
written order, signed by a physician or physician designee, before any
medication, prescription or non-prescription, is administered.
(B) Administer medications per written
orders.
(C) Administer medications
from containers labeled as specified per physician written order.
(D) Keep medications secure and unavailable
to any other individual and stored as prescribed.
(E) Record administration on an
individualized Medication Administration Record (MAR), including treatments and
PRN, or "as needed", orders.
(F)
Not administer unused, discontinued, outdated, or recalled
medication.
(G) Not administer PRN
psychotropic medication. PRN orders may not be accepted for psychotropic
medication.
(d) Maintain
a MAR (if required). The MAR must include all of the following:
(A) The name of the individual.
(B) The brand name or generic name of the
medication, including the prescribed dosage and frequency of administration as
contained on physician order and medication.
(C) Times and dates the administration or
self-administration of the medication occurs.
(D) The signature of the staff administering
the medication or monitoring the self-administration of the
medication.
(E) Method of
administration.
(F) Documentation
of any known allergies or adverse reactions to a medication.
(G) Documentation and an explanation of why a
PRN, or "as needed", medication was administered and the results of such
administration.
(H) An explanation
of any medication administration irregularity with documentation of a review by
the provider agency's executive director or their designee.
(e) Provide safeguards to prevent
adverse medication reactions including, but not limited to, all of the
following:
(A) Maintaining information about
the effects and side-effects of medications the provider agency has agreed to
administer.
(B) Communicating any
concerns regarding any medication usage, effectiveness, or effects to an
individual or the individual's legal or designated representative (as
applicable).
(C) Prohibiting the
use of one individual's medications by another individual or person.
(f) Maintain a record of visits to
medical professionals, consultants, or therapists if facilitated or delivered
by the provider agency.
(20) TRANSPORTATION. A provider agency that
owns or operates vehicles that transport individuals must:
(a) Maintain the vehicles in safe operating
condition.
(b) Comply with the laws
of the Oregon Driver and Motor Vehicles Division (DMV).
(c) Maintain insurance coverage on the
vehicles and all authorized drivers.
(d) Carry a first aid kit in each
vehicle.
(e) Assign drivers who
meet the applicable DMV requirements to operate vehicles that transport
individuals.
(21)
MANAGEMENT OF FUNDS. If assisting with management of funds, a provider agency
must have and implement written policies and procedures related to the
oversight of an individual's financial resources that includes the following:
(a) Procedures that prohibit inappropriately
expending an individual's personal funds, theft of an individual's personal
funds, using an individual's funds for the benefit of staff, commingling an
individual's personal funds with the provider agency's or another individual's
funds, or the provider agency becoming an individual's legal or designated
representative.
(b) The provider
agency's reimbursement to an individual of any funds that are missing due to
theft or mismanagement on the part of any staff of the provider agency, or of
any funds within the custody of the provider agency that are missing. Such
reimbursement must be made within 10 business days of the verification that
funds are missing.
(22)
PROFESSIONAL BEHAVIOR SERVICES. A provider agency must have and implement
written policies and procedures to assure professional behavior services are
delivered by a qualified behavior professional in accordance with OAR chapter
411, division 304.
(23) BEHAVIOR
SUPPORTS. A provider agency must have and implement written policies and
procedures for the delivery of behavior supports that prohibits abusive
practices and assures behavior supports are included in a Positive Behavior
Support Plan.
(a) A provider agency must
inform each individual, and as applicable their legal or designated
representative, of the behavior support policies and procedures at the time of
entry and as changes occur.
(b) A
decision to alter an individual's behavior must be made by the individual or
their legal or designated representative.
(c) Psychotropic medications and medications
for behavior must be:
(A) Prescribed by a
physician through a written order; and
(B) Monitored by the prescribing physician
for desired responses and adverse consequences.
(24) ADDITIONAL STANDARDS FOR BEHAVIOR
SUPPORTS. For the purpose of this section, a designated person is the person
implementing the behavior supports identified in an individual's Positive
Behavior Support Plan.
(a) SAFEGUARDING
INTERVENTIONS AND SAFEGUARDING EQUIPMENT.
(A)
A designated person must only utilize a safeguarding intervention or
safeguarding equipment when:
(i) BEHAVIOR.
Used to address an individual's challenging behavior, the safeguarding
intervention or safeguarding equipment is included in the individual's Positive
Behavior Support Plan written by a qualified behavior professional as described
in OAR 411-304-0150 and implemented
consistent with the individual's Positive Behavior Support Plan.
(ii) MEDICAL. Used to address an individual's
medical condition or medical support need, the safeguarding intervention or
safeguarding equipment is included in a medical order written by the
individual's licensed health care provider and implemented consistent with the
medical order.
(B) An
individual, or as applicable their legal representative, must provide consent
for a safeguarding intervention or safeguarding equipment through an
individually-based limitation in accordance with OAR
411-004-0040.
(C) Prior to utilizing a safeguarding
intervention or safeguarding equipment, a designated person must be trained.
(i) For a safeguarding intervention, the
designated person must be trained in intervention techniques using an
ODDS-approved behavior intervention curriculum and trained to an individual's
specific needs. Training must be conducted by a person who is appropriately
certified in an ODDS-approved behavior intervention curriculum.
(ii) For safeguarding equipment, the
designated person must be trained on the use of the identified safeguarding
equipment.
(D) A
designated person must not utilize any safeguarding intervention or
safeguarding equipment not meeting the standards set forth in this rule even
when the use is directed by an individual or their legal or designated
representative, regardless of the individual's age.
(b) EMERGENCY PHYSICAL RESTRAINTS.
(A) The use of an emergency physical
restraint when not written into a Positive Behavior Support Plan, not
authorized in an individual's ISP, and not consented to by the individual in an
individually-based limitation, must only be used when all of the following
conditions are met:
(i) In situations when
there is imminent risk of harm to the individual or others or when the
individual's behavior has a probability of leading to engagement with the legal
or justice system.
(ii) Only as a
measure of last resort.
(iii) Only
for as long as the situation presents imminent danger to the health or safety
of the individual or others.
(B) The use of an emergency physical
restraint must not include any of the following characteristics:
(i) Abusive.
(ii) Aversive.
(iii) Coercive.
(iv) For convenience.
(v) Disciplinary.
(vi) Demeaning.
(vii) Mechanical.
(viii) Prone or supine restraint.
(ix) Pain compliance.
(x) Punishment.
(xi) Retaliatory.
(25) AGENCY EMPLOYEES.
(a) A provider agency may not knowingly allow
an agency employee to provide community living supports skills training or
attendant care services, other than DSA or employment services, to an
individual that also engages the agency employee's services as a personal
support worker.
(b) A provider
agency may not allow:
(A) The spouse of an
individual receiving services to provide services as an employee of the agency
to the employee's spouse.
(B) The
parent of a minor child to provide services as an employee of the agency to the
employee's own child unless:
(i) The child is
enrolled in the Children's Extraordinary Needs Program; and
(ii) The parent provider and no other family
member of the parent provider has an administrative role, leadership role, or
ownership interest, in the provider agency.
(c) No later than January 1, 2023, a provider
agency must only deliver community living supports through employees of the
agency. Contracted direct support professionals are prohibited.
(26) PARENT PROVIDERS FOR THE
CHILDRENS EXTRAORDINARY NEEDS PROGRAM.
(a) A
provider agency must assure that a parent provider is in compliance with OAR
chapter 411, division 440.
(b) A
provider agency may not allow a child enrolled in the Children's Extraordinary
Needs Program to receive more than a total of 20 hours of attendant care from
one or more parent providers in a workweek, not to exceed the child's total
monthly hour allocation as described in OAR
411-450-0060.
(c) A parent provider is not eligible to be
paid using Department funds for attendant care delivered when any of the
conditions in OAR 411-440-0050(2)
are present.
(27) WAGES.
A provider agency must maintain an average wage for direct support
professionals who deliver hourly attendant care, not including DSA, that is
equal to or greater than the hourly rate stated in the Department's approved
published rate model.
(28) ANNUAL
REPORTING. A provider agency must submit annual data to the nationally
standardized reporting survey organization specified by the Department using
the instructions provided by the organization and the Department.
Notes
Statutory/Other Authority: ORS 409.050, 427.024, 427.104 & 430.662
Statutes/Other Implemented: ORS 409.010, 427.007, 427.024, 427.104, 427.181, 430.215, 430.610 & 430.662
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