Or. Admin. Code § 415-050-0105 - Definitions
The following definitions apply to 415-050-0100 through 415-050-0195.
(1) "Abuse of an Adult"
means the circumstances defined in ORS
430.735 and OAR Chapter 407,
Division 45 for abuse of an adult with mental illness or who is receiving
residential substance use disorder treatment or withdrawal management
services.
(2) "Admission" means the
act or process of enrollment into services regulated by these rules.
(3) "ASAM" means The American Society of
Addiction Medicine, Third Edition (ASAM).
(4) "The ASAM Criteria " means the criteria
in the Third Edition of The American Society of Addiction Medicine (ASAM)
Criteria for the assessment, level of care placement and treatment of
addictive, substance-related, and co-occurring conditions. The ASAM Criteria is
a clinical guide to developing patient-centered service plans and making
objective decisions about admission, continuing care, and transfer or discharge
for patients. The ASAM Criteria is incorporated by reference in these
rules.
(5) "ASAM Dimensional
Admission Criteria" means the specifications described in the ASAM Criteria for
determining that a patient is appropriately admitted to a program based on six
ASAM assessment dimensions. The criteria, dimensions and number of dimensions
indicated differs per level of care and is described within The ASAM Criteria,
Third Edition.
(6) "ASAM Level of
Care" means one of several discrete intensities of services and supports, as
described within The ASAM Criteria, Third Edition, within a substance use
disorders program that are delivered in a structured, programmatic fashion, by
a certified outpatient or licensed residential provider.
(7) "Adolescent" means an individual from 12
through 21 years of age or those individuals who are determined to be
developmentally appropriate for such services.
(8) "Adolescent ASAM Level 3.7-WM Medically
Monitored Withdrawal Management (ASAM Level 3.5-WM)" means a medical, inpatient
setting as described in The ASAM Criteria, Third Edition that provides 24-hour
medically monitored intensive inpatient withdrawal management services for
adolescent patients assessed at ASAM Level 3.7-WM. Adolescent patients meeting
criteria to be admitted to this level of care experience moderate to severe
withdrawal syndrome and therefore require 24-hour nursing care and LMP visits
as needed.
(9) "Adult" means an
individual 18 years of age or older or an emancipated minor. An individual with
Medicaid eligibility, who is in need of services specific to children,
adolescents, or young adults in transition, shall be considered a child until
age 21 for the purposes of these rules. Adults who are between the ages of 18
and 21, who are considered children for purposes of these rules, shall have all
rights afforded to adults as specified in these rules.
(10) "Adult ASAM Level 3.2-WM Clinically
Managed Residential Withdrawal Management (ASAM Level 3.2-WM)" means a setting
as described in The ASAM Criteria, Third Edition in which patients experience
moderate withdrawal symptoms and need 24-hour support to complete withdrawal
management and increase the likelihood of continuing treatment or recovery.
Clinically managed services are directed by non-physician addiction specialists
rather than medical and nursing personnel. This level emphasizes peer and
social support and is for patients whose intoxication is sufficient to warrant
24-hour support or whose withdrawal symptoms are sufficiently severe to require
primary medical nursing care services.
(11) "Adult ASAM Level 3.7-WM Medically
Monitored Withdrawal Management (ASAM Level 3.7-WM)" means a medical, inpatient
setting as described in The ASAM Criteria, Third Edition that provides 24-hour
medically monitored intensive inpatient treatment services for patients
assessed at ASAM Level 3.7-WM. Patients who meet criteria for admission to this
level of care experience severe withdrawal syndrome and need 24-hour nursing
care and LMP visits as needed.
(12)
"Assessment" means the process of obtaining sufficient information through one
or more face-to-face interview(s) to determine a diagnosis and to plan
individualized services and supports.
(13) "Oregon Health Authority (Authority) or
(OHA)" means the Oregon Health Authority of the state of Oregon.
(14) "Community Mental Health Program (CMHP)"
an entity that is responsible for planning and delivery of safety net services
for persons with mental or emotional disturbances, drug abuse problems, and
alcoholism and alcohol abuse in a specific geographic area of the state under a
contract with the Division or a local mental health authority and pursuant to
OAR Chapter 309, Division 014.
(15)
"Care Coordination" means a process-oriented activity to facilitate ongoing
communication and collaboration to meet multiple needs. Care coordination
includes facilitating communication between the family, natural supports,
community resources, and involved providers and agencies; organizing,
facilitating, and participating in team meetings; and providing for continuity
of care by creating linkages to and managing transitions between levels of care
or transitions for young adults in transition to adult services.
(16) "Clinical Supervision" means oversight
by a qualified clinical supervisor of the rendering of physical health,
substance use, problem gambling, and mental health services and supports,
according to these rules, including ongoing evaluation and improvement of the
effectiveness of those services and supports.
(17) "Clinical Supervisor" means program
staff qualified to oversee and evaluate the rendering of physical health,
substance use, problem gambling, or mental health services and
supports.
(18) "Collaborative
Educational Agreement" means an individualized written arrangement between an
accredited college or university and a Division-certified provider pertaining
to a student's internship or field placement experience.
(19) "Community Health Worker (CHW)" means
personnel who meets qualification criteria adopted by the authority under ORS
414.665 and who is certified
pursuant to the requirements in OAR 410-180-0310.
(20) "Consistent with ASAM Criteria" means
containing information that demonstrates use of and adherence to the
description of components contained within The ASAM Criteria, Third
Edition.
(21) "Coordinated Care
Organization (CCO)" means a corporation, governmental agency, public
corporation or other legal entity that is certified as meeting the criteria
adopted by the Oregon Health Authority under ORS
414.625 to be accountable for
care management and to provide integrated and coordinated health care for each
of the organization's members.
(22)
"County" means the board of county commissioners or its
representatives.
(23) "Criminal
Records Check" means documenting the criminal background check results for all
employees, contracted staff and interns that render medical or behavioral
health services and supports or have access to protected health information
such as service records or billing information.
(24) "Critical Incident" means any
unanticipated event that threatens health, safety or the structural integrity
of the facility and is documented in an Incident Report. Critical Incidents are
reported to the Division.
(25)
"Cultural Competence" means the process by which people and systems respond
respectfully and effectively to people of all cultures, languages, classes,
races, ethnic backgrounds, disabilities, religions, genders, sexual
orientations, and other diversity factors in a manner that recognizes, affirms,
and values the worth of patients, families, and communities and protects and
preserves the dignity of each.
(26)
"Culturally Responsive" means services that are respectful of and relevant to
the beliefs, practices, culture and linguistic needs of diverse consumer/client
populations and communities whose members identify as having particular
cultural or linguistic affiliations. Cultural responsiveness describes the
capacity to respond to the issues of diverse communities. It thus requires
knowledge and capacity at different levels of intervention: systemic,
organizational, professional, and patient.
(27) "Diagnosis" means the principal
substance use disorder diagnosis consistent with the Diagnostic and Statistical
Manual of Mental Disorders, Fifth Edition (DSM-5-TR). The diagnosis is
determined through the assessment and any examinations, tests, or consultations
suggested by the assessment and is the medically necessary reason for
services.
(28) "Division" means the
Health Systems Division of the Oregon Health Authority, or its
designee.
(29) "Diagnostic and
Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5-TR)" means the
textbook used to diagnose and classify mental disorders that is published by
the American Psychiatric Association.
(30) "Episode of Care" means the period of
care that begins at admission and ends at discharge.
(31) "Grievance" means a formal complaint
submitted to a provider verbally, or in writing, by a patient, or the patient's
chosen representative.
(32) "Face
to Face" means a personal interaction where both words can be heard, and facial
expressions can be seen in person or through telehealth services where there is
a live streaming audio and video.
(33) "Health Insurance Portability and
Accountability" (HIPAA) means the federal Health Insurance Portability and
Accountability Act of 1996 and the regulations published in Title 45, parts 160
and 164, of the Code of Federal Regulations (CFR).
(34) "Incident" means any event involving an
individual or child of an individual receiving services occurring on the
premises of the program or involving program staff or during a stabilization
plan or care coordination plan activity and including but not limited to
injury, major illness, accident, act of physical aggression, medication error,
suspected abuse or neglect, or any other unusual or critical event that
presents a risk to health and safety. Critical incidents are reported to the
Division.
(35) "Incident Report"
means a written description of any incident.
(36) "Informed Consent for Services" means
that the service options, risks and benefits have been explained to the patient
and guardian, if applicable, in a manner and language that they comprehend, and
the patient and guardian, if applicable, have consented to the services or
prior to or on the first date of service.
(37) "Institutions of Mental Disease (IMD)"
means a hospital, nursing facility, or other institution of more than 16 beds
that is primarily engaged in providing diagnosis, treatment, or care of
individuals with mental diseases, which includes substance use disorders
(SUDs).
(38) "Level of Care" means
the type, frequency, and duration of medically necessary services provided from
the most integrated setting to the most restrictive and intensive inpatient
setting.
(39) "Licensed Health Care
Professional" means a practitioner of the healing arts acting within the scope
of their practice under State law who is licensed by a recognized governing
board in Oregon.
(40) "Licensed
Medical Practitioner (LMP)" means an individual who meets the following minimum
qualifications as documented by the Local Mental Health Authority (LMHA) or
designee:
(a) Physician licensed to practice
in the State of Oregon; or
(b)
Nurse practitioner licensed to practice in the State of Oregon; or
(c) Physician's Assistant licensed to
practice in the State of Oregon; and
(d) Whose training, experience and competence
demonstrate the ability to conduct a medical exam, a mental health assessment
and provide medication management.
(41) "Local Mental Health Authority (LMHA)"
means one of the following entities:
(a) The
board of county commissioners of one or more counties that establishes or
operates a CMHP;
(b) The tribal
council, in the case of a federally recognized tribe of Native Americans that
elects to enter into an agreement to provide mental health services;
or
(c) A regional local mental
health authority comprised of two or more boards of county
commissioners.
(42)
"Mandatory Reporter" means anyone required by law, as defined in ORS
419B.005 or
430.735, who is required to
report suspected abuse or neglect of a child, elderly person, or other adult as
required by law in ORS
430.765, ORS
419B.010, or ORS
124.060.
(43) "Medicaid" means the federal
grant-in-aid program to state governments to provide medical assistance to
eligible patients under Title XIX of the Social Security Act.
(44) "Medical Assessment" means an assessment
by or under the direction of a physician who is licensed to practice medicine
in Oregon. The medical assessment includes a complete physical examination and
a thorough comprehensive health history, which includes review of behavioral
and physical health diagnoses, a description of behavior problems, prior
evaluations, and treatment history. The medical assessment also reviews current
use of prescription and over-the-counter medications.
(45) "Medical Director" means a physician
licensed to practice medicine in the State of Oregon and who is designated by a
substance use disorders treatment program to be responsible for the program's
medical services, either as an employee or through a contract.
(46) "Medical Treatment" means the planned,
medically necessary, individualized program of medical procedures and
counseling services designed to address symptoms of a DSM-5-TR
diagnosis.
(47) "Medically
Necessary" means health services and items that are required for an individual
to address one or more of the following:
(a)
The prevention, diagnosis, or treatment of an individual's condition or
disorder that results in behavioral health impairments; or
(b) The ability for a client or member to
achieve age-appropriate growth and development; and
(c) A medically necessary service must also
be medically appropriate.
(48) "Medical Treatment Staff" means program
staff who are properly trained, educated, and credentialed to deliver medical
services and who, while working within their scope of practice, are directly
responsible for the delivery or oversight of withdrawal management
services.
(49) "Medication" means
any drug, chemical, compound, suspension, or preparation in suitable form for
use as a curative or remedial substance either internally or externally by any
patient.
(50) "Medication
Administration Record (MAR)" means the documentation of the administration of
written or verbal orders for medication, laboratory and other medical
procedures issued by a LMP acting within the scope of their license.
(51) "Medications for Assisted Treatment
(MAT)" means the use of medication in combination with counseling and
behavioral therapies for the treatment of substance use disorders.
(52) "Motivational Enhancement Therapy" (MET)
means a person-centered approach to therapy that focuses on improving a
patient's motivation to change.
(53) "Non-Institutions of Mental Disease
(Non-IMD)" means a hospital, nursing facility, or other institution with less
than 16 beds that is primarily engaged in providing diagnosis, treatment, or
care of individuals with mental diseases, which includes substance use
disorders (SUDs).
(54) "Non-Medical
Program Staff" means an individual who, by employment, contract, or volunteer
agreement, or internship agreement with the program, provides a service or
support within their scope of practice that is not medical and who has the
applicable competencies, qualifications, or certification required in this rule
to provide the corresponding non-medical service or support.
(55) "Nursing Services" means services that
are provided by a registered nurse (RN) or a licensed practical nurse (LPN),
Advanced Practice Nurse including Clinical Nurse Specialist, or Certified Nurse
Practitioner, licensed by the Oregon Board of Nursing within the scope of
practice as defined in OAR chapter 851 division 045.
(56) "On-site" means staff are physically
present within the licensed facility, on duty, readily accessible and available
to assist individuals.
(57)
"Patient" means an individual receiving withdrawal management
services.
(58) "Peer" means any
person supporting a patient or the patient's family member who has similar life
experience, either as a current or former recipient of substance use, problem
gambling, or mental health services, or as a family member of a patient who is
a current or former recipient of substance use, problem gambling, or mental
health services.
(59) "Peer Support
Specialist (PSS)" means a qualified program staff providing peer-delivered
services to a patient or family member with similar life experience under the
supervision of a qualified clinical supervisor and a qualified peer-delivered
services supervisor as resources are made available.
(60) "Peer Support and Peer Wellness
Specialist Supervision" means supervision by a qualified clinical supervisor
and a qualified peer-delivered services supervisor as resources are available.
The supports provided include guidance in the unique discipline of
peer-delivered services and the roles of peer support specialists and peer
wellness specialists.
(61)
"Peer-Delivered Services Supervisor" means a qualified program staff, with at
least one year of experience as a PSS or PWS in behavioral health services, who
is responsible for evaluating and guiding PSS and PWS program staff in the
delivery of peer-delivered services and supports.
(62) "Peer Wellness Specialist (PWS)" means a
program staff who supports a patient in identifying behavioral health service
and support needs through community outreach, assisting patients with access to
available services and resources, addressing barriers to services, and
providing education and information about available resources and behavioral
health issues in order to reduce stigma and discrimination toward consumers of
behavioral health services and to provide direct services to assist patients in
creating and maintaining recovery, health, and wellness under the supervision
of a qualified clinical supervisor and a qualified peer-delivered services
supervisor as resources are made available.
(63) "Program" means an organized system of
services and supports delivered by a provider designed to address the treatment
needs of patients and families.
(64) "Program Administrator" or "Program
Director" means program staff with appropriate professional qualifications and
experience who is designated to manage the operation of a program.
(65) "Program Staff" means personnel who
renders a clinical service or support. Program staff could include, for
example, be an employee, contractor, intern, or volunteer who is rendering or
assisting with rendering clinical services or supports.
(66) "Provider" means an organizational
entity or qualified individual that is certified or licensed by the Division
for the direct delivery of substance use, problem gambling, or mental health
services and supports.
(67)
"Publicly Funded" means financially supported, in part or in full, with revenue
from a local, state or federal government.
(68) "Psychiatrist" means a physician
licensed by the Oregon Medical Board and who has completed an approved
residency training program in psychiatry.
(69) "Psychologist" means an individual who
is currently licensed to practice psychology by the Oregon Board of
Psychology.
(70) "Quality
Assessment and Performance Improvement" means the structured, internal
monitoring and evaluation of services to improve processes, service delivery,
and service outcomes.
(71)
"Representative" means someone who acts on behalf of a patient at the patient's
request with respect to a grievance, including but not limited to a relative,
friend, employee of the Division, attorney, or legal guardian.
(72) "Restraints" means any chemical or
physical methods or devices that are intended to restrict or inhibit the
movement, functioning, or behavior of a patient.
(73) "Screening" means the process to
determine whether the patient needs further assessment to identify need for
referrals or services and supports.
(74) "Seclusion" means the involuntary
confinement of a resident alone in a room or an area from which the resident is
physically prevented from leaving.
(75) "Service Delivery Rules" means the OAR
describing specific regulatory standards for the possible array of services
covered by licenses issued under Chapter 415, Division 012.
(76) "Service Note" means the written record
of services and supports provided, including documentation of progress toward
intended outcomes, consistent with the timelines stated in the stabilization or
care coordination plan.
(77)
"Service Record" means the documentation, written or electronic, regarding a
patient and resulting from admission, assessment, stabilization services and
supports planning, stabilization services and supports provided, and
transfer.
(78) "Services" means
those activities and treatments described in the Stabilization or care
coordination Plan that are intended to assist the patient's stabilization,
withdrawal management and transition to recovery from a substance use
disorder.
(79) "Signature" means
any written or electronic means of entering the name, date of authentication
and credentials of the individual providing a specific service, or the
individual authorizing services and supports. Signature also means any written
or electronic means of entering the name and date of authentication of the
patient receiving services, the guardian of the patient receiving services, or
any authorized representative of the patient receiving services.
(80) "Stabilization" means the application of
medical and psychosocial services and supports, through a services plan, and in
a manner that results in the reduction of symptomology and increase in skill
level to support and redirect patients to the most appropriate and least
restrictive setting. Services are directed at restoring patients' ability to
maintain safety while enhancing their recovery, so they can successfully
reintegrate into identified community settings.
(81) "Stabilization Plan" means an
individualized plan of medical interventions that sufficiently resolve the
withdrawal symptoms or syndrome, and identifies the conditions needed for the
patient to safely transition to the next identified ASAM Level of
Care.
(82) "Status Data" means data
collected through the mandated state data system and includes, but is not
limited to:
(a) Initial admission, diagnostic,
and demographics data;
(b) Updates
and changes as indicated through the patient's enrollment in services;
and
(c) Discharge or other
discontinuation of services.
(83) "Student Intern" or "Intern" means a
program staff who provides a paid or unpaid program service and does not
qualify as a Mental Health Intern.
(84) "Substance Use Disorders (SUD)" as
defined in DSM-5-TR means disorders related to the taking of a drug of abuse
including alcohol, to the side effects of a medication, or a toxin exposure.
The disorders include substance use disorders and substance-induced disorders,
which include substance intoxication and, withdrawal, and substance-related
disorders such as delirium, neuro-cognitive disorders, and substance- induced
psychotic disorder.
(85) "Substance
Use Prevention and Treatment and Recovery Block Grant" or "SUPTR Block Grant"
means the federal block grants for prevention and treatment of substance abuse
under Public Law
102-321 (31 U.S.C. 7301-7305) and the
regulations published in Title 45 Part 96 of the Code of Federal
Regulations.
(86) "Substance Use
Disorders (SUD) Treatment Staff" means one type of program staff certified by a
Division-approved certification body to render substance use disorders
treatment services:
(87) "Supports"
means activities, referrals and supportive relationships designed to enhance
the services delivered to patients and families for the purpose of facilitating
progress toward intended outcomes.
(88) "Transfer" means the process of
assisting a patient to transition from the current services to the next
identified setting or ASAM level of care.
(89) "Trauma Informed Services" means
services that reflect the consideration and evaluation of the role that trauma
plays in the lives of people seeking mental health and addictions services,
including recognition of the traumatic effect of misdiagnosis and coercive
treatment. Services are responsive to the vulnerabilities of trauma survivors
and are delivered in a way that avoids inadvertent re-traumatization and
facilitates patient direction of services.
(90) "Treatment" means the planned, medically
necessary, individualized program of medical, psychological, and rehabilitative
procedures, experiences and activities designed to remediate symptoms of a
medical condition or DSM-5-TR diagnosis.
(91) "Unethical" means any conduct that is
incongruent with the American Counseling Association's (ACA) Code of Ethics.
The fact that a given conduct is not specifically addressed by an ethical
standard does not mean that it is necessarily either ethical or unethical. Lack
of awareness or misunderstanding of an ethical standard is not itself a defense
to a charge of unethical conduct.
(92) "Urinalysis Test" means a urine sample
provided by a patient that is tested by the program using a sensitive, rapid,
and inexpensive immunoassay screen to eliminate "true negative" specimens from
further consideration.
(93)
"Variance" means an exception from a provision of these rules granted in
writing by the Division pursuant to the process regulated by OAR 415-012-0090 upon written application from the provider. Approval and duration of a variance
is determined on a case-by-case basis.
(94) "Volunteer" means a person who performs
a service willingly and without pay.
(95) "Withdrawal Management Technician" means
personnel who supports program staff in the promotion of maintaining a safe and
orderly subacute environment and who may provide direct patient care.
Notes
Statutory/Other Authority: ORS 413.042 & 430.256
Statutes/Other Implemented: 430.345 - 430.375 & ORS 430.306
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No prior version found.